On Heavy Backpacks and Hernia Belts

It has been a long time since I’ve posted on the OstomyOutdoors.com. Just because I have been quiet doesn’t mean life has been void of adventures. In fact, the reality has been quite the opposite. This has been an incredible year full of many wonderful trips in the wilds. In fact, Doug and I spent the most nights backpacking in the wilderness together this year than we have at any other point in our lives. A total of 25 nights were spent in the backcountry.

The biggest of these trips was a 16-day, 90-mile-long backpack in the Wind River Range of Wyoming in August. What made this trip unique is that it was unsupported; we carried all of our food and fuel with no resupply along the way. This led to us both carrying very heavy loads: our packs on the first day of the trip were over 70 pounds.

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I head out on day one of our 16-day trip with my 70-pound pack. Famous Squaretop Mountain is in the background.
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Only 11 miles to go until camp! I made it, but it was a tough day.

Yes, that is an unusually heavy pack. However, depending on the season, my typical pack weight is still anywhere from 35-55 pounds on mountain trips that are over three days. I am sure all my ultralight backpacking friends are cringing!

Though I have incorporated lightweight gear and packing strategies into my backpacking system, an extreme sensitivity to cold (I am wearing a hat and down jacket in my 68-degree home as I type this) means I must bring a higher-than-average amount of insulating clothing and a very warm down sleeping bag–even in the summer season. I also have Raynaud’s Disease which limits blood flow to my extremities when I am chilled. My fingers and toes become waxy-white and numb and are at an increased risk for cold injury such as frostbite.

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At our Peak Lake campsite, Doug shakes out my 15-degree, 800-fill down sleeping bag. It is a great lightweight bag, but wasn’t warm enough for me on this trip. I had to sleep in every layer I brought along and eventually borrowed Doug’s jacket after several sleepless nights due to being teeth-chatteringly cold. Also, we brought our pyramid shelter which is light but spacious (I dislike being crammed in a tiny tent.) It uses our hiking sticks for a center pole which saves weight. Often we will use the shelter without the inner netting which makes it even lighter. However, on our Wind River Range trip there were too many mosquitoes for that option.
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Our trip in the Wind River Range included many river crossings. The stylish rubbery red shoes I am wearing are Vivobarefoot Ultra 3s. They are lightweight and allow me to safely cross streams without injuring my feet or getting my boots wet (which causes Raynaud’s Disease symptoms in my feet.) They also double as great camp shoes.

Mix the extra weight of these body-warmth necessities with the added ounces of spare ostomy supplies, the bear-proof food storage containers that are increasingly being required on public lands in the west and a few minor luxury items like my sketchbook, and the pounds add up. I am quite sure I am never going to be carrying a 25-pound pack on any trip that is more than an overnighter.

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My sketchbook and small set of watercolors never stays home.
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Our 16-day trip in the Wind River Range involved hiking in black and grizzly bear country so special food storage regulations were in place. The white bags in this photo are called Ursack AllMiteys. They are bear- and rodent-proof and are much lighter to carry than regular plastic bear canisters. Fortunately they were a permitted food storage method in the Wind River Range (they are not yet approved for all public lands.) We brought four Ursacks full of food on our trip plus one additional stuff sack full to hang for the first few nights. It was tough figuring out how much food to bring, but we did well and only went home with a few spare energy bars. We each carried 26 pounds of food.
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My spare ostomy supplies weighed about two pounds. I changed my appliance four times on the trip– once every four days. When it is cold or buggy, I usually change in the tent. Fortunately, my output is fairly thick and things are mess-free if I wrap strips of paper towel around my stoma as I work.
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Here is a close-up photo of my supplies as I work on my change in the tent. Though I only changed four times, I brought enough stuff for eight swaps just to be safe. To keep my supplies as lightweight as possible, I did not bring any closed-end pouches as I sometimes do in case I run into situations where it may be difficult to empty. This meant I was always digging holes (about 70 on the whole trip) including at night and in the rain.

