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High Altitude Expedition Doctor, Monica Piris M.D.
1.5k Plays4 years ago
In this episode of the Uphill Athlete Podcast, Scott Johnston interviews Doctor Monica Paris M.D., basecamp doctor for Mount Everest, Cho Oyu, and Manaslu. Join them as they discuss a variety of topics including: approaching 8,000 meter peaks; knowing how the body responds to altitude before heading to the Himalaya; avoiding illness during an expedition; general versus individual medical guidelines regarding what is possible in high altitude alpinism; personal risk assessment for climbing at altitude; using hypoxic tents as preparation for acclimatizing for high altitude; and dispelling misinformation about using supplemental oxygen at altitude.
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Transcript
Introduction to Uphill Athlete Podcast
00:00:02
Speaker
Welcome to the Uphill Athlete Podcast. These programs are just one of several free services we provide to disseminate information about training for mountain sports. If you like what you hear and want more, please check out our website, uphillathlete.com, where you'll find many articles and our extensive video library on all aspects of training for and accomplishing a variety of mountain goals. You'll also find our forum, where you can ask questions of our experts and the community at large.
00:00:31
Speaker
Our email is coach at uphillathlete.com and we'd love to hear from you.
Monica Piras: Journey to Expedition Medicine
00:00:40
Speaker
Welcome everyone to another Uphill Athlete podcast. I'm your host, Scott Johnston, the co-founder of Uphill Athlete with my partner, Steve House. Today, I have the pleasure of talking with Monica Piras, who has been the base camp doctor on Mount Everest from 2007 through 2018, also base camp doctor on Choyu and Manaslu. So she's got a great deal of experience
00:01:10
Speaker
dealing with altitude illnesses and all of the kind of problems that people run into on 8,000-meter peaks. And I thought it might be a very informative talk for us to chat a little bit about her experiences, what she's seen, and what she recommends and doesn't recommend. So welcome, Monica.
00:01:30
Speaker
Hi, Scott. Thank you very much for inviting me to your podcast. It's a real pleasure to chat with you. It's good to see you again. It's been a couple of years, I think. It has. Yeah, it's great. So, well, let's start right off with, how did you find, how did you, you're a normal medical doctor, how did you get roped into doing something crazy like this?
00:01:53
Speaker
Yeah, I guess it came from a love of the mountains initially. I did my normal medical training and I always tried to combine work and spending time in the mountains. And as the years went by, I discovered that there was such a thing called the Diploma of Mountain Medicine. So I did that thinking that maybe there was a way I could combine my medical skills with
00:02:17
Speaker
being in the mountains. And shortly after completing the diploma, which I did in the UK, I met the owner and leader of the Himalayan Experience at the time, Russell Bryce, and he was looking for a doctor. And that was my first kind of entry into being an expedition doctor for commercially-led expeditions. And so that was your first year on Everest? Is that where you went the first time?
00:02:45
Speaker
It was, I went straight into the deep end. I had never been an expedition doctor before and Everest said, I need someone for Everest, can you come? And I said, yes. Well, a question that I've thought about when you say you're over there working with Russell Bryce's clientele, but I would assume you probably also made yourself available to other people. And were there any other doctors in Everest Base Camp when you were there?
Medical Challenges on Everest
00:03:14
Speaker
So it's really variable on different sides of the mountain. So that first year I went, I went with Himalayan experience to the north side in Tibet. And there at that time, there was no official medical setup.
00:03:33
Speaker
And I don't recall there being any other doctors in any other teams. I may be wrong, it was a long time ago, it was 2007, but I don't remember there being any other doctors where there may have been one as a climbing member of a team.
00:03:48
Speaker
it's super different on the south side in Nepal where during the peak season of Foreverst in the spring the Himalayan Rescue Association which is a not-for-profit organization sets up a base camp clinic that is staffed by volunteer doctors from
00:04:08
Speaker
Nepal and other countries in the world. And so that is a point of medical attention that anyone can access. So on the south side, even though I was always more than happy to see anyone who wanted to see me and ask for my advice, people did have another point of call. Whereas on the north side, there was nothing of that sort. And it was way more common for me to be visited by members of other teams, which I was always more than happy to do.
00:04:39
Speaker
And so at this medical center on the south side, were there any other docs?
00:04:45
Speaker
Yeah, yeah, and so every year on the south side of Everest in the HRA base camp, I think they call it base camp, every CR, every CR, there are at least two doctors, sometimes there's been three mixture of Nepalese and Westerners. In the early years when I started going to the south side, there were more Western doctors, Dr. Luanne Freer,
00:05:10
Speaker
was one of the, she's a very well-known mountain medic from the USA, she was one of the founding kind of people behind setting up the Everest ER and she sourced doctors from the US or from Europe and over the years they've integrated more Nepali doctors who have also done a diploma in mountain medicine and now I'm not sure how it stands at the moment
00:05:34
Speaker
It's been a couple of years since I've been to the South Side, and I'm not sure if it's entirely run by Nepalese or whether they still have Westerners. I think probably the latter, so there's a bit of both. But they've definitely tried to integrate more Nepali doctors, which I think is great. What did you treat mostly, would you say, when you were there? That's the most common one.
00:05:55
Speaker
Yeah, it's a shame actually because everyone thinks that being an expedition doctor sounds like a super sexy job and you're seeping lies left, right and center. And actually that's not the case. I mean, what I treat the most is symptoms of upper respiratory tract infections and colds and coughs and tummy ache and diarrhea.
00:06:19
Speaker
And all these minor illnesses that can be significant on an expedition when you're living or trying to live at 5000 meters elevation base camp and trying to do the best climb of your life. So I don't want to belittle them, but that is definitely the vast majority of my work is dealing with people with minor ailments.
00:06:41
Speaker
And do you find that those, I mean, those are all probably fairly contagious diseases or conditions, maybe it's the right word. And do they tend to sweep through base camp when you see that just happening where people are congregating and then you're not washing their hands or coughing or whatever, and pretty soon lots of people have it?
00:07:04
Speaker
Yeah, for sure. I mean, it's a combination of the kind of the number of people who congregate in these base camps, especially the south side, which is generally busier than the north side. But it happens in both places. So it's a combination of the number of people and the difficulty in maintaining just simple hygiene. And over the years, that has improved massively. And certainly the kind of high end expedition operators
00:07:32
Speaker
run a really tight ship and teach their team members, the staff and all the team members the importance of really stringent hygiene.
00:07:46
Speaker
But nonetheless, it's a busy place. There are a lot of people and it's easy for a cold which spreads in any situation. It's really easy for it to spread. And there's been a couple of years where more serious flu-like illnesses have really taken a toll on base stamps and caused a lot of people to get too sick to be able to climb. Not dangerously sick, but just too sick to be able to be successful.
00:08:14
Speaker
And so when you come across someone with those kinds of conditions, especially the upper respiratory condition, do you sometimes recommend that they go to lower elevations to recover or you just try to hit them with antibiotics and have them stay there?
00:08:33
Speaker
Yeah, it's really tricky. So yes, in answer to your first part of the question, yes, for sure. Early on in the expedition when we have the luxury of quite a lot of time, if someone is struggling a bit with a bad cold and not really showing signs of a prompt recovery,
00:08:52
Speaker
I very often have recommended that they drop in elevation to try and get better. And often it doesn't need to be a lot. So both base camps on North and South are at a similar elevation. They're both around 5,000, a little bit more, 5,200 meters.
