This Was Not The Plan

Camping at Trap Pond, Delmarva Peninsula.

i jumped into the pool as I always do, backside first, to start my first swim workout in a few weeks, having just returned from a very enjoyable two weeks in Italy. I positioned my goggles and pushed off, clicking my Garmin as I did. After a mere two 400’s, I noticed my left arm had become swollen and tense. But this is the most recent part of the story. Allow me to go back a few years.

Around the new year in 2021, while I was still busily working as a general surgeon, I went for a run with my friend Pat. We had run about a mile and a half when I was hit by a shearing pain in my right calf. Pat helped me hobble back to his house. I was able to drive my car home. The pain slowly eased, and I went back to work as usual, but had a noticeable limp. I sought out one of my orthopedic colleagues who examined me. He said I ruptured a Baker’s cyst, which is a cyst of the knee’s joint capsule. There was no treatment for it, just had to wait for it to improve. He ordered an MRI of my knee, which confirmed the cyst rupture, but also showed I completely tore off my medial meniscus on that side. He did not say I could not run, but suggested it may increase the wear on my knee.

Running in Haddonfield, Fall Colors

So, naturally, after the pain got better, I started running again, although it took a few months of downtime. I started getting in some longer runs, cycling, and some rowing machine workouts. On a Friday in early November, 2023, I went for a run at the end of a long day at work. Oddly, I got about a tenth of a mile and developed pain in my left thigh. I stopped my run and the pain disappeared, so I started up again. But the pain consistently came back at each tenth of a mile. Being bullheaded I kept this up for a couple of miles. When I got home I rested, then felt back to normal the next morning. I went out for a run, thinking everything was back to normal. The same pattern happened again, and looking down at my left leg, it appeared swollen and blue. I know the signs of a deep vein thrombosis, so I hobbled home and took an aspirin. My wife was out, but when she returned she drove me to my hospital’s ER. It is strange as a well-known surgeon walking into one’s own ER, and explaining I am not there to see a patient, I am the patient. I received very nice care from all the ER personnel, and I recognize that because I work there they looked out for me. But I know from my patients’ experiences they have received the same considerate care. At first, an ultrasound of the veins of my left leg and thigh was done which showed no blockage. But a CT scan of my pelvis followed, which showed a complete obstruction of my left common iliac vein, a major vein leading to my vena cava. This condition has a name, May-Thurner syndrome. I was admitted to the hospital and the next day I was operated on by one of my former trainees who used a catheter to remove the blood clot. I’m thankful she turned out to be such an excellent vascular surgeon. I was discharged the following day, Sunday, and back at work on Monday. But my days operating were coming to an end, as I had planned to retire on January 1, 2024. I did just that, and felt it was good timing. I took up teaching at our medical school, and started running again about six weeks after the surgery.

I noticed early on in 2024 that when. I put a push on at the end of a run, I would get a strange feeling in the front of my chest. I attributed it to a fall I had skiing that February, when I hit the snow hard. The feeling came and went. I had a stress test ordered by my physician which was normal. In fact, while on the treadmill the nurse asked if I was a runner, since they had the pace cranked up pretty high. The chest discomfort persisted, though, and by late October it had become predictable. I would run about half a mile when the squeezing sensation started, I’d stop for a minute or two, then it would occur again at another half mile. I called my physician who spoke with a cardiologist. The decision was to have a cardiac catheterization done as a precaution.

Backpacking the West Rim Trail

A few days later I was in the cath lab. I was awake as the cardiologist snaked a catheter up my right radial artery, through my aorta and into my coronary arteries. He only made a few technical comments as he did this. When he finished the study, but with the catheter still in, he pulled up the video screen and showed my what he found. There was an area of significant narrowing from plaque in one of my major coronary arteries, the left anterior descending. He had taken pressure measurements across the area showing a drop in pressure. He said I could have surgery or a stent, but recommended the stent. While I’m partial to surgery, the stent seemed the best choice. First, a narrow balloon is used to dilate the blockage, then a stent is expanded at the site. As this was happening I notice feeling the same squeezing sensation I had experienced while running. That confirmed that I needed this dilation and stent.

Six weeks later, I took my first run after the stent. I got to a half mile and kept going. I didn’t feel great, but there was no chest pain. I got back to my usual activities, went skiing, running, cycling and swimming, and felt pretty good. My backpacking friends and I tackled the “Grand Canyon of Pennsylvania” in June of 2024. We decided it was along a canyon, but perhaps not so grand. It was also very warm, and as we backpacked we had to be sure to keep enough clean water with us, as we were losing a lot to sweat. By the one year anniversary of my stent, in November, I was very thankful for the skill of the cardiologist and that I spoke up about my chest pain.

Things continued. on an even keel through February of this year when I went skiing again. I felt pretty good on the slopes, although had another fall when Sierra cement-like snow stuck to the bottom of my boot causing a ski to come off as I was flying down hill. I hit the ground hard on my left shoulder. Nothing broken, but the shoulder sure hurt. In mid-March, I noticed something peculiar. My normal resting heart rate had gone from its usual 48 to the low to mid thirties. I again saw my physician, although it was just for a routine visit. The nurse mentioned my slow heart rate which my physician, who happens to be a friend and fellow cyclist, attributed it to my fine athletic conditioning (he he). However, on a trip with my wife to Ireland, I noticed she could march right up a trail on a hill while I struggled and got short of breath. After returning from Ireland, I went backpacking for a weekend. While my companions had no trouble climbing hills with their packs, I had to stop every ten feet to catch my breath. I survived the backpacking trip, but on return had an appointment, routine, to see my cardiologist. I mentioned the shortness of breath. An EKG was done. The doctor stepped in to see me, but got a phone call. So he stepped out the door to take the call. On coming back in the room, he said “that call was about you”. That perked my ears up. He explained that my EKG showed complete, or third degree, heart block.

A little explanation may be needed here. The heart has a natural pacemaker located in the right atrium where the normal rhythm of the heart is set. This pacemaker causes an electrical signal to progress through fibers from the atrium to the ventricles, causing each to contract in turn. This is why a lub-dub rhythm is heard when listening to the heart with a stethoscope. Third degree heart block occurs when that electrical signal does not flow to the ventricles from the right atrium. This leaves the ventricle on its own. It fires at its own rate, which is called an escape rhythm, and at rest is normally in the mid thirties per minute. I was told by the cardiologist I would need a pacemaker inserted.