For the most part, I seem to do well as a “pack mule.” For a couple of summers during my late 20s, I worked for the National Outdoor Leadership School (NOLS) instructing 30-day wilderness backpacking courses. We carried monster packs on those trips– something my body seems to have retained the muscle-memory for despite 20 years passing by.  However, one of my biggest concerns when hauling a heavy load– or during any strenuous activity for that matter– is developing a parastomal hernia. So far I have avoided getting one and I would like to keep it that way.

So what do I do to safeguard myself?

First, I made sure to work back into exercise slowly after surgery– especially during the first year post-op. For my early post-surgery backpacking trips, I double-checked my pack weights with my surgeon to make sure it was okay for me to carry various loads. After a while, he said it was fine to listen to my body.

Secondly, I keep my core strong by doing planks and other ab-friendly exercises (once I recovered fully from surgery and got my doctor’s okay, of course!). I also am mindful of not gaining excess weight by eating a healthy diet and exercising regularly. Being overweight can cause pressure against the abdominal wall and increase one’s risk of parastomal hernia.

In addition, Doug lifts my pack up to my back when it is over about 50 pounds. Once the pack is centered on my hips and legs, my core is not stressed at all.

Beyond that, my most important tool is a hernia prevention belt. Though I have heard mixed opinions from surgeons on the degree to which these belts actually prevent hernias, the abdominal muscles around my stoma absolutely feel more supported when I wear it during activities that could be hard on the core. These include backpacking, mountaineering, rock climbing, weight lifting, snowboarding, Zumba, yoga, and coughing/sneezing when I have a cold or the flu! I figure it can’t hurt to stack the odds in my favor by using a belt.

So which belt do I use?

I wanted a belt that provided substantial support for the abdominal wall around my stoma, not just a stretchy band. My WOC nurse recommended the NU-Hope hernia belts so that is the brand I went with. I wear their Flat Panel model in the Cool Comfort Elastic option (shown on page 5 of the Nu-Hope link below.) This belt is designed with prevention in mind and is made of a breathable mesh that works great for activities that work up a sweat. It comes in various widths. I use the 6-inch wide model for most of my activities as I find it the most comfortable. The one exception is for yoga when this size prevents me from bending. Instead, I use the four-inch-wide belt for yoga.

Nu-Hope also makes models with even more support for those who already have a hernia. The belts have a hole for the pouch to extend through that is specific to the size of your flange. If you ever change the wafer size of your appliance, you  will have to get a new belt. Nu-Hope can also make custom belts if the regular sizes don’t work well with your appliance or stoma location.

Nu-Hope has a great online guide for explaining belt sizing.

http://www.nu-hope.com/beltlit.pdf

I also found the Nu-Hope staff to be extremely helpful when I called with questions on sizing before ordering my first belt. Nu-Hope does not sell belts directly. Once you know your  style and size, you order through your main ostomy medical supply company. Also make sure to check your insurance policy as it may cover a portion of your hernia belt.

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Nu-Hope belts come in various widths and colors. Pictured here are the six-inch- and four-inch-wide belts in white and beige in the Flat Panel Cool Comfort Elastic option. Note that the circular portion is sized for your specific flange measurements. Belts come in standard sizes, but Nu-Hope can also make custom ones.
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The Cool Comfort Elastic belt is made out of a breathable mesh and is wonderful for active pursuits.

I only use Nu-Hope Hernia prevention belts, but there are other brands out there. Quite a few manufacturers claim that their products are designed for hernias, but I would suggest checking with your WOC nurse for their brand recommendations. You want to make sure you get a belt that provides firm enough support and they would know which belts patients have had good experiences with.

Even though I love my Nu-Hope Flat Panel belt, I do pair it with a couple of other things to improve its performance.

First, because the width of my waist is smaller than my hips, the belt does tend to ride up to that narrow spot. I remedy this by always wearing my belt under a pair of Comfizz brand High-waist ostomy boxers or briefs. This underwear does an exemplary job of holding the belt in place so it doesn’t shift. In fact, I love these underwear for sports whether or not I am pairing them with my hernia belt. They are also wonderful for concealing your ostomy appliance under form-fitting pants and dresses. Comfizz is a brand out of the UK, but their products are reasonably priced and ship to the USA incredibly quickly. They also have great customer service!

