Angels Are With Us

As I have been hiking and ridding this week with the constant thoughts  on the fact I have a knowing that  there is a higher power in my life and know I am not alone!  This gives me strength energy and focus!  This  a post I made several years ago but after the the news I received about the health of some one close to me, the spiritual side of this journey is starting to unfold!

Life’s Angels and Life Guards
During my third year of residency I admitted one of my favorite patients. I had been caring for her for the previous three years. She was diagnosed with cancer and had completed her surgery when we first met. She was starting her first round of chemotherapy and it was my job to admit her to the hospital and get her tuned up, so to speak, and ready to start treatment. Over the next three years we became close and it seemed like I was always the one to admit her for chemotherapy or to treat the side effects of the toxic regiment she was receiving. She was a local Librarian and very well read. This gave us a lot to talk about on those long stays in the hospital. She was always up beat and dressed with a smile. She would always state in a matter of fact way, “I am going to beat this Dr Nichols. With your help we will beat this! Do not give up on me!"

This night was different. She was very weak and I could tell she was not doing well. When all the paper work was done, she asked to make one change. That was to her Code status. She had given up the fight and asked to be a “No Code”. I tried to talk her out of it. Despite my best arguments she would not have it any other way. She then asked to talk to me alone without the medical student or the junior resident.
When everyone had left the room she preceded to explain to me how I had been her Guardian Angel throughout this ordeal looking after her, making sure all her needs were met, and that she had the best care possible. She thanked me and wanted me to know she had come to the hospital that night to die in peace. She was crystal clear I was to follow her wishes regarding her “No Code” status. She then went on to tell me that the wish she is going to make at the gates of heaven was to come back to earth and be my personal angel. She wanted to repay me for all that I had done for her. She said she is going to sit on my shoulder and look out for me and protect me from harm. We talked for a few more minutes; I gave her a hug and went on with the duties of being on call.
At about 2 A.M.; I got a call from the charge nurse to come to my patient’s room. When I arrived she had passed on and I had to pronounce her dead. What a night.
Since then I have come to appreciate that we are not going through this life alone and we all share a responsibility to look after one another. Either in the capacity as Angel or in what I like to call Life Guards.
This past Fall my life was upside down. I had crashed and burned. I was in a tough place. Many of my very close friends and family members were going through some very ugly circumstances and I had a patient die just a few days ago. Deaun, my wife, was at the end of her rope with me and knew I needed help.
She spoke with a very good friend of ours to come and get my butt back into the game. To this day I do not think he knows why he was called. He showed up very positive and full of life! His life is just as out of control as mine. He rarely has the extra time to drop everything, but this day he did. I gave all the subtle excuses why I could not mountain bike that day. The bike needed this and that fixed. I had gained 10 pounds since our last ride and no way could I keep up with him. He kept pressing and fixing my bike as we talked, telling me the whole time it would be ok. Just a ride for fun! Before I knew it the bike was fixed and we were on our way! This was one of the best rides to date! EVER!
Jaren, you saved my life that day in more ways than one. I know now we all need to stay in tune with that inner voice when it calls. Just like in Magnum PI. Listen to IT! Do not ignore the prompting to help a fellow traveler. You never know when you are being called upon to be that life guard for someone.

Whether you are an Angel or a Life Guard, the small things you do for others do not go unnoticed. Strive to be an Eagle soaring above and willing to serve and go the extra mile. Do not be a Duck and sit around quacking about how bad things are.
Thank You Jaren for being a great friend!

Jaren and I have had many great Mt bike rides, hikes and a powder ski days since then.  I know  that neither one of us will ever forget ( I have always wounder if his toe nails ever grew back, they turned back and fell off after skiing a  mountain  that was so steep the pressure from his boots destroyed them).  God bless great friends!

 I am blessed to have great family and friends in my life!  Thank you all!

Bells Canyon

 My good friend  Dr Layne Hermansen and I have been trying to get together for a hike this week and today was the day we make it happen.  We got up early and I was able to get  Scott and Chris out of bed  to join us today.  We have been trying to get Bells Canyon is since the hiking season started and today was as good as any.  This is a hike Layne does on a weekly basis so it was good to have him show us the ropes so to speak. 