I was, around the same time, referred to an infectious disease (ID) specialist. Along with the abnormal heart rhythm I had developed a frequent cough. I told my story to the ID doctor, who also happens to be a colleague. He said I would need to be tested for Lyme disease. It turns out that heart block can be caused by Lyme disease, but I could not recall ever having the classic target rash or getting bitten by a deer tick. I got tested, first a screening test which was positive, then more definitive tests. These showed I had Lyme disease, although not within the last few months. He started me on a six week course of doxycycline. Meanwhile, I had a few more tests which showed evidence of congestive heart failure.

So, I was back in the same cath lab again, this time for a pacemaker insertion. The cardiologist was an electrophysiologist, different from the one who did my stent. I received a pacemaker with two leads, one to my right atrium and the other to my right ventricle. The atrial lead picks up my natural pacemaker’s rhythm, and the ventricle lead fires at an appropriate interval to cause the ventricles to contract. I recall saying to my wife as I lay in the hospital bed after the procedure, “wow, I feel so much better already!”.

Cycling in Western Massachusetts

That was at the end of April of this year. I recuperated a few weeks, then at the end of May was able to do a thirty three mile bike ride in Delaware, the “Medio-Fondo”. My knee has gotten a little worse, but I still get in a short run or two, and I got back to swim workouts. In August, I spent a week riding with friends in Western Massachusetts. So, it appears the new pacemaker is doing its job. It is definitely odd feeling the device in my upper left chest and knowing I am dependent on it for my heart to beat properly.

In London, enjoying life.

But about that swelling in my arm. Things were going well. We had a very nice trip to Italy, walking all over Rome, Pompeii, Naples, Venice and Florence. We took very interesting and illuminating side trips to Padua and Siena. We even stopped over in London to visit friends on our return trip. When I got back, I went for a swim workout a few days later. I had not swum very far when I noticed my left arm tightening up a bit. After a second 400 yards, my left arm was quite stiff and the veins were bulging and tense. I got worried that I had developed a blood clot causing a major vein to be obstructed, possibly due to the leads from the pacemaker. I stopped my workout, got dressed and made some calls. First, I called the cardiologist who inserted the pacemaker. He was also concerned and recommended I get a venous ultrasound. My next call was to my vascular surgeon who helped me schedule the ultrasound for that day. The good news is that there was no blood clot. However, the arm was still a bit swollen. It appears I’ve developed some restriction of blood flow out of my arm, and when I stress the muscles, increased blood flow to the arm cannot leave easily. My hope is that with use, other veins will dilate to accommodate the increased blood flow thus reducing the swelling.

I did not anticipate any of this, and am telling the story as a reminder to myself that things like this happen as one gets older. This is both from aging, but also just chance. I must change my ideas about “getting fit”, and setting goals.

Given this is the Christmas season, the end of the year and start of a new year, I hope you all have a very pleasant and safe holiday time and keep going for another adventure.

Keep the Ranger Rolling

We have a great little pickup truck. It is a 2011 Ford Ranger which we bought in November, 2011, the last year Ford made this model. It is a very serviceable truck, which we used frequently to haul water heaters, ranges, furniture, trash, lawn mowers, and all sorts of other stuff which goes along with servicing rental houses. For my wife, it was her only vehicle, and she grew fond of it. Edmunds, the auto website, was not complimentary in its review, but owners gave it mostly five stars with a few four-star reviews, and none less than that. Ford stopped making this model in December, 2011. From various reports, it seems Ford felt this truck was competing with sales of the F-150, their full sized pickup.

Things went wrong with our truck last year after a long ride back from Oklahoma to New Jersey. We had driven it down to Oklahoma filled with family goods, a silver tea service, heirloom silverware, grandmother’s glassware, and other goods to give to my daughter or keep in our place there. It was a bit humorous. We spent two nights on the road, and each stop we would unload the truck into the motel room for safety, then reload it the next morning. We spent the month of July in Oklahoma, and returned with the truck performing beautifully. But shortly after we got back, it started to have problems with the battery draining. Left idle only a few days, the battery had lost sufficient power to start the engine. My first thought was to replace the battery. We had it checked, though, and it was still in good shape. I checked how much current was being drained when it was not running. I measured 25 mAmps, which is not a heavy draw. We took the truck to the Ford dealer near us and reported the problem. Their first response, after keeping it overnight, was that it started up just fine, so per their brilliant analysis, there was no problem. I had them keep it over a weekend, and behold, the battery had drained to the point it would not start the engine. They ran a number of tests, narrowing the cause down to a malfunctioning ECM, or electronic control module. This is a computer which controls distribution of power to various components depending on need.

However, because our truck was made in 2011, the end of the line for that model, they told us Ford does not sell replacement ECMs for that vehicle, and after searching, they were unable to find a replacement. These ECMs are vehicle-specific, requiring programming for the exact model in which it is installed. We brought the truck home, and I installed a switch on the negative pole of the battery, so we could disconnect it when not in use. This was a very simple copper toggle switch. Granted, we had to open the hood when we wanted to start the truck in order to throw the switch, but it worked. One little problem came up when we needed to get the car inspected. The computer reading at the inspection station showed a failure, but we learned we had to drive it 20-30 miles without disconnecting the battery for the ECM settings to pass. We did that, and it passed. Terrific!

Our problems were not over. We used the truck regularly, but only once a week or so. The disconnect switch was working. Then, in November last year, it occasionally would not start, even with a full charge on the battery. I would throw the switch, put in the key (yes, a real old-fashioned key), and on turning the key all the lights on the dash would go out and the engine would not start. There was no clicking sound like one hears when the battery is low. It was just dead. Then, I would come back an hour later and it would start. My wife needed a reliable car. We did not want to get rid of the truck, though, since all the other mechanical parts, the engine, the body, the interior, were all in good condition. We bought a new Subaru Forester in December. At first, she missed the truck, and despised the computer screen in the Subaru used for controlling car functions. But it served us well on our trip up to Vermont with grandchildren, and she started to appreciate its good qualities. She especially liked being able to raise the driver’s seat so she could see better.

We still used the truck periodically, never knowing if we would get stranded somewhere. So, by necessity, we kept trips local. The ranger got worse, though, and by April of this year, it would not start. It sat parked on our side street, a piece of immobile sculpture. I would go out once in a while, check the charge on the battery which was holding, see the dash lights light up when I put in the key, only to have all go out on turning the key to start. Even the cabin light went out.

