High and Dry. (And Cold.)

I’ve mentioned that the phrase “It’s a harsh continent” is a good way to excuse anything that seems to go wrong south of the Antarctic Circle.  But in the case of human physiology, that’s not an excuse but a reality. The fact is that our lineage started out as a gang of happy little Australopithecines, presuming that small hairy bipeds eating shoots and grubs and continually running away from lions and cheetahs and what-not, can be considered a truly happy hominid.  Our forebearers evolved on the African savanna, in a temperate environment.  Across the mighty sub-Saharan plains the land was flat, the air was warm, the sun marked the day, and the moon signaled the night.  (And a good chance to be eaten in the dark by a lion of cheetah or what-not.)

None of these characterize the Antarctic continent. Antarctica is the highest, driest, and coldest continent in the world.  While seals and penguins live quite nicely on the coast because they’ve been doing that for millions of years, nothing thrives at the South Pole itself.  There’s no native flora or fauna of any kind, and humans might best be thought of as an invasive species.  Needless to say, the progeny of Lucy and her kin were not built for this environment. So as the overwinter physician here the South Pole, it’s important to recognize that the unique health issues here in your frozen backyard.

(This may be an exaggeration.  Medical issues related to cold and altitude are seen throughout the world.  But with the possible exception of the top of Mt. Everest, there’s nowhere except the South Pole where humans are subject to such extremes on a daily basis.  Speaking of which, we have a poster up in the Station that reminds us that every dead climber on Mt. Everest was once a highly motivated individual.  Ruminate on this and value your sloth.)

Let’s start by talking about cold injuries. Frostbite is certainly the most popular Family Feud answer here, but before the bite comes the nip.  Everyone here, (including me) gets frostnip on a regular basis.  Frostnip is what happens when you take off your glove to get a picture of the stars, or when the wind edges it’s way past your balaclava, hat, and hood to sting at the margins of your eyes.  The cold causes the blood vessels in those exposed areas to contract (“vasocontriction”), decreasing local blood flow resulting in pale skin and a sensation of cold, numbness, and pain.  This is easily reversible once you get insider put your hand inside of a glove, but if left unmanaged results in frostbite.  Of course, because this is the South Pole where find a way to put a bizarre spin on everything, the biggest concern is that if people spend time in the sauna (yes, we have one) and then run outside to simulate a cold plunge, they’ll get frost nip on their nipples, resulting in a condition called frostnipnip, for which I’ve explained that I really have no interest in the manual application of aloe lotion or any other soothing balm to your tender regions.  The same is true of any frostnip you suffer over any part of your body try to be a member of the 300 Club.

The 300 Club is probably the worst kept secret here at the South Pole. It’s supposed to be a very “hush-hush” thing that nobody knows about because undoubtedly someone will be offended. That being said, references to the 300 Club abound on the Internet.  The 300 Club is joined when you undergo a 300 F swing in temperature.  On a day when the temperature drops below -100 F outside, the initiation starts by sitting in the sauna as hot as it gets, close to 200 F at the heat source.  You then run to the Beer Can (the unheated stairway leading down to the supply areas and power plant), walk down six flights of steps, go outside, run 200 yards to the Geographic South Pole, have your picture taken, and then run back to the Station, go back up the stairs, head back to the sauna, and try not to die. Did I mention that aside from boots, gloves, and a hat, you do this naked? 

I have been asked repeatedly if I have any interest in joining the 300 Club, and my response is a consistent no.  I’m happy to stand in the doorway with blankets and hot chocolate, but I really don’t need the personal growth that comes with  running in triple digits below zero weather in nothing but my near-elderly corduroy birthday suit.  I’ll grant you that it might be an interesting physiologic experiment to see how much someone’s core temperature drops during the exercise, but I don’t feel the urge to periodically check a rectal thermometer as I’m running for my life in the name of science.  Although if I was to join the 300 Club, I should probably do so now as the Station moves ten yards farther away from the Geographic South Pole every year.

