A Quick Guide to Hepatitis C

hepatitis c

What is hepatitis and HCV?

Hepatitis is a general term for inflammation of the liver. Any number of conditions can cause hepatitis, but one of the more common causes is a viral infection from the hepatitis virus, of which there are three types: A, B, and C. Type A is a short-term infection often caused by consumption of a contaminated food or water source. Type B is also short-term, though chronic hepatitis can evolve from an HBV infection in some cases. This type is spread by blood, semen, or saliva from an infected organism entering the body of an uninfected one – IV drug use, sexual contact, and animal bites can all lead to an infection of Hepatitis B. Vaccinations for both Type A and Type B hepatitis exist.

Hepatitis C is of particular concern because the virus can remain dormant for decades, often failing to manifest symptoms until an infected person’s immune system is compromised by age or a separate medical condition. Untreated, Hep C can lead to cirrhosis, liver cancer, and death. It’s also a factor in the fastest growing cause of cancer-related deaths in America presently, hepatocellular carcinoma (HCC). In fact, HCV is the leading cause of HCC in the western world. There is no vaccine for Hepatitis C.

How is HCV spread?

Hep C isn’t spread by casual contact with a carrier or through a vector (mosquitoes, animals, or contaminated food products). Needle-sharing is presently the most common cause of an HCV infection. Prior to 1992 HCV was spread through blood transfusions, but rigorous screening of blood products has eliminated that concern. In some cases, sexual contact, sharing of contaminated razors, and contact with unsterilized tattoo needles has led to an HCV infection, though these are much less common causes of the disease. Finally, a baby born to a mother with HCV will also carry the HCV virus.

What are the symptoms of hepatitis?

An acute infection of hepatitis C manifests with fever, fatigue, abdominal pain often accompanied by nausea and vomiting, jaundice (a yellow discoloration of the skin and eyes), joint pain, clay-colored stools, and dark urine. Bear in mind, however, that an acute infection from HCV is less likely than a chronic infection, which typically manifests no symptoms and takes years or even decades to cause damage to the liver (in the form of scarring or cancer). Many carriers of HCV will have no reason to suspect they’re infected (and as carriers they can still infect another person with it).

Who should be screened for Hep B and why?

Anyone who’s ever been an IV drug user or shared needles should strongly consider HCV screening. Currently, there’s also a huge push for baby boomers (anyone born between 1945 – 1965) to receive HCV screening because of the risk from contaminated blood products. Moreover, because of the time required for HCV to cause liver damage, baby boomers entering middle age are now at the greatest risk for complications. In fact, baby boomers are five times more likely to have an HCV infection than the general population and may not even know it. Health care workers who’ve been exposed to HCV by needle-stick injury or handling blood products should be screened. Some experts also suggest that incarcerated individuals living in close contact with others should also be screened.

Getting an HCV screen promptly will help anyone with an HCV infection receive care to prevent the potentially serious side-effects of hepatitis.

What’s the procedure for HCV screening? 

The first step in HCV screening is a routine blood test ordered by your primary care provider (PCP). This test is used to determine the presence or absence of an antibody for HCV. However, a reactive antibody test (meaning the antibody is present) only indicates that the person is a carrier. To determine if an active HCV infection is present, a second test for HCV ribonucleic acid (RNA) is done (See: “Screening and Management of Hepatitis C,” American Nurses Association). Both tests are required for a positive diagnosis of HCV, however, because (for reasons we don’t fully understand), 1 in 4 people eliminate the hepatitis C virus on their own – meaning they will have the HCV antibody, but not the active infection. Baby Boomers take note: Medicare covers the cost of the PCP-ordered blood test for anyone born between 1945-1965. 

How is an HCV infection treated?

HCV used to be treated with interferons with limited success. However, since the introduction of a new class of drugs called direct acting antivirals (DAAs) in 2012, the success rate for eliminating HCV is now an impressive 90-95%.  DAAs are given as an oral medication with very few side-effects. Unfortunately, they’re also very expensive and this is a major barrier to treatment.

Summing Up

Hepatitis C is a viral infection of the liver, sometimes leading to an acute set of symptoms but most often developing over decades with little or no obvious symptoms in the carrier. However, this chronic form of hepatitis can lead to serious outcomes later in life – scarring of the liver (cirrhosis), liver or blood cancers (HCC), and death.

Anyone with a history of needle sharing/IV drugs use, Baby Boomers (individuals born between 1945 – 1965), and anyone who received blood clotting products or an organ transplant prior to 1992 should consider being screening for HCV through a routine blood test ordered by their provider.

Remember, no one can diagnosis or treat an illness except a qualified, licensed medical professional like your primary care provider. If you’re concerned about HCV, contact your doctor or APRN and schedule an appointment to discuss your concerns. 


Legal disclaimer: Advice offered on this website is for educational purposes only. The information herein is not intended for use to diagnose, treat, or manage any health conditions or offered as an intent to treat any individuals. ALWAYS consult your primary care provider with questions regarding your health.  

Managing You: Why You Must Keep a Personal Health Record

Pop Quiz:

  1. Who is your primary care provider?
  2. When was your Tdap vaccination? Tetanus? Most recent influenza shot?
  3. Did you have a physical this year? What were the results?
  4. What are the medications you’re currently taking, and what are the dosages?

