MUSHING INJURIES: A CASE STUDY

Much has been written about preventing and treating sled dog injuries. Less is written about injuries to mushers. This article is a slightly graphic, and perhaps somewhat jocular, look at the mushing injuries of a perennial Iditarod racer, Jim Lanier (pictured). The SubjectJim is 66-years-old. He began mushing in 1977 and ran his first race of any kind, the Iditarod, in 1979. Since then Jim has run and completed ten more Iditarods, the Hope Race in Russia, and numerous other mid-distance races. Underlying all of Jim’s mushing accomplishments is the fact that in his early 20s, he was diagnosed and has been treated ever since for ankylosing spondylitis, an arthritic condition commonly know as “poker spine.” Agony of De FeetIn the 1999 Iditarod Jim left the Rohn checkpoint after dark setting out on the 90 mile trek to Nikolai. Though Jim did not know it, the temperature had plunged to -40° F that night. “We crossed an open creek. It was almost knee deep,” recalls Lanier. “After wading through the creek, I was going to stop to change my boot liners, but my feet didn’t feel cold so I just kept going.”The next morning, about ten hours later, Jim and his team arrived in Nikolai. He fed his dogs and went about his customary dog chores. Inside the checkpoint, Jim pulled off his boots to put on fresh socks. “Oh my God!” Jim exclaimed. His feet looked burnt, horribly blistered and red. The big toe on his right foot was in particularly bad shape. “As soon as I saw that foot, I knew that big toe was no longer a part of me,” recalls Jim. Despite his frostbitten feet, Jim pressed on and completed the Iditarod in just over 13 days.In the weeks after the race, the big toe on Jim’s right foot turned black and gangrenous. After about 6 months, a line of demarcation formed between the live and the dead tissue, and the toe was amputated at that line. Since this incident, Jim’s feet have been extremely sensitive to cold. Jim now uses chemical heaters in his boots whenever the temperature drops below 0°F. More Agony of De FeetAs fall training began to ramp up in 1996, Lanier went out on an ATV to scout trails. A dog team suddenly came around a corner and met him head on. To avoid hitting the oncoming leaders, Jim swerved and crashed off the side of the trail. “My foot ended up between the machine and a boulder,” explains Lanier. He knew that there was a problem when he “heard a grinding noise” that seemed to come, not from the machine, but rather from his foot. Jim righted the ATV and rode home. He went to the hospital, and an x-ray showed he had fractured his right ankle. Even More Agony of De FeetIn the 2005 Iditarod, Jim was about an hour out of the Rohn checkpoint, just past the glacier and buffalo tunnel. “My sled was lurching over the uneven, snowless ground when I put my foot out on a frozen tussock to brace myself.” There was pain in Jim’s eyes as he described how his foot rolled under his ankle and he heard a distinct “pop.” Jim recalls, “It felt like someone had clubbed me in the ankle with a baseball bat.” Luckily, Jim was able to summon Ray Redington to help him stop his team. Jim told Ray, “I think my ankle is broken.” Ray encouraged Jim to camp and evaluate the injury. But Jim knew that his pain would worsen if he waited. He told Ray he had to keep going before the ankle “gelled.” Almost 800 miles from Nome, Jim struggled on. He made it to Nikolai where he took his 24-hour layover. Jim called an orthopedic surgeon friend and explained what had happened. The surgeon told him that if he could bear weight on the ankle, it probably wasn’t fractured. “I’d go for it!” advised the doctor. Jim went for it. “The snow was really deep that year, and I floundered around trying to feed and bootie the dogs,” said Lanier. The trail had deep ruts from snow machines that were narrower than his sled. A runner kept falling into the ruts. “I crashed dozens and dozens of times and re-injured that ankle over and over again.” Jim has an amazing tolerance for discomfort, so when he says “the pain was almost unbearable,” he means it. Jim continued on and finished the race in just over 12 days. An x-ray taken after the race showed a fracture to Jim’s left ankle. “In retrospect, I probably should have scratched,” concedes Lanier. Two years later, that ankle is still stiff and there is an occasional, mild pain.Cold FingerIn 1985, Jim ran the Cold Foot