Scared As Hell

I’m not gonna lie. It’s scary as hell to be a doctor right now. In Italy, which is our projected immediate future, up to 10 percent of infected people are health care workers. Health care workers are also more likely to experience severe and critical diseases. There’s not a great explanation for why this is, other than just higher risk from repeated exposure over and over to infected persons. When we go to evaluate a patient, we can’t even be sure when we enter a room of who is infected, due to 5 percent of cases being asymptomatic carriers and the failure of our testing systems in the U.S. to actually diagnose people with the infection. So every time we see a patient, it is basically Russian Roulette as to getting exposed to the virus.

I’m not as scared for myself individually, more for all of us health care workers as a whole. So many of us have given our entire lives to medicine; trust us, we have the loans and emotional scars to prove it. It feels scary to know that just doing our jobs during this pandemic could ultimately lead to our demise. Yes, we run that risk every day, as common infections like the flu can still kill you, but those risks are so much greater when facing a novel virus as we have never seen before in our lifetimes.

The biggest challenge facing your health care workers is the lack of PPE, personal protective equipment. The hard truth is that we still don’t understand how much of this virus is transmitted in the air versus in droplet form. Droplet spread infections, like influenza A and B, can be successfully contained with just regular surgical masks, while airborne infections like H1N1 (swine flu) require specialized masks or hoods.

We do know that reports show that workers in other countries such as China and Italy are more likely to become ill as access to protective equipment dwindles, and supplies are exhausted. The bottom line is: Until we have a full understanding of how the virus is transmitted, it is safer for all health care workers who will have close contact with patients to wear N95 masks.

Well, here’s the problem, there is a critical shortage of this and other equipment which we need to protect us. Many communities are even soliciting donations of N95 masks from private companies, as they are often used in construction work.

We need all the help we can get. Without the support and cooperation of the general public, we will not be successful in mitigating the spread of this virus and the ensuing deaths. So please, don’t stockpile masks. If your doctor or nurse becomes sick, who will be left to take care of you when you need it? In countries further along into this infection, anyone with a medical license is being pulled to the frontlines to help combat the shortfall of physicians. That means your psychiatrist, who is extremely well educated and trained in psychiatry, may end up being your general hospital doctor if enough of our current staff become sick and unable to work.

So help us help you. Leave the masks and medical supplies to the professionals that need them. If you own or know of a construction company or other business with access to N95 masks, please reach out to your local hospital to see if you can donate them. This pandemic is not a sprint, it’s a marathon, and we need to be prepared now and for the future. Please share this message in your local communities to encourage the donation of N95 masks.

Covid 19: We Are So Unprepared

I’ll admit that in February, I thought COVID-19 was going to be another overblown SARS or MERS or even H1N1. I talked about it with my friends in the medical field, and we had a bit of a “been there, done that” attitude. But I was wrong, and in the time since, I’ve educated myself as much as possible. This strain of coronavirus is more contagious than the flu, with a R0 value estimated up to 4. It’s more lethal, and though the mortality numbers are currently inflated due to lack of widespread testing, low-end estimates are a mortality rate of 1 percent. The seasonal flu has a mortality rate of only 0.1 percent. COVID-19 has the potential to quickly use all our resources and overwhelm our healthcare system. We have a gory, vivid example of this playing out right in front of our eyes, in Italy. Many people are disparaging the spread of information about this virus, calling it a government hoax or “fake news.” They call the national news outlets “fearmongers” for distributing information about this infection, and about what we can do to protect ourselves. It is up to those of us who have dedicated our life to medicine and science, to help educate and inform our patients and the general public.

The response to this virus in the U.S. has been varied and haphazard. Starting from the very beginning, with our government’s decision not to utilize existing WHO testing kits and to come up with our own testing. Well, the CDC botched coming up with their own test. Instead, individual states have been left to go it alone, all trying to formulate new processes out of thin air. Each state is seemingly reinventing the wheel and starting from scratch. Testing has taken weeks to get online, as it took that long to verify each lab and it’s testing methods. When tests become available, they are hindered by very limited capacity and very strict testing criteria. For weeks, we saw evidence of community spread, but testing criteria was directed only at high-risk travelers. Now, many states still have little to no testing available.

Why does this matter? It matters because we missed many early cases. It matters because we are still missing them. Those cases spread to others, which spread to others.  Many people are asymptomatic or nearly so, and are just carrying it along and propagating it without knowing they are doing so. In Korea, where the outbreak was contained, and deaths were minimized in relation to other countries, they tested early and often. They quarantined all those affected and were able to curb the spread. Less than a hundred people have died in Korea. Contrast that with Italy, similar to the U.S., which tested much fewer people, much later into the outbreak, and was much slower to impose quarantines and lockdowns. Italy currently had 368 deaths from the virus in the last 24 hours alone. Rapid, frequent testing, which we are lacking, has been shown to save lives.

This leads us to social distancing and self quarantining. Why is this so important? Because any of us could have it.  Until we can test everyone, widely, we cannot know. As it stands right now, you may not be able to get tested, as our resources are so very limited and extremely varied from state to state. Therefore, the only way to curb the spread is to assume you may have it, and do your utmost best to limit your exposure to anyone else. Or, like myself, to wait in isolation until you can get tested and cleared. Is this practical? No. Is it fair? No. To borrow a sentiment from our colleagues in Italy: we are at war. At war with this novel virus. We may be forced into unthinkable situations where, like them, we do the best we can to save those that have the best chance of making it. That same dire situation may be coming to a city near you in less than two weeks. It’s already been happening at the overtaxed Evergreen Hospital in Kirkwood, WA.