00:09:09
Speaker
On the south side, it's really easy to lose elevation because you can drop down to Logoshae or Ferroshay and lose a thousand meters elevation relatively quickly. On the north side, it's not so easy, but you can do it and it can make a whole lot of difference. People drop down for a day or two days and they get over their cold and they come back.
00:09:33
Speaker
And when they try and fight it off at base camp, it can take days and become a real drag. So early on in the expedition when you have the luxury of time,
00:09:44
Speaker
It's definitely worthwhile. 99% of these illnesses are viral illnesses, so they don't respond to antibiotics. And even though it's really tempting to try, should we give it a try with antibiotics? It's bad medicine.
00:10:05
Speaker
And it's a really tricky one. I definitely admit to poor use of antibiotics on expedition, as in I use them too much when I know that really this person has a viral illness and antibiotics aren't going to do much.
00:10:23
Speaker
Um, but sometimes again, you know, you, you, you're pushed for time. You know, the weather window is coming up. You really want this person to start feeling better. You think maybe there was a tiny chance they've got a bit of a bacterial infection and the antibiotics might help. Okay. We'll give it a try, which I would never do at home. Um, so it's tricky. It's a tricky one because yeah, you know, too much use of antibiotics is not good and we all know that. Um, but yeah, you kind of have to juggle the two.
Managing Trauma and Emergencies
00:10:54
Speaker
So do you ever, I'm sure you treat occasional trauma situations, accidents and injuries and that sort of thing and like crevasse falls and that, you know, so how do those tend to end up with evacuations or are they most of them pretty minor?
00:11:12
Speaker
Yeah, so actually I've been really lucky and I haven't had to treat a lot of trauma. I've had some trauma cases, I haven't had any major trauma cases, so most of the traumas that I dealt with were
00:11:28
Speaker
minor broken arms or broken legs, but nothing massive. And also I'm lucky in that my years on Everest, especially on the south side, were the years in which use of helicopters just boomed. So I think the first year I worked on Everest south side was 2009 and helicopters were beginning to be used frequently for evacuations.
00:11:56
Speaker
And from then on, it just grew exponentially such that evacuating a person became kind of easy. The pilots were great European pilots of a super high standard with a lot of mountain flying experience. And they would, you know, they would come at the drop of a hat to pick up someone even from camp two in the icefall and take them straight to Kathmandu, which in the context of trauma,
00:12:25
Speaker
is the safest thing because sure, I can deal, I can do a kind of first aid approach to trauma at Basecamp.
00:12:35
Speaker
But at the end of the day, it needs to be fixed and it's hard to, you can't do that at base camp. Yeah, you aren't doing surgeries. No way. Those days are long gone. Explaining doctors in the class, they used to do crazy shit like that. But thankfully, I've never had to do anything like that. So yeah, so trauma almost always in media evacuation.
00:12:59
Speaker
It's a bit more complicated on the north side where helicopters are still not allowed to fly for rescue and evacuations are protracted and difficult. It's a long way into that mountain from the north side. It's a long way on the north side. So from base camp to ABC is a lot of co-needers. I can't even remember how many, but most people do it in two days and if you do it in one day, it's a good eight, nine hour day. It's a long way.
00:13:26
Speaker
And for an injured person to get them off the mountain with manpower and then from AVC back to base camp, usually with yaks or sometimes manpower, it's epic. It's really epic. And the times we've had to do it have been, yeah, stressful and tricky. I can imagine. Yeah, I can only imagine. So were you there the year of the earthquake then?
00:13:51
Speaker
Yes, on the year of the earthquake, I was on the north side, which I was incredibly lucky because on the north side, we felt the magnitude of the earthquake to the same degree as the crow flies. We were pretty much the same, but because of the geography of base camp at the north side, we were only at base camp.
00:14:13
Speaker
It's a huge valley with a wide flat plateau in the middle and the kind of steep sides of the mountain that are quite far away. We were fine. We saw the ripples in the earth like in the movies. But we were far away from Rockfall and nothing happened. And compared to the devastation on the south side, yeah, we were incredibly lucky.
00:14:41
Speaker
And then incredibly frustrated because there was nothing you could do to go over the other side and help because we couldn't get there. Yeah. Wow. Yeah, that was a crazy time. It was. Yeah. Yeah. So when people are getting ready to go, I'd like to walk people through their preparation period at home, training, getting ready to go, the trek, and then base camp.
Importance of Experience and Preparation
00:15:09
Speaker
Can you give us some recommendations as to maybe some preventative measures people could be taking during those times, what some do's, some don'ts, especially, you know, once they get in country and they're traveling in the third world country, what kind of advice would you offer somebody, but maybe even starting from home?
00:15:36
Speaker
Yeah, so I think the most important thing for people preparing to go and try and climb Everest, for example, is to have experience. And unfortunately, it definitely looks like over the past few years there's been more people with less experience and that's
00:15:58
Speaker
partly why there's so much media attention and so many problems and all this kind of negative press. So for me experience of how you respond to altitude is really key and people
00:16:13
Speaker
Yeah, people should know how their body responds to altitude before they go and try something like Everest. So, you know, in North America, you have a huge number of peaks of moderate altitude that are a great place to start.
00:16:31
Speaker
And then, you know, maybe a slightly higher peak before you head off to something like Everest because we're all different and there's no rules that fit for everyone. And some people feel absolutely fantastic the first time they arrive at 5,000 meters and some people want to die there and then. And some people don't even make it that far because they get so sick before then.
00:16:53
Speaker
And there's really no way of knowing until you've tried it. And so that would be my number one tip would be get some experience at lower elevations before you head to the giants of the Himalaya.
00:17:07
Speaker
Yeah, that certainly makes sense to me. And I know we and our coaching business occasionally get people coming to us with little to, in fact, absolutely no mountaineering experience that are hoping to climb Everest. And that's pretty much what we tell them too. So I'm glad to hear you echo that sentiment that
00:17:27
Speaker
They need to start on something a little smaller, not only for the altitude experience, but also the technical skill building that you can only do. We can make someone with our business and our coaching, we can make someone quite fit. But if they've never walked in crampons until they start going through the icefall, they're going to have problems. We do see that from time to time. And I'm sure you've witnessed that firsthand over there.
00:17:56
Speaker
I'm glad to hear you echo that. Like I said, I think it's a very important thing for people to understand that this is not a small undertaking. When I was a young man, Everest would have been the dream culmination climb for most professional mountaineers.
00:18:15
Speaker
um you know and now it's a tourist attraction and I understand why and how that's come about but the mountain is still just as deadly and challenging as it was then it might have some be a little safer in some regards but but still the the the danger element is huge and I think a lot of folks aren't really prepared mentally yeah yeah absolutely and and
00:18:39
Speaker
I think, you know, businesses like yours, the companies that I've worked for as a doctor, I think have done an amazing job at making climbing Everest pretty safe, even for people without experience, but
00:18:55
Speaker
the likelihood of you enjoying it, if you don't have any experience, the likelihood of you being successful, the likelihood of you doing it in a safe way is just so reduced if you've never been to altitude. And an altitude illness is a real
00:19:18
Speaker
It's a real thing. And it's an avoidable cause of death. And I always say that. People who die from altitude illness, it's a death that could have been avoided. And one of the ways in which we can avoid it is by people having experience and knowing how their body responds. And we all respond differently. And you have to know. And the only way of knowing is if you've been there before. And of course, I'm not saying you need to climb Everest.
00:19:45
Speaker
before Everest, but to know how you feel at lower elevations will give you an idea of what feeling okay is and what feeling really not okay is. And that keeps the whole thing safe. So yeah, that's my number one pet peeve, not enough experience. A couple of the guide services that we work fairly closely with,
00:20:10
Speaker
I don't know how if you're making it a requirement, but they are very, very strongly suggesting that you climb a 6000 meter peak and a 7000 meter peak before going on an 8000 meter peak. And I think that makes tremendous sense. I think there's an awful lot of people who.