If you don’t get pieces and parts warmed up in fairly short order, frostnip proceeds to frostbite. It’s surprising how fast that can happen here at the Pole.  At the temperatures we experience, even a mild breeze can give you frostbite in three minutes or less. Frostbite is the cold equivalent of the thermal burn, but unlike the thermal burn which simply destroys tissue there are two mechanisms of injury. The first is the progression of the vasoconstriction seen in frostnip.  Continuing decreases in blood flow to the extremities or other spots causes those body tissues to go without oxygen, a condition called ischemia. Cells need oxygen to survive, and so when deprived of oxygen they suffer damage or may even die.   Smaller, narrowed blood vessels also mean that the blood flow is sluggish, and small blood clots form. Those blood clots physically block oxygenated blood from getting to the tissues and worsen the ischemia. There’s also direct injury from the cold as most of our body is comprised of water, and water freezes.  Ice crystals form in tissues with prolonged exposure to cold, and as ice forms within cells they are torn apart.

Like burns, frostbite comes in different quote “degrees.” First-degree frostbite is usually characterized by feelings of coldness, numbness, and pain in the digits, accompanied by a white discoloration (“blanching”) of the affected area. Second-degree frostbite is characterized by clear blistering, as the superficial and deeper layers of skin separate and fluid accumulates between them. Third-degree frostbite is identified by the presence of blood blisters (“hemorrhagic vesicles”), as injury to deeper layers of the skin with involvement of small blood vessels result in their rupture within the layers of the skin.  Fourth degree frostbite is an injury that extends below the skin, and may totally disrupt the blood supply to the digit. These cases are those pictures you see on the Internet of the climbers who have black noses, fingers, and toes. The problem with ischemia is fully developed here.  Oxygenated blood does not get to the exposed tissues, so they die.  It may take several months for the full extent of damage to be seen, and many times the black digits or limbs will need to be amputated, as dead tissue is really nothing but bacteria food. (The delay in recognizing the full extent of the frostbite injury is summed up in the surgical adage, “Frostbite in January, amputate in July.”)

We remind each other often about frostbite, because frostbite is fully preventable. Appropriate layering of clothing, minimizing exposure to the cold (especially when the weather’s bad and there’s risk of getting lost or disoriented), and eliminating risk factors such as alcohol use is constantly emphasized.  We also talk about how toc are for frostbite before you reach the clinic, including removing wet or constricting clothing, not rubbing hands together or with snow (you can cause more damage if you can’t feel what you’re doing), and avoiding the chance for the skin the thaw only to refreeze.  Once you’re out of the cold, put the affected area in warm, body-temperature water to thaw.  (Use of hot water or a heating pad simply hurt more, and you may get a thermal burn on top of the cold injury.)   Unfortunately, while many different therapies of been tried, other than perhaps the use of Motrin there’s no magic bullet to fix frostbite, and further care is simply a matter of watching and waiting. 

Hypothermia is our other cold-weather concern.  The term “hypothermia” describes a drop in your body’s core temperature.  (“Core” here refers to your internal organs, as opposed to a peripheral temperature as you might obtain from an oral, ear, or forehead thermometer.  Core temperature is usually measured rectally.  See The 300 Club.)

Your body normally does a good job of regulating its own thermostat.  When you’re in the cold, you produce heat through increasing your metabolic rate and muscle activity such as active shivering.  With prolonged exposure, your body loses that reserve capacity to generate heat.  Shivering stops, metabolic rate falls, and you enter an unending spiral of continued thermal loss.

There are four main ways the body loses heat.  Radiation is simply the heat given off by the body into cold surroundings. Conduction is the heat given off when a warm object touches a cold object, such as a human body against snow. Heat loss through respiration and evaporation happens when one breathes out warm air and breathes in the cold.  Finally, convection is heat loss from cold air moving across a warm surface. Understanding these factors explains why even someone in Florida can get hypothermic. If you’re trapped outdoors in the daily afternoon subtropical rainstorm, the wind sucks away heat by convection and conduction transfer heat from the body to your wet apparel.

There are two main roads to mortality with hypothermia.  First, the electrical conduction system of the heart is exquisitely sensitive to cold. The heartbeat is regulated by a set of cells that conduct electricity through the different parts of the heart at different speeds. When someone is exposed to extreme cold and the core body temperature drops, the pulse initially slows and blood pressure falls, which makes it difficult to detect vital signs unless you continue to monitor the patient for an extended period of time.  The difficulty in ascertaining vital signs in the hypothermic patient gives rise to the maxim, “You’re not dead until you’re warm and dead.”

