As I spend more time looking back on the past year and all the wonderful experiences which I am grateful to have had I chose a few to share with you. I give all of myself to my work and I give all of myself to the breaks I take from it. Whenever possible I take those breaks in our nation’s National Parks. This year I was able to visit part of the grand circle from Southern Utah to the Canadian border. I thought I would share some of my favorite memories in the hope that many plans will be hatched on your part for road trips and camping trips in the coming year.

Glacier National Park is our first stop!

Grinell Lake

Earthquake Lake

A massive park which spans from Montana into Canada and includes a great man lakes surrounded by the dramatic elevation changes of the Rocky Mountains.

Views of the Highline Trail

Bowman Lake

In Glacier National Park the high elevation grants the opportunity to see mountain goats and sheep on the trails and parking lots. I especially the picture of the male Ram looking with distain at the park Chevy pickup truck!

I will be heading out to spend time backpacking in Montana, Wyoming and Idaho for a few weeks. Please use the online scheduler to book your appointments now for the week I return. Happy 4th of July!

I often recommend patients make a real effort to get up and move more during their day. We spend so much of our lives now sitting at work, in the car or at home. It seems natural to us at this point in our development as a modern society that this should be the natural way to both work and rest. With all these comfortable chairs and couches around why expend the effort to stand. Ask anybody who has gotten their HR department to pay for a standing desk and you will hear why. Our bodies were not made to be sedentary. They were designed to walk and move and even crouch at times when we needed to work with our hands. It was not designed to sit for hours on end at the computer or steering wheel on even fully reclined at home in front of the TV. It is nearly impossible to keep a good posture during any of these activities and so taking a break and moving can be a beneficial way to improve our circulation, posture, and joint health. I saw this great short film on the TED Videos site and I think it does a great job of articulating why we need to get up and move, not just a little bit from time to time, but as much as possible during our day.

This past memorial day I set out to hike the Lost Coast Trail In Humbolt County. My original plan of a high sierra loop in Yosemite was snowed out so I thought this would be a good alternative for a remote experience. It had the added benefit of being extremely hard to get too! This would allow for some new driving experiences along the remote sections of Highway 1 and the chance to explore all the facets of car sickness. The adventurous driving starts when you turn west at Garberville and enter the King’s Range of mountains. I was so impressed by their size and length. It had much of the feel of being in the Sierra Nevadas but with gorgeous views of the Pacific Ocean extending out beyond the Pine forest.

It takes over an hour to drive the twenty something miles to Shelter Cove where the trail head for the Lost Coast starts from a long black sand beach. We could leave our car here and take a shuttle service to the other end of the trail at Mattole Beach and be able to hike back south to our car over about 28 miles of beach, bluff, and tide pools. Even though the distance was relatively short I found the hiking to be challenging on the sand. It felt like half of all the energy used was lost with each step. With several sections of the trail impassable at high tide it took a bit of planning to cross when the tide was out and not dawdle in the tide pools where one could get stuck.

It was a bit crowded due to the holiday weekend and growing popularity of the trail but all the groups seemed to spread out and respect each others desire for the sense of wilderness. There was plenty of fresh water from creeks along the trail purify and many places to set camp on the beach where you could have stunning views and a chorus of Sea Lions singing you to sleep each night. It was a wonderful adventure and I would recommend everyone to take some time and go north into the wilder parts of our great state. You don’t have to do a multi-day hike either, just go, explore, feel the wind and the fog and rediscover that the Bay Area is hardly Northern California at all.

I arrived in Chalten, Argentina, after a short three hour flight from Buenos Aires to Calafate. followed by a two hour bus ride to the mountains. Maybe I shouldn’t say ‘short’ since there was also the three hours waiting for the bus transfer but that was nothing after our flight to Las Vegas, overnight in the hotel, seven hour flight to Panama City, EIGHT hour layover in the airport before flying another seven hours to Buenos Aires! Well, might at well count the hour plus taxi ride from the airport to the hotel either…so give or take three days from home to hostel.

Chalten is a small collection of hostels and houses surrounded by large mountains which rise steeply from the grassy valley floor. A large river of glacial water flows through the valley and gives the town the feel a wild wet boomtown. Chalten was created in the 80’s by the Argentinian government in the land rush to develop the mountain trekking and climbing industry for future tourism and its mix of hotel styles from Swiss chalet to American west lodge shows the varying origin of its early investors.The town only has about 5,000 permanent residents but is swarming with summer workers guiding treks, backpackers from every part of the world and the much more hardcore crowd of climbers there to attempt summiting the massive Mt. Fitz Roy and Cerro Torres massifs. I was surprised to learn that the border with Chile in this area was only established in the last few decades and in some cases is still fluid along the great Patagonian Ice Field and southern fjords.