So what can we do? How can we prepare but prevent mass, hysterical panic? Well, let us rely on science to guide us now. Let us look to the other countries that have been in this pandemic for longer, and take away all the lessons we can for how to handle it here. What can the average person do? First, stay home. Stay away from other people. Cancel your plans. Cancel your travel. Tell your neighbors to cancel that big party they have planned. Wash your hands, don’t touch your face. Do not go visit anyone in the hospital or the nursing home. Do not go to the ER unless your condition is potentially life-threatening. Save the masks for those of us working in healthcare, who are going to need them to ensure we don’t get the infection, so we can keep taking care of patients. Maybe most importantly: Self-isolate for and symptoms: sore throat, fatigue, chills, stuffy nose, poor appetite, muscle aches, vomiting and diarrhea, and most of all, fever and cough. Get tested is it’s available to you in your area, and if not, stay home and self-quarantine for 14 days. Let your state representatives know that widespread, easily accessible testing is needed. Listen to the new restrictions as they come from the government, and follow them.

When all is said and done, the chances are high that you’ll be completely fine. 80 percent of people will have little to no symptoms. You may feel crappy for a few days, but then you’ll move on with your life. Your grandma with COPD, your friend with a heart transplant, and your nephew with juvenile rheumatoid arthritis may not be so lucky. While you go on with your life, they may be in a coma on a ventilator machine, or they may be one of the one percent who dies. So do it for them. We can’t survive this pandemic unless we do it together. For the common good, for all of us.

Best of the West: Best Easy to Moderate Hikes in the Western United States

We’ve had the unique pleasure of hiking hundreds of miles this year. We’ve barely scratched the surface of the thousands of amazing trails out West, but I’ve decided to compile a list of my favorites so far. These hikes today are all easy to at most moderate. They are good for kids, the elderly (I have been lapped by more people over age 80 than I care to admit), and dogs where specified. The vast majority of our hikes are on National Forest land. These forests are much less crowded than national parks, and they allow our dogs to hike with us. We get to see so many remote, beautiful places this way. I hope to keep adding to these lists over the years, there’s so much wild country out here to explore.

1. Trail 403, from west Washington Gulch Side, to Viewpoint, Gunnison National Forest, Crested Butte Colorado. 4 miles roundtrip to viewpoint only, 400 feet elevation gain. Easy to moderate. The drive to this trail is beautiful as well, through a scenic valley. You must go during wildflower season, that is what makes this hike spectacular. They are unreal. The best wildflowers I’ve ever seen, anywhere. What I also love about Crested Butte is how varied and beautiful the mountains themselves are. The Elks have a lot of interesting, red coloration, and you are completely enveloped by mountains on all sides. At the top there are 360 degree views and some fun rocks to scramble up. Beautiful. This one’s also one I will keep trying to go back to over the years; it’s worth seeing as many times as life allows.

2. Zion Canyon Overlook Trail, Zion NP, Utah. 1 mile, 250 feet elevation gain. Moderate. Such a fun trail! We hiked when it was 100 degrees, but the rocks made for plenty of shady areas. The hiking gets sketchy at times, with narrow rocky trails and steep drop offs. It’s really very fun, especially to scramble near the cliff edge at the top! Wear proper shoes and clothing on this hike. Though short, there are many potential places to injure yourself. The scrambling at end is world class excitement at the edge of the canyon.

3. East Rosebud to Elk Lake, First Part of the Beaten Path, Custer Gallatin National Forest, East Rosebud, Montana. 7.5 miles, 850 feet elevation gain. Dog Friendly. Easy. Mostly flat trail, only one steep part, so the length goes by quickly. Through an amazing valley with roaring river and waterfalls. The lake at the end, with the valley in the background is breathtaking. Our goal is to backpack this entire trail one day. We loved this trail and this area so much I’ve been here multiple times, and it keeps getting better.

4. Rim Loop Trail, including West Rim spur, Dead-horse Park State Park, Moab, Utah. 5 miles, 900 feet elevation gain. Dog Friendly. Easy to moderate. Oh this place. We love this park so much. We’ve seen probably a total of 5 people on the west rim the 5 times we’ve hiked it. A little known gem.

5. West Fork #108, Sedona, Arizona. 7.5 miles, 850 feet elevation gain. Dog Friendly. Easy. Long trail, but fairly flat. This canyon is beautiful! It’s like a less crowded narrows hike, and we creek walked a fair bit. Creek walking is a wonderful, simple pleasure of life. We loved it! We are going back here next month, and this will be a must do!

6. Cape Arago Loop Trail, Ashlee Acres State Park, Coos Bay, Oregon. 1.5 miles, 59 feet elevation gain. Dog Friendly. Easy. The collision of so many ecosystems is amazing. The rainforest, the cliffs, the ocean. It’s stunning!

7. Corona Lake, Arapaho National Forest, Rollinsville, Colorado. 2 miles, 500 feet elevation gain. Dog Friendly. Easy. The drive is rough, rough, rough up there and long!!!! The views at the lane and the top are worth it!

8. Horseshoe Lake and McLeod Lakes, Inyo National Forest, Mammoth Lakes, California. Looping them makes 3.75 mile loop with 500 feet elevation gain. Dog Friendly. Easy to moderate (to McLeod). Horseshoe is nice and flat and McLeod is a little steep. Gorgeous lakes.

9. The Narrows, Zion NP, Utah. As long as you want (we did about 6.5 miles), no elevation gain. Easy. The best creek walk ever.

10. Island and Night Lakes to Beauty Lake, Shoshone National Forest, Cooke City, Wyoming. 7.5 miles, 500 feet elevation gain (without going down to Beauty Lake shore). Dog Friendly. Easy. Flat high on the plateau in grizzly country. Can be very buggy! The views and terrain are amazing and unique.

11. Tower Bridge Trail, Bryce NP, Utah. 3.5 miles, 830 feet elevation gain. Moderate. Long climb back up, the isolation and views of the canyon are amazing.

12. Red Canyon Trails- all trails spanning out from the visitor center on both sides of the street, Red Canyon State Park, Panguitch, Utah. Various mileages and elevation gains. Dog Friendly. Easy to Moderate. Lots of fun places to scramble. So much less crowded than the national parks, and lots to see here.

13. Corona and Bow Tie Arch, BLM land, Moab tied with Windows Arches, Arches NP, Utah. Respectively 2.5 miles and 500 feet elevation gain, and various mileage and elevation gain based on personal route and scrambling done. Corona and Bow Tie Arch is outside the national park and is dog friendly. Easy except the second rope. The arch is really beautiful, get up close if you can!