As hypothermia progresses, the heart becomes irritable and abnormal heart rhythms are seen.  The most dramatic of these is ventricular fibrillation, where there is no organized cardiac activity and every cardiac cell is doing its own thing.  The EKG looks like a squiggly line, like the Swinging 60’s of heart rhythms. This is the one you’ve seen on television where they use a defibrillator to deliver an electric shock.  Unlike TV, people don’t flop with the electric jolt, but they twitch instead.  From my side of the bed, it’s pretty fun to watch.  From the patient’s view?  Not so much.

Unfortunately, once the heart gets cold, it’s more resistant to treatment.  Often the heart continues to deteriorate to a rhythm called asystole (this is the television “flatline”) where there is a total absence of electrical activity in the heart, no corresponding pulse, and the patient dies.

The other pathway to death is from insult to the brain.  Brain activity decreases by about 7% for every degree centigrade drop in your core temperature.  When the core reading reaches 35 C (about 95 F), you often start to see some altered level of consciousness. Continued decrease in body temperatures results in “mumbles, stumbles, and grumbles,” characteristic signs of cerebral hypothermia including loss of coordination, difficulties with speech, and disorientation.  Continued depression of brain function results is fatal. 

As with frostbite, the best care is prevention, and the ways to do so are similar to the means to prevent frostbite as well.  It’s important to practice good layering; avoid prolonged cold exposure, bad weather, and alcohol; and it’s always helpful to be outside with a buddy. Care for hypothermia is also pretty straightforward, focusing on removal from the cold environment and rewarming.  Passive rewarming, with the use of warm blankets or special insulated sleeping bags, is always preferable in mild cases.  One caution with passive rewarming is to be aware of “core afterdrop.” When someone with hypothermic comes in from the cold and is covered with warm blankets, their extremities warm up more quickly than their core.  Blood vessels in the extremities will open up, and as they do they will dump cold blood that’s been pooling in the arms or legs back to the core, complicating issues for the heart and the brain.

When the patient is in dire straits, life-saving care for cardiac and respiratory issues always comes first.  But to maximize the chances of survival you may need to do active rewarming, getting warmth into the core using warmed air to the lungs, warm IV fluids into the blood vessels, and warm fluids directly into body cavities.  In the past, warm water immersion was also part of care.  We tend not to do that anymore, because if it’s hard to manage a toddler and a host of bath toys on a Saturday Night, it’s a mess trying to manage full-grown patient in a tub.

**********

Altitude is also a problem at the Pole.  If you look outside the window, you wouldn’t know that you’re at 9,300 above sea level. There are no mountains to tell you that you’re above something else; the polar plateau is simply a flat, snow-covered plain extending infinitely in all directions.  But the Station sits atop almost two miles of ice, and on days when the barometric pressure is low the effective altitude may be more than 11,000 feet high.  These factors make altitude illness, especially in newbies to the Pole, a real concern.

Our problems with altitude originate with the physics principle called Boyle’s Law. In fancy cocktail-party words, Boyles Law states that the volume (V) of a known unit of gas is inversely proportional to the pressure (P) upon it.  Mathematically, it reads as P1V1 = P2V2.  In real human language, Boyle’s Law says that if you have a liter of gas (like air) and decrease the pressure on it by half, the volume will double.

At altitude, atmospheric pressure decreases.  Boyle’s Law tells us that the volume of a known unit of gas increases accordingly.   If we have a set number of molecules in a volume of gas sea level, at 18,000 feet (where atmospheric pressure drops by half) the volume of that gas doubles and the molecules drift farther apart.  If those molecules are oxygen, it means we take in fewer oxygen molecules per breath.  Less oxygen coming in through the lungs means less oxygen is delivered to the body tissues. 

There’s a misconception that at high altitude, there’s less oxygen in the air. That’s not true. In any volume of air within our atmosphere, oxygen still makes up 21% of the molecules. However, those molecules drift farther apart from each other as atmospheric pressure falls, and so there are less molecules of oxygen coming in per breath.  This wouldn’t be a problem is humans could just increase their lung capacity to stay in synch with changes in altitude.  However, we can only breathe in so much gas at a time, and we can’t double our air intake to keep up with changes in atmospheric pressure and gas volumes.  

(The amount of gas taken in with a normal breath is called the tidal volume…air flows in and out with each respiration just like the tides…and averages about 500 cc in the average adult.) 