We took another trip down to Oklahoma for the month of July, driving the new Subaru. It performed beautifully, and we had a great trip. I still wanted to get the truck working again, though. It became a mission. I had spent some time searching on eBay and various parts dealers, but could not find a replacement ECM. Then, on a web search, I came across a company called Flagship One, Inc., in Lynbrook, New York. Lynbrook is on Long Island, not far from Queens and JFK Airport. It is a privately held company specializing in ECMs and myriad other acronym named computers for cars and trucks. I called the company, got a live person on the line quickly. I told her I needed a replacement ECM for my 2011 Ford Ranger. She took down the VIN, did some quick research, and told me which model I needed. The cost was $214 which I thought was very reasonable. She told me the unit would be programmed for my particular vehicle. Over the next week and a half I received emails informing me of the progress with my ECM. Once it was ready it was shipped second day delivery. After receiving it, I could not wait to install it. Swapping out the old ECM turned out to be very easy. Three cables with connectors attach to the unit. After unplugging them, the unit is held in by two nuts. It was a bit stuck in place, but with a little leverage, I removed it.

The old ECM
The new ECM in place.

With the new device installed, I reconnected the battery. I opened the driver side door and the cabin light lit. I inserted the key, and the icons on the dash lit. However, on turning the key, nothing happened. I noticed one icon which was lit, showing a car with a padlock.

Lower left icon, the “SecuriLock”
From the manual….

The car keys come with a key fob containing a chip. The chip needs to be programmed to the ECM to allow the truck to start. I didn’t know this at first, but had a hunch when I saw the icon, and read about it in the manual. I called the good people at Flagship One. At first, they sent me instructions on reprogramming which required starting the engine. So that was out. I called Winner Ford and spoke to a service rep. I was willing to have the truck towed there to have them reprogram the fob. I was told that since I installed the ECM, they would not help me. I offered to reinstall the old one, but they said, “too late”. I argued that they were the ones who said a replacement ECM could not be found, but again they refused to help. I called back Flagship One, and they said a locksmith should be able to provide this service, as long as they had the right computer setup to work with old Fords. I called Ben’s Lock & Key in Cherry Hill. Twenty minutes later, a very nice man named David (Ukrainian emigre) was parked in front of my truck. He said, “no problem, we’ll get this fixed”. He hooked up a pad to the connector under the steering column and entered some information. Then he told me to insert the key and start it up. The engine roared to life. I got our backup key with fob and that got reprogrammed, too. The cost of all this was about $230 for the ECM and $240 for the locksmith services.

I have also discovered, by leaving the toggle switch on the battery closed and checking its voltage, that the battery is no longer being drained. It turns out a faulty ECM is a known cause of “parasitic” battery drainage. I’m very glad I persisted and did not give up on our pickup. It’s not that old, is in good shape, and should have many more miles in its future. I’m also very appreciative of the excellent service from Flagship One and from David, at Ben’s Lock & Key, without which I would still have that immobile piece of art.

Hiking the West Rim Trail, Tioga State Forest, PA

Pine Creek Gorge

This trail, along what is known as the Grand Canyon of Pennsylvania, or the Pine Creek Gorge, is a 30.5 mile trail known among backpackers as one of the best hiking trails in Pennsylvania. Pine Creek Gorge is a unique formation, formed recently in geological time. Pine Creek had a north-east course until 20,000 years ago when debris from the Laurentide Glacier dammed it up. A lake formed near Ansonia, at the north end of today’s Pine Creek Gorge. As the water overflowed the debris, it drained southward, flowing to the West Fork of the Susquehanna River, and forming the gorge. Early natives of this area used the route of the river for land and water routes, and the surrounding mountains for hunting.

Another view of the gorge from an overlook.

This part of Pennsylvania had forests of eastern hemlock, pine and various tall, straight hardwoods. From the early 19th century to the early 20th century, the trees of this area were harvested for ship building, houses, furniture, shingles, tannins, fuel and myriad other uses. Pine Creek provided the waterway to float the harvested logs down river, past Williamsport and Harrisburg, then on to the Chesapeake Bay and Baltimore. The result of this incredibly rigorous industry was the total stripping bare of the hillsides, leaving tree stumps, dried out tree tops, and dry ground. Fires and floods followed. Wildlife left. Also remaining were rough logging roads no longer needed. These were later used as part of the trail today known as the West Rim Trail. A rail line built in the early 1880’s along Pine Creek, originally part of the Jersey Shore (a town in Pennsylvania), Pine Creek and Buffalo Railway, later called the Pine Creek Railway, transported lumber, coal and passengers along Pine Creek. It made its last run October 7, 1988, as part of Conrail. The track was later removed and the trail became a “rail trail” along Pine Creek now used for cycling.

The recovery of life, flora and fauna, of the mountains of the Pine Creek Gorge began in the 1910’s. It started with mountain laurel and blueberries. Restoration continued with a variety of hemlock, pine and hardwoods. JThe area is now a somewhat protected area as Colton Point State Park, named for Henry Colton, a lumberman from the late 1800’s and the larger Tioga State Forest.

Dynamite shack left from the lumberman days.

I have wanted to do this hike since I first heard of it from a friend at work years ago. Known as the Grand Canyon of Pennsylvania since 1936, when businessmen of Wellsboro started promoting it as a tourist destination, it was recommended to me as an ultimate backpacking experience. With the good company of my backpacking friends, Christine and Michele, we headed up for a planned 3 night 4 day hike on Saturday, June 15, 2024. Many will do this hike in one or two nights, but we wanted to have more time on the trail and in camp, and enjoy our time there.

The northern end of the West Rim Trail, Christine and Michele.

We stopped in Williamsport Saturday night and stayed at the Genetti Hotel. We began that evening at New Trail Brewery, one of the best in Pennsylvania, and had dinner at the Bullfrog Cafe. The next morning, after a fortifying breakfast at the hotel, we drove up to Rattlesnake Rock, for our pick up. We were being picked up by Pine Creek Outfitters and driven to the northern end to start our hike. Our car would be waiting for as at the end of our trek. Of note there is no cell service there.

We joined several others in the van, all cycling the path along the river, for our drive north. Our packs were piled in the front passenger side, and we sat together in the second seat, quizzing the driver about the weather. It was predicted we would have a decent first day, then a major heat and humidity bubble would envelope the area the following day. Our driver did not give us the answer we wanted. He said being up on the trail would not be much different than the weather in Ansonia, with highs predicted in the 90’s.