14. Trinidad Beach Trail System, Trinidad Beach, California. Various mileages and elevation gains. Dog Friendly. Easy. The coastline here is stunning.

15. Eagle Rock, Lake Tahoe Basin Unit Management, Homewood, California. 0.7 miles, 250 feet elevation gain. Dog Friendly. Easy to moderate. Some steep scrambles at the top, watch your step! 180 degree view of the lake.

16. Big Circle Tree Trail, and spurs, Prairie Creek Redwoods State Park, Orick, California. 0.5 miles, no elevation gain. Easy. A nice short immersion in the giant trees. Make sure to lay down flat on your back and look up!

17. Painted Wall, Black Canyon of the Gunnison NP. 0.2 miles, no sig elevation gain. Dog Friendly. Easy. My favorite viewpoint. I scrambled off on the rocks at the cliff edge, of course. Huge drop off!

18. Grand Canyon South Rim Trail, Grand Canyon NP. Various distances and elevation gain- start as far from the visitor center and campground as possible. Dog Friendly. Easy. Once you get away from the crowds you ca actually enjoy waking the rim, great for the dogs.

19. Incline Village Flume Trail, Lake Tahoe Basin Unit Management, Incline Village Lake Tahoe, Nevada. We hiked 5 miles out and back, 10 total, elevation gain maybe 500 feet. The full trail is much longer. Dog Friendly. Easy. So flat for so long! Great intermittent views. Lots of bikers.

20. Sunset Point to Sunrise Point, Bryce Canyon NP. 1.1 miles, 82 feet elevation gain. Dog Friendly. Easy. Short trail but amazing views.

21. Upper Two Medicine Lake, Glacier NP. From Ferry to Lake (skip the hike round the lake, at least one way), 3 miles, 350 feet elevation gain. Take the ferry! The hike around the lake isn’t scenic enough to be worth it! The upper lake is beautiful!

22. Secret Harbor, Whale Beach, Toiyabe National Forest, Incline Village, Lake Tahoe. 1.4 miles, 350 feet elevation gain. Nude beach alert! Dog Friendly. Easy down moderate back up. Nice little cove, may see some naked people. Great place to get in the lake in summer, but crowded!

23. Ski Lake, Bridger-Teton National Forest, Wilson, Wyoming. 4.0 miles, 892 feet elevation gain. Dog Friendly. Moderate. Uphill hike to a lake. The lake isn’t very scenic in late summer, water is very low. There is a nice view before the lake and pretty meadows.

24. Black Canyon Trail, Bridger-Teton National Forest, Wilson, Wyoming. First 2 miles out and back, to high point. 750 feet elevation gain. Dog Friendly. Easy. Right along the ridge overlooking the valley. Big views for little work.

25. Lithia Park, Ashland, Oregon. This is more of a stroll (but there are steep side trails if you want that), but I’m including it because it’s a beautiful and unique park. Amazing trees! Dogs can only walk on the road.

Best of the West: Best Towns West of Denver

1. Red Lodge, Montana. Red Lodge is a little town at the foot of the Absaroka-Beartooth Wilderness. It’s about an hour outside of Billings. The town is small, with a population of 2,200, and so charming. It’s Main Street is a throwback, but at the same time has loads of little adorable stores and restaurants. Red Lodge also has one of my favorite restaurants of our travels- Mas Taco. I could literally eat it every lday. It’s so delicious and addicting. What I like most about Red Lodge is that it hasn’t gotten too commercialized and elitist. Many of the towns we visited are incredibly expensive and prohibitive for regular people to live there. You can still buy a house in Red Lodge for a reasonable amount, and the groceries, food, and gas are all fairly priced (for being out in the middle of nowhere like it is). We are always able to rent affordable houses (via vrbo) right off the Main Street, so we can walk everywhere, which is my favorite! The people in Red Lodge are also amazingly friendly. We loved walking up and down Main Street with our dogs and stopping and chatting to people or letting them pet the dogs. Of course, the wilderness surrounding the town is some of my favorite in the whole country. Much for the same reason I love the town, it’s still not widely known about and there are some of the most beautiful trails and scenery around- including the most scenic drive in America, the Beartooth Highway. The ski area for Red Lodge is not very big or nice, which is a reason it hasn’t grown overly much. I only hope Red Lodge stays like it is and doesn’t expand and become unaffordable like so many other tourist towns. For now, I’m glad I’ve gotten to go there multiple times and experience its charms.

2. Crested Butte, Colorado. Well, talk about elitist towns. Crested Butte is a actually smaller in population than Red Lodge, which surprised me (population 1600). It is a very expensive town, with houses starting at at 400,000 for a 1 bed, 1 bath. Because of all the big money in town, it is really nice. Main Street is beautiful. It’s painted bright colors and absolutely adorable. It also has a lot of amenities like a huge new recreation and arts center and fancy schools. We stayed in a very charming small cabin right off the main drag, and again the walkability is amazing. It even has multiple trailheads right in the town, which is a huge bonus that we took advantage of. Now, everything is very expensive here, and it does not have a nice grocery store (which I found surprising, they need to build one!). The wilderness around Crested Butte was hands down the most beautiful that we encountered anywhere. The mountains, valleys, wildflowers are all stunning. They are also easily accessible, within a half hour of town. It’s also very close to the famed Maroon Bells- we will be back to visit that area, as it was inaccessible due to an avalanche this year. The ski resort is right outside town, and there are a lot of condos there. There is currently a bit of a battle going on with the city council to build affordable housing so the people who work at the ski resort and restaurants and shops can have somewhere to live. Fave restaurant there so far: Bonez. This town should definitely be on your bucket list, check out my upcoming hiking lists for the best hikes!