Ultimately, this is again a problem that comes from our origin on the African savannah.  We are physiologically just not equipped for high-altitude living. It’s true that people who are born and live at altitude have some compensatory mechanisms, but it’s not something inherent in the human condition. So when we’re at altitude, we experience low levels of oxygen in the blood stream (“hypoxia”) which results in poor oxygen delivery to the places that need it, and our body tries to compensate.  We breathe faster, trying to get more oxygen molecules out of the thinner air; our heart rate goes up, as we try to pump the blood faster to the tissues that need it; and our blood pressure rises as well, as narrowing the arteries raises the pressure inside small blood vessels resulting in faster flow, the same way that a garden hose drenches the lawn faster with more pressure behind the tap.

The modern-day hominids experience a spectrum of altitude illnesses, but physiologically the common denominator is hypoxia. The main way we compensate for this is to increase our respiratory rate and volume (the “hypoxic ventilator response”), but it’s thought that some people compensate better than others.  Those who have more difficulty are prone to altitude illness. Decreased oxygen to the brain is thought to result in increased cerebral blood flow to answer the brain’s needs; however, this increased blood volume under pressure may cause fluids to leak through fragile blood vessel walls into brain tissues resulting in brain swelling (‘cerebral edema”).  Increases in pressure within the blood vessels that flow to the lungs may cause a similar problem, with fluid leakage filling up the air sacs in the lung (alveoli) where gas exchange normally takes place.

The mildest form of altitude illness is Acute Mountain Sickness (AMS). This usually develops shortly after assent to altitude, and is at its’ worst in the first 24 to 48 hours of arrival.  AMS symptoms are often non-specific, and include headache, fatigue, dizziness or lightheadedness, insomnia, and gastrointestinal upset. Because the symptoms are non-specific and self-limited, and most ski resorts or climbing expeditions feature adult beverages, it’s often confused with a hangover.

There is one medication known to be helpful in the prevention of altitude illness.  Diamox (acetazolamide) is a carbonic anhydrase inhibitor that induces a metabolic acidosis.  Carbonic anhydrase is an enzyme in the kidney that helps to reabsorb bicarbonate into the body.  Bicarbonate is used to buffer, or neutralize, the acids produced by metabolism. When you prevent reabsorption of bicarbonate in the kidney, there’s less of the chemical to buffer any acids in the blood stream, and you become slightly acidotic (a condition known as metabolic acidosis). Metabolic acidosis promotes hyperventilation, as one of the ways that you can get rid of acids in the body is to breath out carbon dioxide. Breathing faster expels more acids, and we know that altitude illness tends to be associated with a decreased ability to hyperventilation compensate for altitude. Diamox kick-starts that hyperventilatory response.  The drug also has a bit of a diuretic effect, clearing water from the body, which may help with excess fluid build-up in the lungs and brain as well. Usually the medication is started 24 hours in advance of ascent and continued for several days after arrival.  However, Diamox does have some annoying side effects, most commonly tingling of the extremities and a metallic sensation in the mouth (especially with carbonated beverages), so it’s often discontinued as soon the adult drinkies at the apres ski bar taste funny. 

High-Altitude Pulmonary Edema (HAPE) is a more serious condition.  Starting several days after ascent, patients initially have shortness of breath at rest, fatigue, and a dry cough.  Over time, the cough may produce blood-tinged mucus as a result of leakage of fluid and the occasional red blood cell into the alveoli, which are the small air sacs within the lung at the end of the bronchial tubes where gas exchange takes place.  If unrecognized, the victim of HAPE will develop further signs of respiratory distress, such as a blue discoloration to the fingers and toes (cyanosis); if we listen to their lungs you can hear a bunch of sounds like Rice Krispies known as rales, a sound created when the fluid-filled alveoli “snap” open during inspiration.  Fluid in the alveoli interferes with the gas exchange as the body struggles to intake oxygen and expel carbon dioxide.  Worsening hypoxia simply propagates the underlying problem and eventually leads to respiratory failure and death.

A second feared complication of travel to altitude is High-Altitude Cerebral Edema (HACE).  HACE is a result of excess fluid within the blood vessels leaking into the brain with subsequent swelling of brain tissues. This swelling can result in difficulty walking, speech problems, and altered elves of consciousness.  Left unchecked seizures, coma and death ensue.