The hike starts just before the mouth of Little Cottonwood Canyon at (N40 34.306'; W111 47.826').  There is a small parking lot that tends to fill up early.  There is a pit toilet at the trail head and this is a water shed so use it if need be before you start the hike.  But if you must answer the call of nature, you must be 200 feet from water and if #2 it must be berried 8 inches. Remember you will be drinking this water. So protect it!  The hike begins as a short but steep trail that levels off as you approach the reservoir.  Fishing is allowed but no bait only spinners.  No swimming secondary to it being a water shed.  It is  how ever great place for a family/date night  picnic.  As you approach the lake you have a split in the trail.  Stay to the left. The right will take you around the lake.

Press on ward and up ward.  The rule of thumb with this hike is when in doubt,  head east.  If you are not climbing, you are on the wrong trail.  As you leave the the lake you get into more tree cover and soon will be crossing the river on your journey up the trail (N40 33.744'; W111 47.195).  This is a nice place for a photo Op and to take a short rest if you need to.  From here you continue eastward up the trail.  Remembering to stay left and head east.  As you reach the second stream crossing will see a fork in the trail(N40 33.624; W111 46.225) the right continues to the upper falls and a second lake.  It is very steep and requires some bush whacking to get to the second lake.  If you take the right you will not regret it.  In just a few short yards you will be overcome with an oasis of green and instant cooling from the mist of one of the most breath taking water falls I have seen in Utah (N 4033.659'; W 111 46.198, 2.2 miles for the trail head at  6,770 feet).

At the top of the falls is a nice place to sit and take it all in.  Be very careful here.  I would not recommend jumping across in the early season.  The water flow here is deceiving and if you do not make it the current will take you right over the falls.  A young women was killed here last year doing just that.

This is an enjoyable hike.  We covered a total of 4.91 miles, 4,520 vertical feet in 3.0 hours and burned 1,535 calories.  I will do this hike again and will also use this hike as a training run for my trail runs.  I will also do this trail in the winter.  It connects into the Red Pine trail for what I understand is some Epic powder skiing on  the right day!  Be aware this is a very popular hike and on Saturdays and holidays sees a lot of traffic.  As we were leaving the parking lot was full and we passed several large groups starting their hike up the mountain.

Red Pine Lake

We had a lot of rain and snow in the high country the past several days and with my Mt Bike bike in the shop  and Chris back from Cabo  we thought Red Pine lake would be a great hike.  Our good friends Brock, Corvin and Jace are in town and always up for an adventure so we loaded the Jeep and headed up Little Cottonwood Canyon.

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The trail head is at the White Pine parking lot.  It sits at 7,650 feet of elevation (GPS N40, 34.516'; W111, 40.868').  As you start down the trail you cross a bridge and turn west (right) an follow the trail up the mountain. The trail was flooded with water and to quote Jace "it's like we have been hiking straight up a water fall all day".  Do not let that discourage you from doing this hike.  the views are out standing!  The smell of pine fills the air and with the right shoes the water is really no big deal.

The trail splits into two trails at about 1 mile.  You can go left  up canyon to White Pine Lake or right to Red Pine Lake.  As you follow the trail to the right you will cross a bridge in about 50 yards (N40, 33.93; W111,41.351). 

The trail is an easy traverse up the mountain.  At 2.9 miles (8,952 feet, N 40, 33.197'; W 111, 41.725) there is a second bridge that if you take the right turn and cross it, it will take you the May Bird area.  Stay to the left and follow the trail.  At times you are following the stream.  Just walk on the rocks and stay off the mossy bog to the right.  It is wet and muddy. 

We took a short rest here to rehydrate and ask a fellow hiker if we were on the right path and what the snow conditions we were headed into.  We got the trail report and excited to continue on ward. We kept moving.

As we continued up the trail it became completely covered in snow!  We tracked upward in the snow.  We all agreed that the next time we do this hike we are bringing our skis!  To ski down this slope today would had been an all time Epic experience!  We kept on  walking up the steep trail.  We finally figured out we were on the Phiferhorn trail and above the lake.  We work our way to the left using the peaks to guide us to where the lake should be.  Bam! As we came over the ridge there it was!  Lower Red Pine Lake!  Ya!  Get out the beef jerky ! Lets eat!  Yep!  Beef jerky, gummy bears and water! It was an well earned snack! 

The lake sits at 9,700 feet above sea level (N40, 32.671'; W111,41.524') 3.51 miles from the trail head.  What a view!  This is impressive!  It was a blast!  First in the mud then in the water and then snow!  What a hike!  We are now headed back.  I can not wait to do this hike in the summer! 