3. Moab, Utah. Just a few short years ago, Moab would have been at the top of this list. It is such a funky, weird, cool little town in the desert. This year we’ve gone there twice, and what we’ve noticed is that it has changed enormously in the 2 years since we were last there. It’s a bigger town, population 5,200, but I cannot believe how much it has expanded. Everywhere you look there is a new hotel or condo development. I have never see anywhere in the country grow this quickly. To be honest, it kind of sucks. I loved when Moab was a sleepy little town with hippie vibes- now it’s just so crowded and getting more and more expensive. I think the way to have the best experience in Moab is to go in the winter when it won’t be crowded, that will give you the feel for how it used to be. Of course Moab has the national parks, and one of our utmost favorite parks- Deadhorse, but it also has the La Sal mountains. These mountains are just 30 minutes outside town and rarely frequented by tourists, so we found the solitude we wanted there. There’s also a lot of BLM land that’s less crowded than the parks, which is good for us and the dogs. Strangely, I don’t have a must have favorite restaurant here- there are a lot of good places but I haven’t found one I’m obsessed with. Do get the Quesadilla Mobilla, it’s a cool food truck. Moab also doesn’t have a lot of single family houses for rent in the downtown area, so we usually stay a few minutes outside of town. That is fine, and we have a beautiful house we stay in there, but I miss the walkability of being off Main Street. There’s just something about Moab though, every time I drive in and see the river, canyons, and red rocks, my heart feels immediately happy and full.

4. Sedona, Arizona. Somehow the first time I went to Sedona was this year. I had heard a lot of good things about it, but it was always further south than easily fit into our travel routes. Verdict: I freaking love it. Yes, it’s expensive and very touristy, and bigger- population 10,300. But my goodness, the red rocks. The red rocks are mesmerizingly beautiful. Just like Moab, they hypnotize you with their immense beauty. We stayed at a very funky little cabin off the canyon road, and were in a little secluded Narnia land which included free roaming peacocks. I mean, what’s not to love. Sedona is somewhere we are going to need to go back to in the off season and spend at least a week there. It has a plethora of amazing restaurants, shops, and hilarious hippy crystal and vortex establishments (fave restaurant so far: 89 Agave Cantina).

5. Bend, Oregon. Oh, Bend. I went to Bend to interview for a job at a family medicine clinic, and immediately fell in love. It was winter and it was freezing rain the entire time I was there- and it didn’t dampen the trip one bit. Bend’s downtown is super cute and, being in Oregon, very hipstery. Yes, again, it’s super expensive, population 97,000, but it does not feel that big! It has a very small town feel. Bend also has Mt. Bachelor which is a huge, huge ski area, and where we plan to do a good amount of skiing this winter. And it is right on the Deschutes River, by Three Sisters Wilderness, and an hour from the very cool Smith Rock state park. I just love the vibe of Bend, and look forward to spending more time there since it’s a pretty short drive for us now!

6. Mammoth Lakes, California. An isolated town in the Eastern Sierras- the most beautiful, rugged wilderness in the lower 48, population 5,200. How many books have been written about the Sierras, Yosemite, and the Muir Wilderness? The dream is to one day hike the John Muir trail, but for now Mammoth has countless trails for all levels of fitness just 5 minutes from town. Also a huge ski area, which was open till Mid-August (!!!) this year thanks to the huge snowpack. It doesn’t have a concentrated Main Street area, it’s more spread out, so it’s not as charming as other towns.

7. Winter Park, Colorado. My brother lives just up the road from here, in Fraser. Winter Park is another typical ski town, but it has its charm. It’s main strip is very hopping and has great restaurants and bars (Volario’s for the win). Population is 30,800, but it feels smaller. It has a cool outdoor venue for music, and they get some pretty good acts for being so small. Really I just consider Winter Park and Fraser to be one town, they just flow into one another. Winter Park’s skiing is awesome, with some incredible views from the top of the mountain. There’s also a lot of hiking, and it’s very close to RMNP, which is nice. It’s starting to get more and more crowded as Denver people come up, so that’s a bummer! Best bartender and margaritas at the Ditch!!

8. Tahoe City, California. I specifically like the north side of Tahoe, on the California side because it’s less crowded and it doesn’t have all the awful casinos. It’s a small town population 1,557, but it has a cute downtown that’s very walkable if you stay close to it. It’s also very close to some of the major ski resorts, which is a huge plus.

9. Ashland, Oregon. This one’s just 20 minutes from our new home! I had never heard of Ashland (or Medford) until I found a posting for a job at the regional hospital. Ashland is home to a huge Shakespeare festival, and so it is brimming with culture and arts. It’s Main Street is lovely, and Lithia Park, besides not allowing dogs, is incredible. There are also a bunch of trails starting from the city, and it has a ski resort as well. It’s small- and right now is probably above my current skills, but I’ll get to those black diamonds with time. It has a university as well, so it has that college town feel. I think I’m really going to love this town, and getting to know it more.

10. Jackson Hole, Wyoming. This one was tough. The downtown area is super cool, charming, and has lots of neat stuff. It is also extremely touristy and the most expensive place we visited. Like so expensive we couldn’t afford to stay there and had to stay over the pass in Idaho. It has two ski areas, loads to do, including a ton of art galleries. We saw a celebrity here (Scott Conant from Chopped) and it is known as a celeb hot spot. It is just too big and has too much traffic for me to feel totally at home there, but surely worth a good visit!

11. Kanab, Utah. This is a town that reminds me of how Moab used to be. Small, quiet, kinda funky. It had the Best Friends Animal Sanctuary right outside town, and they do amazing work. Close to Grand Canyon and Zion, so it’s a good jumping off point.

12. Ouray, Colorado. “The Switzerland of America” is a charming small town in a beautiful mountain valley. It has a ton of trails starting just from Main Street. That said- Main Street is lacking really good restaurants and just didn’t have that special something. And there are way too may RV parks all around, packed like tin cans! More beautiful from a distance than up close.

13. Florence, Oregon. We only stopped here for a night but it’s historic downtown on the waterfront was so charming. Reminded me of Wilmington, NC back east. Worth a stop if you are in the area.