The ultimate treatment for all altitude illnesses is immediate descent.  If ascent to altitude caused the problem, getting lower can fix it.  Minor cases of Acute Mountain Sickness can often be managed symptomatically as a self-limited problem, but HAPE and HACE require the patient to get to a lower altitude as soon as possible.  But what if you can’t get the patient down the mountain or, as is the case at the Pole, there’s no way off of the high plateau?  In addition to the use of oxygen and selected medications, the ideal solution would be to put the patient in a hyperbaric chamber.  This is a large metal tank, often large enough for the patient and an attendant, that has air pumped into it to increase the atmospheric pressure within the chamber, simulating an artificial descent to lower altitudes or under the waves.

It would be great to have a hyperbaric chamber at the Pole, but (and of course you saw this coming) that’s not an option here.  Instead, we have several Gamow Bags.  A Gamow bag is a portable, zip-up bag that can be pressurized with a foot pump to simulate a descent of about 3,000 feet, often enough to temporarily stabilize acute problem.  Only one person fits in the bag, the patient cannot be accessed by others during care, and it can be quite claustrophobic while inside.  Still, it’s a useful adjunct when options are limited.

(In the “It’s a Small World” Department, the Gamow Bag was invented by Igor Gamow, son of the physicist George Gamow, who did work on the Big Bang Theory.  Looking for the cosmic background radiation remnants of that event is the focus of much of the telescope work at the South Pole.)

Just like hypothermia, virtually all altitude illnesses can be prevented. Diamox is one option, but the best choice is slow ascent. It’s suggested that you don’t go any faster up than 2,000 feet per day once you hit 8,000 feet, and that if your trip starts at 10,000 feet or higher you should spend at least three days at that altitude before your next climb.  Exertion seems to make things worse.  We have signs outside the weight room here asking people to not use the facility in the first week after arrival, as the flight from McMurdo to the Pole takes you from seal elvle to 10,000 feet in a matter of hours.  It also seems to be that what matters more is not the maximum altitude you reach during a day, but the altitude where you sleep.  So keep going up those chair lifts, but come back down for your nap.

There’s one other altitude issue that’s never talked about, though it is certainly noticed.  I’ve mentioned that gases expand at altitude; this is true of the gas generated by your gastrointestinal tract.  When these gases expand in volume, they want to go somewhere, usually out the back.  This results in High-Altitude Flatus Explusion (HAFE), and is why you tend to pass gas (because saying “fart” is just so common) when you’re in a commercial aircraft. The only preventive measure I know is to eat less beans.  You would not want to be trapped in a Gamow Bag.

(By the way, the son of the Best Girl Friend Ever had recently amplified my education in these matters by letting me know that the reason that human farts are usually heard and dog farts are not has to do with the speed of the flatus as it exits the rectum. According to his research, apparently in humans the velocity is such that it flaps the butt cheeks back and forth in a way not seen (or perhaps I should say heard) in dogs.  It turns out that’s not actually true; the noise we hear is dependent upon the volume of gas, the force with which it’s expelled, and, well, the size of the hole.  The more open and relaxed the passage, the lower the sound; the most relaxed sphincters produce the “silent but deadlies.” Still, I’m going with the butt cheek theory, because I’ve never really seen dog butt cheeks flap but much to my chagrin I’ve seen it a lot in humans.)

**********

The other physiologic stress here is the lack of humidity.  Much as we lose body heat through respiration, we lose water vapor as we expire as well. Normally we inhale water vapor in the ambient air, so as long as we intake enough water to offset our losses through urine and sweat we exist in a rough state of equilibrium.  However, in this environment we don’t inhale any water vapor through the air, and one can become dehydrated just from the insensible loss alone, exacerbated by noting that at altitude we breath more often due to hypoxia.

While hydration is always important, it’s especially so here. Not only do most of us carry water bottles with us at all times, many folks put humidifiers in their room to help stay hydrated at night.  Skin dries out quickly, and itchy skin rashes (“dermatitis” sounds better) are common, as are minor respiratory complaints from irritated airways.  I’ve noticed that my fingernail are brittle and randomly crack in odd ways that even a manicure and some polish won’t fix.  

