10 MPG…

Portland, OR to Taos, NM in one weekend. This was the first time I tested out the ol’ RV for real. Over 1,500 miles with a gas milage of 10 MPG at best equals a lot of time behind the wheel and a lot of time filling up with gas!! I had decided to try and cut the costs of traveling and post on craigslist for rideshare and see if anyone wanted to catch a ride between Portland and Taos. At one point I had 3 people confirmed for the ride to Denver, but all 3 bailed at one point or another. So at the last minute I called back one other person who had e-mailed me prior who was looking for a ride for him, his bike, and his Bob trailor. With only 5 hours until the time I was planning on heading out, I figured he would not have the ability to get all of his stuff together in time, I was wrong though.



After getting off the phone with Mark, he did a 5 mile run from his current location to where he was storing his bike, to get on and ride back to his orginal location. At that point he picked up his Bob tailor, gathered all his belongings, and biked over to the Gateway Transit Center. I, in the mean time, was running around Hillsboro getting all the final logistics squared away before I leave the pacific NW for the next 7 months. After arriving 1 hour after my predicted departure time, I met Mark with in 10 minutes of arriving at the transit center.





Friday evening was spent driving long hours and sharing lots of stories. Mark had just finished biking across the country and was heading down to Prescott, AZ to re-incorporate into a less transient life style. He had many crazy stories of long hours in the saddle, big mountain passes, amazing generosity found along the way, and many other anecdotes. On Sunday morning we pulled into Ogden, UT where Mark jumped ship and aimed his bike south towards AZ in much awe of how many miles we covered in such a short time compared the rate of speed he had been doing over the past several months.






Summit and I continued on in our journey, driving across the incredibly flat and amazingly boring state of WY. We made to the Colorado border without being blown off the road too many times and with great expectations of meeting up with friends in Denver. Sunday morning I met up with my good friends Mike and the very pregnant Mary Bateman. We walked down to the local breakfast diner and spent a couple hours catching up on life. After wishing Mike and Mary the best with their new house and, soon to be, new baby Summit and I headed over to the local park. Within 20 minutes of being at the park (which has no posted signs about dogs or leashes) we attracted the attention of the dog cops and a $50 ticket. Summit’s first ticket; I’m so proud. The county of Denver is going to be receiving an appeal…







At the Colorado, New Mexico border I was able to watch my engine heat gage slowly rise to the red line as we crested the pass that separates the two states. A little rest for the tired old RV and we were back in business. I rolled into Taos and was greeted by an amazing sunset looking over the sagebrush and the Pinon Trees.

Catching up…

So I have been a slacker and have neglected this blog for most of a month; but here goes an attempt to bring the cyber world up to date with my life. The return from Alaska was bitter sweet. There were many thousands of miles of amazing hiking and exploration that were left untouched and unseen by myself, but it was also time to move on in my clinical year. (I think the ratio of play time to clinic/study time while in AK was very much one-sided: so leaving such an amazing playground might do well for my studies!! I do have to pass a board exam at sometime.) I know that I will return to Alaska at sometime in the future and will come back for more adventures, though this was a great introduction to the largest state in the nation, punctuated by meeting lots of really cool people.

I was met in Portland by some great friends who were gracious enough to store the old RV at their house while I was away and we re-connected over breakfast (after flying all night). Thanks Jordan and Cecily. Next stop was to reconnect with Summit up in north Portland and the amazing Missy who gave Summit lots of love and caring over the past 6 weeks. Summit had the “wiggly-bottom-syndrome” when he saw me and was so excited to play frisbee yet again.
This week was supposedly focused on a week of lectures bolstering our knowledge and bettering ourselves as a PA student back in Hillsboro, OR. By Monday afternoon I was wondering how I lasted a full year sitting in a chair for 8 hours of the day, 5 days a week. Much of the time, however, was spent catching up with classmates, sharing stories of being flung to the far reaches of the country, and crazy stories of seeing patients and getting pimped by your preceptors.

There were also a lot of extracurricular activities that filled the week. Monday night my friend Ryan organized a night ride at Tillamook Forrest which was an absolutely amazing ride and much overdue ride!! I was able to reconnect with my bike and give Summit a chance to really stretch his legs. A group of 7 or 8 of us headed out on the Brown’s Camp loop which is one of the greatest rides around the Portland area. Right about dusk, my Yeti mountain bike decided to punish me for neglecting it for the past 6 weeks and ejected me from the saddle after I didn’t see the rock covered by grass on the side of the trail. One quick flight through the air sent me rolling down the lush green hillsides of Tillamook Forest. Thanks for a great ride Ryan!!