We were dropped off with our packs and poles and the van left. There was nothing to do but get started on the trail and work our way to the end. It is an interesting feeling, knowing you are relying only on yourself and your companions to get to the southern end.

The trail starts with a long uphill trek to the rim of the gorge. It is close to 900 feet up. Once up to the rim, the trail goes up and down, and weaves along and away from the rim. At times the trail skirts the margins of the rim, providing occasional spectacular views of the gorge, but also plummeting drops on one side of a rocky and narrow trail.

For our first night, we stopped at a campsite near the rim at the 11 mile mark. It was a nice campsite, but had no water close by, so we needed to pack in water.

Porcupine visited us the first morning. He was munching on carrot sticks inadvertently left out of our bear bag.

The next day got very warm and humid. We skipped our usual morning campfire and got on the trail fairly early to try to get to camp before it got too hot. Our trail map, which we purchased from Into the Backcountry, was very helpful in pointing out campsites, reliable water sources and seasonal water sources. Since we saw that some of the seasonal water sources had dried up, we needed to plan the route carefully. Due to extreme heat and humidity, we would need to adjust for water availability. So, our second day, while only 7 miles, seemed very tough and we were grateful for the trickling stream we found at mile 17. Along the way, we stopped at the Bradley Wales picnic area for a rest and lunch. There was a hand operated water pump there. But a posted sign said it went down 250 feet, and while it would provide water, about 15 minutes of pumping was needed to bring the water up. Since the pump was out in the sun, and the day had gotten quite hot, we skipped trying to get pump water.

Mountain Laurel, found everywhere on the trail.

We made camp at mile 18, along the trail but only a few hundred yards off a gravel road. It was next to a beaver pond and near a water source on the other side of the road. It was a muggy area, but nice enough. The next leg would take us a long way without reliable water, so we were satisfied. After camp was set up, we started a fire mainly to keep away the gnats and flies. We had dinner, and were relaxing when we started to hear thunder in the distance. Michele’s Garmin InReach Mini 2, gave us a weather report stating the chance of rain was 4% and the expected amount under 0.1”. But the storm clouds were coming for us. Around 9:30 some drops were falling. We closed up our food supplies, hung our bear bag and got in our tents. By 10:00, a violent thunderstorm was passing directly over us, with heavy rain and no time between brilliant cracks of lightning and explosive thunderclaps. The rain seemed to ease up in a half hour, only to get heavy again, with more lightning very close by. We checked with each other to be sure we were all okay. The storm passed us for good by around midnight. Early the next morning we were up, our tents standing us in good stead.

The work of a beaver.

Our next day’s plan was to get to a campsite at the 27 mile mark. While again, not long miles, with the heat, humidity and climbing, we figured it would be a challenge. We loaded up with water, filling our drinking bottles and also carrying an extra liter of water each in a dirty water bag, to be filtered along the way. Michele and Christine allowed me more frequent breaks than they needed, as I was sweating a lot and getting fatigued on the climbs. As it turned out, a couple of seasonal water sources were flowing with sparkling, cold, clear water. We happily stopped, filtered some more and headed on.

Photo from Michele. These are called “ghost plants”. They opportunistically come up like this when conditions are right (see the link).

The trail varies from narrow, rocky, challenging paths, to long stretches through heavy growths of fern and stinging nettle. We had on long pants to keep the nettle from irritating us. I happened to have a brush of it on my lips and tongue. This caused about 15-20 minutes of numbness and tingling of these parts. It was an interesting experiment, though not on purpose.

Narrow trail through ferns and stinging nettle, in the early morning haze.

Christine was picturing our next campsite to be the best of all, good fire ring, running stream in which we could cool off plus have the pleasant sound of running water as we slept. While I was skeptical, she pretty much got what she was hoping for. At mile 26.5 a stream flows down through a side canyon, creating a little pool near the campsite. After setting up camp, we stripped to essentials and one by one got into the little pool to wash away the accumulated sweat and grime. It was very refreshing. Christine brought the instant ingredients for rice, bean and vegetable burritos which we had for dinner. We had cooled cans of beer in the creek. So, at Bohen Run we had a bath, burritos, beer and a babbling brook. Bliss!

The last night in camp. Christine and Michele.

The last day was our short hike day. Knowing well that other backpackers would not want to take 4 days and 3 nights to complete this hike, our desire was to camp 3 nights and get a good feel for the trail and its history. The last 4 miles were relatively easy, 1.5 miles uphill, 1 mile flat and 1.5 miles down about 900 feet to Rattlesnake Rock, southern terminus of the trail and where our car was parked. We arrived a bit bedraggled but in good spirits. And, as we end all our backpacking trips, we headed to Taco Bell to satisfy a hunger craving.

While this is an iconic trail, and well worth the trip, I probably would not go back and repeat it for a while. The scenic views were nice, but many were obscured by overgrown brush. Hiking along a very narrow trail with a steep drop on one side is challenging, but means one is always looking down rather than being able to glance at the scenery. The heat and humidity, and the constant buzzing of gnats around my ears and eyes influenced my opinion, I’m sure. So maybe if a friend were to say they were doing this hike in April or May, want to join me, I’d likely say yes.

Sources used for history and trail descriptions:

https://trails.dcnr.pa.gov/trails/trail/trailview?trailkey=215

https://en.wikipedia.org/wiki/Pine_Creek_Gorge

https://www.dcnr.pa.gov/StateForests/FindAForest/Tioga/Pages/Wild_NaturalAreas.aspx

Camping with Moths

Campsite day 2 on the Old Loggers Path

Last weekend my friend Christine, her son Dillon and I backpacked the Old Loggers Path in north central Pennsylvania. After our second 12 mile day, we set up camp, cut firewood, filtered water out of the nearby stream, changed hiking boots for comfortable sandals, started a fire and prepared dinner. We went through swarms of gnats while hiking, which is no more than just annoying. At the campsite, caterpillars were all over the fire pit and surroundings. Again, an annoyance but no more.

After brushing them away, they seemed to stay away.

But at night, after the sun set, the moths came out. It seemed about a thousand benign little white-winged moths fluttered around. As you may know, moths are drawn to lights. On bedding down for the night, I had to trick them by leaving my headlamp out of the tent until I got in, zipped up the screen and snatch the headlamp as I closed the zipper. One got in, so I cupped my hand around it and released it into the wild.