Second, I do get some skin chaffing and soreness from the hernia belt when it is compressed under my backpack hip belt– especially with very heavy loads. I remedy this by sliding some 8″ by 8″ squares of polar fleece in between the hernia belt and my skin. This adds a bit of cushion and prevents friction. Fortunately, the fleece doesn’t make the hernia belt too much warmer to wear, as those areas would be under my thick, non-breathable pack waist belt anyway.

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Pictured are the layers I wear for backpacking when a hip belt can cause extra pressure on the belt and my skin. I wear Comfizz Level-one Boxers over the hernia belt to keep it from riding up. I put a layer of folded fleece between my belt and skin to prevent chafing and soreness.
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Putting on my hernia prevention belt set up before shouldering my heavy pack. All the layers mentioned above can be seen. I also wear a cotton pouch cover to keep the plastic corners of my pouch from chafing my leg. Yes– this is many layers but they are oh-so comfortable!
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This set-up works great for rock climbing too, though I usually don’t need the cushioning fleece pieces without the weight of a heavy pack pressing on my hernia belt.

In the first couple of years after surgery, I used my Nu-Hope hernia prevention belt during all exercise. However, as the years went by and my core got stronger, it felt like overkill for some of my milder activities such as running, cross-country skiing and bicycling. However, I still like some abdominal support when engaging in these sports and found a product I love for them: Comfizz Level-two boxers.  Similar in shape to the regular Comfizz Level-one Boxers, the Level-two have an extra-thick section of stretchy fabric over the abdomen which provides really nice support when I don’t want to wear a full-on hernia belt for less core-intensive exercise. These undergarments are also available as briefs if you prefer that style over boxers.

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On the left are Comfizz Level-one Boxers and on the right are Level-two. You can see the thicker fabric panel on the Level-two Boxers. These undergarments are also available as briefs rather than boxers.

Though there is no way to completely safeguard oneself against a parastomal hernia, these products help me feel much more secure during all my active pursuits. If a hernia or fear of developing one is keeping you from getting out in the wilds, I would encourage you to talk to your WOC nurse and medical team and explore belts and other options that could offer protection.

I am going to end this post with a few more photos from our big trip this summer. Happy hiking!

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Only a mile left to camp! I am tired but happy on day two of our trip. This was one of the hardest with 2,700 feet of elevation gain and a heavy pack.
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The snow levels in the Wind River Range were 200-300 percent of normal. Areas that would normally be snow-free in August were still frozen.
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Doug does a map check on the way to the North Fork of Bull Lake Creek–one of the most remote areas of the Wind River Range. We prefer a traditional map and compass for route finding.
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Doug surveys the landscape from our campsite along the North Fork of Bull Lake Creek beneath Blaurock Pass. This place is breathtaking and is one of my favorite spots in the Winds.
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Testing out my new RockPhone. Too bad the reception wasn’t great at our campsite beneath the Knife Point Glacier. 😉
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The Wind River Range was a prime spot for viewing the total eclipse, but we avoided the crowds by taking in the spectacular event from the base of the remote Knife Point Glacier. We even had our very own two-person eclipse-viewing party–complete with special celebratory trail snacks and a goofy commemorative selfie.
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I ascend the Knife Point Glacier after viewing the total eclipse.
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Is there any place in this range that isn’t spectacular? Here I travel through Indian Basin.
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Doug and I have been to the Wind River Range many times, but had never previously explored the popular Titcomb Basin.
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We are jumping for joy to be in this magnificent Titcomb Basin!
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The peaks of Titcomb Basin, seen from Island Lake, glow in the evening light.
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I stroll through the wildflowers near Clark Lake.
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Doug ascends the pass to the Lozier Lakes. Clark Lake is in the background.
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Doug soaks in the peace of the Porcupine Creek Valley. We saw more grizzly bears (a mom and two cubs) than people during the two days we spent this less-traveled area of the range.
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Doug and I feel the mixed emotions of reaching the end of the trail: happy to have had an amazing trip but sad that the adventure is over. It is always hard to return to civilization after living a life of simplicity in the mountains.
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Patience and progress

It’s as harsh out here as on top of peak in a snowstorm. This thought pounded in my head as I cross-country skied down a slope in my second-ever biathlon. The wind was blowing against me so strongly that I had to use my poles to make downward progress. I was freezing in my minimal layers, and I felt eerily alone on the course with no one in sight and snow swirling all around me. The weather was declining rapidly, and I was relieved to be on my final of five laps.