If you did poorly, don’t beat yourself up – many Americans are unaware of how to keep track of their health. But think about it: do you keep your motor vehicle documents like registration and proof of insurance in a handy folder in your car, along with records of all the service work you’ve had done on it? Do you store your tax returns and important personal documents in a safe, convenient place at home? If you do, then why aren’t you doing the same about what is arguably the most important thing you possess – your body? Shouldn’t you be showing the same diligence, if not more, for your health and wellness?

Allow me to introduce the concept of the Personal Health Record.  Simply put, the PHR is a detailed library that contains all of the most up-to-date information from your electronic medical record (EMR) – the database held by your doctors and insurance providers for the purpose of medical coding and billing – and your own notes on your health. In contrast to the EMR, your PHR is yours to control, modify, and manipulate as you see fit. It can be used through a platform of your choice: an online database, an app for your phone, or – as in my case – a hard copy in a three ring binder with color-coded tabs.

If you’re familiar with pedometers, FitBit, or apps for your phone like CouchTo5k and Fooducate, you already understand a little of how a PHR works. Most Americans, in fact, have used a fitness or weight loss program or app at some point in their lives. You’ve probably written down how much exercise you did, or tracked your caloric intake for a diet, at some point in your life. Your PHR, however, is more complete, integrating the information your health care team already has into a more comprehensive picture of your biological profile. A good PHR can include your fitness routine and calories consumed, but also keeps track of much more. 

The benefit of maintaining a PHR is, of course, knowledge – and, thank you Sir Francis Bacon – ipsa scientia potestas est: knowledge is power. Here’s how one paper, in the Journal of American Medical Informatics, put it:

Personal health record systems are more than just static repositories for patient data; they combine data, knowledge, and software tools, which help patients to become active participants in their own care.

In other words, PHRs give you a variety of additional tools to manipulate data. For example, if you track you blood pressure daily, you can use you PHR to determine your average BP over the course of a week. You can form a data set for how many calories you’ve burned while exercising. Raw data is just the beginning; with the magic of mathematics, your basic data allows software programs to draw conclusions about your health, and advise changes when needed. (You can also manipulate the data yourself, if you’re so inclined.) The article continues:

One of the most important PHR benefits is greater patient access to a wide array of credible health information, data, and knowledge. Patients can leverage that access to improve their health and manage their diseases. Such information can be highly customized to make PHRs more useful. Patients with chronic illnesses will be able to track their diseases in conjunction with their providers, promoting earlier interventions when they encounter a deviation or problem. (The complete article is available here. The National Center for Biotechnology Information is a tremendous, free scientific resource by the way.)

This a critical conclusion: tracking your health improves your general well-being. If you’ve got up to date information, you can – as is described above – note quickly any deviations from the norm and get medical assistance faster. Keeping on top of your weight, having blood tests results on your white blood cell count, A1C, iron levels and much more, recording changes in your weight or sleep patterns, and so on allows you to make smarter decisions. Being conscious of your health on a daily basis gives you an advantage, too, when time is crucial. Often, it’s small symptoms that are overlooked or – worse – ignored that signal a serious health issue.  

And they’re not joking about speed and ease of communication, either. I get my office visit summaries, diagnostic images, test results, and more through MyChartPlus, and last time I had blood work done I had all of the lab results before my doctor did. I can also make, cancel, and reschedule appointments online or with my phone. My doctor can send me letters or messages through it, too.

So what should you include in your PHR, and how should you manage it? Well, the format is a matter of personal taste; you may prefer a desktop software program – as simple as a Word or Excel sheet or a more complete program created specifically as a PHR like Microsoft’s HealthVault (n.b., Microsoft ended support for the Healthvault for the Windows phone literally today, as this article was published. The online and desktop service seems to still be available). Web-based applications like MyMinerva or Dossia Health Management System give you the piece of mind of knowing your data is backed up offline – though, conversely, it comes with the risk of security breaches that could put your private medical information into someone else’s hands. For smartphone users, the MyMedical and OnPatient PHR apps are both great, but shop around to find the one you prefer. And, as I mentioned before, you can also keep your records in a well-organized binder – a bit old fashioned, I suppose, but easy to access and reference when you need it. I print my information from my EMR or get copies at the doctor’s office, and file them away for use when needed.  

As to what information to include, I am of the mind that more is better. I include a daily record of all my exercise, I take my vitals and record them each morning, and I even have flow sheets to monitor my diet. Full disclosure, however: I am of the “Type A” personality, to the degree that I color coordinate my pens to my scrubs, and my scrubs to my lunchbox.

Here’s a saner list of what you want to include, at a minimum, in your PHR: 

  1. Your prescriptions, the dosages of each, and the frequency of administration
  2. Your immunizations
  3. Your physicals, including the list of current health concerns/chronic illnesses and doctor’s report on your overall health
  4. Lab results – (blood work, biopsies) and imaging results – ultrasounds, X-rays, and the like.
  5. Your insurance information.
  6. Reports from any specialists you’ve seen, histories of any procedures (surgeries) performed
  7. Emergency contact information
  8. Your allergies to any medications and/or latex
  9. A copy of your living will, advanced directive, or any legal documentation of this sort (including DNRs)
  10. A journal with anything you’ve noticed or consider worth reporting (what are called Observations of Daily Living or ODLs). This can include simple reports such as, “I’ve had a dull pain in my side for the past three days,” or “I’ve been feeling nauseous a lot lately.”
  11. A brief record of your emotional/cognitive health and what you do to maintain it. This isn’t often recommended, but I think it’s important. Doing things you enjoy – and that reduce anxiety – are vital to good health. Making a record encourages you to remember to take care of your emotional being, too – through meditation, creative arts, gardening, a hobby, or whatever it is that gives you joy. 
  12. Your fitness routine and at least a sketch of your diet. 

