Lessons Learned

Or the most expensive blister in history

Get ready for a saga!

Oh, how the mighty have fallen. I bragged about how beautiful my feet looked when I finished the AT. I had a good routine, took precautions, didn’t have any foot problems. No blisters. No raw spots. No ingrown toenails. Not even plantar fasciitis. They looked great the whole way. I took care of my feet and they took care of me.

And one week on the CDT and I’m brought low by a blister. A simple blister.

How it started

On Day 2 or 3, I developed a blister on the outside of my left heel. It hurt, but not terribly. A day later, I discovered one in the same place on my right heel. Even though I was following the same routines that had worked for me on the AT, a few things were different. I chalked the blisters forming up to these possibilities:

• sand in my shoes constantly.
• changing my gait for the continually shifting sands and pebbles, as well as all the other surface textures in the dessert.
• my trail runners are a slightly newer model than my tried and true ones.
• they are also the women’s version and I usually wear the men’s version.

So, when each new blister developed up, I treated them appropriately, covering them with duct tape or KT tape.  (I forgot I had a square of moleskin in my first aid kit.) When they popped, I had antibiotic ointment and large bandaids.

The big issue.

And then the most expensive blister in history came.

The evening of day 3, I could feel a hot spot developing at the base of the second toe on my left foot, right by the ball of the foot. I pretreated it, hoping to stave off a blister by covering it with KT tape. No luck.

Day 4 presented a full blister on the ball of the foot. It was more painful than the other blisters, but didn’t look concerning otherwise. Just caused a mild limp. I covered it and hiked on the next day.

Day 5 it popped. Still painful, but it didn’t look concerning and I treated as usual.

Day 6 it didn’t look bad and I was still only walking with a mild limp. My hiking buddies and I got into town midday, got lunch, then went to our respective hotels. I got cleaned up, did laundry, and cleaned and dried my gear. All the usual town chores. The pain wasn’t any worse or any better, so I just went on with my day. I was sharing a room with Chop Chop and we discussed our individual hiking plans for the next few days. As usual, they aligned pretty closely, so we decided we’d plan to meet up each evening to camp together. We packed our bags, filled our water bottles, and prepared to leave right after breakfast.

Yikes!!

The pain woke me up around 2 am on Thursday morning. It felt like my toe was being sawn off. I quietly got up, so as not to disturb my roomie. I  grabbed my first aid kit and went to the bathroom.  It looked a little red, but otherwise, much the same. I washed my foot again, applied more antibiotic ointment, and a new bandaid. Then I tried to get back to sleep. My mind was racing through what-ifs. How to continue hiking and keep the wound clean. What to do if I couldn’t keep hiking. Any and every possible and impossible scenario ran through my mind.

I didn’t check my watch but it must have been at least a half hour before I devolved into the most convoluted nightmare with Chop Chop and people from all parts of my life. People who don’t even know each other were part of the horror. I don’t remember all the specifics a few days later, just that it was bad. And I don’t usually get nightmares.

The next morning.  I got up, completed my toiletry, dressed, and packed the rest of my backpack. My foot still hurt, but it was not as excruciating as what woke me. I visited the bathroom one more time before breakfast and looked down at my foot in my Teva.

In the bright light of the bathroom, I saw red streaks on top of my foot coming from my second toe. I hemmed and hawed, discussed options with Chop Chop, and left a message at my doctor’s office back home, requesting a telehealth visit. I was hoping to get an prescription for an antibiotic so I could get back on trail quickly.

At breakfast, the doctor’s office called back and said they had no telehealth appointments available for the day. I knew I needed to get this taken care of. I also knew it would be next to impossible to keep it clean enough on the trail. Not with the amount of sand filtering into my shoes and the wind blowing sand into my tent every night. And definitely not with all the cow pies we were hiking past. As hard as it was, I made the decision to find a ride to the next town where there were urgent care clinics.

Medical care in this rural American town

After some searching on FarOut, I managed to get a shuttle from the next town to come down to get me. They weren’t officially open for the season yet, but they were willing to help me… for a price. I know it was a long drive, and they have to make a profit, but good golly. >GULP< This was my most expensive hiking shuttle ever. Since I had confirmed a way to get to town, I reserved several nights at the cheapest motel room I could find. I planned to meet up with Chop Chop when she hiked in and hike out with her the next day.

The shuttle took me to the urgent care that was just a block from my motel. When I got to the door, there was a sign posted that said they were closed for the next 3 days. I quickly flagged the shuttle down, told her, and asked her to take me to the only other urgent care in town. She dropped me off there and I went inside. At the front desk, was the same sign as the first place. I almost cried then and there in front of the receptionist.

Instead, I hobbled myself across the street to the bus stop. And then I cried.

I figured I might as well get checked into my room and then decide my next best action. I checked the bus schedule. (I had downloaded it on my phone before leaving the last town.) It would be more than 30 minutes before the next bus and I didn’t even have exact change. So, I checked to see if there was Uber or Lift in town. There was! I called an Uber and then called a good friend who is a nurse practitioner to see if there was anything I could do for self-care while waiting for the clinics to open again. She strongly urged me to get seen that day.

Uber dropped me off at the motel, I checked in, ate a snack, and left my pack. Then I called for another Uber to get to the ER. Uber arrived and it was the same driver. He said he is the only driver in town. Small towns. I’m glad for him, though since the bus doesn’t run past dinner. He dropped me off and I told him I didn’t know how long I would be. He left, and I checked into registration.

Treatment

I felt like such a baby. I got triaged fairly quickly, but had to wait for a room to open up. While I was waiting, the top of my foot started swelling. I told a nurse and she said they’d get me back soon.

At this point, it was more painful than the early morning wake-up. When I got a room, they took my vitals again, asked how it happened, and discussed treatment. The nurse practitioner in charge of my care said he would drain it to relieve the pressure, and give me pain meds and an antibiotic to start. Then he would send me with a script for a course of antibiotics to take with me. He cleaned the wound with betadine – before they gave me pain meds. Yeee-ouch!! He started gently probing and found an ultra-sensitive spot. I cried out and almost came off the bed! It was horrible pain. Like, almost as painful as childbirth. It was really bad. I felt like such a baby about it, but it was awful.

Because that one point was so painful, he wanted to get x-rays to make sure no foreign body had lodged in there. They got an iv port in my arm and took bloodwork to make sure my white blood cells were not too high. They also gave me pain meds in the iv and an initial dose of antibiotics. Fortunately, x-rays and blood work were good and he lanced the blister to completely drain it. The nurse came back, dressed my blister, and gave me a hospital sock to cover it to help it stay in place and clean. I got my discharge paperwork and left.

Aftermath

The next morning, I went to the pharmacy to get my script filled and the appropriate supplies for cleaning and dressing the wound. Then I got my mail. I didn’t have to call another Uber when I left the post office because a very kind woman gave me a ride back to the motel when I asked her. We talked during the drive, and she wanted to follow my adventure. We exchanged phone numbers and I texted her my blog address.

It’s good that I went to the ER that first day getting into town. The medical staff agreed that I possibly could have been admitted for a systemic infection if I waited longer. It was a very good decision NOT to continue hiking.

I spend a lot of time sitting around the motel room, reading, with the foot propped up on a pillow. Now, a few days later, I am only taking half the pain meds but the full antibiotic dose as prescribed. I rarely have a limp, now. The swelling and redness are gone. The pain is mostly gone, too. Just a mild ache when I think about it. I’m hoping that by the time Chop Chop gets here, I will be ready to leave. Mentally, emotionally, and physically, I never wanted to get off trail.

But this blister.

Oh, this blister.

This very expensive, painful blister.