|Memorial Day on Mount San Gorgonio.|
In January I tackled one of the hardest climbs I'd ever attempted. California's Cactus 2 Clouds route to San Jacinto's 11,000-foot summit tested my legs like few other adventures had. Standing on top, I recall looking down at my legs and feeling much gratitude for all the mileage they had given me--all the peaks, meandering canyons, and remote desert spaces I had explored in the Southwest. I then looked over and saw an even higher peak just 20 miles to the north. San Gorgonio or "Old Grayback" at 11,500 feet is the tallest in all of southern California. Little did I know it would be my next victim, and little did I know how improbable and meaningful that climb would be.
On April 11 when my doctor confirmed I had rheumatoid arthritis, it wasn't a surprise to me. In fact, it was a bit of a relief. Just two weeks earlier I had suggested to my doctor that RA would not only explain my painful left knee that caused me to limp, but it could also explain why three of my fingers continually ached, why I felt so stiff in the morning that getting dressed was a chore, and why I could no longer lift my right arm over my head. "Oh, I see you consulted Dr. Google" he said with a smile.
I can't blame him too much for brushing off my self-diagnosis--after all, I didn't fit the profile. I'm not a woman. I'm not black, Asian, or Native American. I've never smoked. I'm not obese. I don't know anyone in my family that has RA. These are the risk factors commonly seen in newly-diagnosed RA patients. Apparently, there is something in my genes that made me prone to RA and all it took was some environmental trigger. A certain virus or bacteria, asbestos, Teflon, or simply stress have all been proposed as triggers. The only change in my environment I can think of was a switch from Honey Stinger stroopwaffles to Walmart-brand waffles as my go-to snack during workouts, but I'm not ready to blame Mr. Walton for my woes.
I'm not exactly sure when my own immune system started attacking my joints. In mid January the base of my right thumb began to mysteriously ache. By mid February my left knee would feel stiff in the mornings and at the beginning of runs, but would later loosen up. No big deal I thought. I was now 41 years old and I was expecting little aches and pains like these to flare more often.
By early March my left knee continued to stiffen. After an intense, but relatively short mountain bike race my recovery was uncharacteristically poor. I rarely get sore legs after even 60+ mile rides, but this shorter race left me hobbling. The week after the race I spent some family time in Moab and I managed to do some light hiking and biking, but clearly I was not the same person physically that I was just a month before. And every day--despite no running and just easy biking--I seemed to be getting worse. It was time to call the doctor.
Not impressed with my RA hypothesis (I certainly wasn't impressed with my RA hypothesis), my doctor ordered an MRI to check for a suspected torn meniscus.
With my RA hypothesis initially shot down by the doctor, I figured my bum knee was just one of a long list of sports injuries starting to pile up. A damaged meniscus during a killer hike. A torn rotator cuff from a bike crash. And thrashed fingers from digging a huge hole in my back yard (stupid trampoline). Surely, I was just having a string of bad luck. But, for the life of me, I couldn't recall tweaking my knee during a hike. Nor could I recall a crash that could have possibly hurt my shoulder. I could clearly remember, however, in excruciating detail, digging a 15 foot hell-hole into a cemented pile of boulders that is my back yard (stupid tramp).
I REALLY HOPE I HAVE RA
When my MRI report came back negative, showing the menisci and tendons in my knee were all intact, my flustered doctor offered a cortisone shot. He couldn't understand why I had so much excess fluid in my knee. By this time I was absolutely certain that I was not dealing with unrelated sports injuries. There had to be something systematic, body-wide going on here. I explained to my doctor that in the past week alone conditions had worsened. My jaw started to hurt making eating difficult. All ten of my fingers would now be swollen like sausages every morning. My knee pulsed with pain throughout the night making sleep elusive. I knew I was getting older, but how do you explain going from climbing 11,000-foot mountains to struggling to walk down the porch stairs in a matter of weeks? After an emphatic explanation of all of this to my doctor, he finally decided to put in an order for some blood tests.
These days you can see your lab results quicker than your doctor can. This is not always a good thing. My blood-work results had several parameters listed in bold red meaning things were outside the norm. My blood's neutrophils, lymphocytes, and monocytes were all out of sorts. Some too high, others too low. My CRP was off the charts and I tested positive for the rheumatoid factor protein. But what did it all mean? While I waited for my doctor to call I couldn't help but consult the always-available good ol' Dr. Google.
The general consensus from Dr. G seemed to indicate either rheumatoid arthritis or...cancer. Obviously, I was really hoping I had RA, because we all know there is not much worse than cancer.