Race in the central part of the Brooks Range. Before the race, his handler gave him a pair of Fagin gloves (named after the fingerless gloves worn by the conniving career criminal in Charles Dickens’ classic novel Oliver Twist). To Jim the gloves seemed like they would be handy for mushing because they would keep his hands warm, yet his fingers would be uncovered so he could nimbly perform little tasks like putting on booties. As you might expect for a race called the Cold Foot, it was cold. The first night the temperature dipped to -45°F as Jim prepared to feed his team. Back then, the state-of-the-art dog food cooker was a Coleman stove fueled by white gas. Jim held a small funnel with his left hand as he poured white gas into the camp stove’s fuel tank with his right hand. During the process, a small amount of the white gas spilled onto the first two fingers of Jim’s left hand. At the time, he was wearing only the Fagin gloves. Jim completed his dog chores, rested his team, and continued down the trail unaware of any problem with his hands. At the next checkpoint, Anaktuvuk Pass, Jim pulled off his mitts and immediately recognized that he had a big problem. “My fingers were red, blistered, and horribly swollen. I knew the the ends of those first two fingers were gone.” Jim realized that the little splash of white gas at -45°F had flash-frozen the flesh. By phone, Jim consulted a frostbite specialist who advised him to scratch from the race and go straight to the thermal burn unit in Anchorage. Jim lingered around the checkpoint for six hours until he saw former Iditarod champion Joe May preparing to leave. “I told Joe that I’d really like to go on with him and asked him if he’d help me hook up my team.” That was one of several tasks Jim could not perform with his frostbitten fingers. Joe agreed and the two headed out onto the trail. Jim finished the final 200 miles of the race with a big mitt on his left hand. Twenty-two years later, Jim recalls that the biggest problem with having severely frostbitten fingers was his inability to undo the various zippers necessary to go the bathroom. Meanwhile, as a courtesy, the Anchorage thermal burn unit called Jim’s wife to reassure her that they would keep the unit open until Jim arrived. She appreciated the fact that the hospital was so accommodating in this time of need, but was dismayed to learn that Jim had the injury. Jim had neglected to tell her anything about it. Her dismay grew when she learned that Jim had continued on with the race rather than seek medical treatment. Six months later, a doctor amputated the tips of two of Lanier’s fingers. Before they were amputated, the ends of Jim’s fingers were jet black, like they had been dipped in ink. Jim says that “ever since that race, my fingers on that hand have been extremely sensitive to the cold. I always have to have hand warmers in my mitts and wear gloves to bootie the dogs.” As kind of an afterthought to the whole Cold Finger story, Jim mentioned that the frost bite wasn’t his biggest medical problem during that race. “By the end of the race I couldn’t even walk. At the finish line I needed to be carried from my sled to the headquarters building.” Jim had developed severe bilateral plantar fasciitis, an inflammation of the fibrous tissue on the bottom of his foot connecting the heel to the toes. This is an affliction that has plagued Lanier, off and on, ever since.Morton’s NeuromaIn the 1990s Lanier developed a Morton’s neuroma, a thickening of the tissue that surrounds the digital nerve leading to his toes. This condition develops as a result of trauma, irritation or excessive pressure and is typically found in women who wear high heeled shoes. People with a Morton’s neuroma experience burning pain in the toes and ball of the foot that intensifies with activity. “My continued racing aggravated the Morton’s neuroma,” said Lanier. “It was the boots. After being out on the trail, it felt like my toes were in a vice.” Eventually, he had the neuroma surgically repaired. The Duct Tape CaperDuring the ceremonial Anchorage leg of the Iditarod, mushers are allowed to have a second sled, commonly referred to as a “whip sled.” In the 2003 race, Jim’s wife was riding in the second sled and got whipped into a large tree. This abruptly stopped the team. Jim was catapulted over his handle bar and landed, apparently, unscathed. Everyone got back on the sleds and finished the run. At home that evening, Jim took off his insulated mushing pants and found his long johns were soaked with blood. Upon further investigation, he discovered a 3” gash in his left groin. “The cut was so deep that fat was pouching out of the wound.” So Jim proceeded to his local emergency room where a doctor carefully closed the wound with 25 stitches and a large bandage. The doctor cautioned Jim to “take it real easy for the next few days.”