00:20:27
Speaker
just want to tag the Summit of Everest and say they've done it. And so they don't want to spend two or three years developing that skill base. But I commend those guide services that are holding people to that standard just because I think it obviously causes them fewer problems in the mountains with people getting sick or inexperienced people not being able to complete the climb.
00:20:49
Speaker
But I think for some folks, it's a hard pill for them to swallow that they're going to have to take. This might be viewed as a multi-year project instead of a multi-month project.
00:21:01
Speaker
Yeah, yeah, I agree. I mean, I work for Alpinglow Expeditions now, and Alpinglow does require our clients to have climbed lesser peaks before they go to Everest. And I wholeheartedly support that, like you say. I think it's really important. And although you're right, people do kind of approach it, or maybe some people approach it in a bit cross, like, oh, why are they making me do this? I don't want to do this. I just want to climb Everest. But at the end of the day, hey, climbing a 5,000-meter peak can be amazing.
00:21:31
Speaker
It's not a tour, it's amazing. And not only are you gaining experience and knowledge that's going to make you way more likely to be successful on Everest, you're having an amazing experience. So yeah, I feel strongly that that should be the case.
00:21:50
Speaker
that people should demonstrate and experience a desire to climb mountains that will ultimately
00:22:02
Speaker
protect them because it will give them knowledge and know how that's going to keep them safe on whichever mountain they choose to go to. Right. Absolutely. Well, then let's take the next step. So let's say they've got this experience and, but they're still going to Everest. So now they've arrived in Nepal. Can you kind of walk us through, I mean, I haven't been to Kathmandu now in
00:22:25
Speaker
over 15 years, but I imagine it's still a pretty dirty city, because that's where they're going to land, right? Yeah, usually people go to Everest Fire Camp and do certainly everyone who's going to the south side. Nowadays, some people climbing from the north side avoid Nepal altogether and travel through China.
00:22:47
Speaker
Yeah, so some companies just do all their travel logistics through China now and go straight to the north side. But either way, you know, you're travelling in a country that's very different to the countries that a lot of the clients come from, so Western Europe or the USA or Australia, New Zealand.
Health Risks and Precautions for Climbers
00:23:07
Speaker
And again, a lot of it is experience. If you've climbed some other peaks, then you're likely to have traveled in different countries. And the experience you gain traveling outside of your comfort zone is huge. So that goes back to point number one, which is get some experience.
00:23:25
Speaker
Otherwise, I encourage people to be pretty cautious. The approach and travelling to a new culture is always super exciting, and it's part of the experience. But if climbers are really focused on succeeding on a climb of the magnitude of Everest, then getting really sick in Kathmandu because they bought some street food
00:23:52
Speaker
or because they've been out partying super late is not going to do them any favors. So I actually turn into a bit of a boring bossy boots when I meet people in Kathmandu or in Lhasa or whatever because I don't want people getting sick before we start because
00:24:11
Speaker
you know you get there you have a reserve of health and energy that you've been building up for months before you arrive and you want to keep that reserve intact for as long as you can and if you already start eating into it with a little bout of diarrhea or a little hangover or a little something on the way in then you know you're eating into your reserve so so yeah so I advise you know it's super careful choice of restaurants that you eat in uh be really careful
00:24:41
Speaker
green salads or uncooked food. Think about ordering meat. Are you somewhere where there is good refrigeration and you're confident that the meat is in a good condition? If you're not, then just don't eat meat. Hand-washing, tap water, avoid it unless you're absolutely sure it's safe, which means most of these places it isn't, so you can rush it into the bottle of water.
00:25:03
Speaker
Yeah, exactly. It's a lot to take in, but again it's something that if you have experienced travelling in developing countries before, then it kind of comes as second nature and it doesn't put you so out of your comfort zone. Whereas if it's the first time you've ever left a developed country,
00:25:23
Speaker
It can be stressful. So it comes back again to the same point we had before. It's like experience is going to help you deal with everything from the minute you leave your home to the minute you get back. Everything that isn't new is going to be less stressful and easier for you to deal with. And especially for Everest, the kumbu being the most common approach for people to arrive at Everest Base Camp,
00:25:54
Speaker
It's filled with thousands of people coming from all over the world, all congregating there in early April and traveling through the same guest houses and lodges and that sort of thing. And that would seem also to be, they're bringing all these bugs with them from different places. And so that would seem to kind of complicate the issue.
00:26:16
Speaker
Yeah, I mean, it does. And it's interesting now because of the coronavirus pandemic and COVID-19, we're all suddenly kind of really tuned into infectious diseases and virology and all this kind of stuff. But it's been around forever. And infectious diseases, upper respiratory tract infections are the most common, spread like wildfire through the lodges in the kumbu. Like you say, there's people from all over the globe. They're each bringing their local
00:26:45
Speaker
kind of current cold which in Japan is not the same as it has been in Germany because you know we're so far apart then their virus is different to our virus and it's just a cold it's nothing serious but it is enough to spread super easily and it's enough like we said to to just give people get people off to a slower start than you'd like
00:27:07
Speaker
So in the kumbu, in the lodges again, I try and get people to be super strict. Lots of hand washing, lots of alcohol hand sanitizer.
00:27:16
Speaker
try not to mix too much or we don't share drinks, you don't share food, there's no shared plate on the table, there's no someone putting their fork into your plate to taste how your chips are. There's just super strict rules about not infecting one another with whatever it might be.
00:27:39
Speaker
And even then it's hard and it's common for people to pick up a cold or a cough or a stomach bug on the way in to an expedition. And when that happens, I mean, they're going to be continuing, let's say they get sick, you know, in Namche even, something fairly early along on the trek.
00:28:02
Speaker
In order to stay with the group, they're going to have to keep walking every day, right? Or would you sometimes have people that get really sick stay behind?
00:28:10
Speaker
Yeah, for sure. Depending on how sick someone is, on several occasions, I've had someone stay behind with either myself or with a shepherd guide or a western guide, whatever. It always depends on the size of the group and the logistics. But at the end of the day, if someone is sick,
00:28:34
Speaker
ascending and altitude doesn't make any sense at all because they're not going to get any better. So if someone picks up something nasty as early on as namche, they're way better to stay in namche for a couple of days, recover, and then catch up. That makes total sense, yeah. And similarly, I'm wondering about on the mountain, once they're in base camp and you're starting to do the acclimatization rotations up onto the mountain,
00:28:59
Speaker
What happens then when someone gets sick? And it seems like it'd be quite likely they can fall out of synchronization with those acclimatization clients. And how does that affect their potential outcome of the summit?
00:29:16
Speaker
Yeah, it depends again on what capacity the team has to absorb that kind of mismatch. So in bigger teams where there are multiple guides, then normally you can account for that. So if someone's too sick and they need another couple of days at base camp before they can do their rotation, then there will be someone available to do a rotation with them.
00:29:41
Speaker
a couple of days after the main team has gone and most of the most of the high-end operations do that you know they they have they have a really high guide to client ratio which is one of the things that makes it so much safer.