It was a huge relief to have my my real doctor confirm the RA diagnosis so I could finally try to understand and tackle my ailment head-on. But my doctor made it clear: other than prescribing prednisone (a synthetic corticosteroid) to reduce joint inflammation, there was nothing else he could do. RA was well beyond his area of expertise. The next step was to meet with a rheumatologist to assess my condition and begin a treatment program. The somber tone in my doctor's voice hinted that this could be a problem.
Turns out there is a dearth of rheumatologists nationwide. There is exactly one rheumatologist in all of southern Utah and he has not taken on new patients in years. Several medical professionals told me that I'd better expect waiting 6 to 9 months to get into a specialist.
A CRAZY PLAN
The prednisone made an immediate impact. By the end of April my joints began to feel better and I was able to resume some easy running and hiking. It was around this time that Susie schemed up a plan to surprise our kids on the last day of school and drive to Carlsbad, California, and stay through Memorial Day weekend for some beach time. We would be very close to the San Bernardino Mountains and San Gorgonio. With a newly-diagnosed debilitating disease, and just a few short weeks to prepare, would it be crazy to take a shot at the summit?
Luckily, I was able to get a rheumatologist appointment in late June. At the time of my diagnosis, this was still more than 2 months out, and it would be a few weeks after our California trip. I was feeling better with the prednisone, but after some more internet research I learned that the prednisone is really just a band-aid for the underlying disease. More aggressive medication called disease-modifying anti-rheumatic drugs (DMARDs) would be necessary to short-circuit the inflammation process and preserve my joints. The earlier you can catch the disease and begin DMARD treatment, the better your chances of getting the disease under control.
I called and pestered my doctor to prescribe me methotrexate, a DMARD that is commonly used as the first line of treatment for RA. It can take up to six weeks for the drug to have an effect. I took my first dose just 3 weeks before the California trip, so I wasn't expecting much improvement from the DMARD in time for my climb.
Regardless, I felt like I had nothing to lose so I continued to train for the climb. I didn't dare ask my family doctor his thoughts on attempting such a hike, but I did ask him about running in general. I liked and accepted his simple answer: if it hurts, stop. This became my mantra while I trained. Biking wasn't a problem and never really caused any pain. And if my knees started to hurt while running, I would immediately stop or slow to a walk until the pain would dissipate. Slowly but surely I was able to build my fitness back up and I grew increasingly confident that my knees would be okay.
|The climb up Mill Creek is a steady 7% grade for 10.5 miles gaining 3,500 feet. I took the climb super easy, making sure to save my legs for the grueling hike up the Vivian Creek Trail.|
|Once across Mill Creek the trail steepened and never seemed to let up.|
|With huge pines towering overhead, an occasional gurgling stream, and lush grass lining the path, the trail along Vivian Creek was a delight and the miles seemed to tick by effortlessly.|
|Climbing quickly out of the Vivian Creek drainage toward High Creek.|
|Meadow below High Creek Camp.|
|This nice little stream near High Creek Camp was perfectly positioned for topping off my water for the final push to the summit.|
|Galena Peak ridge from the Vivian Creek Trail.|
|Near tree line on San Gorgonio Mountain.|
|A few slushy snow patches made for some fun glissading near the summit.|
|Trail junction at 11,265 feet.|
|About 30 little notebooks stuffed into a metal box cemented into the rock serve as the summit register on San Gorgonio. Apparently, this is the hike everyone must do to prepare for Mount Whitney (Does this mean I now must climb Mt Whitney?).|
|San Gorgonio benchmark.|
|View of San Jacinto from the summit of San Gorgonio. These are the taller two of the "Three Saints" of southern California. The other is Mount San Antonio, or "Baldy", east of Los Angeles which stands at 10,068 feet.|
|Lunchtime at 11,500 feet. As busy as this summit can be, I was shocked to have the summit to myself for the 30 minutes I spent on top. I passed several hiking groups that day that never made it to the top.|
I maintained an easy hiking pace during the decent off of the mountain and I had no pain. I arrived back at the Vivian Creek trailhead at 4:30 pm for an 8-hour hike. I was back at my car at 5 pm for an 8.5 hour total trip time.
Down the road, I don't know how long my legs are going to hold up with RA. I have since met with a rheumatologist and he thought my prognosis looked good. I was able to catch it relatively early in the progression of the disease, and I've responded well to the medication. Many people with RA have not been as lucky as I have been. Eventually, the efficacy of methotrexate will probably wear off. There are other drugs to try, but they too can only do so much for so long. But as long as I'm able, I'll have my sights on the next peak...