Off the Beaten Path.

Yesterday, I was THAT girl. The one you wonder why is she walking on the side of the road? Well, I was at least in Joshua Tree National Park, in broad daylight, facing against traffic. Let me back up and tell you why this was the scenario. 

I had been hesitant to go on a hike by myself in the park since I have been back. The reason was I am afraid of snakes. While, I know they are not all poisonous, this is rattlesnake season. They come out as the temperatures rise to sun themselves. Although I personally have not seen one yet, I have two friends who have seen them on their property in the past few weeks. One of my coworkers who has lived in the desert for years gave me some wisdom. Rattlesnakes often can sense you coming. They are usually more afraid of you than you of them. (I am not sure about that one). He said that usually if you just keep walking, they will not bother you. He also said that the most common place to be bit is on your bottom. This occurs as people will sit on a rock to rest without looking before they sit. A rattler may be in the crevice or just behind the rock. This was confirmed with a ranger.

I thought when I woke up around 6:45am: "I enjoy hiking. I have a day off with beautiful weather (60- low 70). I am not going to let the snakes win. I will be careful and go early in the day before it gets too hot."  I was at the trailhead by 7:45am. The hike was supposed to be 12 miles round trip (not much elevation gain until the last 1.5 mile or so) ending on the highest peak in the park. I started out on the hike playing the new game of looking for flowers in the desert (it like an egg hunt). I was rewarded with finding several different ones along the trail. It was interesting to see baby Joshua Trees as well. Many of the trees in this area had been burned by a forest fire years ago. The burned Joshua trees send out roots to start another right beside it.

According to the trail description in my book, about 4.5 miles into the hike there was a trail that went north from the end of the dirt road was on leading to Quail Mountain. I found what looked like a trail. Here in the desert it can be questionable sometimes as the sand moves with the wind. If the trail is not used heavily, it can become less clear. I followed the trail making sure I remember the peaks behind me for landmarks. I trekked across the "field" staying on the "trail" best I could. It ended at the base of the mountain. I started to ascend the mountain up a rocky wash. The "trail" became less and less clear and the description in my book was not helpful. I decided it would be best for me to abandon the effort and turn around so I would not get lost.

I retraced my steps down the mountain to the trail that I had followed, or so I thought.  I  never returned to the dirt road. I was in a big open space and could not see it. I knew which peaks were ahead of me. I thought that if I ascended them I could see where the trail was to head back to my car. I could not see it anywhere. I was grateful I had a simple map, extra water and food with me and that it was only noon. I knew the general direction to go so I continued bushwhacking of sorts through the scrub bushes. My fear of snakes was usurped by getting back to the trail. I picked another peak for the landmark and off I went. After hiking a ways, I saw some building off in the distance. I knew it was in the opposite direction of the car, but figured I could get to a parking lot that I knew. If I could, I would walk the road back to my car.

Off I went walking in the wash which had some foot prints, a welcomed sight. I continued walking in the wash for awhile until it seemed to go a different direction than the buildings. I then decided to head straight for the buildings. I carried my hiking sticks behind me making noise by hitting them together to alert any animals of my presence before I arrived. I saw one snake, not a rattler, two jack rabbits, one coyote in broad daylight, and many lizards. When I arrived to the buildings I was sad to see there was no clear trail to it. I did see a dirt road  that seemed to lead towards the parking lot I was going towards (not where my car was located), so I walked towards it. I did see cars driving in the distance. This was another welcomed sight. I knew that I was going to be able to get back to my car and out of the wilderness. I continued walking towards the parking lot. I arrived. taking the opportunity to sit in the shade and empty the sand out of my shoes before walking the several miles on the road back to my car.

Once walking on the road, I felt much safer as I knew exactly how to get back to my car. I finally did at 2:30pm (6.5 hours after heading out). The trail book stated it would take about 6-8 hours for hike. I usually am significantly under the suggested time. I took one more big sip of water when I got to the car. It was the last of the water in the pack. God is so good!  Also young woman looking for a different hike asked my for directions. I was able to give her clear directions as I had been there before myself. I am glad I knew the park fairly well. I clocked the distance I had walked on the road in my car on the way home. It was 3 miles. I think I must have hiked at least 14 miles, may be more. I was only worse for wear with a big blister on one foot. Not too bad.   