It may seem daunting, but I ask you again to consider: aren’t you worth it? Don’t you deserve at least as much attention as your car? At least some experts think most of us just don’t care, and that’s why PHRs have yet to come into widespread use. Maybe they’re right. I prefer to think, however, that most people would embrace PHRs once they see how easy they are to use and the benefits they offer. Being “in charge” of your health is empowering. There’s a sense of pride in ownership when we are diligent monitors and protectors of this fleshy vehicle that carries us through life. Maintaining a PHR gives you a complete picture of your wellness, and with that knowledge you’re better prepared to make smarter choices for continued good health. 

One final note – if you need some information to get your PHR started, remember that the Health Insurance Portability and Accountability Act gives you the right to inspect and receive copies of all of your medical records, electronic or otherwise, upon request. Ask them what software program they use to manage your EMR, and how you can get a login ID and password to access all of your health information. If your PCP doesn’t offer an online EMR, ask that they do so (it’s 2016, come on).  

Note: This article also appears on medium.com.

Happy 100: The Post-Game Analysis on Bariatric Weight Loss

Salutations, friends!

I love it when the universe aligns for a fortuitous coincidence, and how’s this for kismet: yesterday was the six-month anniversary of my sleeve gastrectomy, and when I stepped on the scale in the morning it read: “168.0” One hundred pounds lighter than I was about a year ago.

I’ve been carefully monitoring my progress throughout the procedure, all the way back to the first pre-op appointment in 2014. The total process from an initial seminar at Hartford Hospital to the surgery proper on January 19 took roughly one and a half years. That time was spent in close consultation with a dietitian, pulmonologist, and cardiologist in addition to my surgeon, the rock-star and pioneer in his field, Dr. Pavlos Papasavas. A psychiatric examination, sleep study, and support group attendance were also part of the preparation.

Considering the significance of a centenary drop in body weight (and, incidentally, a drop in BMI from 39.0 to 24.5), I think a recapitulation on the journey is needed. If you’re thinking about surgical weight loss, or you’ve had it, or you’re just curious, you’ll enjoy my look back at what I’ve lost and gained from having my stomach removed.

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January 19, 2016 – three hours after surgery. 

The replay on…the value of surgical weight loss.

The question I’m most often asked is, “Why have surgery?” Some folks want to know if I tried it “the old fashioned way” first (I did, many times) and others wonder why I took the risk of going under the knife for a serious elective procedure. In medicine, everything is about odds. Treatment for an illness, whether with drugs or surgery, is always a risk. The health care team calculates the dangers of treatment against the risk of not treating an illness at all. I approached my surgery with the same mathematical rationale: was the risk of complications and even death from surgery greater or smaller than the long-term damage of morbid obesity? I already had a very high BMI, hypertension, hyperlipidemia, sleep apnea, and a pre-diabetic fasting blood sugar (my A1C was 6.5). The research showed that each of these symptoms related to weight would be dramatically reduced or eliminated by surgery. Overall, life expectancy for someone who has a gastric bypass or sleeve is increased by 85% compared to obese persons who do not have surgery.

So it was, logically speaking, a no-brainer. Of course I was nervous ahead of surgery – who wouldn’t be? But after the procedure, the payoff became immediately evident. Within a few months, my hypertension, hyperlipidemia, and blood sugar levels were resolved. Sleep apnea was gone by May, and I felt incredible – more energetic, focused, and grateful than I had been in decades. At six months out, my doctors concur: I’m in outstanding health.

The next step: At my last consultation with the surgery team, in May, we set a weight goal of 170-175lbs. I’ve exceeded that, so technically my weight loss target has been met. I still continue to lose weight, however, at a considerable more modest rate of one to two pounds biweekly. I would be happy to settle in at around 155-160, providing a comfortable buffer for any weight gain after the so-called “honeymoon” phase is over. But with all of my health issues resolved, any surplus weight loss is really just icing on the low-carb, sugar-free cake.

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In 2010 (258 lbs) and again in 2016 (185 lbs). 

The replay on…diet and exercise.

Of course, surgery is the catalyst for a weight-loss journey, not the panacea for obesity. I used the initial “boost” of losing 40 pounds in the first month to exercise constantly. Sticking rigidly to the nutrition guidelines prescribed by dietitian have also made this process a success. I have a “rule of five” to which I adhere fanatically; these five foods are strictly verboten, never to be eaten: rice, pasta, bread, refined sugars, and ANY kind of corn or potato-based fried or baked snacks (chips and their like).

For proteins, I stick to non-fat dairy (Greek yogurt), 1-2 ounces of nuts per day, fish, beans, and lean meats. About 70% of my daily diet is vegetables, greens like kale and spinach, and low-glycemic load fruits like cherries, raspberries, and strawberries. Never before in my life have I eaten so many salads, nor did I ever think I could relish a good salad as the old me did a fat pork chop or bowl of Chee-tos. River and I counted the number of salad dressings (no more than 5 grams of fat per two tablespoons) in our fridge the other day, and there were nine!

I am obligated to take in a minimum of 64 ounces of water per day, and since I can’t “chug” 32 ounces of that in a go, I need to sip constantly throughout the day. I still take my morning coffee – with skim milk and Stevia. Soda is a never, ever – I have not had a single drop since the start of this year, and never will again.