Best of the West: Scenic Drives

I had a lot of time to think and write on this trip (while my wonderful hubby drove), and I’ve compiled a few “best of” lists. The first is scenic drives. There haven’t been many scenic byways we have passed up on this trip because it really just is always 100% better to take the scenic route.

This is our 25 favorite drives, west of Denver. Some of these are remote scenic byways, and some are major interstates, but they each have magnificent views. I should note that these are all legitimate, paved roads. A great amount of our time spent driving scenic roads is on dirt, rocky, rut-filled forest roads or even “off-road” trails. That is it’s own separate experience, and takes a bit of know how. These drives are accessible and for everyone.

1. Beartooth Highway 212, Wyoming and Montana. (Pictured above). This is hands down, the most beautiful drive you will ever take. Make the trip, go out of the way, just do it! I recommend driving from the bottom up, starting in Red Lodge, MT; it’s a cooler experience.

2. Zion National Park via East Entrance to Visitor Center

3. Yosemite National Park via Tunnel View and the Loop around the Valley Floor

4. Trail Ridge Road, Rocky Mountain National Park

5. Going to the Sun Road, Glacier National Park

6. Upper Colorado River Scenic Byway 12, Moab, Utah

7. Highway 89A Flagstaff to Sedona, Arizona

8. Newton B. Drury Scenic Parkway, California

9. Redwood Highway 199, California and Oregon

10. Million Dollar Highway, San Juan Range, Colorado

11. Highway 14 eastern entrance of Yellowstone National Park to Highway 191 all the way through Grand Teton National Park

12. Highway 163 Arizona, through Monument Valley

13. State Highway 135 St. Regis to Paradise, Montana following the Clark Fork River

14. Dead Indian Memorial Road (I know, the name is awful!) from Klamath Falls to Ashland Oregon

15. Black Canyon of the Gunnison, South Rim Road

16. California Routes 88 to 89 going to South Lake Tahoe

17. Pacific Coast Highway 101

18. US Highway 160 in Colorado over Wolf Creek Pass

19. Historic Columbia River Highway, Oregon

20. State Byway 44 through Badlands NP, South Dakota

21. Shoshoni Wyoming to Thermopolis Wyoming, State Highway 20

22. Colorado State Highway 125 through Willow Creek Pass

23. Highway 395 Eastern Sierras, California

24. Interstate 70 through central Colorado

25. Interstate 90 from St. Regis Montana to Coeur d’Alene Idaho

Traditional and Alternative Therapies For Anxiety and Depression, My Personal Experiences

I’ve written about my personal experiences with anxiety, panic disorder, and depression. I have had some form of anxiety since my teenage years, and intermittent bouts of depression. I have largely tried to ignore this as much as possible, and to power through on my own. I college, during a time of deep depression brought on by a breakup, I ventured to the student health center, but chickened out and left before getting help. As a medical student I went as far as going to cognitive behavioral therapy with psychiatrist, who gave me a Zoloft prescription I never took. In residency, in the wake of a serious injury, I lay around for days, weeks, even months without doing anything. I didn’t leave the house. I sought help from my mentor and our residency psychologist, but soon was lying and telling them I was fine when I was anything but.

Then last year, I had what I’ll call a breakdown. That may be a negative term, but it’s exactly how I felt, like I was breaking down. Like I was some old rusty piece of equipment that wouldn’t work, that instead just took up space and caused annoyance. Suffering from anxiety and panic attacks, plagued by chronic pain and daily migraines, I finally sought help and followed up. At first I went to the ER. If you were to look in my chart you would see the classic signs of someone having physical symptoms of anxiety. Several trips for migraines, neck pain, and even for passing out. I understood empirically what was really happening, that I needed to treat my anxiety, but I continued to think I could just will my body into feeling better. The day I passed out at work in front of my colleagues was the day I knew I had to get real. I continued to seek help separately for my migraines and neck pain, but I went to my PCP for prescriptions for medication. I initially wanted to just take Buspar, but she convinced me that I was in crisis and needed an SSRI for stabilization. SSRI stands for selective serotonin reuptake inhibitor, and it’s job is to increase serotonin levels in the brain to lessen depression and anxiety. My SSRI, Celexa, did its job and helped increase the serotonin in my brain, and made me less depressed. It took about 2-3 months to work. Interestingly, for me personally, it did not make me happier. It made me less sad, so that I wasn’t just bursting into tears for no reason. It made me much less anxious, and it’s the only time in my life I’ve actually slept restfully. It was very much “sleeping like the dead”. However, instead of happiness, the Celexa just made me feel apathetic. It brought about the complete absence of emotion. I understood that this was happening, and for some months, I continued to take the medication anyway. After all, isn’t the absence of emotion better than the unrelenting chasm of depression and the constant panic of anxiety? (If you’ve read the book My Year Of Rest and Relaxation, you’ll have some idea of what I’m talking about).

Then we underwent the horror of euthanizing two of our dogs, Josie and Pippin, on the same day. At that point I finally had a flood of emotion briefly come back, as I sobbed over their cold limp bodies, and I realized how robotic I had become. I wanted to feel, even if it was a negative emotion, I wanted to, I needed to experience it. In the months following their deaths I weaned myself slowly off Celexa. There is no scientific weaning protocol by the way. A mental health advocate, Laura Delano, has developed some informal guidelines and helps people wean off medications as she herself once did (I read about her in the New Yorker and found her story fascinating). The fun part about coming off psych meds is that many can and will cause discontinuation syndrome, which can cause symptoms worse than the disease you originally set out to treat. More docs are wise to this now, and can help work out a weaning schedule designed to help minimize those symptoms. For me, I used my symptoms to guide my weaning. If I started to feel sick (nausea, dizzy, anxious), I stayed at the current dose or went back up slightly for a few weeks until the symptoms dissipated. This got me safely off of Celexa within about 2 months.