**********

So given this hostile physiologic milieu, how am I doing?  I have to say that I don’t notice any particular problems with the cold.  If you had told me six months ago that I would be perfectly fine…in fact, happy to go outside when it’s -80 F, I would have thought you were crazy.  But now I’ve learned that with proper layering, the cold is eminently tolerable, and the real problems are darkness and wind.  I don’t know that you ever get “used to” the cold; if I were to step outside in my street clothes I would feel it instantly.  I do still get frostnip from time to time, especially around my eyes where the cover of the balaclava ends and in my fingers if I take to long to snap a picture.  But you simply learn how to cope, and soon preparing for the cold itself becomes simply part of your routine.

As far as problems with altitude, I do continue to have shortness of breath with exertion.  What’s surprising is after nearly 5 months here, I’m still not even close to acclimated.  While I was probably not in great shape to start with (and I can always blame age and evolution), I would have hoped that after a certain amount of time it would get easier to go up steps, carry small loads, and take a brisk walk outdoors.  I even get short of breath when I talk too fast.  It’s a little disheartening, because you would like to think you would get more adapted over time, but again I’m going to fall back on age and evolution because unlike my level of fitness for which I must bear some responsibility, I carry no guilt in assigning blame.

This experience has really made me rethink my own health. I’ve been very fortunate my entire life to not have any significant medical issues, and while I admittedly haven’t been partial to diet or exercise I was able to skate along through life with no particular cares.  But the back pain I experienced here in March and April was a wake-up call.  I had never been incapacitated before, and while there was very gradual improvement it took about a month before I was really able to be up and about like normal.  While there’s not much literature on it, I suspect that based on my experience and those of others, that soft tissue injuries take longer to heal at altitude because of the relative hypoxia. We know the people who have problems with wound healing are often placed in hyperbaric chambers to deliver increased levels of oxygen under pressures to the injured tissues; it would make some sense to think that the opposite might be true, that healing from illness or injury would be delayed at altitude due to the relative hypoxia previously discussed.

The worst part about the back injury was not necessarily the pain (although it was considerable), but the implications of my incapacity.  I was never fully immobile; despite the discomfort, I was always able to do the little things I needed like get to the bathroom and the galley.  However, motions like lifting, bending, standing, or sitting were nearly impossible for the first several weeks. Not being able to do my share of the daily grind made me feel absolutely worthless. I understand that at my age, and with my level of fitness, I’m simply not going to be shoveling like a 30-year-old.  But I should still be able to clean a bathroom, lift a bag of trash, or wipe down a laundry machine. I should be able to walk down the hallway to check the batteries in a defibrillator.  But these were the things I just couldn’t do.  I felt like a drain on others, that in not being able to perform my duties I had lost any respect I had gained during my time on post.  I felt for myself the same contempt I sometimes have for those who seem to milk pain for their own advantage.  I didn’t think I was doing that, but I was convinced that this was exactly the perception others had of me and that view would continue to fester throughout my stay.  My self-esteem was the lowest it had ever been, and my ego is normally such that I could be from Argentina.  (How does an Argentino commit suicide?  He jumps from his own ego.  Even Federico, our Argentine Heavy Equipment Operator, agrees with that.)

Fortunately, my colleagues on Station could not have been better help.  I’m truly grateful to them all.  But what they couldn’t change was the pain at night, sleeping not more than an hour so at a time, lying awake in the dark with this terrible gnawing hurt in my back and an achy feeling of fatigue in my lower leg which never seem to go away. It was in those inky nights of agony that I had moments of despair, when I would think that there was no way I can go back to practicing medicine like this, not sleeping, in constant pain, not able to get up-and-down, unable to see patients through the fog of hurt.  I questioned what I was going to do for a living if all I couldn’t be up and about, if the BGFE would even stay with me if I had to live like this, and why I wouldn’t blame her if she left.  And I think for the first time, I physically felt my own age.  I won’t say I become obsessed with my eventual demise, but after 60 years this was a wake-up call that something was truly different, and that I might never get better and never be the same person again.

(I was looking through my photos the other day and realized that for nearly a month, I didn’t get outside and I missed the best of twilight.  During the first few weeks after sunset, there’s a wonderful glow over the horizon as the sun continues to sink until nightfall.  But because of my back issues, I didn’t get to go outside and see it in it’s fullest glory.  I’m looking forward to the latter part of August, when I can be outside as the sun begins it’s journey back to our horizon and I can really absorb the beauty and vastness of an Antarctic sunrise.)