“Almost immediately, the bandage fell off,” Jim recalls. “The groin is a hard place to make something stick.” Knowing he faced the Iditarod restart in just a few hours, Jim found his solution in a roll of duct tape on his garage workbench. “To protect the wound, I duct taped my entire pelvis. It looked like I was wearing a silver swimsuit. I wore that thing all the way to Nome.” The wound was well protected, but there were certain drawbacks. “It isn’t very comfortable to wear a duct tape swimsuit for 11 days. I don’t even want to talk about how hard it was to finally peel that thing off in Nome,” Jim said matter of factly. Rib FestIn 2006, Jim finally completed the Iditarod without any notable injuries. In the weeks after the race, the ground in his dog yard was extremely slippery due to an extended period during which the snow covering the ground would thaw, then refreeze. While cleaning the kennel, Jim lost his footing, slipped and fell onto a plastic poop bucket. “I fractured a rib, and it took me six weeks to recover,” recounts Lanier. All His Troubles Are Behind HimA recurring mushing injury Jim has dealt with over the years is hemorrhoids. The strain of standing on a dog sled for days on end in somewhat unsanitary conditions, and of being so physically worn down, often results in this uncomfortable condition. “With my new sit-down sled, I hope this problem is all behind me,” quips Lanier.More Hand ProblemsJim has degenerative arthritis in his hands. He attributes the genesis of this affliction to an incident back in 1979 during his first Iditarod. “I was crossing the ice on Norton Bay and my hands got unbelievably cold,” recalls Jim. “My right hand became so swollen that I couldn’t close it.” Jim thinks the degenerative arthritis is related to that cold, as well as to all the other hand traumas he has sustained over the years of working with his dogs. Now before each Iditarod, Jim has his knuckles injected with cortisone, a steroid. This is not the kind of steroid that some professional athletes reportedly use to enhance their athletic performance. Rather, cortisone is a powerful anti-inflammatory medication used to reduce pain and inflammation in diseased joints. Mental TraumaLong-distance sled dog racing can be punishing mentally as well as physically. In the 1979 Iditarod, Jim was “riding high” until he reached the now defunct Farewell checkpoint out in the Burn. There Jim experienced what he describes as a complete physical and mental collapse. He suffered from a paranoid delusion that all the other Iditarod mushers had lost their minds and, sadistically, they wanted him to finish the race so he would lose his mind too. Jim planned to foil those “mad mushers” by scratching from the race. It made perfect sense to him at the time and, looking back, it still kind of does. “My mental problems were possibly related to severe dehydration, and I kind of snapped out of it after some rest and liquids in McGrath.” Jim went on to finish the race in just over 24 days.On other races Lanier has experienced auditory hallucination of sounds and voices. “They come from dehydration and lack of sleep, but the sounds can seem pretty real out there in the middle of the night,” notes Lanier. “After a while, you learn to ignore the strange voices in your head.” Trail Weary Jim tries to deny that age is an impediment on a long race like the Iditarod. “When I get to the end of an Iditarod, I’m totally wiped out.” Jim figures it takes a day of recovery for every day on the trail. “If I ran an 11-day race, I would never go back to work for at least 11 days after the race. Your sleep is abnormal, your dreams are abnormal and your thought process is abnormal—for a while.” A New Twist on an Old ThemeIn some ways the first three quarters of the 2007 Iditarod was a magical ride for Jim. He led the race into Skwentna. At Ophir, he was still running with the likes of Jeff King, Martin Buser, Zack Steer and Robert Sorlie. During