So what is life like now? Am I cured? No. I remain on Buspar for anxiety. It helps make the anxiety manageable and tolerable. It does not have the same severe dampening of emotion that the Celexa did. Buspar works differently that SSRIs, and we don’t really fully understand how, but it is a serotonin receptor agonist, meaning it has a strong affinity for binding to those receptors It’s also been side effect free, and in general has very low risk for side effects. It’s a great medication for anxiety, and I prescribe it frequently in my own practice when applicable because it is safe and effective.

What about alternative methods? I’ve tried more than my share over the years.

The foundation of alternative treatment is three things: healthy diet, regular sleep, and exercise. All these things I go on about and struggle with all the time, affect mental as well as physical well being. They are sooo important!!!!

Meditation and deep breathing. This is the first line treatment I recommend my patients do as well. Simply being quiet and still, inhaling deeply through your nose and out through your mouth is an effective treatment for anxiety. It slows the heart rate and stops the nervous system firing off fight or flight signals, thereby acting as a instant calming method. Repeated habitual use of these practices will help to prevent anxiety. Yoga works in this same vein, and I will practice yoga for the same effects. Mindfulness practice is in this same category as well. Simply being mindful and acknowledging your emotions is a powerful tool. For someone like me, who’s main instinct is to bury and suppress emotions, acknowledging them is the first step.

Massage. I initially got massages for my neck pain and migraines. I found that these did not help those issues at all (bummer). Massages did greatly help my anxiety though, that time for full on relaxation was very helpful.

Acupuncture. I’ve not been very successful with this. Acupuncture has been proven to help a variety of conditions from anxiety and depression to acute and chronic pain. The military uses it regularly on soldiers, and have had good results. I tried acupuncture about a half dozen times, with varying practitioners over the years. I flat out just didn’t like or was creeped out by a lot of them, but one woman of Chinese background was the most thorough. I tried a few sessions with her, but did not find any relief. It’s something that I would try again, though, I think with more persistence it could be valuable.

Essential oils/aromatherapy. I’ve tried many of these. I do find lavender, when put in my bath water, is relaxing. I like this methodology more for my headaches, though. I use peppermint oil on my skin and in a diffuser and it helps my headache lessen a little. My wonderful work family got used to our little office area smelling like the North Pole for awhile, when I was in the thick of my migraines.

Vitamins and supplements. I cannot even remember all the different ones of these I’ve tried. Needless to say none of them helped (my migraines either). I do still take melatonin to help with sleep, it is a standby. Some of the duds: valerian, L-theanine, GABA, chamomile, passionflower- just a handful of others I’ve tried over the years. the good thing about vitamins and supplements are that MOST of them are safe- but not all! So talk to a doctor before you start piling them on.

CBD. Yep, tried it. I acquired it in Colorado and tried if for several months. (Aside- I’ve tried on my dogs as well, for they be crazy like me, but it made them more agitated!) There is no dosing guide for CBD. Basically it’s trial and error. I tried various dosages over several months time. I ultimately found none of them to be effective. I’m sure CBD helps some people, but I was not one of them. It is something I recommend people try, though. It is safe without much evidence of side effects, so I think it’s definitely worth people trying.

Hypnosis. I am mentioning this because at one point I was desperate enough to consider it. I even went to an appointment. My logical brain quickly shot down the practice, and won out. There is no empirical evidence that hypnosis works, and I don’t recommend it.

Nature therapy. This has been the big alternative therapy in my life. Looking back on my life, I realize I’ve been employing it without knowing since I was a child. I was always happiest and felt safest in the outdoors. When I felt sad or upset, I would venture out to the woods for relief. And this is what I still do today. Nature has been shown to have some of the same effects on serotonin levels as medications. It doesn’t need to mean becoming a hermit and living in the woods- it’s as simple as taking 5 minutes out of your workday and sitting outside on a sunny day. Now I’ve been lucky in that I have been able to take an extended break where I have traveled for several months and hike nearly everyday. It has been so restorative. I know I should be more stressed about starting my new life in Oregon, but when I’m out on the trails all that falls away and I live in the serenity of the moment. It makes me be in the present only, and not ruminate and stress about all the what-ifs of daily life. So how am I going to keep this going once I start my new job? Definitely mini-breaks to get outside during the day, those are great pick me ups. Also walking my dogs everyday. Even if it’s just around the block, it’s time outside and it’s meaningful. We plan to travel and hike as much as we can when I’m not working, and see as much of this beautiful country as we can.

Coast to Coast Adventure, Days 62-67. The End.

My husband Rob and I have quit our jobs and are moving from Dayton, OH to Medford, OR with our two dogs Moose and Schuyler. Before we settle there, we embarked on a 2.5 month adventure across the US. I’ll be working as a hospitalist when we get to Oregon starting in just a few short weeks!

The end is here. Not many people get to call a time out on life and travel for over two months. We made a conscious choice to do this. We spent all our savings so we could have this freedom. We are going into the unknown, with just each other. Will it be worth it? Will we have a good life in Oregon? Will our relationship withstand the severe stress of moving cross country to where we know no one and where I’ll be the only one working? These are the questions on my mind today as we drive to our new home in Medford.

We spent the last week of our trip in Victor, Idaho. We had an amazing little “tiny house” that we rented there. I would really like to have a house like that build for us for our next house. It was small, but had everything you need. And it wasn’t truly “tiny” it was probably 600 square feet at least of space. We stayed here because it was adorable, but also because Jackson Hole was sooooo expensive it was out of our reach for what I wanted to spend. It was only 30 minutes across the Teton Pass to Jackson, and 45 minutes to the Tetons.

We had some good hiking days here. Most were pretty chillaxed because we did one epic summit hike. The tiny house was not a good place to leave the dogs, so we did not get to hike any in the Teton park itself. Our first hike was up to a nice subalpine lake, Ski Lake, off Teton Pass. There is a TON of dog friendly hiking off the pass. We did this chill hike and then drove around the park. The great thing about the Tetons is that you can appreciate it so much from your car. The mountains are right there, just framed like a painting.