The two main hikes from the town to the towers of Fitz-Roy and Cerro Torres can both be done in long day trips but we chose to do a three day circuit with two nights camping near the lagunes at the bases of both towers. There was a surprising amount of forested area filled with white birch trees called “Lenga” in spanish which are nearly the only tree that can grow in the climate. The height of the forest was 25-30 feet at most but do to the extreme weather conditions of Patagonia they can take hundreds of years to reach this height. The wind blows constantly there and ranges from mild 20 mile an hours breezes to 60-80 mile an hours for prolonged periods. Some days the wind was so strong that it was challenging to walk and we had one friend who had to spend one whole day laying down on the ground due to the wind speed. The fact that the forest floor was littered with large branches and snapped tree trunks was not lost on us as we hustled along the trail. Nights in the tents under those trees was slightly apprehensive as you heard the wind start high up in the mountains before coming down half a minute later and roaring through the campsite before violently shaking the tent.

Both nights we were able to see the summits of the main massive, during the day as well as the twilight hours, which are not until 11pm this time of year. Sunrise coming at 4am each day. At the base of Fitz-Roy we were lucky enough to see the twinkling lights of climbers headlamps on the face of the mountain as climbers continued into the night or set up tents on small ledges to sleep halfway. Our guide told us that it can take 2-3 days to reach the mountain. Each person carrying their own food, clothing and gear which can reachup to 140 pounds. I got a very small taste of the difficulty when we had to cross over a glacial river by suspended rope without the assistance of a pulley. I cannot imagine doing the full trek across the glacier with that weight.

Chalten was a first start for our trip and it fulfilled our expectations to the fullest. The hikes were mild with warms days despite the wind and we were well prepared for the nights with our first bottles of Argentinian Malbec wine. After our warm up of three days we were excited to move on to the big 7 day trek in Chile that awaited us next.

When we arrived in Puerto Natales, in Chile, we were very happy to find continued good weather and a open laundrymat waiting for us. The bus ride from Argentina had been a long ride with a tremendous wait at customs. I think “3 hour bus ride” in Argentinian translates to “8 hour ride” in English. We were eager to go out and check out our new town and were starving after the extended ride. Our streak of stumbling into great restaurants continued and we filled up on one last meal of vegetables before heading out into the world of camp food again. Luckily with it being Summer down there the produce was exceptionally good and nearly identical in selection to what is available in California in the opposite months. So yay Avocado!

The next morning we started out early with our new group of trekking friends. One Frenchman, two women from London, and one women from Singapore plus a transplanted Columbian guide. It was a veritable World Cup of a nations! Our first day took us by bus into the Torres Del Paine National Park, passing many Guanacos, (Lama cousins), Andean Condors, and millions of imported wild Hares (being eaten by the Condors). We set up our camp and climbed the first valley to see the towers of Torres del Paine and the lagoon beneath.

In the following days we passed on through the Enchanted Valley, which lived up to its name, covered in a sea of daisies, and full of aquamarine lakes and free roaming horses belonging to Gaucho horseman living nearby.

Our camp at Glacier Dickenson had a brilliant blue river running out of the ice which made for a perfect swim to freshen up after the hike and to escape the mosquitos for a bit.

We continued on through days three and four through 300 year old forests of birch, battling mountain passes and roaring winds, and on to the base of the John Gardner Pass, our most challenging day. There we would walk to through a steady rain, snow fields and broken talus fields before reaching the 4,500 foot summit. Though the wind and cold were too severe to linger at the top the descent showed us the full view of miles and miles of the South Patagonian Ice Field which is the third largest reserve of freshwater in the world after the ice reserves of Antarctica and Greenland.

We crossed large ravines by ladder, a terrifying experience in the high winds with a sixty pound pack on, and over suspension bridges before reaching our final camp at the end of a long day. It was December 24th and all of the camp, some few hundred people, gathered at the Paine Grande campground for a dinner and party which went into the night as if it was New Years Eve.

Our last day we climbed the final part of the trail at the French Valley before sailing back to our start on a Catamaran across Lake Pehoe with all the Paine massif before us. It was a grueling 7 day trek but one that formed new and hopefully lasting friendships across the world.

For the last four days of my trip I sailed by boat from the Chilean port of Punta Arenas through to Ushuaia. Along the way we stopped at a colony of Magellanic Penguins and Cormorants. While we were not able to exit our Zodiac boats but when we approached the shore the small birds in tuxedos cautiously approached us for a closer look. They cannot see very well out of the water and came right up to the edge of the water and swam in passed us.

We hiked on the Island of Tierra Del Fuego, the largest in South America, and came close to a whole variety of glaciers both hanging from mountains and entering the sea. Our ship docked in the bay of Cape Horn and we landed on the point at the southernmost tip of the continent. Antarctica was so close and yet out of reach! Next time, next trip, all the way to the pole!