But, it is a given that every night at the campsite, usually around 2:30 or 3:00 AM, I will be awakened with a serious need to pee. This not just me. All my backpacking friends have the same experience. I worked my legs out of my sleeping bag, put on my sandals, donned my headlamp, opened the tent zipper and stood up outside. If it was a clear night with a full moon, there would be enough light to walk safely to a spot to pee. Of necessity, though, when it is dark like it was that night, I needed my headlamp on. As I walked an appropriate distance from the tent, closer than ideal for propriety during light hours, but far enough to not pee in camp, the moths started to come at me. As I performed my necessary function, they swarmed around my face, drawn to the light of the headlamp. They flitted and fluttered very close, landing on my forehead, my eyelids and my ears. They stalked my nose and cheeks. Using one hand to direct flow and the other to madly swipe at them, I knew I had to continue until finished, or undoubtedly need to get up again in another hour. Resolved, I stuck it out, and then, relieved, headed back to my tent.

In the morning, the moths were gone, back to wherever they hide out during the day.

Old Loggers Path is a great place to backpack. The trails are well-marked, there are some steep climbs and descents as well as stretches of flat terrain. There are scenic overlooks, some timber rattle snakes, waterfalls, and beautiful mountain streams. We had a very nice hike.

Starting up the fire from embers in the morning.
Dillon’s Tent
Timber rattlesnake with a garter snake coiled with it.

Start off Slow…

And then ease off.

That was our joke with each other on Sunday morning runs ten years ago when I was almost always training for a marathon, or half, or the Broad Street 10 miler. Now, I have settled into running slower, cycling slower and skiing with more care.

Here is the view from the back of the pack. It is odd to start running with the group Sunday morning only to have them blithely move ahead while I trot a respectful distance to the rear. I am adjusting, though, and there is a calmness to my runs I didn’t have before. I pause every now and then to catch a breather, and even stop to take a photo, as I did last Sunday, a day after heavy rains, when our local park was flooded.

Flooding along the Cooper River.

Regarding cycling, I still am pushing it to keep up with the other guys I ride with. They are mostly around my age and so I can’t pull that “I’m older than you guys” stuff with them. Fortunately several of them have dropped down from their peak a decade or more ago, but some of the guys were not listening, and continue to be beasts on two wheels. So right now I’m using the smart trainer to get the early spring training needed to look respectable in May. I signed up again for the Delaware Gran Fondo, a 100 km ride through the hills around Wilmington. It’s a fun ride with a nice party afterwards.

And skiing? I decided to improve my form. A friend of mine who is a ski instructor at Killington in Vermont suggested I try the “Carv” system. It consists of thin plates with sensors one inserts under the lining of the ski boot, inside the boot. They connect with electronic transmitters to my cell phone. I also got Bluetooth speakers for my helmet. I realize this sounds like a lot of gadgetry. But while skiing, a lovely English-accented Samantha gives me tips and encouragement on how to carve better. I actually feel it is improving my form! But the best part of skiing right now is seeing my two granddaughters, aged 7 and 4, learning how to ski. We took a trip to Switzerland and they had a great time with their ski instructors and also skiing with mom, dad and me after their lessons were finished. We were in a small village high in the alps called Grimentz.

So that’s the plan: start slow and then ease off. It seems to be working. Adapting to slower also means keeping one’s pride in check and not obsessing about time, pace or how many runs I got in.

But by all means keep going!

What’s Good about Primitive Camping

On a trail in the woods, scant or no cell service, hiking 10 miles or more with over 30 lbs. on one’s back, following hard-to-see trail markers attached to the trees, sleeping on the ground, eating freeze-dried food out of a pouch, and facing weather that can change quickly might seem uncomfortable at best to many people. But, I’d like to describe some of the good stuff.

I’ve had a yearning to go backpacking for decades. I had a taste of it in Boy Scouts, at Camp El Rancho Cima in the hill country of central Texas. Back in the 1960’s, backpacks had external aluminum frames, were made of heavy canvas, and were not weather resistant. At that camp, I recall going on a trek using donkeys to carry our food and tents, and loving the idea of existing out in nature without access to anything comfortable. We took good care of the donkeys, and had a great time looking up at the stars, unlike anything we could see back home in Houston. That was it for my backpacking experience as a youth.

Seven years ago I paid a visit to REI. The hunger to go backpacking got me motivated, and I wanted to be equipped. The sales people at REI really are good at capturing one’s attention. I spent an hour with the guy selling backpacks, and settled on my Deuter ACT Lite 65+10 model. He showed me how to get the straps adjusted just right, and made sure I was comfortable. I also bought an REI branded cocoon sleeping bag, an air mattress, a Big Agnes Copper Spur tent and a camp stove. I was very happy bringing these items home. I set up the tent in my backyard, and marveled at the ease of doing so. I tried out the stove, to be sure I could light it properly in camp. Unfortunately, I could find no one who was interested in a trek in the woods, and I was not about to go out solo for my first real backpacking excursion. These items got stowed away in a corner on the third floor of our house, tucked into a trunk.

In 2021, five years after I bought all that camping gear and buried it in a trunk, things turned around. Two of my running partners, Steve and Pat, said they were interested in backpacking that spring. Both had fairly extensive experience, and so were ideal partners for me. We made plans for an overnight outing in May, and started some training with our packs. We chose to do the Loyalsock Link Trail in north central Pennsylvania. The trail is about nine miles, and starts at the World’s End State Park, on the banks of the Loyalsock Creek. It was an ideal first trek for me, including clambering over large boulders, some steep climbs and descents, and wound up at a great site for setting up our tents. It was by a stream, flat, and had a fire ring and boulders set up for sitting near the fire. 

Steve and Pat

Since then, we added two more to our group, Christine and Michele from our running club, who also had the bug to go backpacking. We have done several two night trips with various members of our group taking part, on the Loyalsock Trail and the “Old Loggers’ Path”, as well as a two nighter on the Pinchot Trail in the Pocono Mountains.

What makes these jaunts so rewarding? Any time you can get out in the woods, away from the business of daily life is a treat. As soon as you are a quarter mile into the trail, the civilized world seems distant. This sets me at ease, and I can concentrate on the trail, following the blazes, learning the clues the blazes give for when there is a change in direction, and noting the great variety of plant life we encounter. The subtle, and sometimes obvious, changes in ecosystems along a trail are wonderful to appreciate. Along the Pinchot trail, for example, there are tunnels created by overarching rhododendrons, which then give way to pine and hardwood forests. It is remarkable how much natural spring water comes flowing down these mountains, creating rivulets which empty into larger rills, then into creeks and rivers. 