Today, I went on a 3 mile hike with elevation with a coworker. At the top of the mountain I could see exactly where I was yesterday and where I had gone. I did a very large circle for sure. I am so thankful I follow the guidelines every time I hike...Tell someone I am going and what time I should be back home, carry extra water, carry food, headlamp, sunscreen, hat, pocketknife, handkerchief, long sleeve shirt, whistle, and ID and a map of some sort. I knew that I would be ok.

 Don't worry; I learned my lesson stick to well marked trails only and hike with someone when ever possible. When I was driving out of the park, I passed two other people who were outfitted for hiking walking on the side of the road no where near a trailhead. I debated about posting this, but figured it was an adventure afterall. I know I should have GPS,etc believe me I have heard it all before. This is the first time and hopefully the last I will get off the beaten path literally. 

Two Worlds Collide

I had a wonderful time with friends spending the afternoon and evening in Palm Springs. It is about 30 mile drive from Joshua Tree. Many of you have probably heard of this city. Many of the movie stars and musicians would come hang out in Palm Springs to get away from the business of Los Angeles.  Some apparently still do. With that being said, it is a nice area with several golf courses, stores with high end items as well as the closest Target and Trader Joe's. There is a strip in the middle of downtown full of nice restaurants, bars, shops, and hotels. Even though it is still in the desert, there is much more green than up the hill in the hi desert. The tall palm trees are everywhere with the backdrop of 8-10,000 feet mountains.

My friends and I stopped at a consignment store, Starbucks, Target, Tiki bar with pool, live music and vendors, nice restaurant, and Trader Joes. Several people have asked me how I am transitioning to life in the United States. God has been gracious as eased the transition by stay with friends, spending days hiking alone in beautiful parks and spending a weekend in Joshua Tree getting settled. Today was the first day I was truly aware of the distinct differences in way of life between developed countries and cities and developing countries and rural settings since I have been back. I seem to have more reverse culture shock. I have more difficulty coming back here (United States) than going there (where ever there is).  Simply expressed, two different worlds. 

As I was thinking about two worlds colliding, I realized this happens anytime two or more cultures interact. Different cultures, one of the very things that makes this world so fun and interesting to explore. I have realized through my travels near and far that a different culture may be encountered by sharing a meal with a neighbor at their home, hanging out with coworkers, or traveling aboard. Each family has their own culture. Their culture is influenced by tradition, world views, learning new things, blending the past with the present, laws of the land, and more.  While the culture may be starkly different than mine, it is not inherently wrong. In fact, I usually learn something. Perhaps I will learn a new food I enjoy, a new way to prepare food, clean, decorate that makes life better, easier, simpler. The culture of course tends to vary the wider you go: different area of town, different town, different part of the state, state, area of country, country.While there are a few things that are morally wrong and sinful, like murder, many of the differences should be appreciated.  

My life here in the United States is not wrong. In fact, it is because I live here in a comfortable apartment with a car, nice clothes, food in the refrigerator, lights to turn on/off, water to run, and air conditioning that I can serve others far and near. Serving others can be people down the street with a smile and a wave or giving a listening ear to the older lady I met at the grocery store today who lives by herself and needed to share with me about her dogs, cats, and birds at home for 15 minutes. It can be volunteering in another country or on a college campus or reservation or teaching in a school. It can be done in such a variety of ways! I hope you enjoy your little corner of the world while continuing to learn about others.

Mailing Address?

What is your mailing address? A simple question; one I never hesitated to answer until about two years ago. For a majority of people, there is an easy answer. For a traveling physical therapist it is not so easy to answer. For a traveling physical therapist who leaves the country for extended periods of time it is even more difficult to answer. 

Recently, I had to put my mailing address on a form. I asked the person "Will you be mailing something?" She looked me with a puzzled face and said no it is just for the records. The answer to the question what is your mailing address depends on several factors. Will I need the actual piece of mail? A bill or contract, for instance. When do I need it? Can it wait a week to be forwarded? Will it be left outside my door? Will I be able to get the package after business hours?  

Most bills can be paid online, but some it is still easier to pay through the mail. If I needed it right away, and my current address is on record with the USPS I will have it mailed to the current address. If it can wait, I will have it mailed to the permanent address and have it forwarded to my current address. If if is a package, I will usually mail it to work. Often if you are not home, they will either leave it outside or not leave it at all. When I work business hours, 20 minutes from the local post office, it is challenging to get items there. When filling out forms I now have to make sure I have the correct billing and mailing address depending on the factors above. 