It took a bit over a month, but eventually with time and exercise I was pain-free and mobile.  Once I was up and about, I wasted no time in trying to make up for all the things I couldn’t do, and that others had done in my stead.  I mentioned that one of the worst things about the pain was not the pain itself, the fact that I felt worthless. So when I could get up and do things, I wanted to do everything.  I wanted to do all the “House Mouse” cleaning chores, I wanted to do all the trash pulls down to the Beer Can, and I wanted to do more time in the Dish Pit as a way of trying to make up for what I missed. The problem is I didn’t realize other people have that same feeling of wanting to be useful, and when I started to do everything, people became irritated because I was taking away their feelings of being useful.  It took me a while to figure that out.

I am much more physically active now than I ever have been, and if the back pain lit a fire under my posterior to ensure that I can stride and not hobble through the next 30 years, I’ll take that month of pain as a blessing.  Every day I’m doing at least on doing at least 20 minutes slow walking on the treadmill, followed by 30 minutes on an elliptical for fitness. It turns out that slow walking is a pretty good challenge, and it’s a lot more difficult than simply gliding along at a higher speed.  I’m doing this because it was noted that my gait was off and my left foot tends to drag.  I had never realized that, and it’s probably been that way for decades.  But now that I know about it, I can see it when I lay on my back.  My right foot points straight up, while my left could direct one towards Cleveland.  It turns out that one of the best ways to walk slowly, taking time to coordinate the direction of your feet and the motions of your arms.  If you walk fast your momentum simply carries you along, and you don’t really get a chance to work on pace and balance.  (It’s kind of like how riding a bicycle fast is easier than doing so slowly.)  When I first started, there was a lot of discomfort, especially in the front part of the shin, because my foot was now twisting and moving in a different direction as I tried to keep it in line.  That’s much better as well, and while I don’t think the left foot drift will ever go away, I do notice that I walk somewhat better.  I’m also doing the treadmill and elliptical in bare feet, because it turns out that you need to retrain proprioception (your sense of position) to fix your gait, and that’s hard to do that in shoes where your feet really can’t grip the walking surface.

Every other day I do yoga as well.  I like yoga, and I’ve done it off and on for the last several years.  My studio is the Large Conference Room, which is a quiet place where I can turn off the lights and use the Norwegian Flags honoring the Amundsen Party as a point of focus, and where no one can see me trying to contort myself into odd shapes, a sight no doubt made all the more alluring by visions of an old guy doing downward dog in Jacksonville Jaguar pajamas.  (I used to do yoga in the Quiet Reading Room, but they’ve got Christmas lights strung up in there for mood and every time I would raise my arms in “temple hands” I would get caught in strings of blinking bulbs.)

I do Cat and Cow and Pigeon and Ocean-Sounding Breaths to one my instructor’s routines, and even though I’ve heard it a hundred times I still have the same internal argument with his voice.  It’s the debate between the spiritualist and the empiricist.  He talks about long lines of energy running throughout your body; I feel this as pain.  The cracks and pops you which he terms “minor realignments” are signs of arthritis.  I also dispute labels for the poses; one called “Happy Baby,” where you lay on your back, grab the inside of your feet, and spread your legs wide should, in my opinion, be called “Please Violate Me.”  But I do think yoga is a good thing.   I feel better after a good stretch, I’m more flexible, and while I’m still alarmed by whatever parasite that lives in my left hip and makes it snap like Danny Kaye’s fingers in The Court Jester, the first part of a Rice Krispie, I’m able to deal with the fear of whatever I just broke with a guided meditation and few cleansing breaths.

I’ve recently started some weight training, which I need, but I’m horrified by how little weight I can lift. It’s a strange dichotomy, because if I think about it I can stand and lift all 160 pounds of up a staircase, but if you isolate the quadriceps I get fatigued after doing reps at 20 pounds, and it’s even worse with leg curls. Not sure how that works, but I am looking forward to seeing if I can progress over the course of the year.

Thinking about the weight room leads to one of my few really irritating peeves about the polar life.  A number of my peers are fanatical about workouts, and in an effort to increase their protein will eat half a dozen or more hard-boiled eggs every morning.  We only have so many fresh eggs, we’re about to run out, and it’s not even mid-winter.  All I ask are two hard-fried eggs every other day.  So the muscle men have been effectively stealing my future breakfasts when they could just chase down a glass of fake milk with protein powder.  We ration showers; why not eggs?  Or just get us some chickens.  Who’s gonna know?