Rhododendron Tunnel

As you hike along, you get to know your backpacking partners pretty well. When you are out in the wilds and dependent on your partners for help should you need it, you get a great appreciation for their skills and support. Conversation along the trail ebbs and flows. Sometimes, during a tricky ascent, we hold the talk, but it resumes when we are on the flats. Crossing streams becomes a puzzle to solve, are there stable rocks to use, or do we need to switch to water shoes, hike up the leggings, and wade through? Spotting various forms of wildlife is also a reward. We’ve come across all varieties of mushrooms, sprouting plants, old decayed and fallen trees, and brilliant colors, in spring from blossoms and in fall from the leaves. Animal life is a bit scarce sometimes, but there have been some great sightings. We did have a bear run across the road in front of us driving to a trail head, and have seen bear scat on the ground, but fortunately have not encountered bears along the way. I spotted a beautiful eight point buck, about a quarter mile from us, who then bounded away when he saw me. We’ve seen small frogs and toads, newts, and spiders. We’ve seen trout in streams, and a great variety of birds flying about.

This butterfly explored around our camp.
A remarkably well camouflaged toad.
delicate growth of a fungus
I think this is the juvenile form of he eastern newt.

Finding an ideal spot to settle for the night is fairly easy on the trails we’ve chosen, since there are established campsites. These come with stone circles for campfires, and some even have large stones set up around the fire ring for a place to sit. Now, this may sound a bit too comfortable, but we didn’t ask for them, they were just there, set up by scout troops decades ago. One of the chores we approach with great vigor is collecting firewood for a campfire. There is usually none to be had around the camp, but searching a short distance away is usually productive. We learned early on to carry small collapsable saws with us so that we are not limited to what we can break with just our hands. We look for good, solid, fallen wood which is not spongy or saturated with water. It gets chilly in the mountains in the spring and fall, so having a nice warm campfire is not only for pleasure. Warming oneself by the fire, and watching the flames, is mesmerizing. The other chores, setting up our tents, getting water into our filter bag, and getting our air mattresses and sleeping bags set up is a practiced skill. Since it gets dark quickly in the mountains, we set up a stove early to boil water for our freeze dried dinners. Now this may sound unappetizing, but these meals turn out to be pretty tasty. Some backpackers stick with old standbys, such as ramen noodles with added freeze dried vegetables from home, but the pre-made packets are nice for variety, spices, and simplicity. We’ve also brought marshmallows, which add very little weight to a pack, by the way, and had toasted marshmallows as a desert.

Toasting marshmallows.

You might think sleeping on the ground in a tent in the woods would be a poor sleeping experience. I have found the opposite to be true. The air mattress is comfortable, the sleeping bag is warm, and sleeping in the cold night air feels very natural. It may not always be a bed of rose petals, granted. I have had two air mattress incidents. One, which woke everyone up in camp, was a loud pop, which turned out to be one of the channels in my air mattress rupturing. It put a hump in the middle of my air mattress which made me slide one way or the other, but did not allow me to remain centered. That was annoying. On another outing, my brand new replacement for this failed mattress developed a profound leak before I got to use it a single time. This made for a very difficult night with little sleep. I could not get comfortable on the hard ground, and in the morning, could not identify the leak point. The next night, since this trip was in the fall, I collected a large amount of leaves under my tent floor for cushioning, and, as suggested by my partner for this trip, used a foam pad from my backpack under my hips. I slept very well that second night. So another great thing about primitive camping is learning to make do with natural resources.

Camp set up near, but not too close, to a stream.

Peeing in the woods, for the guys, is a pleasure. For the women, I recognize it is more problematic, although the principles still apply. It might not occur to those who are stuck back home, but taking a “natural break” whenever and where ever you are is liberating. It also gives an indication of how well hydrated you are. Dark yellow, and infrequent peeing is an indicator one needs to drink more.

Pooping in the woods is another means of reward. It can be tricky, at times. Digging the appropriate hole can be challenging, especially if all you have around you is trees, roots and rocks. But given an appropriate hole, a tree for support, and enough privacy one is not inhibited, it becomes a chance to score nature points by hitting the hole. And, of course, everyone poops.

Getting to the end of the trail is a mix of relief and letdown. You wish you could keep going, enjoying the life in the woods, campfires, philosophical chats, tucking into your sleeping bag at night, rekindling the fire in the morning and enjoying that delicious cup of hot coffee. On the relief side, you have gotten to the end of the trail, are likely hungry, and your limbs might be a bit fatigued. We’ve had some interesting end-of-the-trail experiences. On our first backpacking trip, we got back to the car and found we had a flat tire. It took a while to get the tire changed and get moving. We drove back through Williamsport in north central Pennsylvania, and were fortunate to find a tire shop as we drove into town. We were able to get the regular tire repaired and get the little donut tire back in the well of the car where it belonged. While it was getting fixed, we strolled over to a Taco Bell across the street and gorged on burritos and tacos. This has become a required stop for us on our return from the woods.

On a recent backpacking trip, one of our friends who was backpacking for the first time, was asked at the end of the trip if she had fun. She said it reminded her of making a long trek in an airport carrying a suitcase. I don’t think she’ll be joining us again, although we would love for her to try it again. For the rest of us, it is a wonderful trip into the woods and away from the civilized world.

I’d like to give credit to Christine, Michele and Pat for the use of some of their photos for this blog, and also for their great companionship on our backpacking trips, and for more to come.

Turning 70

It’s a world of difference, turning 70. In 2013 I wrote a remembrance of growing up, maturing and turning 59. But, life kept moving. Suddenly, things have radically changed. I decided to retire at the end of a long career in general surgery. While working, I always had to squeeze in the time for training for half and full marathons, several shorter races, and for my annual cycling vacation with friends in Northampton, Massachusetts. One of my favorite cartoons shows a peasant training for a marathon. This cartoon, by Frank Cotham, publishedin The New Yorker 3/12/2018, captured my style. (My wife bought a print for me for Christmas and I have it hanging next to my race medals).

After 59, I still had room to improve. Almost 61, I ran my half marathon PR, at the Caesar Rodney half in Wilmington, March 22, 2015.