In the distance I could see the biathlon range as I steadily made my way up a final incline. Snow was filling in the trail with drifts, and I felt like I could have walked faster than I was skiing. All that powder would have been much beloved if I were out snowboarding, but I didn’t much appreciate it in a Nordic race. As I got closer to the finish line, I could see the person recording times from a stopwatch. It seemed to take forever for me to reach him. But I finally made it! I finished the race and was super happy that I stuck with it and did not give up. I couldn’t remember doing anything that felt so physically strenuous– not even hiking up Mt. Rainier. Skate skiing is one of the most aerobically intense activities I have ever done.

Happily leaving the starting line before the wind and snow picked up.
Happily leaving the starting line before the worst of the storm blew in.
I could barely stand up in the wind after shooting in the prone position. Miraculously, I actually hit four of five targets!
I could barely stand up in the wind after shooting in the prone position. Miraculously, I actually hit four of five targets at 50 meters away!

We wrapped up the weekend with more fun. After completing the race, we stayed overnight at Snow Mountain Ranch/YMCA of the Rockies (the place where the biathlon was held) and even hit up the climbing wall in the pool. The next morning, we got up early and drove to Copper Mountain to go snowboarding.

A little post-race climbing at the pool.
A little post-race climbing at the pool.
Powder day at Copper Mountain!
Powder day at Copper Mountain!

When the event results came in a day later, I discovered that I had the slowest pace of anyone who finished any of the various distances. It wasn’t a surprise. This is a new activity for me and I didn’t expect to be good at it right away. I had been working on my shooting a bit, but had put very little attention into becoming better at skate skiing. That changed last weekend when I took a beginner lesson and picked up countless tips that will help me improve. I also plan to begin working on my cardiovascular fitness again by running and going skate skiing as much as I can. I know it is going to take a lot of time and many little steps to get better at the sport.

That reminded me a lot of getting back into the fitness activities and sports I loved after ostomy surgery. Like training for biathlon, it wasn’t a quick process. One of the most common questions I get from blog readers is how long it took me to get back to “X” activity. Since a lot of information on that subject is buried in other posts, I thought I would create a summary of how long it took me to return to activities and what some of the challenges were. Keep in mind that I did have some significant complications with my abdominal incision healing due to a rare reaction to my particular suture material. This extended my healing time.

Snowboarding:  I did this activity for the first time at around five months post-op, but because it was the end of the season, I was only able to get a few days in. I was surprised at how effortlessly the movement of boarding came back to me after losing so much strength after surgery. The most difficult part was getting back into a standing position after taking a tumble. Due to the crunch-like movement involved, it felt hard on my core. I wore (and still wear) a six-inch wide hernia prevention belt to help support my abdominal muscles. At first I was also careful to not venture onto icy terrain since falling onto my butt hurt the area where my anus had been removed. By the next season (about a year post-op), all that pain was gone and I was able to return to my pre-surgery level of boarding.

Getting up after all the falls on my first post-surgery snowboarding trip was tough on the abs!
Getting on my feet during my first post-surgery snowboarding trip was tough on the abs!

Hiking and backpacking: I went on my first backpacking trip at around five months post-op as well. I checked with my surgeon to make sure carrying 25 pounds was okay and then headed into the backcountry at the first opportunity–which happened to be a very cold and snowy April weekend!  Once again, I wore a six-inch wide hernia prevention belt and was mindful to keep the weight in my pack light. Doug carried many of my things and helped lift the pack onto my back. Once it was centered on my legs, it didn’t strain my abdominal muscles at all. The cold made this first trip with my ostomy difficult, but I was happy with the extra challenge. I knew if I made it through that, warm weather adventures would be easy.