Tuesday night I reconnected with some friends in Portland who were storing my car and my kegerator. I reaped the benefit of loaning a kegerator by sampling some excellent home brewed beer. On Wednesday night most of the class met up for the 2nd annual PA Bowl Off. It was a night filled with great costumes, a lot of trash talking, a little bowling, and some great live blue grass provided by 3 PA faculty members. It was great to intermingle with other PA classes and hear the trials and tribulations of the classes above and below us.

Thursday night Jessica and I met up with the victim from the dirt bike accident (see entry on 4/21/09) for dinner. Galen is doing remarkably well and was just released from his halo head stabilizer the week prior. For the extent of his injuries, it is amazing that he spent less than 2 months in the hospital and transitional care centers. He is doing well marked by his biggest concern of whether he will be given his driver’s license back next month or not. After going through such a horrific accident, it is great driving is his biggest concern! Best of luck to you on your driver’s test Galen.

20,320 feet of rock…

You can’t be in Alaska and at least make an attempt to see Mt. Denali (the original and native name for Mt. McKinley). With the rain for the past 2 weeks I had all but assumed that I was going to be looking at a bunch of clouds imagining looking at Mt. Denali, but Mother Nature smiled on us and allowed the clouds to part on Saturday and provided us with clear blue skies and absolutely stunning views of the mountain!!


Friday night we piled 5 people and all our camping gear into Colin’s 2 door Ford focus (which was quite impressive) and headed north out of Eagle River. Four hours later we threw down at a campsite just inside Denali National Park boundary. The car was left at the campground because no private vehicles are allowed in the part past mile maker 18 of the park road; instead there is a great bus system to make all of us gas guzzling, isolationist, Americans do something good for the environment and possibly interact with each other. A darn good idea!!


The bus ride out to Wonder Lake Campground, the campground furthest into the park took almost 5 hours with numerous stops for wildlife viewing and blowing through megapixels on amazing vistas. Denali’s big animals put on a great show for us starting out 15 minutes into the ride when a moose came meandering across the road in front of the bus. This was followed up by numerous caribou, bald eagles, ptarmigans, and many other smaller animals.


We saw a great interaction of survival and the food chain play out in front of us. The bus came to a stop because there was a red fox just ahead of the bus, then the eagle circling above came to a perch just 20’ from the fox. With his tail up straight and puffed out, the fox was trying to look domineering and scare away the eagle from his road kill meal. The eagle was eyeing both the road kill and the fox as a possible meal. When the fox finally left his road kill, the eagle began circling the fox and following him down the road, setting up the scenario for a possible survival of the fittest contest. The eagle soon lost interest, however, and went off to soaring on the thermals high above all of us.


What about the almighty grizzly?? About half way through the drive we were traversing a hillside with the bus and looking down at the river bed below when there was the first sighting. Momma bear was running down the river bank with 2 cubs in tow, with one little trouble maker trailing far behind momma. Momma was being playful with the close by and took a few playful swats at him as they were running. According to Cindy our bus driver, the cubs were probably 2 years old and over the next year or so momma will become less hospitable to the cubs and force them to strike out on their own. These were the first 3 of 6 grizzly sightings throughout the trip, with one of the big guys walking with in 20’ of the bus!


What about the mountain?? About 2/3’s of the way into the park rode we had our fist view point of the Mt. Denali. We came around the corner and saw the huge base of the mountain pushing itself up into the clouds that were shrouding the peak. As we got off the bus the clouds began to part as if on cue and suddenly there was the amazing peak as if sitting on top of the layer of clouds covering the waist of the mountain. Thirty minutes later the peak was completely shrouded in clouds again. I was happy; I had my 20 minutes to see the top of Denali and I could have gone home a very content man.


Denali, however, decided to reward us with more amazing views throughout the weekend. Saturday night, as dusk set in at midnight, the clouds left completely and the entire face of the mountain was visible in the incredible low level light that only certain times of the day can offer. We woke to clear skies and amazing brilliant light bouncing off each ridgeline of Denali providing an amazing sense of the topography of this mountain.


“Today is the best viewing day we have had of the mountain all summer,” was the comment from a park ranger as we ascended one of the mountains near the Eilsen visitor center on Sunday. That is a pretty impressive statement given this ranger looked at the mountain on a daily basis. We hiked up to the top of the ridgeline behind the visitor center which provided amazing views across the valley at Denali. The entire sky cleared out and there was only the occasional cloud blowing by in the sky.


