How You Should Really Handle Injuries and Illness on Trail

Today I want to take some time to run through some scenarios, and discuss what hikers really should do when dealing with injuries or illness while out on a trail. From first hand experience, I can tell you that I know how hard it is to make that decision: is this bad enough that I need to go to a clinic? These are all true scenarios that I’ve dealt with on my hikes.

Like for instance my first scenario of the day:

You’ve been excited to get to Upper Goose Pond Cabin in Mass since you heard about the blueberry pancakes, so you did your mileage quickly, got in just in time for lunch and were looking forward to enjoying the pond for the rest of the day. Little did you know what the outside stairs had in store for you until you had claimed your bunk and were on your way down them with your food bag. You stepped wrong on the last step, your ankle gave out, and the might have been a pop you just felt. You sit there for a moment staring at your ankle which is throbbing and starting to swell. You’re grateful it happened after you finished hiking for the day, that it’s noon and you have a pond you can soak it in. First things first, you head back up the stairs to grab some Vitamin I. The next morning it’s still tender to the touch and swollen, but you can walk without hobbling.  Do you:

A. Pop some more Vitamin I, eat 4 blueberry pancakes and hike 18 miles. Then continue on that pace for the better part of a week without so much as a nero even though you know you did a number on it.

B. Pop some Vitamin I, eat your pancakes and do 8 miles, just to the next shelter, and see how you feel the next morning? Maybe you’ll grab an ace bandage from town….

C. Take a zero, stay off your ankle and soak it some more. The rest will hopefully give the ankle enough time to heal. If not you’ll go to a clinic in town.

The correct answer should be C, followed by B, depending on your body and how it feels on the pain scale.  I, of course, follow the A. route, and I know a lot of other hikers that would. Some because they get so focused on deadlines and mileage that they stop listening to their bodies, and others (like me) just trust our bodies to heal as we go. I can tell you, that when I messed up my ankle on my way up to the Long Trail this year, it was still swollen, sore and had me limping by the end of the day, days after I finished the hike.
What sounds better: Extending your hike by a few days to heal and not be in pain the rest of the way? Or pushing yourself to stay within your timeline, while quite possibly messing up your ankle even more, making it so your hike isn’t as happy as it should be? In retrospect, I would chose the former. Maybe I’ll learn for next time.

Scenario 2:

You’re in Lincoln, NH, the gateway to the Whites! You decide to spend the night in a town and rest up before starting the hardest section of the trail. You’ve been craving nachos and order some tri-colored ones. Towards the end of the day your stomach and intestines start hating life and throughout the night you are forced to get up and go down to the bathroom about once and hour. You’re blaming it all on the tri-colored nachos because, well, your poop is tri-colored. By morning you are exhausted and still feel like crap, so you tell the people you’ve been hiking with that you can’t possibly hike today. You spend the rest of the day in your sleeping bag or in the bathroom, unable to eat much, and unable to move much. You hope it’s just food poisoning. By the next morning you feel 75% better and get a hitch back to trail. The day goes alright, you just need to use every privy you find, but at least you’re making it to the privies and getting some miles in. Your appetite is shite, but you aren’t too concerned. It isn’t until that night, when you have to crawl out of your tent 5 or 6 times that you realize, something has to be very wrong.

Thankfully, it’s just 4 miles to the next road crossing that would lead you back to town. That 4 miles feels like eternity,  because you have no energy and aren’t able to stomach any food. You get back to town, only to remember it’s now Saturday and the clinic wont be open until Monday. Do you:

A. Wait until Monday and go to the clinic to try and figure out what’s going on with your body.

B. Spend the night in town, feel better the next morning and decide that you don’t really need the clinic, so you get back to the trail.

The correct answer, of course, is A.  Which means, from what you learned about me in scenario 1, I chose B. And I dealt with the loss of appetite and intestinal issues for the remainder of the trail. It made for slow, long, cranky days. All my trail friends were either hiking past me, or getting fed up with me and wishing they could just leave me to fend for myself. I had a few good days here and there, but for the most part I was a terrible hiking partner and I was even fed up with myself. I finally ended up going to an ER just after the Bigelow Range – about 218 miles later – because I could only do 5 miles before I couldn’t go any further. My stomach was threatening to lose it’s contents (and it did on the drive), I was exhausted, and I had pretty much just given up. The ER tested me for Giardia, and Lyme, and some other waterborn illness, but came up with nothing. Two bags of fluid and $$$$ later I was sent on my way. My stomach was still unsteady the next morning when we got back to trail, but for the most part the fluids seemed to help matters a lot. My appetite was still crappy, but I had a bit more energy and wasn’t so moody.

Lesson: If something is wrong with you’re insides for more than 24 hours, go seek medical attention.

Lyme was never something I had to personally deal with on trail, but I know many who did, and it can be hard to decide whether or not you’re just the “normal” hiker level tired and sore, or if it’s gone beyond that. Especially when you don’t have a bullseye, which in only shows up in 70-80% of cases. Some times it takes your friends to make you realize something isn’t right with you.

Here are some key symptoms of Lyme:

• The bulls-eye: a redish rash that will increase in size and be a bit painful and itchy. 20% of those infected will not have the rash.
• Flu-like symptoms: Fever, chills, fatigue, body aches, swollen glands, and a headache may accompany the rash
• Neurological problems: Bells-Palsy (temporary paralysis to one side of your face), numbness of limbs, impaired muscle movement.
• Joint Pain
• Eye inflammation, hepatitis, shooting pains, and severe fatigue are also possible.
• Long term effects when untreated: difficulty with short-term memory, migraines, dizziness, ‘brain fog’, poor sleep, lack of verbal fluency, confusion or disorientation, and decreased ability to concentrate.

Some of which, if you’re a long distance backpacker, seem like familiar ground. Of course you’re going to be tired, have body aches, some numbness (especially in your toes), and joint pain. This means you need to pay attention to any changes in your aches and pains.

You should see a doctor if you are bitten by a tick and develop the rash or symptoms of Lyme disease. Treatment is most effective if begun early.

Although only a small number of tick bites lead to Lyme disease: the longer the tick remains attached to your skin, the greater your risk of getting the disease. So make sure you’re checking yourself! And helping other people check hard to see areas, such as their backs. Carry a tick key, or tweezers with you. Make sure you kill the tick rather than flick it somewhere – especially when in camp. I carry a small bottle of rubbing alcohol with me and plop any ticks into the bottle to kill them.

Hopefully you all were able to take something away from this, and make smart choices when confronted with injuries or illness. Especially tick born illnesses.