After this trip, I kept hiking every weekend and slowly upped the distances traveled and amount of weight carried. I went on a few more overnight trips and began hiking 14,000-foot peaks. I remember walking like a turtle on the first one, but I just kept at it. By ten months post-op, I was able to go on an eight-night backpacking trip carrying 52 pounds.  Through all these adventures, I was continuously experimenting with supplies and techniques for dealing with my ostomy outdoors and I tried to put myself in challenging situations to maximize my learning and face my fears. For instance, I could easily have changed an appliance before a wilderness trip, but instead I would purposely wait to do it in my tent in the backcountry just so I could get the practice and become confident with my ostomy in those situation.

A little snow couldn't keep me out of the backcountry once my surgeon gave me the go-ahead to carry a pack again at 5 months post-op.
A little snow couldn’t keep me out of the backcountry once my surgeon gave me the go-ahead to carry a pack again at 5 months post-op.

Running: I waited seven months after surgery to go running and I progressed really slowly. For whatever reason, this activity made me much more fatigued than hiking or backpacking. I also had pains in various areas of my abdominal wall (almost like a stitch or side-ache in the muscles surrounding my stoma) for almost a year after surgery. I never knew exactly what caused this, but it always felt okay again a day or two after running so I chalked it up to muscle fatigue. After all, I had been cut open from belly button to pubic bone. That is bound to affect the abdominal wall a bit! Eventually those muscle aches went away and now I am able to go on long runs with no discomfort. I also wear a six-inch wide hernia prevention during this activity to help support my abdominal wall.

Jumping for joy on my first trail run which happened a little over a year post-op.
Jumping for joy on my first trail run which happened a little over a year post-op.

Rock climbing: This is the activity I took the longest to return to. Climbing involves many twisting and stretching movements and a lot of physical exertion. My surgeon never said I had to wait a year to go, but that is what I decided to do in order to give myself plenty of time to heal. I knew my ostomy was permanent and I wanted to do everything in my power to reduce the possibility of a long-term injury like a parastomal or incisional hernia. I was willing to wait as long as it took for my body to tell me I was ready. In the meantime, I worked on hiking and backpacking so it never felt like I was sitting around waiting to climb. To get stronger while I was waiting, I worked with my physical therapist to strengthen my core with gentle and safe exercises. By eleven-months post-op, I finally felt that I was strong enough to rock climb. I started in the gym by ascending routes that were easy and low-angle. Then I started to do the same outside. Over the following year, I slowly bumped up the difficulty of routes I was attempting and ventured onto more vertical terrain. At 22 months post-op, I led my first easy sport route. Now that I am over three years out from surgery, I am climbing in the gym on a weekly basis, doing overhanging routes and am back to scaling rock walls at my pre-surgery level. The only thing that I have yet to do is return to leading traditional routes where I place my own gear. Just like with every other strenuous activity, I always wear a six-inch hernia prevention belt.

Leading a climb at Shelf Road in Colorado this fall. I was back to leading sport climbing routes 22 months after surgery.
Leading a climb at Shelf Road in Colorado this fall. I was back to leading sport climbing routes 22 months after surgery.

Yoga: Like rock climbing, I waited a year to do yoga. I know I could have gone earlier, but I was busy working on the core exercises with my physical therapist and decided to wait to try yoga until my incision area felt solid. Interestingly, I found corpse pose to be one of my most uncomfortable poses. Lying on my back made my incision area ache like crazy. I think this was the result of horrible posture during the first four months after surgery when my incision was extremely painful. During that time, I was protective of the area, and I found myself walking in a hunched-over position. It took a while to reverse that and make my muscles to feel okay with being lengthened again. Nowadays, corpse pose feels fine and the only thing I still have trouble with are bridge positions. My body tells me to go easy on those and so I do!  I wear a hernia belt while doing yoga too, but switch to a four-inch model as it is easier to bend with that width.

Bicycling: This sport was gentle on my body and would have been perfect after surgery save for one thing: my butt hurt from having my rectum and anus removed. And this pain was not quick to go away. It took almost a year for the deep muscles in that area to feel like normal again. Fortunately, once I hit six months-post op, my pain had at least diminished enough that I could sit on the seat without too much discomfort. Now I can spend hours on the saddle with no issues.