the first half of the race, Jim managed to avoid many of the sled-smashing and bone-breaking crashes that plagued other racers. He had gotten ahead of the storm that shut down Rainy Pass. “Until I started making long runs after Ophir, my team was screaming down the trail,” recalls Lanier. “It was fun!”Along the trail, Jim developed blisters on the heels of his feet. “My feet were painful running up the hills. I didn’t look at them; I just kept putting more and more duct tape on the blisters,” says Jim. By the coast, Jim’s feet were getting progressively more painful. Even by the standard exhaustion one experiences in the latter stages of an Iditarod, Jim was not feeling well. Something was wrong. “I stayed in Elim for four hours when I should have kept going.” In an understated tone, Jim said, “I was feeling really poor at that time.” The run from Elim to White Mountain was excruciating for Jim. “Running up Little McKinley and all those other hills on that heel was brutal.” At White Mountain, Jim tended to his team and then laid down to sleep. After 10 days on the trail, he was not able to sleep. “I felt lousy and cold.” Even inside and warmly dressed, Jim could not warm up. He couldn’t understand why. He called his wife, and she encouraged him to keep going since he only had one more run. So Jim slapped a little more duct tape on his heel and kept going. Lanier left White Mountain at around 8:30 p.m., so the run to Safety was in the dark. Jim struggled through the Topkok Hills. At some point he passed a cabin with a light inside and became confused about his location. Eventually, Jim decided he was no longer on the trail when his team headed out onto a gravely beach. So Jim turned his team around and headed back into the Topkok Hills. “Honestly, I have no memory of going back through those hills that second time. It was a big blank. I was mentally confused. I lost lots of time backtracking.” Finally, in a lucid moment, Jim realized that he was going the wrong way and turned around again. For the third time, his team ran through the Topkok Hills. “After that, all the plastic ripped off my runners, and I pushed the sled along on a wing and a prayer.” Seven teams passed Jim between White Mountain and Nome.Dazed and confused, Lanier straggled into Nome in 27th position. Almost immediately, Dr. Paul Steer, father of 3rd place finisher Zack Steer, examined his heel. Under the duct tape was an awful bloody, pussy lesion that covered his entire left heel. Jim’s lower leg was noticeably swollen and red. He had large, painful lymph nodes, and ugly red streaks running up his thigh. Dr. Steer diagnosed Jim with ascending lymphangitis, more commonly known as blood poisoning. Untreated, Jim’s condition carries up to a 20% incidence of mortality. And the big toe on Jim’s other foot—the one with all the toes still intact—was black from frostbite. Even after three weeks of antibiotics, whirlpools, bath treatments, and topical ointments, Jim was still unable to walk or put weight on his left foot. Final ThoughtsAlready the oldest musher in the 2007 Iditarod, Jim Lanier says he plans to continue running the race for another eighteen years (until the year 2025). His ultimate goal is to break the late Norman Vaughn’s record for being the oldest man to run in the Iditarod at 84-years-old. His injuries have, however, taken a toll. It is debatable whether Jim will first break Norman’s age record or run out of toes trying. With a little luck and a lot of duct tape, Jim may just be the first 85-year-old to cross under Nome’s burled arch in March of 2025. Clearly, mushing is fraught with risks. Bad things can happen very quickly. Hopefully, others can learn from Jim’s experiences. Mistakes are more likely to occur when one is extremely sleepy, hungry or dehydrated, which are prevalent in distance racing. It is important to carefully plan for all expected contingencies and then follow through with those plans no matter how poorly (or well) things are going. At the same time, the glass is not half empty. Despite the injuries and setbacks, Jim attributes mushing with keeping him in excellent physical condition and holding the many of the maladies of age in check. Gunnar Johnson is an accomplished musher and outdoor writer who, although he does not own sled dogs, continues to race and be involved in the sport of mushing.

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