I am thankful for the US postal service. I have used it more in the past few months than ever in my life; I think. If you are like me, you likely do not realize how useful it still is. I have used it to get important documents, information, medications, shoes, etc from across the country. When you are a traveler, it is nice to have a home base. A permanent address which includes someone who can tell you of important mail as well as mail items too you. Thanks Dad! 

This too is effected on Mercy Ships. Yes I can receive mail on Mercy Ships. I will give details when the time approaches for me to return. Also, I found it interesting that the mail carriers are the crew. Often when crew return to their country of residence the will be asked to carry letters from fellow crew in their country. Pretty neat!

While I do think I will settle one day, I am not sure when. For the unseen future, I will continue to think about my answer to "What is your mailing address?"  This is a small factor in the life of adventure that I did not think about until I began my journey. 

A Look Below the Surface

While I was in physical therapy school, we were taught that it all hinges on the bones. Our curriculum began with human anatomy and a functional anatomy class. In other words, learning the muscles and bones and how they move. During my career in physical therapy so far, I have worked in a variety of settings. These include pediatrics (1 year old to 17 years old), outpatient orthopedic,  some prosthetic (new legs) and neurological (after stroke, nerve damage, and traumatic brain injury), acute care (hospital), orphanage, summer camp for children with physical disabilities, and tent on dock with Mercy Ships (plastics/burn contracture releases).  Many of the settings, I have not had much guidance or learned on the fly. Tricks of the trade and gaining knowledge from other therapists always carry over to the next setting. Due to working in a variety of settings, I am not a specialist in any one setting.  Often when I am not sure where to begin with a patient, however, I go back to the anatomy and functional anatomy I learned in school.

Yes there are specialties within physical therapy. Some I mentioned above. Within each area of physical therapy there are specialties and techniques of treatment.  At the root ,it is my experience that it all builds on the foundation of orthopedics. With pediatrics or after a stroke, for example,  if the muscle tone is too little or too much (a neurological component), the bones are unable to be moved as easily to roll, sit up, crawl, walk. If the tone is atypical, it effects the alignment of the bones and the developing strength of the bone. If there is nerve damage no matter the cause, the muscles are not told how to move. Therefore, the bones do not move. The brain and the body will adjust as they are able often leading to compensation patterns for walking, reaching, transitioning sit to stand, etc. The compensation patterns themselves over time can cause further damage or create additional issues. This is where surgeries, orthotics, braces, special suits, prosthetic legs,wheelchair designs and components and the like come in to play. These are all used maintain proper postural alignment as much as possible and facilitate movement pattern as close to correct as possible.

Mercy Ships was definitely another unique experience and setting. As mention in earlier blogs, I mostly worked with children and adults after burn contracture releases and skin grafts. At first, I was unsure how to exactly work with these patients. It did not take long to realize that one of the primary goals for these patients was to attain as much range of motion as possible to provide function. Strength in the new range of motion is necessary to keep the new gains. So, at the foundation, it is similar to orthopedics. It is just wrapped in a different wrapper...skin grafts. Keeping in mind that some of these joint have been in atypical positions for years, the surrounding ligaments, tendons, nerves, and bone alignment may hinder achieving perfect movement patterns. Surgery is the first important step for these patients. It gets the bones and tissues as close as possible to the proper place. It is after the surgery the long road of rehabilitation begins. 

 There were a few instances when I was glad I had some experience in looking below the surface. All the different therapists on the Rehab team have varied experiences. This works out well as we play to each others strengths and truly work as a team. One time I was asked to work with a middle age female who had burns on her arm, hand, face and neck. She was slowly gaining more bend in her elbow and hand. One day, she reported that she had pain in her elbow that was different. Upon further questioning through the translator, it became clear it was pain related to a nerve being pinched somewhere. After a brief exam of her neck, it became clear that the nerve was being impinged in her neck or anterior shoulder area. I showed her the difference posture made on the position of her shoulder and neck. Amazingly, simply by sitting upright with her shoulder blades in neutral position and head and neck in line, the pain turned off. I used a special tape (the type you see in the Olympics) to cue her muscles to maintain neutral position of her shoulder blades. While the tape was on, we trained the muscles that support and move the shoulder blade and neck. She left with no pain that day and was able to sleep with little bit of elbow pain. During the next several sessions, some time was spent on continuing to train the postural and shoulder muscles as well as continuing to gain range of motion in her elbow and hand. The "different" pain went away for good. Now we could continue to bend her elbow aggressively without the nerve pain. This was the first time I realized how things below the surface matter more than we think.