00:29:56
Speaker
And that's one of the reasons why it allows a lot more flexibility to accommodate individuals and their individual needs. On teams where there is less manpower,
00:30:13
Speaker
it may be more difficult and and that's the kind of team where people run into trouble more often because either they push to go high too soon or they push to go high when they're sick and they shouldn't and then they get sicker and then that's the end of the trip or
00:30:28
Speaker
Yeah, these little details are the difference between a really well-run, well-cushioned expedition or one that just doesn't have a lot of margin for error. Yeah. So that brings us right back to the point that we've hammered on before, which is experience. I mean, those details are going to be much more familiar to you if you have had these experiences.
00:30:53
Speaker
So that you yeah that you can make adjustments you and or the guide service, you know Most of these guide services, of course have a lot of experience but I've actually had one or two clients who when they went to Everest were so concerned about falling out of the acclimatization rotation that they went to Camp 3
00:31:17
Speaker
Camp 2, Camp 3, with pretty significant bronchial infections that then turned into, you know, like, had this, I'm not a doctor and I wasn't there to diagnose it, but it sounded like it became like pulmonary edema for them. And so once that happened, the trip was over.
00:31:34
Speaker
and that's just so unfortunate that makes me really sad that it happens and it makes me a little bit cross with whichever company is leading those people because because that's a mistake um you know and maybe in the end that's what people pay for you get what you pay for if you pay a lot less then you're going to get a lot less support but
00:31:54
Speaker
But yes, having an upper respiratory tract infection is a risk factor for developing hate. That is fact. There's no argument there. If you have an upper respiratory tract infection, your chances of getting hate on moving up the mountain are higher than if you're healthy. Therefore, if you have an upper respiratory tract infection, you should wait until it's better before you move up.
00:32:17
Speaker
And if you don't wait, you're playing with fire, and fire is death, because hate can happen super quickly, and people die of hate. So yeah, so like you said, experience has so much to do with all of this, because you know, you'll know, oh, I've got a bit of a cold, okay, I need to wait a day. Yes, everyone's going up, but I have time and I will catch up.
00:32:44
Speaker
If you don't have that experience, then you have this pressure, this fear, this anxiety that everything is going to go out the window and all you've got is a stupid little cold. And yet you'd make the wrong decision and your stupid little cold, you push through and you go to camp three and you get hyped and have to go home and maybe just two more days at base camp with a little cold, you'd have been fine. Yeah. Yeah. And I think in one of those cases, this person was quite fortunate to be able to be helicoptered out of camp two or they would have died.
00:33:13
Speaker
Yeah, like I said, nowadays the helicopters save a lot of lives on the south side of Everest by being able to evacuate people super quickly. They can't fly higher than Camp 2, I think, can they?
00:33:26
Speaker
So not regularly, they can. The highest rescue on the south side of Everest was a long line rescue done from 7,900 meters so that the rescued person was an Indian climber and he was just, I
00:33:44
Speaker
I think just below the yellow band, although don't put me that because my knowledge of the route is pretty amateur. But 7,900 meters, that's for sure. An Italian pilot with a stripped down helicopter on his own, super, super experienced, Maurizio Fellini. And he had a long life and he went up with a helicopter, just him, no technician or anything.
00:34:08
Speaker
and the climber's sherpa clipped him in to the long line, unclipped him from the fixed line. I mean, he was practically unconscious and Maurizio flew him down and then flew him to Leclerc and he survived. Yeah, unbelievable. No, getting down fast is the safest thing we can do when things go wrong at altitude and
00:34:30
Speaker
You know, not much faster than a helicopter these days. Yeah, exactly. I mean, this guy went from 7.9 to Kathmandu in the question of hours. It was unbelievable. Yeah, but we felt pretty good when he got to Kathmandu. It's like, hey, it was fine. Why did you bring me down? Yeah. Yeah.
00:34:48
Speaker
Funny. So there, no doubt you have had many in all those years, you must have had some kinds of experiences that stood out for you as, you know, either like
00:35:04
Speaker
kind of maybe funny might be the wrong word but you know sort of humorous anecdotes or and I'm sure some tragic ones as well but which do you have anything like that you can elaborate on for us and something that sticks
Innovations and Elite Climbing on Everest
00:35:19
Speaker
out in your mind as a yeah um
00:35:25
Speaker
I'm thinking that, well, in particular, I remember during when Killian was on the north side, and that was a year that you were on the north side of Everest with Adrian Ballinger, Alpin Glow. What were people thinking when he showed up to do this crazy thing? I mean, that must have been created quite a buzz around the base camp. Yeah, I mean, for sure.
00:35:51
Speaker
Yeah, I mean Killian is amazing and I think there are a lot of people that just didn't believe that it was a reasonable thing to try.
00:36:06
Speaker
And it was spectacular to watch. And he opened my eyes. I'd never seen anything like that. And I was worried. But that reflection on me, not on him. Killian's super experienced. And he's got a lot of experience at Extreme Altitude. And he's an amazing athlete. And he knew what he was doing. And he
00:36:26
Speaker
And he made his decisions based on all of his experiences and his knowledge. My anxiety is a reflection of me and my lack of knowledge and my lack of understanding what he was capable of. But I was super anxious and I was so happy to see him when he came back. And the speed at which he recovered was just astonishing. Because he turned right around in a few days. He turned right around, went back up and then he came back down and he sat there and chatted with us.
00:36:56
Speaker
you know, sat there and drank a little bit and had a bit of a chat and then wandered off to base camp. I mean, just utterly astonishing. It is, it really is. I mean, my experience with people returning from 8,000 meters and where they have not been using supplemental oxygen is
00:37:15
Speaker
they're often not fit to talk to. They're like professional fighters. They've had their head too many times or something. Absolutely. Just destroyed. Yeah, destroyed. Right. Yeah. I mean, it's rare that I've seen someone after no oxygen climb not be destroyed to a degree. There's degrees. Some people still manage, but they're still wrecked. And other people, you just think, wow, I can't believe you're
00:37:45
Speaker
Alive.
00:37:48
Speaker
Yeah, it's quite incredible. And yeah, like I said, Killian's just amazing. He threw the ball out of the park. And what's amazing to me is that he just opened a whole new zone. He's like, hey, look, what's possible? Because he's the most humble guy in the world. He's like, hey, if I can do it, there's nothing special. Of course, I think he's special. Lots of people think he's special. He's probably a bit special.
00:38:16
Speaker
But he's like, hey, this is possible. And it's great. It's great. So much of what we believe is based on dogma about altitude. And here's the sky. And he comes along. There's a few of them out there. And they're like, we're going to try. We're going to try and move fast. We're going to try and move light. We're going to try and make progress and be safe in our speed rather than trudging up these mountains and spending days and days at extreme altitude. We're going to attack.
00:38:46
Speaker
And yeah, it's amazing. They're totally opening the gates to a whole new kind of domain of what can be achieved at altitude, which is very exciting to watch. It is. It's very exciting to see. And you know, I think I'll give Steve a bit of credit here, but I think, you know, Steve, in a way,
00:39:07
Speaker
15 years ago or 20 years ago was doing the same thing, showing what was possible in terms of light and fast, a sense in places where people would have normally fixed ropes and taken days and days and taking this to the Himalaya and the Karakoram and doing it at really high altitude. And Steve has said repeatedly, I know in public that when we get
00:39:34
Speaker
someone like Killian, with Killian's fitness base, who's also, not that Killian's, Killian's no slouch as a climber, but he's certainly not at the cutting edge of alpinism. But if you get someone with sort of Steve's alpinism skills in Killian's fitness, we're going to really see the world of alpinism get turned upside down, I think. Yeah, yeah, for sure. And there are guys out there, you know,
00:40:00
Speaker
Uli was heading in that direction. David, he's up there and he's biased, but he's up there and there are more guys and hopefully women just working on that theory. And like you said, Steve was one of the first people to kind of
00:40:18
Speaker
encapsulate that idea and say hey this is something that people can try and i have to say that i think the mountain medicine community for the large part we're a bunch of old stodges who sit around and criticize and say oh that's too fast you can't go to altitude that fast that's crazy that's insane that's not possible you know and and actually
00:40:42
Speaker
That's wrong, you know, sure. The advice we give to the general population has to be the safest advice for the largest number of people. But we also have to recognize that that advice isn't necessarily the right advice for an elite group of super strong, super experienced, high altitude mountain athletes. And yeah, I think there's a lot of mountain medics who are kind of eating some humble pie with some of what's going on now.