This was another amazing Alaskan hike punctuated with a couple of caribou, numerous arctic squirrels, a few marmots, and some amazing arctic tundra. It was incredible to look across the valley at the ridgeline of mountains which were relatively comparable to the continental divide in Colorado, but these mountains were dwarfed by Mt. Denali which is another 8,000’-9,000’ taller. This is by far the largest mountain I have ever seen and I am in awe of the shear mass and majestic beauty of her. Thank you Denali.

80% of the town lives in that one building…

It was 50˚ F, rainy, and only 1 mile of visibility: but it was a great day to be out on the water. It has been a long time since I have been out on a sea kayak, and Whittier, Alaska provided an incredible opportunity to do just that regardless of weather. Huge, green forested cliffs ending abruptly in the ocean. Innumerable thin, twisting waterfalls draining the glaciers where the water was racing and rushing to reach the ocean. Our kayak tour led us into many inlets and bays, exploring all the crevices of the coastline.

My partner in Alaskan adventures, Colin, and I, as well as Brian headed out for a custom kayak tour. Our trip (which was just the 3 of us) was geared more towards pushing the tempo up a little bit to see more terrain rather than the tourist idea of lily-dipping and gawking at every bird that flies by. We had a great guide who was pretty psyched to be able to go further out Passage Canal than the average trip.

We were geared up in multiple layers of polypro, fleece, paddle jacket, vinyl raingear, and a spray squirt to top off the ensemble. Once on the water I soon found the joy of kayaking once again. It is a unique feeling of sitting in the water, feeling the heaving of the ocean, finding your rhythm of paddling, and being able to get up-close and personal with the coastline unlike most other boats. We were able to see several bald eagles, a few seals, and a million and two Kittywake gulls, with a couple Kittywakes picking up fish 10’ off the bow of my kayak.

As a part of the whole deal we were supplied an extravagant lunch spread out on a table cloth on the beach. Smoked salmon, pasta salad, crackers and cheese, trail mix, hot apple cider, and lots of other great things to fill your stomach. The 4 of us worked hard at putting down all of the lunch, but 4 young active people couldn’t even polish off all of the food supplied.

“80% of the town lives in that building right there, and another 18% lives in that smaller building next to it,” our guide said. The rest of the town’s population squats in RV’s, pickup trucks (like him), the back of their store, or some similar location. When the cruise ships dock and release there 2,000 plus guests onto the docks of Whittier, the population literally doubles until the cruise ship guests are whisked away by the waiting train to other parts of Alaska.

The only way into Whittier by land travel is through a one lane, 2 mi. long tunnel, shared by cars and trains. When I say 1 lane, it was truly 1 lane with rock on either side and cars driving on top of the train tracks when going through the tunnel. We waited for the oncoming train, then oncoming traffic, then waited for the train to go the other direction, then finally we were allowed through. Evidently the military picked Whittier as the best deep sea port that would be least likely to be bombed during WWII due to the weather conditions there. This led to the saying: “it’s sh*tier in Whittier.”

When not on the water the weekend was rounded out with a couple of amazing hikes. We hiked Winner Creek trail (I’m a winner!!) which headed out of Alyeska Ski Resort in Girdwood, Alaska. This was a great hike with amazing views and the opportunity to take a hand tram across a large river crossing. Saturday night we threw down tents at the Passage Canal trailhead above Whittier and found a couple of people who were scheduled for the same kayak company the next day as well. They were on break from doing research way out in the remote areas of Alaska on Eider ducks, so to them Whittier was a “big city.” We did a quick hike up to the vantage point of the nearby glaciers and found ourselves working hard not to let the wind push us over. Great views, and a great place to enjoy a beer!

7/21/09: Grandma rides snow machines!!

Here is a short list of the cast of characters I saw today:


1) 99 year old woman presents with an episode of palpitations and chest pain in the middle of the night. “I woke up from a scary dream and had these chest pains.” She recounts the dream: “I heard they were digging up the graves on Fox Island across Resolution Bay, and I have family over there. So I was going across Resolution Bay on my snow-machine and, (in a very quiet voice) I don’t usually use this word, but I “goosed” the gas to get up and over this high point. And then I woke up with chest pain.” This 99 year old woman who had full mental capacities and only used a cane to get around the house was escorted by 70-something year old daughter who was just as alive and vibrant. It is amazingly refreshing and inspiring to see people who have aged gracefully. My hat is off to these two wonderful women who I had a chance to meet.