It is especially important to make sure and spend an adequate amount of time outdoors during the Fall months. With many of us now arriving home from work after it is dark each day it can become challenging to find the time to fit in a walk in the neighborhood or a hike on the trails. In this colder weather it can be very alluring to stay in for the football game on our days off, choosing warmth and comfort, and maybe an afternoon nap, over braving the wind and rain outdoors. I too feel the increased effort it takes to head out the door when I know I will be greeted by a cold wind in my face. But, the trade off I often find is that I am one of the only people who made it out of the house that day. What was a crowded trail or city street on a warmer day can now be had almost entirely to myself which enables a greater connection and focus on the natural world around me.

If the grey weather still feels a bit foreboding to you maybe drag a friend, pet, or family member out with you for some cheery conversation. If you are walking in a safe place, enjoy a podcast or music that fits your choice of activity. A nighttime walk to the city center or a decorated neighborhood can also be gentler activity to choose. Making the effort to schedule an hour or two outside each day during these months will pay off greatly for your mood and sense of calm after being cramped inside at work all week. If you plan it right you can still make it back into the warmth of your home in time for that sports game or holiday movie that you wanted to catch.

Last weekend I had a trip planned to camp in the San Pedro National Forest by Santa Barbara. When I started my long day on the trails the rain slowly increased to a steady drizzle which last for hours. I really struggled at first to find some enjoyment in the moment when I was cold and wet with the sky covered up by dark clouds. Luckily, I was finally able to find some humor in the moment as the sticky mud on the trail kept building up on my shoes making me feel like I was walking on giant sponges. As soon as I scraped the mud off the inches would build back up again on my soles after just a few minutes leaving me an inch or two taller though somewhat more unsteady. Finding some laughter in the crummy weather saved my hike and I was able to find the sunshine in the experience among all the clouds. My reward for staying out there on the planned route was that the rain did stop, I saw incredible views of the mountains, and I saw hardly a single other person on the trail that day. By sunset the clouds were opening up and I found myself full of amazement at the beauty all around me. I laughed again, thinking about how much one’s mood can change, if you just keep going outdoors.

It felt like the season of Fall came all at once this past week. The great finale of excitement that October often brings was to be found everywhere this year. From the ‘torture’ of Bay Area sports teams which brought us another World Series title, nature bringing us our first real rain in many weeks, and ghosts and goblins bringing tricks and treats to children across the city. Now that the sun is back out and the air has held on to the crispness of Fall it feels like a time to begin and contemplate all the transitions that we and our families have gone through this past year. Soon enough time will begin to feel sped up again as the family gatherings and travel requirements of the holidays approach.

I think back about all the stories that patients have shared with me over the last year of work in the clinic. Some joyous stories of weddings, births, and worldly adventures. Some that are sad because of chronic pain, emotional suffering, and the loss of close loved ones. I notice that my mind tends to focus on these polar ends of the joy/sadness spectrum and I feel less clear on all the stories and casual events that were shared with me by patients which fell somewhere in that neutral territory in between. Life’s memories seem to remain especially sharp when the emotional context was particularly intense, perhaps making a greater effort to impress upon our mind the relevance of that transition in our life.

Changes from birth to life always seem most clear to me in the season of Fall. Nature itself is pulling inward and becoming more dormant for the next few months. The shades of grass grow more pale and after one last brilliance of color the leaves fall from the trees. We should savor the introspection and even momentary melancholy of this moment to recall all the transitions of our past year. Many of the lessons will take time to extract meaning from, to find an opportunity for growth, and to place them into context as our lives move forward.

Fall is a wonderful season of memories and new plans for winter trips and the hope for Tahoe snow. I enjoy the opportunity to remember all the people who made up the stories that fill my mind when I think of 2014 and my time in the clinic and I look forward to the Winter months and the continuation of that path that I share with all of you.

While running in Connecticut I found these trails which crystallized the season for me. It felt like running through a tunnel of golden light and I felt like a kid again.

Taking the time to explore natural wonders when the opportunity presents itself has always been a habit of mine. Hiking to the promise of a distant waterfall or pursuing a difficult uphill trail to find that largest redwood in a particular grove can end up being more work than I originally planned on. These efforts can sometimes seem to be too difficult or the goal too remote to justify the effort or even risk involved in getting there but I believe the reward of experiencing the object in a tactile way, through touching, smelling, seeing, and listening, always makes the aching muscles and pounding heart worth it. I take these risks within reason in the hope that I can come closer to something other-worldly, something completely outside the sphere of my normal life, and extend my senses out to meet it.

While hiking in Juneau, Alaska I was able to traverse the ice on the Mendenhall Glacier and climb inside of the giant itself. Entering the cavernous ice caves with my friends and reaching out to touch and smell its infinitely deep walls was magical. The color of the blue was something completely unique to me and the effect of being able to stare so far into the depths of the ice was a memory I will never forget. The caves collapsed just hours after I had passed through and I will never be able to travel through them again but I am very happy that I was able to travel out of them before they disappeared.