00:41:10
Speaker
which is great. And also learning, you know, it's like, wow, this is possible. Look at this. And it's great. Well, certainly, you know, let's clarify just for a moment. David Goodler, your partner, is also an athlete that I coach and have coached for, I think, five years, close to five years now.
00:41:33
Speaker
And David and I did a podcast interview just a week ago discussing some of his exploits in the mountains. And so I want to make it clear that, yeah, I think we both have some bias. In fact, with regard to David, but I would agree that he is, you know, at the very, you know, he's at the top of that heap of high altitude alpinists and mountaineers. And he's an incredibly fit guy. He's, I think, you know,
00:42:01
Speaker
taken this to that level that we've been talking about. And as you know, he was good friends and climbing partners with Uli Steck and together they did some amazing things. And I think that helped open David's eyes to what was possible. And so I think it's really important that there are groundbreaking people out there like Steve or Killian and David,
00:42:26
Speaker
when climbing those routes that he and Uli did on the south face of Shishapangma, that those were pretty major alpine climbs by very highly competent climbers who did them first. But they took several days. And here are these two guys running up and down them in a matter of hours. And I think that was astonishing for a lot of folks. And I think it's a little bit like Roger Bannister breaking the four-minute mile.
00:42:55
Speaker
You know, once somebody's broken the four-minute mile, then other people go, oh, now I get it. I see. And then the flood, like you said, the gates open and more people can rush through. And I think we will see, you know, in the next decade or two, we're going to see an explosion of that kind of thing. Very fit people who have high skill levels and lots of experience going into the mountains.
00:43:19
Speaker
It's exciting for me to see that. Yeah, me too. It's super exciting. Even from a physiological level, like I said, you know, mountain medicine is kind of, it's a slow, slow genre of medicine because it's so difficult to do studies and get evidence-based to change protocols and stuff.
00:43:38
Speaker
And I just feel like we're stuck in the 1970s or the 60s from the silver hot expeditions, which were phenomenal at the time. And they came up with a huge amount of data that helped us understand what happens at altitude and the physiology of altitude. But we haven't made any progress since then. And suddenly, we see these guys, like you say, climbing a huge alpine face at 8,000 meters in a day, up and down.
Genetic Research and Acclimatization
00:44:04
Speaker
Yeah.
00:44:05
Speaker
When kind of mountain medicine dogma says you can only ascend 300 meters a day, you need to take a rest day every three days. You know, along those lines, I think, you know, Rob Reich.
00:44:23
Speaker
So I think maybe you and I have had this private conversation at one point, but a couple of years ago, Steve and I were invited to present at an international special forces symposium on high altitude and winter warfare. I mean, we don't know anything about warfare, but we know a lot about
00:44:44
Speaker
high altitude winter and Rob was one of the other presenters there and I've been trying to get Rob to let me release a videotape we have of his talk on our website but he's still working on this study so he didn't want me to publicize it but I can tell you some and I'm sure people you probably maybe even already know this but other people might be interested in it that
00:45:09
Speaker
So Rob did an experiment where he took a group of collegiate cross-country runners from the University of Oregon, so a very high level program, so very fit young people, took them to Ecuador, Bolivia, can't remember which country, where they could live at approximately 16,000 feet,
00:45:32
Speaker
And they had a dormitory and these, there were some observatories there so that there was a place to, they could, people could live and they weren't having to rough it, they could live indoors. And he also took an entire genetics laboratory down there with him. And one of the first things they did was they ran, well, they took these like 20 young people and the first day they made them do, I think it was about a,
00:45:59
Speaker
almost a two mile, so a three kilometer uphill time trial, hard as they could run at this high altitude. And of course, none of them really liked that very much on that day. And then they did two weeks of everyday testing blood markers to see what was changing during the two weeks. And he chose two weeks because
00:46:20
Speaker
During those two weeks, very little happens to your hematocrit levels. You don't really make many new red blood cells very much during that time. So he wanted to see what other effects were happening to people that would allow them. Because we all know that even if we've been in altitude for just a few days, we tend to start feeling better. Yeah, for sure. So one of the things that Rob said during this talk was that
00:46:45
Speaker
there were over 5,000 genes that were affected when people went to altitude, which is roughly, what, a quarter or a fifth or something of the whole human genome. So that is a pretty major effect. And I found that kind of interesting, but what was sort of dumbfounding for me was,
00:47:09
Speaker
he only knows he, and if he doesn't know, probably no one knows what two or three of those genes do. So we have barely scratched the surface of understanding how the body reacts to altitude.
00:47:22
Speaker
There was one particular gene that was massively upregulated when people went to altitude, and it turns out that that particular gene is also one that's really prevalent in indigenous high altitude populations. So that kind of makes sense, and that was the most responsive gene of all of the others. But if out of 5,000 that are affected, some upregulated, some were downregulated, and we only know what a handful of them do,
00:47:49
Speaker
We don't really understand acclimatization very well at all. Absolutely. Yeah, I mean, no one could argue with that. Our understanding of acclimatization is so basic at the moment. You know, we talk about respiratory rate and heart rate and changes in these super kind of basic physiological parameters and going down to that next level of
00:48:16
Speaker
genetics and really what's happening at a cellular level or an intracellular level but I mean it's way out of kind of field for me that's way beyond my pay grade um but it's fascinating and and Rob I think he's spent his life pretty much working on on on altitude high altitude medicine and he's one of the people who probably knows most about this
00:48:39
Speaker
So if he doesn't know, I don't know, who knows? That was the way I came from. It was super interesting as well. And I remember, I think after talking to you about it, I watched that video and found it fascinating. And the other thing that's interesting is, of course, there's an inter-individual variability in those responses. So some people, people who respond super well at altitude and continue to perform really well are obviously better at
00:49:06
Speaker
making all those changes at a genetic level, upregulating, downregulating, and all these little things that make them adapt at altitude, and other people just don't do it so well. In the same way as so many other things, we're just all different, but we're all different at altitude as well, which is why some people do super well at altitude and some people really don't. Our bodies are the same in so many ways, but so different in the minute ways that can really have an impact on
00:49:36
Speaker
individual performance at altitude. Yeah, for sure. So at the end of that study, two weeks, he had those young people do the time trial again and their average time improved by 25% and yet
00:49:54
Speaker
the increase in red blood cell or hematocrit was almost negligible. So that's the part that really shocked me because my understanding of altitude acclimatization has always been related to, oh, we increase our red blood cell count and that makes we could carry more oxygen. And that makes a lot of intuitive sense for someone who doesn't have much background in this.
00:50:16
Speaker
But to find out that there could be a 25% improvement in performance. Before that's even happened. Yeah, before that's even happened means something else was going on in there that we don't know. And if you as a coach, you must know, like, how easy is it to get a 25% improvement in an elite athlete?
00:50:34
Speaker
especially in two weeks. I mean, does that ever happen? No, it doesn't ever happen. Yeah. So it's really crazy. Working with someone like David, who I've been coaching now, as I said, for a number of years, and who's a very fit and elite athlete.