My first bike ride at six months post-op: a short jaunt to see a Rockies game. It did hurt my healing butt a bit, but was tolerable.
I took my first bike ride six months post-op when Doug and I pedaled a short distance to see a baseball game. It did hurt my healing butt, but was tolerable.

As I get into my new sport of biathlon, I realize that it is going to take a lot of hard work and patience to get better. I know someday when I am skiing a bit more efficiently and faster, those early times when I struggled up the hills or felt like taking a nap in the snowdrift will seem like a distant memory. It was that way with my ostomy. Getting back to my pre-surgery activity level took perseverance.  My progress sometimes seemed dauntingly slow. However, as I moved towards that goal, I celebrated each small victory. Before I knew it I was back on my favorite slopes, trails and rock faces and my life was richer for all the tiny but amazing steps that got me there.

“It is good to have an end to journey toward; but it is the journey that matters, in the end.”
-Ernest Hemingway

Me and my wound vac going for our first trail hike after surgery. I traveled a whopping 1/8 mile and I was thrilled. After having major incision healing complications, this was a huge milestone for me and I went home and celebrated with my first post-op beer.
Me and my wound vac returning from our first trail hike after surgery. This was four months after my operation and I traveled a whopping 1/8 mile. After having major incision healing complications, this was a huge milestone for me and I went home and celebrated with my first post-op beer.

Back to climbing

“The scariest thing for me through this whole ordeal has been the rapid weight loss over the past two weeks. My muscles are gone and when I squat down to the floor to pick something up, I can barely get back up. I feel like I am doing the hardest move on a rock climb just to do some simple movement. I try to do a couple walking laps in the hall everyday to stay strong and keep my legs moving. I just want to be healthy and well again.”

Around this time last fall, I emailed the above update to a couple of good friends while I was in the hospital with my UC flare. I was so weak that it was difficult to do even the most basic things, like stand in the shower or walk up the stairs. I seriously wondered if I would ever be strong enough to rock climb again.

Last night, thanks to the health I regained through surgery, I made my first trip to the rock climbing gym in over a year. At first it felt foreign to put my harness on and tie my figure-8 knot, but once I placed my hands and feet on the holds and began ascending the wall, the movement felt natural to me.

On my first route in over a year

Continue reading “Back to climbing”

Pacing Yourself After Surgery

One of the hardest things in recovering from surgery and getting back into outdoor activities is knowing how to pace yourself. There are times in the months after surgery when there are clear lifting restrictions and guidelines, which provide easy-to-understand parameters for your activities. However, once those restrictions are lifted and you are feeling ready to get back to your normal sport routines, the path isn’t as clear.

Though it may seem like I am doing a lot of outdoor activities since surgery, I have paced myself very slowly. I started out with many short walks. When those felt good, I moved on to longer and steeper excursions. On the hike to Mt. Elbert covered in this video, my legs got extremely tired on the hike out, and I thought perhaps I had overdone it. Still, within three days, my sore muscles had completely recovered–a sign to me that the hike, though strenuous, was not at a level that pushed me too hard. By the next weekend, my muscles were feeling great and ready for a new adventure.

The following is a list of additional things that I am doing to prevent injury:

  • I always wear my Nu Hope hernia prevention belt when I do any outdoor activity beyond a short, flat-terrain day hike when I am carrying no significant weight (say 10-15 pounds).
  • I have my husband, Doug, help me lift my heavy backpack on to my shoulders. Once it is resting on my hips, I am better able to handle the weight without straining my abdominal muscles.
  • I use hiking poles to help with my stability as I get stronger.
  • I leave for hikes extra early to allow myself the ability to hike at a slower pace with more frequent breaks.
  • I pay very close attention to my body. So far I haven’t witnessed anything more than normal post-workout muscle aches. However, if I feel something more significant, I will back off and give my body more time to adjust to the next level of activity.
  • I am working with a physical therapist to strengthen my core muscles using very mild and low-impact exercises that are safe for the level of healing I am at.

My goal for the fall is carrying out a week-long backpacking trip with a few peak ascents. Hopefully with my training regime, I will be ready for this challenge.