I was doing pretty well the next few years, at work and at play. My good friend Brandon, with whom I’ve run many training miles, often told me that once I retire, I can train even harder and really do great things.

Due to unanticipated problems, that didn’t happen. Or, at least, not as I wished. We experienced the covid pandemic, but I cannot say that affected me personally, too much. People still needed surgery, so other than three months in 2020 when we postponed certain elective procedures, we still worked. I got my vaccines when they became available. Running, though, was a great way to get outdoors, mask-free, and enjoy nature. But a couple of problems came up. Two years ago I was out for a run and got a shearing pain in my right calf. It came on suddenly, like a knife wound. It turned out I had ruptured a Baker’s cyst, which is a thinning and bulging, then tearing of the joint capsule around the knee, releasing joint fluid into my calf muscles. I had an MRI of the knee which also showed A complete tearing off of my medial meniscus. Consulting with three orthopedic surgeons, they all came to the same conclusion. Surgery won’t help, you are kind of old. I attribute this condition not to running, but to standing hour after hour in the OR, constant pressure on the joints, and hyper-extending my knees to be able to get procedures done. This waylaid me for months. After about four or five months I tried running again, very gingerly. While it felt okay, I was still limping and had some pain in the knee. Also, no running for that long makes getting back into fitness a big challenge. Slowly, I hauled myself back, into running and cycling. Yet, I found myself going much slower than before.

Over the next year, things slowly improved. I felt fitness returning. I signed up for a 100 mile bike ride in London, the London-Essex 100, put on by the London Marathon Association and scheduled for the end of May, 2023. I got in some good training, including the Delaware Gran Fondo, a 65 mile ride with 5000 feet of climbing. The London ride went great! I had a good ride, finishing under six hours.

At the London-Essex 100 start.

It was then I decided it was time to retire. Work was as busy and satisfying as ever, but taking call, having to wake up in the middle of the night multiple times, sometimes having to go to the hospital at night and still work the next day, was too much. I gave my six months notice. At first, six months seemed like a long way away. As time went by, though, my wife and I had to start planning for Medicare and Social Security. It turns out, there is a lot to do for both those items. The last two months of my employment we spent deciding on things like a Medigap plan and Medicare part D drug coverage. Up to late August, I didn’t need drug coverage. But my blood pressure got the best of me and my friend Glenn, cyclist and physician, started me on a pill. Then, when that wasn’t enough, he switched me to a pill twice a day. Still, not too bad. But in early November, I went for a run after a day in surgery. I got a tenth of a mile and the muscles of the front of my left thigh, the quadriceps, became painful. I stopped, and the pain went away. Being obstinate, I did this numerous times, but had the same problem repeatedly. I tried again the next morning, a Saturday, but still had the same result. When I got home I noticed my left leg and thigh were swollen and bluish. I can recognize a vein thrombosis when I see one! My wife took me to our ER, where I entered like I usually do, the back way, and chatted with the ER doctors. They set me straight, got some imaging done, and discovered I have a condition called May-Thurner syndrome, or a thrombosed left common iliac vein. I was started on heparin, a blood “thinner”, and the next day had surgery to open the vein. Since then, I am on an oral blood thinner which happens to be very expensive. So, now I need that Medicare drug plan. On the positive side, I’m able to cycle and run again.

There is some pressure applied when one retires. Many of my friends have said they are eagerly waiting to see what I do in retirement. They predict all sorts of great projects and activities. That’s a lot to live up to. Right now, I have taken a week off to visit my daughter’s family in Texas, and help my brother-in-law work some calves and cows on our ranch in Oklahoma. But this feels like a regular vacation, as if I’ll return next week and have a full schedule in the OR. Nope. But I will be starting a teaching job at our med school teaching first and second year students. This means I have to relearn all that I learned in med school plus all the new information discovered the last 40 years. I will have more time to run, though….

Vaccinating the cows
Me and the herd
The sunset, as in “riding off into”!

Pinchot Backpacking: A Trail of Two Loops

My running and backpacking friend Christine and I headed into the woods last weekend for a three day two night backpacking adventure. We knew rain was forecast for the first day and steeled ourselves to it, thinking we are equipped for rain, so we can deal with it. Our only concern was would we be able to get a fire going with everything thoroughly soaked.

The Pinchot Trail is in the Pinchot State Forest, about 18 miles east of Wilkes-Barre, Pennsylvania. This land was purchased from lumber companies in the late 1800’s, by the actions of Dr. Joseph Rothrock, a pioneering environmentalist and first president of the Pennsylvania Forestry Association. It had been clear cut of old growth trees and left as tree stumps and dried out tree tops. Much of Pennsylvania’s forests had been treated this way. The man after whom the forest was named, Gifford Pinchot, was a prominent forester, served as Governor of Pennsylvania, and was the first chief of the U.S. Forest Service. He promoted clearing and replanting heavily clear-cut areas to preserve the land from fire and erosion. The state forest began small, in 1902, at 2854 acres. It has been greatly expanded several times, most recently in 2005, to 49,635 acres.

The trail layout was created by connecting multiple shorter trails into two loops, a north and south loop, an effort spearheaded by Frank Gantz. He organized forest service workers and volunteers who blazed the trail with orange blazes.

We parked our car at the entrance to the south loop. A light rain was falling with the temperature was in the mid 60’s. We put the rain covers on our backpacks and headed off. We didn’t wear rain jackets, figuring we would just sweat in them and get wet anyway. Once underway, we really were not bothered by the rain, even though it got heavy at times. A unique feature of this trail are long tunnels of rhododendrons arching over one’s head.

Rhododendron Tunnel

This being autumn, there were no blossoms, but I could imagine them in the spring. The terrain at the start was mostly flat, but into the south loop there are some changes in elevation. The trail passes through hardwood forests (newer growth), the rhododendrons tunnels, and some open meadows. There is a fair amount of mud, standing water and shallow streams to get through, with some parts of the trail quite rocky. We came upon the remains of a stone tower, reported to be a monument to someone who died in a boating accident, although I could not find detailed information on that.

That’s quite a pile of rocks!

Farther on, the rain did not let up as we made our way through the mostly narrow trails. We found it hard to stop for a break. Any downed logs to sit on were water-soaked and soft. We took a short break standing in the now light rain to have a snack and water then headed on.

We came upon this little creature.