00:50:50
Speaker
We talk in terms of 1% and 2% if we're lucky over the course of a season to see those kinds of gains because when you're athletically mature, you're much closer to your own genetic potential at that point and it's harder to make gains.
00:51:05
Speaker
Yeah, yeah, yeah, it's crazy. It's super interesting. And yeah, I mean, I don't know, I think you were optimistic in saying in the next couple of decades, we may understand more certainly at that level. I don't know. I don't know if we'll see it, hopefully. Well, Rob was pretty optimistic. And I don't know if you remember at the end of that talk, he was
00:51:27
Speaker
Tossing out this notion that within years there will be a pill that we can take that will help us speed up the acclimatization process and And I was a little skeptical, but you know, who knows? Understand what some of those genes do maybe that'll be possible Yeah
00:51:54
Speaker
When you, let's go back to the, maybe we've told a couple little anecdotes here. If we can find, is there something, I mean, any instance that stuck out with you as a base camp doctor where you were just, like those kind of pulmonary edema instances where you just are slapping your forehead and thinking, why did you do this? I mean, why did you make that kind of a mistake? Are there any other examples like that?
00:52:23
Speaker
Yeah, I mean, I can think of an example now. I mean, a lot of the kind of press or lay people talk about people having summit fever. And that's definitely a thing. There's such a strong desire to be successful and reach the summit that people will do anything, even put themselves at risk or put their teammates
Risks and Realities of High-Altitude Rescue
00:52:46
Speaker
at risk. And I've certainly witnessed that on a number of occasions
00:52:50
Speaker
even in climbers who have experience. Yeah, I remember one occasion with a super experienced 8,000 metre peak climber, you know, calling me from Camp 3 on a mountain on one of the 8,000 metre peaks and saying, hey, I feel really rubbish and I kind of can't see straight and slurring my words a bit, which are signs of cerebral edema, which is the other form of severe altitude illness.
00:53:19
Speaker
And I was like, well, you have to turn around and get the hell out of there. You're showing signs of cerebral edema, and this is bad, and you cannot continue. You should not continue. He wasn't a client for the team that I was working for. He knew me, and he was calling me for my advice, and that was my advice. And he absolutely disregarded it, and popped some Diamox and popped some dexamethasone and continued on up.
00:53:47
Speaker
And it was disastrous. And him and his team took way, way, way, way, way longer than anyone should ever have taken for the distance remaining. They had to cover. And they made it to the summit. And then on the way down, they ran into trouble. And it was late. And it got dark. And it was just horrendous. And in the end, a lot of teams had to pull together to help rescue this group of people off that mountain. And it was epic. And it just...
00:54:14
Speaker
I don't know, it just made me so, yeah, I don't know, just so deeply uncomfortable that really people just lose judgment so much. Yeah, I don't know. And I wonder whether I'm just not passionate enough about anything to be able to empathize with that, maybe. Or you've seen the downsides of it and I think that, you know, having
00:54:42
Speaker
I've done quite a number of rescues and body recoveries myself, including one from 7,000 meters on K2. It was not a body recovery, it was a rescue. But still, when you've been involved in those kinds of circumstances, you realize how dangerous, how much risk that this accident, in this case, it was an accident, it wasn't the person's fault.
00:55:07
Speaker
that put a whole bunch of us at risk for two or three days of managing to get him down off that mountain. And I think that that's something that is easily disregarded by people who've never been involved in that kind of situation. That once the rescuers come out, now it's not just one person who's in trouble, but potentially 10 who could have problems.
00:55:32
Speaker
Absolutely. And as soon as you're talking about altitudes of that level, 7,000 meters, it's not even potentially putting rescuers at risk. You are absolutely putting anyone involved in helping you off that mountain at risk because being at 7,000 meters is a risk.
00:55:54
Speaker
And it's all very well for you, Scott Johnson, to say, I'm going to climb this mountain and I've assessed the risks and I know the route and I know that altitude is a risk and that's fine. I'm going to do that in my climb. It's a totally different story for you to then put yourself at risk to help someone else off the mountain. And of course, everyone does that because it's human nature. It's very rare that people don't help other climbers.
00:56:24
Speaker
But there is this element of risk that I think people don't understand. And if you run into trouble because you've made some really stupid decisions that you shouldn't have made because you're someone who has experience and knows the deal.
00:56:41
Speaker
Then, yeah, it's hard not to get mad at those people. I was really mad at those climbers. I was really relieved that in the end, most of them were fine, but I was mad because the number, the amount of resources and the number of people that were put at risk in that rescue was enormous.
00:57:02
Speaker
And yeah, again, it comes down to experience that we've kept kind of banging on about throughout this chat. If you've been somewhere and you've seen that and you've had that experience, you learn. It helps you make decisions better. In the very best case,
00:57:21
Speaker
the people who are needing to be rescued are asking the rescuers to give up their summit. You get involved in a major rescue like that on a big mountain, you can be so wasted by the end of it, you're not going back up. At the very best circumstance, if somebody doesn't get hurt, they have just sacrificed their own trip to save you. Yeah, absolutely.
00:57:46
Speaker
And I think, again, it's that experience thing that people don't understand. This isn't like calling 911 and having the ambulance show up at your house, you know, and putting you in your sun. As soon as the paramedics get there, you're in good hands and everything is going to be fine. No, it could be literally days before you receive any kind of significant medical help.
00:58:06
Speaker
especially on some of the more remote mountains. And I think a lot of the kind of problems are arising on Everest in the last few years with so many people. And like I was talking about before, helicopters have become so prevalent. They're omnipresent in the Kumbu Valley day in, day out. So I think there is a false sense of, hey, if anything happens to me, a helicopter will just come and get me.
00:58:33
Speaker
And it's true to a degree and not true in so many other cases. And a helicopter can't always get you. And that one rescue I mentioned earlier at 7,900 meters is unique in the history of mountaineering. It's a one off, you know.
00:58:49
Speaker
Most times the helicopters cannot fly at the altitude, they can't rescue people at that altitude and most of the big problems happen at those altitudes and so you're already going to rely on people getting you down to somewhere where the helicopter might be able to come and get you if it's daytime and if the weather's okay and there's suddenly a lot of ifs in that that people perhaps put to one side when they're making their
00:59:18
Speaker
Well, one thing I want to cover about, I've kept you a long time, but I do want to touch on one subject before we end this, and you helped Steve write a very deep article for us on the website about the use of
Hypoxic Tents: Pre-Acclimatization Controversy
00:59:34
Speaker
the simulated altitude environment living in a, you know, one of the companies is called Hypoxico and that they provide these tents and these generators that lower the oxygen content, relative oxygen content in the area of breathing so you can, according to them, acclimatize at home before you go on these trips. And could you talk a little bit about, you know,
01:00:00
Speaker
what you know, I mean, I know David's experience, he spoke about it a little bit last week when we talked, but give us some of your understanding of how that works and what you've seen in the field with regards to the use of those.
01:00:16
Speaker
Yeah, so I think the basic thing that's important for everyone to understand, and most of your listeners probably get this, but just in case, is that the reason why altitude is so difficult physiologically is because there is less oxygen available. And at altitude, the reason there's less oxygen is because the pressure is lower, the atmospheric pressure is lower, so the oxygen molecules are way more spread out. So each time you take a breath in, you're getting less of them.
01:00:45
Speaker
In the hypoxic tent system the pressure is not altered but what they do to recreate that lack of oxygen is remove some of the oxygen in atmospheric air and replace it with nitrogen which is inert.