As we headed back we continued to talk about the time in the future we will on e day come and ski this mountain!  As we continued to hike we took  photo's and continued to take in the surroundings.

Hike stats:  7.57 miles, 7,400 vertical feet, 2,178 calories burned, max speed 8 miles/hour and it took us just over 3 1/2 hours to complete the hike.  It was a blast!  I am looking toward   the next hike!  We are hiking Kings Peak soon with this same group!  I can not wait! 

High Altutude Sickness

When the topic of me doing the family hike this year came up,  my wife Deaun asked me why the hesitation.  I love the out doors.  Hiking, fishing camping Mt biking ect. I knew Mt Whitney was the highest peak in the lower 48 and all I could envision was the documentaries I had seen on Everest and remembering the mountaineering it took to climb it and most important the altitude.  I finally had to  had admit to her that I had two concerns to over come.  First of all my fear of heights.  Second, my concern was altitude sickness.  She started to laugh!  You the one who rides his motocross bikes at 40 plus MPH on the the  track and catapulting himself into the air 20 plus feet  and think nothing of it! 

Or not to mention the fact one of your favorite places to ski is  out at the Book Ends at Snowbird.  To get out there it requires a traverse around a cliff where the tips of your skis hang half way over a 300 foot drop off.  Ya, right you scared of heights!  No!  Really I am!  Ever since my college room mates took me out repelling and strapped a modified jock strap around my waist and called it a harness.  Hooked it to a rope and said jump!  Right of the side of a cliff I went!  Ya,  I am scared of heights!

But my fear of high places and how I deal or not deal with will be address in another instalment of my blog.  The intention of this installment is to deal with High Altitude Sickness. Which for the record, I unknowingly experienced this first hand.  When I was in my last year of my training, the chairman of the department offered me a deal that I could not turn down.  He offered my a trip to the location of my choice for additional training if I finished out my residency as the Chief resident.  This required me to do the call rotation for the rest of the year,  Which was a nightmare to do.  I agreed to do it.  Knowing I would be  most likely heading back to ski country, I picked a ski meeting in  Breckenridge Colorado. 

Breckenridge sits at 9,000+ feet above sea level.  Omaha, well, not even close.  So I arrive in Denver, drove to Breckenridge and checked into my hotel.  I arrived late, got a bite to eat and went to bed.  My nights sleep was poor and very restless.  I awoke the next morning.  I now truly understood what the band Y and T meant by the lyrics of their song Ballroom Boogie "I woke up this morning with a trash can head!"  No had not been drinking.  I my head felt like it was going explode.  I took some Motrin and started to feel a little better.  I set off for the breakfast  put on by the conference.  As usual there were announcements. One in particular caught my attention. "If anyone of you is suffering form high altitude sickness please let us know  so we can get you evaluated".  I thought to my self no way.  I could not have high altitude sickness.  I am from Utah.  I grew up at altitude.  I spent my summers in the Unita mountains fishing.  Literally running from one lake to the next at altitudes higher than here.  I spent my winters skiing at 10,000+ feet off the tram at Snowbird! Altitude sickness, No Way!  Not me!  I forgot one simple fact.  I had spent the last 9 years of my life in the Midwest.  Not even close to elevation I was currently at.

Yep, that's right.  Altitude sickness.  I had it.  It was mild but I had it.  It slowly resolved and by the last day I was there I was able to ski and enjoy my trip. 

Altitude sickness can be very dangerous.  Two years ago a physician from LA died from it after hiking Mt Whitney.  Two hikers last year had to come off the mountain and be hospitalized  according the the official web site because of it.  The silver lining for me and my brothers here is the vast majority of people suffering from altitude sickness come from sea level to the trail head and off they go up the mountain.  Because we live at 5,000 feet above sea level this gives our bodies a fighting chance.

So what is altitude sickness?  What causes it?  And how can we prevent it or at least minimize the effects of altitude?

Altitude sickness results from a low concentration of oxygen.  As one moves from sea level to  higher  altitudes the oxygen in the air decreases secondary to the pressure of the surrounding air decreases.  There is a old rule of thumb "for every 1,000 feet of elevation gain you loose about 3% of the oxygen in the air"  This rule is not totally correct.  So at sea level the oxygen concentration is 21%.  At 18,000 feet it is 10.5% and at the top of Everest it is about 6%.  At the top of Mt Whitney where we are headed, the oxygen concentration is reported to be about 12%. 