Eating out has been a bit of a challenge. Not only is it hard to ascertain what you’re eating when someone else prepares it, but I’m budget-minded and dislike paying too much for a meal I can’t possibly finish. I get creative and order side dishes, salads of course, or just plan to take my meal home to finish over a few days. On the bright side, I have a much greater appreciation for the quality of food. Like many of us, I used to go for quantity – line me up at the buffet so I can pack in as much crap as possible. Now, I can afford to eat small portions of excellent-quality foods.

The next step: Despite the protests of my dietitian, I’m considering going pescetarian (a vegetarian who still consumes fish). The goal for someone post-surgery is 70 grams a day, and I’ve calculated out how to take in that amount through beans, dairy, nuts, and fish. It isn’t very difficult at all. Relying more on these foods for protein would cut out some of the very unhealthy and hard to avoid saturated fats in meat. In terms of fluids, I grew tired of plain water about a month ago and have been adding those dreadful aspartame/sucralose based sweeteners to it. Not only are the sweeteners problematic for health, but the dyes are nasty as well. I’m challenging myself to return to plain water, or sweeten my drinks with fruit.

In terms of fitness, I have a lot of sagging skin around my lower abdominal region, and I need to strengthen and tone my core. Time to use my gym membership and left those weights.

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One week ago, at Mount Misery.

The replay on…emotional and spiritual benefits.

You’ve already read about my renewed sense of gratitude and joy. To some extent, I’m sure, these are products of improved biology, but it’s also how different I perceive myself…and how others treat me. I must say, I have not been complemented on my physical appearance this much since, well, ever. It comes so constantly that I’ve become quite unsure of how to respond, anymore. It’s flattering and I am always humbled. My dating options have improved; apparently I’m now in a different “league.” Even strangers seem warmer and more appreciative of me. It’s bizarre, too, being one of the lightest people in certain places, or realizing in a room of people who’ve never met me before that I’m not “fat” to them. A guy at work even asked if I’d been on a wrestling team before…it blew my mind.

Next step: Interestingly, the surgery has completely eliminated my libido (and I didn’t have much of one to begin with). I don’t know if this is a result of the surgery itself or just a facet of my new perspective on life or understanding of myself. I now struggle with dating, even though I have more options in that arena. Do I really want a partner? Have I become a sapiosexual or even an asexual person, now? Has my sexual identity changed? I’m still trying mostly because I feel obligated to not “give up” on romantic life, and the superficial perks (a readily available babysitter, second income, someone to go out with for fun) are compelling. But most of the time, I’m rather frustrated and even feel some antipathy for becoming romantically attached to someone. Maybe I just haven’t given it enough time.

I also want to keep up with mindfulness practices like yoga and meditation. As work in nursing is very stressing and frantic, I need to cultivate more pose and calm in my life.

So there you have it! I’d really love to hear from YOU, readers, so do feel free to post in the comments below.

Stay positive!

Getting It All By Giving It Away (Free Photo!)

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Free photo of day! (Attribution: “Photo by Jace Paul, 2016.”)

Hello friends,

Whenever we lose a patient on my unit, I try to take a second to whisper, “Thank you.” No, not “thank you that it wasn’t me,” but rather for that person’s life, witness, gifts, and all they gave to the ones they loved.

Maybe it was the sun shower that hit just as I left work, maybe it was the date I went on last night with a girl that made my heart sing, but today, as I came to a field bursting with black-eyed-susies on my hike, I decided to shout my gratitude out loud. I spread my hands wide, let the wind and butterflies twist around me, and just let my voice speak for the mass of my soul: “Thank you!”

Working in healthcare, I see death often enough that it’s honed my sense of urgency about the whole “carpe diem” thing. Perhaps it’s a shuffling of priorities. So much of my life has been spent in the pursuit of Truth that I have often forgot that other aims are more important. Life presents opportunities for us to be right and kind – but sometimes it gives us a choice to only one or the other. Insecure, unhappy, and overly-educated, I have all too often chosen to be Right and not kind. I’m glad that, in recent years, I have learned to be kind more often.

At an in-service for work today, we took the new hires on a tour of the building. Our wonderful Infection Control/Safety Compliance Officer, Jane, stopped to talk about responding to a combative patient. The question was when it’s right to argue with an angry patient, and when it’s better to avoid an argument. When safety or health is at risk, she said, it’s important to be right. But if these concerns aren’t present, it’s better to be kind. If a dementia patient thinks it’s 1945, let them think it. What good will come of trying to convince otherwise?

“As often as possible, choose to be kind over right,” Jane said to cap the conversation.

A patient in a wheelchair, on leave from long-term care (the unit for people who won’t, most likely, ever be going home) suddenly spoke up.

“That’s very good advice,” she said. “I’ve seen people who spent their lives trying to be right and not kind, and let me tell you…they don’t get many visitors.”

We touch down on this earth and barely find our feet before the ground disappears below us. The sliver of time we occupy in the greater lifetime of our cosmos is such a small space within which to move, to learn, to create. How do we want to use that time?

It’s a question that is never fully answered; or one that dips below the horizon of our awareness as we become focused on the immediate, the logistical, and the mundane. I try to bring it forward each day and use it to stay focused on the things that really matter – those virtues and choices that will mean more meaning, more love, and – yes – more friends and loved ones at our side when time runs out. 

My friends, don’t listen to the pragmatists or cynics. Give away the “stuff” you think you need and become rich with freedom and peace. Love wildly and impulsively. Believe in gods or good people or fields stuffed with flowers.