The next day we did our most ambitious hike yet with the dogs. We hiked 10.7 miles roundtrip to the Summit of Jackson Peak. What’s so cool about this hike is that 3 miles in there is an alpine lake! I fucking love alpine lakes so much. We stopped to swim here for good half hour. There were few bugs, the water was cold but not freezing, and best yet: no one else was there! I will always always cherish having a lake to myself.

We then pushed up to the summit. The last mile was the hard part, steeply graded up the mountain ridge. We took plenty of breaks and then enjoyed ourselves at the summit. Moose and Sky kept trying to pull us off the mountain in pursuit of chipmunks, so we had to be on our toes. It feels amazing to be on a summit, looking at the 360 degrees views and feeling the wind in my hair.

We spent our remaining days doing some short hikes (the dogs were toast after that big one). We relaxed in town and in the tiny house and just enjoyed the freedom of our last days.

And now we are driving again. This time for the last time. What’s to come? I hope nothing but good times and more adventures. Thanks for following along. ❤️

Coast to Coast Adventure, days 54-61

My husband Rob and I have quit our jobs and are moving from Dayton, OH to Medford, OR with our two dogs Moose and Schuyler. Before we settle there, we are embarking on a 2.5 month adventure across the US. I’ll be working as a hospitalist when we get to Oregon in September.

We grudgingly left Moab, that little oasis that draws us back year after year, and started on the road for Colorado again. I wanted a little taste of the San Juans without having to drive too far south, so we settled first for a couple days into Ouray. Ouray bills itself as the Switzerland of the US, I guess since it’s in a lovey mountain valley and everything is super expensive? Anyway it is a cute town, and the cool thing is that it is literally tucked right into nature. There are miles of trails starting right from Main Street that go to waterfalls, creeks, up the mountains, and all around the town. It’s pretty cool how integrated it is into its surroundings. We hiked some of the perimeter trail, and there we great views of the mountains and valley. We had an awesome vrbo right on the river, and the sound of it rushing constantly was intoxicating.

We elected to go further out from Ouray to Ridgeway to hike the Blue Lakes Trail. This is a hard trail, 8.5 miles round trip just to the bottom lake, and it was steep and difficult going the first 1.5 miles. Really steep switchbacks that kill your knees and quads coming back down. Eventually we were rewarded when we got up to a waterfall and then the trees parted to reveal a gorgeous turquoise lake set in the basin of Mount Sneffels. I will never ever get over or stop loving alpine lakes. They are like magical little Narnias. We chilled out by the lake for awhile, it was too cold to swim, and then hiked back out. It was already starting to get dark, so we didn’t hike the upper lakes, but we definitely will need to if we get back here again.

From here we were on our way to Crested Butte, but first with a stop in the Black Canyon of the Gunnison. My brother told me this was a must see stop, and he was right. It is such a rugged canyon. We hiked a bunch of the short rim trails, and the views were amazing. I can’t help myself for climbing and scrambling on the rocky cliff edge, luckily I didn’t plunge into the canyon and die.

We were taken aback just driving into Crested Butte. It is an absolute charmer. Elk (Main Street) is a string of beautiful colorful old buildings that house amazing shops and restaurants. We were a block off the main drag, in an adorable little cabin we got through vrbo. The town sits in a scenic valley, surrounded by mountains on all sides. We loved waking around the town with our dogs. I wish we could live here!!!

Our first hike was the absolute best wildflowers we have seen on this trip. Even the drive to the hike, was just fields and fields of flowers. It was an easy hike up through Washington Gulch to a view point that gives you 360 degree views. My legs were still spent from our tough hike to Blue Lakes, so I was grateful for the gently graded switchbacks that offered stunning views in every direction.

The next day we did what has become my very favorite hike. Scarp Ridge Trail to 421, which is above Irwin Lake about 3 minutes west of town. This is a fairly strenuous hike up to a 12,500 ridge-line. It is hard to fully describe how beautiful it was. It was a place that stunned me to silence and brought tears to my eyes. There are mountains everywhere you look. We had perfect clouds dotting the sky, making the whole thing look like a canyon. It was just a dream.

We are going to the Tetons today, our last stop before going to our new home in Oregon. I wish I could do this full time; I am going to miss this life so much.

Coast to Coast Adventure, days 44-53

My husband Rob and I have quit our jobs and are moving from Dayton, OH to Medford, OR with our two dogs Moose and Schuyler. Before we settle there, we are embarking on a 2.5 month adventure across the US. I’ll be working as a hospitalist when we get to Oregon in September.

This last section has been in one of our favorites- Utah. Utah is probably my favorite overall state. It has so many amazing parks. There is ample world class skiing. Even the areas that aren’t designated public lands or parks are beautiful. I could do without all the Mormons, as they do influence state policies, but thankfully in the modern age their significance in Utah seems to be dwindling.

We spent our time at a nice house we rented through VRBO just off highway 89 and 14. 45 minutes to Bryce and an hour to Zion, the perfect location!! Because we travel with our dogs, a lot of research goes into where we stay and how close it is to dog friendly hikes. We try everyday to either do one long hike that takes most of the day with the dogs, or do a morning hike with them and then go to a national park in the afternoon.

There are two gems for hiking with dogs both within 30 minutes drive from our house. The first is the Virgin River Rim Trail. It is a 30 mile long trail, but the best section is from mile 6.5 to 11.5, and we hiked this as two separate day hikes from the Cascade Falls trailhead. The views from the rim are amazing!!!! It is a bit of a workout to get up to the rim, it had me huffing wind, but once up there it meanders at elevation flat along the rim. A perfect hike with our babies.

The other amazing area for hiking with our dogs is at Red Canyon. Most people drive right through this on their way to Bryce or only stop for pictures on the side of the road. It isn’t a huge park, but there are miles of amazing trails. It was August so we had to go early in the day to make sure it didn’t get too hot. Plenty of water needed- for all these hikes, no water sources in most trails in Utah. Definitely hit this area up and don’t just drive through it!

We had plenty of afternoon, evening time to hit up Bryce and Zion. At Bryce, we hiked down into the canyon near sunset. We were totally alone down there. It was silent. It was mystical and beautiful and special.