01:01:02
Speaker
and so again when you take a deep breath in you're getting fewer oxygen molecules but the pressure remains the same it's just that some of the oxygen molecules have been removed and so there's this machine that does that process for you and it takes air atmospheric air from your bedroom or wherever you have it it pulls out some of the oxygen replaces it with nitrogen to differing levels depending on the altitude you want to try and recreate
01:01:26
Speaker
So there's no change in pressure using these tents. They do nothing to the barometric pressure of what you breathe. They just replace oxygen with nitrogen.
01:01:38
Speaker
There are some people who question as to whether the validity of that, how much is actually the pressure difference relevant to what our body does when it goes to altitude? Or is it really just a question of the oxygen? I think nowadays, most people would agree that the vast majority of symptoms of altitude are due to less oxygen.
01:02:02
Speaker
some small things may be a question of pressure, but most of what we experience when we go to altitude is because of less oxygen. So in that respect, you could say that the hypoxic tense, they're probably recreating altitude in that way, the reducing amount of oxygen that our body has available. There's no
01:02:26
Speaker
solid scientific evidence with these systems. And for me as a doctor and a scientist,
01:02:36
Speaker
that makes me quite uncomfortable because in every other branch of medicine, we try and base our practice on evidence because we can all have a gut feeling about what works and what doesn't, but gut feelings are very often wrong. And that's why we rely on sound evidence and sound evidence is gained by doing big controlled trials. And that's really difficult to do in this context.
01:03:05
Speaker
In an ideal world, you'd have a group of people acclimatizing in the tents, and you'd have 5,000 people acclimatizing in the tents, and a group of 5,000 people not acclimatizing in the tents, but they wouldn't know, and it would be double blind, and we'd get loads of data, and we'd do this massive trial, and we'd see who did best, and see who had side effects and who didn't, and then we'd get an answer. But that's not going to happen in the foreseeable future.
01:03:30
Speaker
So everything to do with what people discuss when they discuss the hypoxic tense, it's all anecdotal. Now that's okay, and over the years since I've been working with them, which is a few years now, I've seen a lot of people use them. So the numbers that I get my experience from are growing.
01:03:51
Speaker
But there's still miniscule in terms of what is deemed to be solid scientific evidence. So I think that's really important for people to understand that no one can say with their hand in the fire, this works and it's safe because we don't know that. We can say so far what we see is that it does appear to work and it does appear to be safe.
01:04:18
Speaker
And in my experience, so I work for Alpinglow Expeditions now and Alpinglow Expeditions is fully behind the use of the hypoxic tents and reducing the time spent on expedition. The aim of using the hypoxic tents is to enable people to arrive at the altitude of base camp
01:04:42
Speaker
in a shorter time. The reason that that's felt to be important is because like we touched on earlier, trekking in over two weeks, it's quite a long period of time to be exposed to infectious diseases and get tired and get ill and all this. So if you can reduce that, then you're more likely to be healthier when you arrive at base camp. In my experience, it's tricky.
01:05:07
Speaker
The people using the hypoxic tents have arrived at base camp and been well. I don't know whether that same group of people would have also been well had they not used the tents. I just don't know the answer to that. So I can say now, the years that I've been overseeing people preparing for the hypoxic tents, I have seen people arrive at 5,000 meters in a shorter period of time and remain well.
01:05:37
Speaker
I believe that quite a lot of those people would have actually been well anyway because there are people with experience and having experience at altitude kind of gets rid of people who don't do well at altitude. Stay home.
01:05:53
Speaker
They stay home. It's like, yeah, I went to try and climb a 4,000 meter peak and I got super sick. I think I'll give it an 8,000 meter for the mess. That's why experience is so important. So there is a bit of me that although I can say that what I've seen so far is that yes, people who have used the system come to Basecamp and overall remain well. Some of them not. It's not 100%, but it's a high percentage.
01:06:18
Speaker
I can't say whether or not that is because they've used the tense when they're not. Because I've seen a lot of people go to the altitude without using the tense and also be fine. So it's really tricky. David being like this. Yeah, like David. Yeah, exactly. And sure, and yes, but even people who aren't a David, you know, like, yeah, some people just seem to manage. So
01:06:41
Speaker
So yeah, so it's difficult to really say categorically, hey, this works. Because like I say, there is no solid scientific evidence, anecdotally.
01:06:54
Speaker
It seems that people who use it certainly aren't having any negative effects with regards to the altitude. However, your side of the story is the other bugbear I have with the system is that people who have a high intensity of training prior to going to
01:07:15
Speaker
on an expedition. You know one of the most important parts of training is all your kind of expertise here but sleep and recovery are absolutely essential to effective training and sleep and recovery and the hypoxic tense is definitely negatively affected. Yeah for sure. So it's a tricky balance. People who want to use them generally are people who want to use them because they want to reduce their time on expedition
01:07:45
Speaker
Um, by reducing their time on expedition and using the tent, they may be negatively affecting their training, which is going to negatively affect their success. Possibilities of success from the mountain. It's a double-edged sword. I agree. I, I, I, I'm behind, I work for Appleco and I'm behind what they do.
01:08:09
Speaker
And a significant reason is I do believe that people preparing to go on these expeditions need oversight from someone who understands hypoxic illness whilst they're using the tents at home. And I think that there are a lot of people using these tents who don't have that. And I'm in close contact with clients when they're using the hypoxic tents and, you know, daily emails or whatever checking in and how was the night and how were your stats.
01:08:37
Speaker
And if there are any alarm bells, then I'm like, okay, well, we need to turn it down or you're sick for a week. Let's turn it down. And it frightens me to think that there are people out there with little or no experience of altitude and hypoxia suddenly going to bed at a simulated altitude of 5,000 meters. And I'm like, wow, that's crazy. That's insane.
01:09:03
Speaker
thinks they're doing something great for their preparation to go on this mountain and actually they're doing something super reckless and super dangerous that needs some sort of supervision by someone who understands. So yeah, I don't know. It's tricky.
01:09:19
Speaker
It is tricky. We juggle the same things. When we're working coaching a client that's going to be using hypoxic tent we're sleeping in, we're the same as you. We want to know what elevation they slept at, how they're feeling, quality of their sleep. Then we vary that we reduce the training load if necessary, or we will
01:09:43
Speaker
If they're starting to feel a little tired, we'll have them go back and sleep at a lower elevation for a night or two. But I agree with you, it's not a simple thing to deal with. And I think that's the misconception that's out there, is that somehow this is a magic bullet.
01:10:00
Speaker
and it's much more complex. I think we've made it apparent over the last hour or so that this is a pretty complex subject, that we have only a pretty cursory understanding of, and most of that understanding comes from observations of what we've seen in real life on the mountains. And I think that it's
01:10:24
Speaker
whether it's the experience of climbing an 8,000 meter peak or having climbed other high elevation peaks. But something gives most of us that have done this before a little more humility. When we're charging into it, we might think, oh, maybe I don't really know all there is to know about this. Maybe it's going to be a little different than I think it would be.
01:10:49
Speaker
Yeah, for sure. My first expedition was in 2007. As the years have gone by, I feel like I know less and less and less. And I think that's
01:11:04
Speaker
Yeah, that's what happens, right? You see more, you realize how little you really know. And it's interesting. And yeah, and back to the whole experience thing. Again, it's another reason why I like the companies who really require their clients to have climbed lesser peaks. Because often people will climb lesser peaks without having to use pre-acclimatization or
01:11:32
Speaker
And it's all about knowing how your body is responding to a lack of oxygen. And therefore then when they do go and use the tent, if they do, they already know what it feels like to be hypoxic and they know what it's okay and they know it's not okay. Whereas if you get someone who's never been hypoxic in their life before and you stick them in a tent on their own in their bedroom or in the cellar and their wife's upstairs in the bed, you know, that's scary. Could be, for sure.