This is the eft form of the eastern newt, which is between the larva and adult stage. According to Wikipedia, this stage lasts about three years, during which time the eft travels seeking a new pond. The bright coloration is an example of aposematism, warning coloration to predators that the tissues contain a toxin, tetrodotoxin.

About 7 miles into the south loop, one reaches the waterfall on the Choke Creek. The water was flowing briskly when we got there, making for a beautiful spot to rest a few minutes and enjoy the view. According to write-ups about the area, the falls are not too far from a road, so in the summer, it is a spot crowded with visitors. But on this rainy and chilly Saturday in October, there was no crowd, just us.

Another two miles and we were at our campsite along Choke Creek. The campsites along this trail are flat areas, usually close to water, with fire rings. The one we chose was very nice, with room for our tents and next to a confluence of creeks forming the larger Choke Creek.

In defiance of the wet weather (the rain stopped about a half hour before we got to camp), we were able to get enough wood and get a fire going. This was the result of our carrying folding saws and Christine’s remarkable fire building talent. Also, she carried a piece of fat wood with her, knowing it would be a challenge.

As it got dark, after our dinners of freeze-dried meals, we sat in front of the fire as the temperature was descending, drying boots and socks for the next day.

It got chilly overnight, to about 37 F, so we got the fire going in the morning to keep us warm for breakfast. We then broke camp and headed out for the second day’s hike which would take us close to our starting point then on to the north loop.

To get to the north loop, we decided to avoid a section called “the swamp”, part of an actual swamp which, given the rain the day before would have been a real trial of mud and muck. Christine hiked through the area previously on a dry day and said it was miserable. We had to take a long bypass around it, adding a mile or so to the hike that day. We also walked along a gravel road lined the whole way with dense rhododendron bushes.

On the north loop, the terrain changed, with narrower trails, more rocks and a change from hardwood trees to a mix with pines. While there are no real vistas, the trails are very well marked and, with the fall colors, very eye-pleasing. Again, we had tunnels of rhododendrons and water under foot.

Our second day hike to our campsite along Painter’s Creek was about 11 miles, due to our diversion around the swamp. Our campsite was a peninsula bordered on three sides by flowing water. The sound from the water was very peaceful. We gathered wood for our campfire, and had to rebuild the fire ring which was not in good shape. One luxury we afforded ourselves, knowing it adds to the weight of the pack, was carrying a beer, which we chilled in the creek and shared sitting in front of the fire.

From a joint effort of New Trail Brewing and Bullfrog Brewing in Williamsport

It got even colder overnight, to 36 F, but we came prepared. The next morning Christine got the fire going again, and we had a hot cup of coffee with breakfast.

On the peninsula

Heading out for the third and last day, our first effort, after breaking camp, was to cross Painter’s Creek. We managed to find some extended tree roots and slightly submerged rocks for footing, so did not need to roll up the pant cuffs and get our boots soaked. The north loop has some long trails with knee-level scrub, lots of rocks, and the width of the trail is about the length of a boot. One of the trail segments was the Sassafras Trail, and sure enough, we found sassafras growing there.

Very narrow trail.

The rocks and boulders made for slow going, but we also came upon spring-fed creeks coming from under the boulders.

There was some lumber industry activity along the trail, which, according to the Pennsylvania Department of Conservation and Naturall Resources is part of an ongoing plan for management of the Pinchot State Forest.

Clear cut area of forest with a new gravel road.

Clambering up some steep bouldered trail was our challenge for the third day’s hike. Along the way, we found some bear scat on the trail, but saw no bears. We also spotted a six point buck who quickly ran off when he saw us looking at him.

Yup, a bear was here.
Steep climb with boulders.

The last day’s hike was about six miles, plus another mile or so on the road to get back to our car. One thing other hikers have mentioned is the number of ticks they picked up going through the narrow trails and scrub brush. At this time of year, though, we got no ticks on us. We came across other backpackers on the trails, but just a few. While this trail gets crowded in the summer, this was an ideal time to hike it.

In the Garden

This is a brief ode to sitting in my garden. After a long and very busy day, there is little more satisfying than sitting in my garden. The last bit of light from the setting sun is fading from the sky. The heat of the day is gone, but the humidity stays on. The cicadas loudly vibrate their tymbals, making their familiar droning chorus as they try to draw in a mate. Traffic noises are rare. Although mosquitos are around my insect repellent seems to be working, thankfully. It is peaceful in my garden.

Man vs Nature

A group of my friends and I are heading to the woods soon for three days of backpacking. Conflicts make stories. Classic conflicts are man vs man, man vs himself, and man vs nature. Added to that can also be man vs society. I am referring to people, not a specific sex. I am not anticipating any significant man vs man conflict as we are a group defined by our equanimity. Not to say it couldn’t happen, but I feel confident we can work out any difficulties. Man vs himself is certainly possible. Taking on a rugged hike, setting up a campsite in the woods, one does look inward and face doubts. Age and infirmities take their toll, and a person will wonder if he or she is up to the challenge. Knowing that one has prepared, trained, and come equipped to handle emergencies helps overcome these doubts, yet still there is a fear that must be ignored. To me, man vs nature carries the implication that nature is working to defeat man. However, nature is just there, and man must adapt to it. We have constant natural challenges, but to go hiking in the woods, or take on any adventure means facing sometimes extraordinary and difficult challenges. I can think of many that are specific to backpacking, such as not getting lost, scrambling up and down steep hills with a heavy pack, keeping warm, well hydrated and nourished, avoiding injury, dealing with wild animals, including insects, knowing one’s limits, to name a few. The rewards of taking on these natural challenges are many and they are enriching to the body and spirit. I’m very excited to be going on this trip, and many more in the future.

Uncorking Croatia

The Blog of WINES OF CROATIA

RunnersOnTheGo.com

To help enrich the lives of others, we developed RunnersOnTheGo.com to help runners save money on races, running stores, and much more. We also provide the specific local information that makes your travel for business, vacation, or racing as rewarding as possible.

getsetandgo

Travel Blog of a Budget Traveler sharing stories on travel, books & Vegetarian Food

Marc Hemingway

Trying to keep track of my life (and my life on track)

Mid-Life, Mid-Level, Masters Running

Exploring ideas about running to contribute to a more enjoyable pursuit for the mid-level masters runner

therunningtherapist

"One foot in front of the other and one thought at a time"

WordPress.com News

The latest news on WordPress.com and the WordPress community.

retireediary

The Diary of a Retiree