Say it with me: “Thank you.” 

Ten Tips For Hiking Like a Pro

Hi friends!

Let me tell you, it’s spring at long last here in the Last Green Valley, and hikers are out in droves. (Which, in hiking, means meeting two people on a typical hike instead of one.) As usual, I’m seeing the usual mix of seasoned trail explorers and neophytes, and remembering my first forays into the forests some years ago. When you’re just getting starting with hiking, it’s common to make choices that seem smart from a ‘common sense’ view, but are actually harmful to your hiking efforts. Today, I’m going to cover some of the mistakes that newbie hikers make, and highlight some quick and easy tips that will help you hike better – and enjoy your time on the trails much more.

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A natural marsh along the Nipmuck Trail, May 2016. (c) Jace Paul

For this post, I’ll be joined by my amazing friend Haley, who is a dietary aid and nutrition major at the University of Connecticut. Haley knows her stuff when it comes to health and diet, and she’s a great cook too – check out her blog for diet tips, recipes, and more. It’s right here.

 

Tip One: Take Care of Your Feet

Wearing running or training sneakers on the trails is a rookie mistake I observe all too often. These types of shoes are best suited for level to moderately-sloped surfaces, and they don’t offer the type of arch and ankle support you need on rocky trails or steep ascents. If you’re waking up the day after a good hike complaining of sore feet, chances are you’ve got the wrong footwear for the job. Be smart and get some hiking boots, paying special attention to ankle support. Distressing the muscles around your ankle can lead to sore feet and even knees and serious injuries down the line.

Tip Two: Stagger Your Fluid Intake

Keeping hydrated during exercise is obvious. But don’t guzzle twelve ounces of water at the start of your hike, and then down another twelve or more at the end. You want to ration your H20, sipping 2-4 ounces about every 10-15 minutes. Chugging a bottle of water is going to place extra strain on your already hard-working heart, because the sudden influx of fluids will raise your blood pressure (which is partially a function of fluid/blood volume). Your kidneys will also work extra hard balancing the alternating states of hydration and dehydration. Keep your metabolism running efficiently with a consistent fluid intake. Oh, and don’t forget the electrolytes – these are critical to proper fluid balance in your body. Just don’t grab Gatorade or any of the sugary beverages…

Tip Three: Throw Away the Refined Sugars

Your pack should always have a few snacks in it for extended hikes. Exercise of less than sixty minutes’ duration won’t place enough of a demand on your body for extra calories, so if you’re just out for a quick hike, you can consume some lean protein about 20 minutes before and after for muscle recovery. But while it’s tempting to grab a trail mix with M&Ms or sugar-coated raisins, these processed sugars are used least efficiently by your body, and can actually slow you down when your glucose levels drop. “Most people know this as the ‘sugar crash’or ‘crashing,'” Haley explains, “and it happens when your insulin levels are too high.”

Your best snacks contain natural sugars. Bring some strawberries, cherries, blueberries or another low-glycemic load fruit with you. Nuts like pecans, cashews, pistachios, and almonds are another great source of energy that also contain healthy fats and a good dose of protein, too. Granola bars and oat-based products are fine, but check labels – refined sugars are often found in excessive amounts in many of these foods.

For sustained activity, Haley recommends complex carbs. “Complex carbs, like oats or whole grains, are important for hiking and sustaining the body for a long period of time,” she says. A bag of potato chips, on the other hand, will kill your energy levels, and the high sodium content will make you thirsty even when your body is adequately hydrated.

Tip Four: Be a Smart Packer

Bringing a lightly packed day pack on any hike is a great idea. However, don’t overdo it. Many new hikers are giddy with the prospect of taking photos, reading a book, or trying out new hobbies like rock-collecting when they hit the trails. Just remember how much harder your body (and back) have to work with a heavy load. If you must bring a book, pick a slim, softcover one – but to be honest, most people find the forest itself stimulating enough, and never crack a book to begin with. Photography equipment is great, but plan ahead and select just the lenses and tools you know you’ll likely need. With equipment, don’t fall into the trap of buying tons of gadgets and gizmos in the outdoor section of the store. You won’t need a portable shovel on a hike. Really. A compass, a whistle, a map (all of which, to be honest, you have on your smart phone), a poncho, a little food, and water and extra clothes (see below) are really your only necessities. If you’re going out in the evening, add a headlamp and bug spray to that list. Cooking equipment or utensils are only necessary for extended hikes, and if you need to cook, get a “pocket rocket” collapsible stove – they typically weight just a few ounces.

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Pro photographers may balk, but a light, plastic 18-35mm lens (which I used to take this photo) is adequate for most of what you’ll want to shoot on a hike – unless you’re aiming for wildlife from a distance, where lenses with at least a 300mm focal length are required.

Extended hikes require even more frugal packing, especially if you’re trying to make good time. Liz Thomas, an exceptional distance hiker who recently completed the Pacific Crest Trail, carried a pack with her that weighed just seven pounds for the 80-day journey. (She hiked into nearby towns for food and water.) That’s on the low end, but certainly a day hiker can carry everything he or she needs in 15 pounds or less.