01:12:01
Speaker
And then the other thing that always worries me and I think is
01:12:09
Speaker
It's a little bit of an excessive of me, I'm sure, because I worry about unidentified pre-existing conditions. Now, generally, your clients, an uphill athlete and clients who are planning on climbing Everest or a big Himalayan peak, they generally fit people who don't have any illnesses that they know of. And hypoxia is something that uncovers things that we didn't know about ourselves.
01:12:39
Speaker
And with respect to the hypoxic tents, I worry that one day some guy who's chosen to use this tent without supervision didn't know that his coronary artery was two-thirds blocked because he's been fine until now. And suddenly he's, like I said, in his bedroom and in a hypoxic environment and boom. So yeah, they're really, they're not, I think,
01:13:06
Speaker
I'm not against them. I'm against the blase approach to them. I think they really need to be used with great care and a lot of guidance from people who understand what they're about.
Supplemental Oxygen: Media Misconceptions
01:13:25
Speaker
And I think anyone involved in high-altitude mountaineering, especially on the commercial level, just needs to embrace them nowadays because they're here and they're not going anywhere. So I think to kind of
01:13:35
Speaker
request using them and say, I want to use this. Exactly. Or in the case with Adrian's, you know, Alpenglow, he requires that they use them. Yeah, because Alpenglow only runs rapid trips now, so it's a requirement. So I think to be, to kind of stick my heels in the ground and say, no, no, no, no, it's not useful. But I do think we need to kind of encourage
01:14:04
Speaker
Just a cautious approach to using them and like you say, you have people using them but you supervise them and that's great. Yeah, not be okay with people jumping in there.
01:14:20
Speaker
thinking it's just sleeping in a tent. And I think there's some instances where people think that's all they need to do, that they're just going to get pre-eclamatized in this tent and screw the training. I don't need to train. And good to go. Yeah, good to go. Again, it's sort of we live in an age where so much of what we see pushed at us in the media or on the internet is some sort of quick fix, silver bullet, magic pill.
01:14:50
Speaker
and you know life is generally not that simple and especially something like this and I think that hopefully we've dispelled that myth uh here today just within these last 15 minutes um people can see a complex thing and and if they want more information they should go to our website and read the article that you helped Steve put together about this the use of this as well as in that article you also touch on um
01:15:18
Speaker
flow rates, oxygen flow rates and what that does to the altitude that you're at. And I think that's another good informative thing for anyone who's planning to be using supplemental oxygen or go over 6,000 meters. I think these articles will be very worthwhile reading.
01:15:37
Speaker
Yeah, yeah. Yeah, the supplemental oxygen thing is another thing that I think I really feel like there's a real lack of understanding and a lack of explanation out there available to people. You know, anyone who considers themselves in a mountaineer or is any way a professional athlete or mountaineer understands the difference between no oxygen and supplemental oxygen, and that's great, but there's a lot, a lot of lay people coming to these mountains now.
01:16:03
Speaker
And they really don't understand the difference between using oxygen and not using it. And I feel like as professionals associated with this world, the onus is on us to get that message across and explain to people the differences between using oxygen and not using oxygen. And then with supplemental oxygen, if you use it, use it.
01:16:28
Speaker
No one's ever going to ask you what liter flow rate you want. Therefore, it makes absolutely no sense to go up on a half a liter flow rate because why not just use it properly and make it safe? And using supplemental oxygen makes all of these climbs way safer if you're with a team who understands how to use it and has enough and has a safety net around all of these things.
01:16:53
Speaker
And yeah, again, it's just, it's one of these things that I feel like there's so much misinformation out there. And, you know, to clearly make a difference between people who climb without oxygen and those who climb with oxygen, because the difference is unfathomable. I mean, they just shouldn't even have the same name. They're different sports. Different activities.
01:17:15
Speaker
And I feel like so many lay people just don't understand that and it makes me really frustrated that we're somehow not able to get that message across and we need to work on that.
01:17:26
Speaker
Well, I think that chart that is in our book, Training for the New Alpinism, and I believe it's in that article on oxygen on the website that basically shows what, I think it was a four liter per minute or is it two liter per minute flow rate that dropped the summit of Everest to the equivalent of about 7,000 meters. But I can't remember which flow rate it was. I could quote me on that.
01:17:54
Speaker
And that's a pretty big difference. 7,000 meters is uncomfortable and difficult. But it's survivable. It's quite doable. But 8,000 and above without oxygen is a completely different story.
01:18:11
Speaker
Yeah, yeah, absolutely. And yeah, and the risks and the experience required to confront that are completely different. And yeah, it's just something I wish that people interested in this world would know more about because it's super important. Yeah, it's super important that we differentiate between those achievements.
01:18:36
Speaker
And sometimes people get kind of crossed because they say, hey, but Monica, you're just trying to belittle what I've done by pointing out that I used oxygen. And that's absolutely not the case. I'm not belittling anyone who's climbed Everest with oxygen. It's a phenomenal achievement. There's no doubt about it. But it's a very different thing to climbing Everest without oxygen. That's it. And in the story, that's the fact.
01:19:03
Speaker
And there's no belittling involved. I mean, if I had it my way, I mean, you know, it's just so difficult, isn't it? Like, yeah, it comes back to experience and people making the right decision for their degree of experience, their level of experience. And that's what's tricky.
01:19:24
Speaker
Yeah, I mean, I've heard, I mean, I'm in your camp with on that, of course. And I think that there is a general lack of understanding or knowledge about how much difference it makes, you know, what a huge difference it makes to have that. But again, it doesn't change. I mean, these people who are climbing Everest with oxygen doesn't change their achievement.
01:19:47
Speaker
But it does mean they've done something different than, for instance, what David did last year, you know, without oxygen, or what Killian, especially with something like Killian did. Yeah, I think it's just that perspective. Yeah, absolutely. And in the mainstream media, it's definitely been completely
01:20:10
Speaker
missed any article you read in any mainstream media doesn't mention whether a climber used oxygen or didn't. And the single thing about Mount Everest that makes it so phenomenally difficult is its altitude and the lack of oxygen.
01:20:30
Speaker
Therefore, if you replace that oxygen, you are changing the difficulty of that mountain. And that's okay, but that's the truth. It needs to be acknowledged, yes. Yeah, it needs to be acknowledged. And I just, yeah, like I said, it frustrates me that that isn't more part of the conversation.
01:20:49
Speaker
especially when there's so much media attention on the rest of the crowds and the people and safe or unsafe or people die. That's okay. Well, let's talk about it, but let's talk about it with facts and with information that really point out, you know, what's going on and who's doing what in what way. Yeah. So another good. Well, we've been on our soapbox now about that. That's good. I think we're entitled to have our opinion.
01:21:20
Speaker
Well, I've kept you longer than I had promised you I would, but I really appreciate your taking the time today, Monica. It's been great chatting and good seeing you again. Yeah, it's been really, really fun.
01:21:32
Speaker
Yes. Well, thanks a lot. And for anyone who's interested in more of this type of information, they should feel free to check out our website. There's a lot of free articles on there. We have a forum for anyone who's interested in communicating with any of our experts and asking questions. So until next time, thanks very much. And bye-bye. Bye.
01:21:57
Speaker
Thanks for joining us today. For more information about what we do, please go to our website uphillathlete.com.