Another time the orthopedic viewpoint came into play was with a middle school age boy who had surgery on his foot several months ago. He had made great progress with strength and range of motion. He was able to walk without a AFO/brace better than with one. He, however, continued to have pain in his midfoot. One of the therapist asked if I could look at his foot. After performing some joint mobilizations and foot alignment assessment and gait, it was apparent that his foot remained in supination (his big toe never made contact with the ground) throughout the whole gait cycle. After some joint mobilizations, his pain abolished. I brainstromed about putting corkboard on the outside sole of his foot to tip his foot flat. By doing this, he was able to walk with increased muscle activation in the arch of his foot and in his big toe allowing him to walk with improved mechanics and no pain. We attached the corkboard in his too big shoe with velcro to keep it from moving in his shoe. He walked with it for a week with no foot pain. 

Well, now that you have had your lesson physical therapy and the importance of anatomy and functional anatomy, you may appreciate what is below the surface more. The complexity of the human body has amazed me from a young age. The bones, muscles, nerves, digestive, respiratory, skin, biochemistry of hormones, neurotransmitters, etc. It is truly amazing that it ever works correctly. Truly astounding how all interconnected it is and how it functions well so much of the time. I agree with God, "It is good."

Right Side Mirror of the Car...Prosthetic Leg...Poncho

When I arrived back to the United States, I got into the driver seat of the car and starting driving. At some point, I needed to change to the right lane on the highway. I looked over into the right side mirror to see if there were any cars to my right. It was only then I noticed the right side mirror had been folded in and was only showing my hands on the steering wheel. I did change lanes safely, but had to do additional steps of checking in the rear view mirror extra times and physically double checking my right blind spot. When I arrived at my destination, I promptly got out of the car and carried on with life. It was not until I needed to change lanes to the right again that I remember the issue. This time I realized how we all are like right side mirrors, flipdown sun shade in the car, and ponchos in life. 

We all have a specific role, purpose, gifts that have the potential to work well together to do wonderful things. Yes jobs can be done if we do not all perform our part, but it is more difficult for everyone. One of the examples of everyone working together came to mind...making a prosthetic leg for a little girl I met on Mercy Ships. It took two creative physical therapists, carpentry department, and a sleeve from another little boy on the ship who has a prosthetic leg.  

A paper cup was cut open in order to size over the stump and measurements taken. The cup was then filled with plaster. Once it hardened, splinting material was molded over the plaster to make a cup for the stump to fit into. Carpentry spent many hours cutting, shaping, connecting, and securing the metal components of the leg to the cup. It fit the little girl! A sleeve that helps secure the prosthetic leg to the stump was given by another little boy on the ship. 

Immediately after putting the leg on, the girl who had never walked in her life was able to stand up with very little support. She was given a walker to borrow while learning how to walk. The very next appointment, it was evident her mom was very involved and had a strong intuition on how to work with her daughter. She had her daughter kicking her hand or other items to work on shifting weight and balancing. The little girl could walk independently using the walker. The mom did not pick her up when she did not want to walk any more. She would let her rest and then ask her to continue. Within about a week or two, the child had much improved knee control. It was amazing the teamwork.  

I went on a road trip and hiking trip to many National Parks in southern Utah this past week. (More on that later).  This meant I had a lot of time to think. So, be ready for many more blog entries in the near future :) As I was thinking about the importance of everyone's "job", I encountered two other examples. The first is the sunshade thing that you can flip down while driving into the sun to make it easier to see in necessary. We do not use it every day. When we need it though, we simply reach up and flip it down. We expect it to be there when we need it. It does a great job!

The second example is a poncho. Some back story is required to full appreciate this one. Mom and Dad had a lifelong dream to travel to the Colorado Rockies. The summer I was 16 years old, we went as a family of four. Mom and Dad planned and prepared for months. Mom is a detailed person and likes to be prepared for all possible circumstances. We all had appropriate hiking shoes, personal day backs which held water, snacks, jacket for higher elevations, extra socks, and last but not least a poncho that we could wear over the backpack when it rained. During the summer month, it is common for a thunderstorm to suddenly blow in in the afternoon. We used the ponchos multiple times that trip.