We did two hikes in Zion, one up to the canyon overlook and one in the canyon up to the Watchman. It was hot as balls! 100 degrees both days when we set out. We passed so many people without water, what idiots. Bring water people!!!! The bonus of hiking in the hot late afternoon early evening is that it’s always less crowded. We are always able to find many moments of quiet and solitude. That is soooo important to me. It’s why I won’t do hikes like Angels Landing- I do not want my experience with nature to be crowded, loud, and regulated. I want to be able to hear the silence and appreciate the sights without a gaggle of people around me. This is possible even in the most crowded parks, it just requires a little extra effort and planning.

Next we were off to Moab. I love Moab so much. We’ve been here 5 times in as many years. It is a little oasis. So much beauty to be found. The desert, canyons, red rocks, mountains, Moab has it all. Now it was August, and it was over 100 degrees everyday. To get around this, the first day we went up to the La Sal Mountains and hiked up to the top of one. The temp was max 75 degrees up there. It was a tough hike, up and up and up, but well worth the 360 degree views. There was also beautiful aspens and wildflowers everywhere!

We didn’t go up to our favorite park, Deadhorse State Park, this time. We elected to do some dawn hikes to arches in the canyon instead and then went into Arches in the evening. I love scrambling and climbing on slickrock. It’s so fun and makes me feel like a kid again.

The end of this trip is rapidly approaching. It makes me really sad. I often wonder if I would be better off in life if I never went to college and med school. Would I be happy living in a van, traveling the country with my dogs? I think I would be. In my reality though, I love being a doctor, and I have to continue being one- there are hundreds of thousands of dollars of loans to pay off after all.

Coast to Coast Adventure, days 29-43

My husband Rob and I have quit our jobs and are moving from Dayton, OH to Medford, OR with our two dogs Moose and Schuyler. Before we settle there, we are embarking on a 2.5 month adventure across the US. I’ll be working as a hospitalist when we get to Oregon in September.

California. We spent three days driving from Montana to the California Coast. We stopped in the middle of Washington state first- a bleak part of the country that looks like any of the states of the Great Plains of the Midwest. We made a pit stop in the lovely little town of Hood River for lunch from a charming bistro. It was nearly 100 degrees that afternoon, so we settled for a short stroll in town. From there our first stop on the coast, Florence Oregon. A charming old downtown area made this town stand out, and we spent an hour walking around and then picking up dinner. This was our first time anywhere on the coast in Oregon, and the dunes there were insane! They are huge, they go on for miles. There were a lot of ATV areas there, but we elected to stay far away from that.

We kept on driving down the coast, stopping at an Oregon state park- Cape Arago. This place was truly spectacular. It was like something out of Lord of the Rings. The rainforest comes right up to the shore. Like nothing we’ve ever seen. We spent a couple hours on trails on the coast, and really fell in love. This was also our first time seeing sea lions!

We really enjoyed watching these guys bark and roll around and slip into the sea. From here we drove to our next vrbo rental in Crescent City, California. We had a beautiful drive along the coast and stopped at a beach where we had the whole thing to ourselves. A lovely little treasure.

Our house was nice, just one house down from the Ocean. There was a great beach by the house where we watched sunsets and walked in the morning.

We spent a few days exploring the coastline. We wound up in a little beach town called Trinidad, and found the trails and scenery to be spectacular! You hiked up on the coastline and cliffs, then down to pristine coves, and then through rainforest. Truly an ecological treasure.

Unfortunately Crescent City itself and the areas around were not good. It was like we went back in time to the 80s. Run down, terrible restaurants, nothing cultural of note (Except racist restaurants with Indian statues out front). We went on one trail to the beach that was covered in disgusting horse shit everywhere. The saving grace was the beach itself. Seemingly untouched by man, without any other people for miles and miles. We spent a long time on the beach, watching a sea lion swim and bald eagles fly overhead. It was a spot where you just felt like could exist 100 years ago, when we hadn’t come in and ruined the environment yet.

Lastly, the main reason we came to this section was to see the redwoods. We drove through the parks and took a short hike (since dogs are banned ours stayed in the car, the weather was cold). The trees were incredible. They just make you understand what an ant must feel like in the world. Hopefully we humans don’t destroy them, and they live for many more years.

From here we drove to Tahoe City. Lake Tahoe is truly one of the most beautiful places in the world. The fact that you have the lake, many other alpine lakes, the mountains for hiking and skiing all right there- one of a kind. With that being said, I’d never been there in the summer. The traffic and tourists were awful!!! We had to change our plans quite a few times to try to avoid the people and get the solitude we desired.we were able to do a few good hikes, but we will definitely need to come back when it is not so crowded.

From Tahoe, we drove just a few hours to Mammoth Lakes. I have been waiting my whole life to see the high Sierras, and this area did not disappoint! The only downside is, we are still not in good enough shape to do a lot of the harder trails up into the remote mountains. So we had to settle for those in our wheelhouse closer to town. We WILL be back here again and do a backpacking trip!!!

We hiked to many spectacular alpine lakes. It was hard to choose a favorite. The only downside is that due to the high snowpack year, the bugs were awful!!! There was still snow on a few of the trails we did as well. We also stumbled unexpectedly into what has now become my favorite hike we’ve ever done. We went into the hike without expectations of how it would be. The hike is at saddlebag lake and twenty lakes basin. Well. What we found was incredible. Mountain views everywhere. Snow still on the trail, requiring kicking steps and route finding. So many beautiful lakes, everywhere.

I think I loved this hike even more because I wasn’t expecting it. The first lake you see is saddlebag, which is perfectly fine and scenic, but once you get into the lake basin, it is spectacular. It was a dream. We will definitely hike this again, I will remember it forever.

The other hikes we did we to some crystal clear lakes around Mammoth. I continued to swim in them, and it is now somewhat of an addiction I think! They are sooooo cold, but it is exhilarating!!!

Mammoth was a lovely town. We will definitely be back here.

Our new home in Oregon will be within a days drive of all these wonders. I cannot wait to come back. Thanks, California.

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