Tip Five: Be Prepared for Weather Changes

Checking the weather before you go out to hike is smart, but weather conditions can change unexpectedly and accidents do happen. Many a new hiker has gone out in shorts and a tee shirt in the morning, only to find themselves shivering in cold, wet weather later on. Get a cheap plastic poncho for rain, and keep some extra layers of clothing in your pack. An extra pair of socks, a light jacket or sweatshirt, and a hat and gloves in the spring are strongly advised. (By the way, those extra socks will come in handy if you should be crossing a river or stream and slip, too.) A savvy hiker dresses in easy to remove layers. As weather conditions change, or as your body’s internal temperature rises, you’ll want to be able to remove outer clothing as needed. And even in sub-zero temperatures, avoid absorbent fabrics like wool. They may feel toasty and dry at first, but after you’ve started sweating, you’ll be drenched and uncomfortable. Choose fabrics that wick moisture away from the skin instead.

Tip Six: Let Someone Know Where You Are

The standard wisdom for hiking is “Never hike alone.” I routinely flaunt that convention, and to be honest it’s just not realistic for many of us, anyway. So instead, just give someone advance notice about your plans in the event something should happen. Let them know where you’re going, and about what time you expect to be back. It’s extremely unlikely that any catastrophe will befall you on the trails, especially if you plan ahead. But just in case you should experience an injury, it’s wise to have someone in the know about your location.

Tip Seven: Adopt an Attitude of Gratitude

We all want to reap the physical and spiritual rewards of a good hike, but remember: this hike isn’t just about you. Be mindful of the forest and its inhabitants by adhering to the rules of the park. Stay on the trails, pack out your trash. Most professional hikers cultivate a sense of respect and gratitude for the earth, reminding themselves that they are guests in the woods. As your time spent hiking increases, your sense of connection and respect for nature is sure to increase. Notice that feeling and cultivate it.

Tip Eight: Take a Break (But Not For Too Long)

If you’re trying to lose weight or build muscle mass, you probably want to push yourself to the limit. While you definitely want to keep your heart rate high and keep burning calories, your body will manage both more efficiently with brief breaks to rebound. Break every thirty to sixty minutes, but only for three to five minutes at a time. Resist the urge to punish yourself; your body knows what it can do and when it needs a break. Haley explains that resting is “about listening to your body and taking a break when you need to. If you get fatigued, you may not be able to work a, hard or continue going as strong as you would if you took a short rest.”

Tip Nine: Hiking is the Best Training for Hiking

If you’re planning to hike for a weekend, or thru hike a major trail, consider working hiking into your daily routine beforehand. Many pro hikers carry their gear with them any time they leave their house in order to adjust their bodies to constantly carrying a load. Wear your hiking boots to the grocery store, and use stairs to mimic steep ascents and declines. Getting your body used to the strains of hiking will decrease the adjustment time once you’re on the trails. And, it’s helpful to take a hiking “mentality” too – focus on your steps and where you plant your feet, be mindful of balance and posture, and practice moving at a pace that works for you. One way of looking at hiking is “mindful walking.”

Tip Ten: Show Courtesy to Your Fellow Hikers

Hiking is a pretty lonely sport, to be sure. Most days I don’t encounter any other people when I hike. But when you do run into someone else, be friendly and say hello. If someone hiking behind you catches up and wants to pass, step to the right so they can pass on your left. Offer some trail mix or a little water if you can spare it. You’ll find hikers are a special type of people, with great stories to tell and knowledge to give to anyone who’ll listen. Most of them are there for the same reasons that you are: to test themselves and their limits, to find a deeper connection with the world, to uncover new truths or wrestle with hard questions. Hikers are wanderers and seekers, and they will welcome kindred spirits.

Oh, and many hikers have “trail names” that serve as shorthand in the same way that CB radio call signs do. Mine, you may have guessed, is “Factotum!”

See you on the trails!

An Ethics of Hiking (and a Free Photo of the Day)

Hello readers!

I’ve been working on a chapter in Eastern Connecticut from the Trails that considers some prolegomena (“first words”; the Greeks used it to mean “prologue” or “introduction”) for a new philosophy of hiking. In its formal presentation, it considers the big questions of philosophy but specifically geared toward hiking. For example, what is a hike? Is it the distance? The location? What makes a hike distinguishable from, say, a particularly long walk to the store? And, what do we learn from hiking (epistemology)?

One of the more, shall we say contentious, subjects with which I’m grappling is the question of why we hike. Unfortunately, my reflections have drawn me to the conclusion that almost all hikers are motivated by internal stimuli: the desire to be fit, the hope of finding solitude, inner peace, a great view. Some hike as amateur scientists: for bird watching, identifying rare or beautiful plants, collecting rocks. But the relationship with nature, too often, is one-sided. We benefit from hiking, but the natural world receives nothing from our presence. Indeed, as the seemingly endless parade of trash on the trails indicates, the forests and wildlife are worse for our interference.

There’s nothing wrong with going out for exercise, spiritual nourishment, or a glimpse of nature’s secret majesty. Every hike I’ve ever done has been compelled by some degree and combination of those aims. If there’s a philosophy of hiking, however, there’s also an ethics that entails from the truths that philosophy proffers. What ethical duty do we have as hikers to ourselves, do others, and to nature?

A full treatment of the ethical dimension of hiking is a bit much for a blog post. But here are some thoughts to get the ball rolling.

For a start, don’t litter the trails. I don’t wish to sound like priggish, so let me underscore that I make it a point to be very generous in my estimation of other people. We’re all human, we all make mistakes. To harp on the folly and ignorance of other people too often is a prescription for a miserable life. But I would gently suggest that, in the ethics of hiking, there’s an obligation to anyone who sets out on the trails to “do no harm,” as the Buddhists say. And I would encourage anyone thinking of hiking to conduct a little self-analysis and honestly assess if they can meet that minimal goal or not.