 High altitude sickness usually occurs at altitudes over 4,000 ft, is caused primarily by hypoxia but is also compounded by cold and exposure. It presents as one of three forms: Acute Mountain Sickness (AMS), High Altitude Pulmonary Edema (HAPE) and High Altitude Cerebral Edema (HACE).  The symptoms include dyspnea on exertion (short of breath) and at rest, cough, nausea, difficulty sleeping, headache, restless sleep and mental status changes. These symptoms   are very similar to the flu.  Vomiting can also occur.   The symptoms occur secondary to the low oxygen (hypoxia), creating demands on the heart and lungs to work harder to compensate.  The  increase in the  blood pressure of the pulmonary system  leads to swelling, if allowed to progress leads to leaking of the capillarys  in the pulmonary tissues thus developing into  HAPE.  The same physiologic effects that occur in the lungs eventually start to effect the brain leading to elevated blood pressure and swelling  that result in  HACE.  

The first description of AMS, written in 32 b.c.,  attributed to To Kan, a Chinese governmental official, who noted, “A man's face turns pale, his head aches and he begins to vomit” when crossing the Himalayan Kilak Pass. The occurrence of AMS depends primarily on the rate of ascent, the altitude attained and the individual person's susceptibility. AMS affects 15 to 30 percent of Colorado resort skiers, 50 percent of climbers on Mount McKinley, 70 percent of climbers on Mount Rainier, and 25 to 50 percent of climbers who trek to the base of Mount Everest. Bottom line, nearly 25 percent of those who travel above an elevation of 8,500 ft develop manifestations of high-altitude illness.  The rate of ascent and time spent at altitude all factor into the development of these issues.  It takes at least 1 to 3 days for the symptoms of HAPE or HACE to set in.

 The best treatment is to stop your ascent, acclimate and then continue on.  If you are not improving or getting worse descend the mountain.  It is recommended to descend the mountian1,500 feet for AMS and 2,000 feet for HPPE and HACE.   Get oxygen supplementation and seek medical attention. 

Prevention of AMS and related diseases is still being investigated.  However the amount of exertion and the rate of ascent play  big roles in the development of these diseases.  It is also strongly recommended to take time to acclimate to the altitude.  One recommendation is to do a

 staged ascent. This involves traveling to an intermediate altitude and camping for several nights before continuing the ascent to the target altitude. For example, if a person is planning a prolonged trek at 10,000 to 14,000 ft (Mt Whitney), he or she should acclimatize at 6,000 to 8,000 ft two to four days beforehand it is also recommended to Hike high during the day and sleep low at night.  All of this is in our plan for  what we are going to do on our hike up Mt Whitney. 

Simply stated, the best prevention is to do slow ascents and acclimate. Usually in increments of 1,000 to 2,000 feet per day.  Again, hike high during the day and sleep low at night. 

For us on our trip to  Mt Whitney, we already live at about 5,000 ft and we are spending our first night at the Whitney Portal which is above 8,000 ft.   This will allow us to acclimate to the altitude.  I have also built in to my training regiment elevations at or above 8,000 ft on a regular basis to  help acclimate me to altitude during extreme physical activity.  Although physical fitness is not proven to eliminate AMS the better shape one is in  has been proven to help with work tolerances and better performance physically.

Also in the realm of prevention and treatment are medications.  Diamox can can help as well as dexamethasone and procardia.  Most important is aggressive hydration and keeping up with nutritional demands of the hike will help prevent AMS. There are some homeopathic remedies but none have prove in scientific trials to really work.

Diamox is a sulfa based diuretic that stimulates the renal system  to increases the amount of bicarbonate that passes into the urine. Bicarbonate draws water alongside it from the kidneys into the urine.  Which in turn increases urine production (weakly) and increases the acidity of the blood.  Given the loss of the bicarbonate, a basic buffer in the blood,   Hydrogen ions increase. This increase increased the acidity of the blood which has been made more basic from the increased breathing rate to  meet oxygen demands.  This in turn increases the efficiency of pulmonary system to supply more oxygen to the system.  If you are allergic to sulfa you should not take this drug.

Procardia is a calcium channel blocker.  It is unique in the fact that it is one of the few medications that works directly on lowering the blood pressure in the pulmonary arteries.  Thus treating the cause of HAPE. 