I have kept mine ever since. It has gone on many many hikes over the years. I have never used it, but glad to know I had it if I needed it. This past week while traveling in southern Utah, I used it! Thanks Mom! The forecast was for rain and snow all day depending on the elevation. I decided I had rainpants, wintercoat, and a poncho. A little or alot of rain won't make me melt.  The rain had stopped when I began the hike into the canyon. About 15 minutes into the hike, the dark grey clouds were nearing and thunder rumbled in the distance. Soon the big raindrops began to fall. I pulled out my trusty poncho from the backpack, and put it on over the backpack. The rain continued for about another 20 minutes, but the buds and new leaves on the cottonwood trees were bright green from the rain. The rain let up and I made it to the beautiful waterfall with everything underneath the poncho dry. The poncho did its job!

I hope you are encouraged as I was to be reminded that we all do have a "job" and "place" in this world. We are needed. We may live for several days, weeks, or years without the fulfillment we are seeking, but one day everything will click and we will be needed. We will be at just the right place for such a time as this. 

Stars, Oceans, and Fires

You maybe wondering what do these three items have in common? Why are they grouped together in this blog? This is a blog that I have debated about writing, but have decided to share it with the world after all. As is expected with all new situations, it takes time to adjust and make a way in the surroundings. Mercy Ships proved to be no different. The first two weeks were challenging in many ways, making new friends and acquaintances, figuring out how to live with a bunkmate and cabinmates, eating food served only three times a day in a commercial setting, working with patients in ways I had not before, treating with a translator for even simple commands to name a few. I was continuing to blaze ahead the best I could with God's help. I knew that it would get easier with time. It always does. I also knew that I did not have much time here. 

Mercy Ships has several planned activities each weekend that crew can chose to participate in if they want. This particular weekend was a bonfire on the beach with worship songs. This happened to be on the same day as the Gorge adventure. At the last minute, I decided to go to the bonfire. The pleasant evening commenced with a very colorful sunset over the ocean. The bonfire had built above the high tide line and we all quickly settled down sitting in the sand listening to the guitars and African drums. We began singing songs. The music and singing were competing with the sound of the crashing waves behind us. It was very peaceful.

Soon they were singing songs to which I did not know all the lyrics. I entered into my individual conversation with God. Here I was on a beach in the Republic of Congo singing songs, watching the fire, listening to the waves crash into the sand with people from all over the world (34 nationalities on board, not all of them at the fire).  How neat is that?! I began thinking about how small the world is to God. He knows us all and the details of our lives. He told Abraham he would be the Father of the Nations. God illustrated this to him by showing him the vast numbers of stars in the night sky. Not only did He show his the vast number, but He loved all of the people the stars represented. Another neat thought that I have had before but was reminded of then was that Abraham and I were both potentially seeing many of the same stars. 

My thoughts continued to wander down the path of God's love for all of us yet loves us individually. I was thinking about lyrics in hymns and contemporary worship songs that describe God's love. Some describe it as deep deep love of Jesus, vast as the ocean. The oceans are both deep and wide. It is amazing to think about God's love for each of us being more/bigger/vast than the ocean. I cannot easily comprehend that fact. It is life changing when we grasp it.

My thoughts were interrupted by screams and people jumping up quickly as the tide had come up higher than anticipated getting many people wet. They were actually able to start another fire further up the beach by carefully moving some of the flaming wood. After the new fire was steady and worship started again. I began thinking about how both fire and water can be so peaceful (waterfall, waves crashing, fire in fireplace or while camping), helpful, necessary to sustain life yet can be so destructive when they are out of control. Humans over thousands of years have made many successful attempts to tame them and use them for great benefits such as fuel, heat, power, cleaning, growing food. Sometimes, they will override man-made constraints in floods, wild fires, hurricanes, etc. They can destroy in an instant what has been there for years. I am so glad I have a personal relationship with God who is more powerful than natural disasters. We do not understand why they occur, but know He is more powerful. Amazing.

Well there you have it some of the inner wanderings of my thoughts a night of stars, oceans, and fire.