2) These two gentlemen come in together, and they gave the movie “Grumpy Old Men” a run for its money!! If you combined the procedures done on both of the men, it would probably cover nearly all of the procedures that could possibly be performed on the heart; but they were still alive and kicking. They were also slinging the mud back and forth so fast to looked like monster truck pull:

“6 cigars a day!?! You bought a case of 100 cigars at the beginning of the month and they are all gone now!”

“Sugar, don’t talk to me about sugar. I bought a dozen donuts and only got one because he ate the whole box by himself!”

And on, and on, and on the bantering went. If we raised any lifestyle changes, the focus was always pushed to how the other guy was worse off about that specific vice. The bantering could only come from two people who knew each other for years and who actually care deeply for each other.

The full story is very touching: “George” is 65 years old and is about 10 years older than “Bob.” George is an ex-cop who worked in New York City, lives with and cares for his wife with multiple sclerosis, and lives in the same apartment building as Bob. Bob has no family, is in very poor health, has a difficult time with many of the activities of daily living, and has a history of severe depression. George brought Bob under his wing about 8 years ago. He takes him to doctor appointments, fills his pill box, makes sure he has a freezer full of packaged dinners, gives him companionship, and genuinely cares for Bob as if he were a brother. George brought Bob to my preceptor specifically because he felt she was the best cardiologist in Anchorage and has set up his wife and now Bob with only the best providers in the city “in case anything should happen to him.” Though George’s heart is very sick, it is also very large and he cares deeply for those around him.

3) The 67 year old engineer who was trying to engineer his health. He presented us with a perfect spreadsheet with documentation of every single medication he was on, what dosage, what time taken or if he missed the medication. He also informed us that he had taken the liberty to tinker his Coumadin dosages just like a carburetor of an engine. Unfortunately if you tinker with you Coumadin levels too much you either turn your blood into water or you can start throwing clots. He received stern orders not to mess with his Coumadin dosages, but once an engineer, always an engineer.

7/20/09: “Would you rather it be opium & cocaine??”

Stress test report:

“Mr. Addict decided to have a few cocktails prior to his treadmill stress test today. After a few minutes of running Mr. Addict lay down on the treadmill and fell asleep.”
This was the report from about 3 weeks ago, fortunately Mr. Addict either decreased or eliminated (highly unlikely) the amount of liquid courage he needed for the pharmacological cardiac stress test 4 days prior. At any rate, he showed up to the clinic today reeking of alcohol demanding the results from his test. When confronted about his alcohol and tobacco consumption he exclaimed: “have you ever heard of addiction!?! Would you rather it be opium or cocaine?” Later in our conversation he dropped the not so subtle hint that the cost of opium in Egypt (where he was when he had his heart attack and stent placement 6 weeks prior) was incredibly cheap.

Choose your battles:

When my preceptor was confronted with the choice of opium or cocaine, she readily suggested that opium (by far) is the lesser of 2 evils for his heart.

Despite his multiple life style choices, Mr. Addict passed his stress test 4 days prior and it did not show any significant heart disease going on now.

Go figure: you can be a marathon runner and in the best shape of your life and drop dead secondary to a heart attack if genetics are not on your side, or you can put every poison known to man into your body and your heart can still be as strong as a bull’s. I guess the moral is that you should have fun in life no matter what it looks like, but I’m going with the have fun and be healthy choice.

7/20/09: The heart bone is next to the skin bone, right?!?

Day 2 I of this rotation I look at my preceptor’s calendar. Over 2 weeks of the 6 weeks I will be in Alaska he would be off on fishing trips, grizzly bear viewing trips, and a multitude of other trips. The limited days we were working sometimes had as few as 2 patients scheduled, and on any given sunny Alaskan summer day, half of the patients would cancel or not show for their appointment thinking that fishing is much better thing to be doing on a sunny day.

I cautiously called the PA program clinical team (knowing I was opening a can of worms: but with no idea how big the can was) to ask about other clinics I might be able to work with another clinic in Anchorage to bolster my educational opportunity. This request was quickly turned into a desperate search for another clinic when I was told I would not have enough patient contact hours at the dermatology clinic and I would have to repeat this rotation after my expected graduation date. For 2 days I was in a constant state of logistical juggling to make something work out for this rotation until I heard that “ooops, actually dermatology should have enough patient contact hours and you are all good.”

The ball had already been put into motion in a couple directions for alternative clinic experience, one of which was the Alaska Heart Institute. With the reassurance that my derm rotation would suffice, I was able to piecemeal together a combination of dermatology and cardiology into the same rotation!!

The process was a painful rollercoaster ride, but the net result has turned out to be an amazing opportunity!!