Let’s imagine a person who simply can’t get behind the wheel of a car and obey the laws that keep the roads safe. They run red lights. They drive at twice the posted speed limit – in a school zone. They frequently drive drunk. Would it be controversial to eventually say this person, who is unwilling to alter their errant ways for the good of the whole, “Perhaps you should just stay off the roads?” And, would it not be responsible and laudable if that person said, “Yes, indeed, I should stay off the roads until I can adhere to the standards that keep our roads safe?”

I think the same situational ethics apply to the trails. If a person cannot hike without casting beer bottles and soiled diapers into the dirt, if the woods are merely a convenient place to have sex and leave used condoms for the rest of us, if they simply must destroy a tree to declare their love “4 ever” for their partner, if they find leash laws and prohibitions against fires, motorized vehicles, and leaving pet excrement on beaches and foot paths too encumbering, then I think it’s quite fair to say: stay home. The trails are not for you quite yet, but we’d love to see you when you can engage in a symbiotic relationship with the outdoors.

This, I believe, points to the one axiom (a statement that is necessarily true, accepted as fact) I’ve discovered in hiking: nature itself has value beyond what it can do for us. The forests, the flora and fauna in their diversity, the ecosystems – all have an intrinsic worth that’s separate and immutable – unlike the value of meat, timber, ore, and other “products” we harvest from nature.

So beyond doing no harm, perhaps we can also aim to help. A small example – I carry a garbage bag, a mere 5 gallon one, in my pack when I hike. When I see a bit of rubbish on the trail, I pick it up and pack it out with me. It’s what I consider a basic courtesy to the natural world and to other hikers and our park systems, too. We can volunteer our time maintaining the trails. We can donate to our cash-strapped Forestry, Parks and Recreation, and Environmental Protection agencies (all of whom rely increasingly on volunteers and outside organizations with each round of budget cuts and layoffs).

But perhaps most importantly, seek out greater knowledge and peace in yourself and in your dealings with nature. Learn the names of the trees, rocks, and animals around you. I am convinced that intimate contact with the forest abolishes all delusions of a self apart from nature; that as our understanding of the intricacy and diversity of the Earth’s geology and biology increases, our feelings of emptiness and disunity decrease. Meditate on these bare but astonishing realities. Hike, but stop and sit in the sunlit field, close your eyes, and listen to the music that was once your home.


What is hiking to you? What does your ‘philosophy’ of hiking include? Comment below!

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‘One Month Thin’: The Skinny On Surgical Weight Loss

A look at the month following surgical weight loss – and how losing weight improves your life in just about every way.

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Though I’ve shared little about the subject on this blog, I’ve suffered from obesity for the better part of my adult life. I was always fit and trim as a child, and through most of my twenties maintained a healthy weight. It was around the age of 26 that I began to gain weight as a result of a poor diet and infrequence exercise. Hiking – a subject that I have covered here in detail – has been a great help, but like most Americans I’ve never been able to lose weight and keep it off.

By winter of 2014, I reached 260lbs, the highest I’ve ever weighed. Crucially, I’d developed two conditions co-morbid with obesity (as part of a general health status called “metabolic syndrome“): hypertension and high blood sugar. (My triglycerides were also high.) I knew that the combination of hypertension caused by obesity and diabetes was a deadly one; my life expectancy was surely lower than the statistical average for men in America.

I would look at my daughter and wonder if I’d see her graduate from college, get married, or have children of her own. River is clever and sufficiently literate about health and nutrition to know that obesity is a form of sickness. She would say that she wanted me to live to ninety, and I would flinch knowing that my weight and the ailments caused by it made that improbable.

And so it was that I decided to investigate surgical weight loss. The process itself, from an initial orientation to over a year of medical tests, visits with a dietitian, preoperative physicals, even a psychological evaluation, is a fascinating one. It’s something about which I will probably write in the future.

But for now, I’d like to discuss the immediate aftermath of my surgery – a vertical sleeve gastrectomy – and both the expected and unexpected outcomes I’ve experienced.

My surgery was on January 19. For 12 days prior, I had been on a highly restrictive diet meant to shrink my stomach and liver. My grandmother dropped me off at Hartford Hospital, and after checking in with Admissions, I was brought to the OR waiting area. A parade of patient care techs and nursing staff came through to check vitals and keep me occupied with paperwork. The anesthesiologist walked me through the risks of general anesthesia, and had me sign off on a consent form. Finally, my doctor arrived to look over all the pre-op work and see how I was feeling. This would be my final opportunity to back out of the procedure if I so desired.

I knew there were risks. Any surgery comes with them, and if you’re overweight, have diabetes, or high blood pressure, the danger increases. A sleeve gastrectomy also comes with a 0.3% chance of death, usually caused by a rupture in the stomach suture causing sepsis. But I knew this surgery was the right choice. I thought of River and the life that would be mine after all the hard work was done, and with that image I had the courage to say, “Let’s do this.”

The procedure was done in about an hour. Weight loss surgery in all forms is now done laparoscopically, a tremendous improvement on the invasive techniques required a few decades ago. (A laparoscope is a device with a camera. It’s inserted into the stomach, and the surgeon makes small incisions in the abdomen in order to complete the procedure while being able to see with laparoscope.)