Dexamethasone is a steroid that decreases the inflammatory response within the vascular system thus treating the capillary leak effect of the hypertension and treating the edema within the the tissues of the lungs  and brain.

Before you take any of these drugs or involve your self in this extreme environment you should consult your physician to make sure you are fit enough to involve yourself in this type of activity and which drugs you may or may not need.

So there you have AMS in a nut shell.  Acclimate. Ascend into thin air slowly.  If you start to experience symptoms, stop and acclimate.  If symptoms do not improve or worsen descend to a lower altitude.  Any sign of HAPE or AHCE seek medical attention ASAP!  

Through knowledge I have empowered myself  to be better prepared thus allowing me over come one of my concerns.  Knowledge is power! I will keep on training and and learning. I truly believe the better understanding one can have of their fears the better it is to  cope and most defiantly over come them!

There is so much more and I have resources if you want to learn more.  Below I have included the best paper I found on the topic.  I just felt that I should cover the basic facts and give a foundation for those heading out in to thin air!

http://www.aafp.org/afp/1998/0415/p1907.html#afp19980415p1907-t1

The Great Western Trail American Fork Canyon

It is 3:30 in the morning and my alarm is going off.  Ouch!  That hurt!  My son Chris is off to Cabo to hang with Halie his girl friend and her family for their family Christmas present.  I had to get him to the airport and on his way by 5:00 A.M.  Jumped out of bed, quick shower and off we go!  Parked and ran in to the United desk only to find out that he  was only checked in through Denver.  We got it  all fixed, Chris through security and on to the gate!  With my wing man on his way out of the country and   knowing my good friend Mitch is up early on Sundays,  I call him to see if he was in for a "Walk About"  up American Fork Canyon.  "Of course!" he said.  We worked out the particulars I hustled home to get packed.  Mitch was able to talk his son  into joining the party and all I had to do was say the word "Hike!" and Maui jumped out of bed and into the Jeep.

My goals for our hike today was to use my Jetboil stove and my water filter to make sure I knew how to use them and if they worked.  I picked out freeze dried meals that got the best ranking by REI, packed them, added  some treats and filled the the water bottles.   Picked up Mitch and son, stoped at Starbucks for an eye opener and hot chocolate, put  gas in the Jeep and finally we are on the road. 

Knowing the gate would be down at mid canyon (it usually is until Memorial Day), we decided to park at the over look for Timp (N40 degrees 26.996, W111 degrees 38.618) and head up the Great Western Trail.

The day was beautiful!  The smell of fresh pine in the air and the sound of the near by water falls,  we just took it all in!.  The wild flowers are starting to add color to the landscape.Simply amazing!  Even snail shells littered the path!

We continued up the path.  We made plans for lunch at the meadow at the cross ways for the Great Western Train, Trail 150 and Salamander Flats (N 40 degrees 26.730, W111 degrees, 37.670).

We placed our drinks in the near by creek and set up camp.  I got out my JetBoil stove.  This stove has won all kinds of awards and with its 5 stars in backpacker magazine, my expectations are high.  On the REI web site it is reported to boil 32 oz of water in less than 2 minutes.  I got it out of the pack, set it up, turned on the gas and bam!  The first click of the auto ignite, we were cooking!  It held to its promise!  2 minutes boiling water and our freeze dried Beef and noodles is cooking in the bag!  That worked so well and was really cool!  We had to to make more! I got out the Thai chicken!  Again,  2 minutes, water boiling and the chicken is cooking in the bag!

I was pleasantly surprised to find the meals tasty and they hit the spot!  Easy to fix with good flavor and light weight to boot!  I would recommend these to anyone looking for backpacking meals.  The stove worked like the Awesome high tech piece of equipment it was sold to be!  This should be in every back packers pack. 

We cleaned up camp and with Maui in the lead we started off again. More energy now and ready to see how my filter would work now that we were out of water. We set course for the next creek.

We arrived at the creek only to meet two Mt bikers there for a rest and to rehydrate. I got out my filter and started pumping.  Within 2 minutes we had fresh clean and very cold water to drink!  It was great to see how easy it was!  We filled all our water bottles and headed to the road to complete our hike.

Hike Statistics:  4.5 miles, total elevation (up and down)  3,000+ total vertical feet,  average pace 3.2 miles an hour!  Total calories burned just over 2,000 according to Garmin. What a great hike!  I had a great time hiking with my good friends and  dog!  I can not wait to head out again!  I love this high tech gear!  It's a blast to use!