I had a two day hospital stay following surgery. The staff on the OR floor – Bliss 8 at Hartford Hospital – were simply amazing. Under their diligent care, I was tested for fluid tolerances (tea, chicken broth, sugar-free popsicles, and water were all I could ingest) and monitored for complications. The ability to stand, walk the floor, pass gas, and urinate were the additional benchmarks required for discharge. Before leaving, I was given a detailed seven-week diet plan and a pile of prescription meds.

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Here’s what I’ve noticed in the month since I left the hospital.

First, my blood pressure began dropping. In fact, it began to drop during the pre-op, low-carb diet. Within two days of discharge, I was getting normal blood pressure readings (<120 / <80). Often, my pressure was too low due to hypovolemia (lack of sufficient blood volume) caused by insufficient hydration. Dehydration is the primary health concern after surgery, and my post-op diet called for 64 ounces of water per day. By three weeks after surgery, my diagnosis of hypertension was rescinded and I was taken off my hypertension medication. A huge win for my health.

For two weeks after surgery, liquids were all I could consume. I mainly drank protein shakes, water, and broths. I tried a number of brands – Atkins, Muscle Milk, Isopure – but to be honest, they all taste like chalk eventually. It may sound like a brutal diet, but another immediate effect of the gastrectomy (and this might seem obvious) is that I don’t feel hungry. At all. There are times, of course, when low blood sugar triggers the notion that I need to eat in my brain, but I never feel the ravenous pangs I felt before. Two weeks on liquids was a cinch.

During the two week liquid diet, I began monitoring my glucose levels. A week before surgery, my fasting blood sugar was 136, and my A1C (a measure of average glucose levels) was 6.5. Following surgery, my blood sugar immediately began dropping – now, my fasting blood sugar is around 70-80, and post-meal it’s 95-105. Perfectly normal.

At week three, I was allowed to add mushy foods – non-fat yogurt, oatmeal, low-fat ricotta cheese, and anything that could be pureed – to my diet. I experimented with pureed concoctions like ground turkey, gravy, and spices (thumbs up), or pureed hard-boiled eggs with paprika and lite mayonnaise (thumbs very much down). In addition to 64 ounces of water, I was to consume 70-90 grams of protein each day. The protein would help with healing and help my body get used to a low- to no-carbohydrate diet. So, the mantra provided by my dietitian was “Always choose protein first.” For the short term, that meant putting vegetables and fruits aside, and eschewing carbs almost entirely.

I began to notice a few other changes in the third and fourth weeks. For example, I had a lot more energy than I ever had before. Whereas once I would only feel rested with 9-10 hours of sleep, now I feel great after 7 or 8. Of course, I was also exercising nearly every day – I’ve hiked more in the past month than in the entire autumn of 2015 – and my resting metabolism was improving – evidenced by a resting heart rate of 65-75 bpm.

I was saving a lot of money, too. I found that halving my estimate of how much food I could eat wasn’t enough; I had to reduce it to a quarter or eighth of the portion that “seemed” right in my mind. (After surgery, the size of my stomach was about equal to a banana, or to a 4oz total capacity.) So suddenly a pound of lean beef lasts a month. A can of broth lasts a week. A batch of chili using the standard recipe needs to be frozen because I can never eat all of it before it goes bad. There was, unfortunately, considerable waste as I adjusted to this new way of eating. I used to shop like a bargain hunter, you know the mindset, the most food for the least price. Now, I look for the smallest servings and the highest quality ingredients. I can afford to get better quality meats and superior organic staples. I’ve completely eliminated processed sugars from my shopping list. I’m also saving money in unexpected ways – toilet paper, for example. (I won’t be too candid here, but suffice it to say that when you eat less, you need the bathroom less, too.) I don’t need to buy antacids – heartburn is a thing of the past.

At week two, I also began taking supplements. Because of the limited capacity of my stomach, I will need to take a daily multiple, B12, calcium, iron, and vitamin D supplements every day for the rest of my life. Getting used to this routine was a challenge, so I began tracking my supplements, diet, exercise, and vitals in a daily log. It’s been tremendously useful for staying on top of my fluid and protein goals, too.

A few cognitive changes related to the weight loss took me by surprise. First of all, my tastes changed. Prior to surgery, I despised mushrooms, but now find myself liking them. Rotisserie chicken or roast chicken used to be a favorite indulgence of mine; now I get nauseous at the thought of it. Fast foods, once a bane to my health and a craving I couldn’t shake, hold no appeal. Mostly I find myself jonesing for salads, fish, and – occasionally – Cheez-Its. But without the hunger pangs, I breeze right by the chips and snacks aisle at the store and think nothing of it.

I found my anxiety decreased and my mood improved. Feeling healthier and more fit brought me an inner peace and joy like I have not felt in my life before.  Prior to surgery, I set up a meditation area in my living room, complete with an indoor greenhouse and small waterfall. These, of course, helped me develop mindfulness practices that aid in keeping my grateful and happy in my life, but the diet and exercise – both tied to surgery – have made it easier still.

So, the big question: has it been worth it so far? I have to give a completely unqualified “yes.” Though I’m 47 pounds lighter, the real victory is the remission of the hypertension and diabetes, two serious health issues that I have successfully treated with the surgery. Prior to making a final decision, I went to a handful of friends who’ve also had weight loss surgery (mostly gastric bypass) in order to ask them if they were happy they had it done. The answer, from all of them, was nearly always the same: “It was best decision I ever made.”

I can now add my voice to their number, echoing their joy for the new life surgical weight loss – and their own hard work – gave them.