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Mountain climbing and altitude sickness

Dr. Richard Thurmer joined hosts Shannon O’Kelley, Physical Therapist and President of Integrated Rehabilitation Group, and Maury Eskenazi, radio personality from Fox Sports radio on Health Matters radio, KRKO 1380am, with thanks to Integrated Rehabilitation Group physical and hand therapy. He talked about mountain climbing and altitude sickness.

Read the transcript of Dr. Thurmer's talk on mountain climbing on Health Matters radio.

Health Matters: Joining us right now from The Everett Clinic, he's board certified in family medicine, it's Dr. Richard Thurmer. We're going to talk about altitude sickness, altitude sickness. Can you get altitude sickness here?

Dr. Thurmer: Yes, you can, certainly. If you go up to Mt. Rainier you certainly can.

Health Matters: Well, tell us about your background. I mean, you're a family medicine physician, but how did you get interested in mountain medicine, basically.

Dr. Thurmer: Well, my father got me into some climbing. I was 12. We climbed Mt. Whitney and then every year we would do something, and I have done Everest and Aconcagua.

Health Matters: Did you summit?

Dr. Thurmer: Yes.

Health Matters: Wow, that's incredible. I'd like to talk about that. Did you get sick? Tell us about altitude sickness over there.

Dr. Thurmer: Everybody is sick. Base camp is about 17,500 feet, and, interestingly, my wife spent the entire time with me there at the base camp, so it's about a 7-week stint. She got some pulmonary edema when we attempted a sub peak nearby. Now, she just needed oxygen therapy for a few days and then she recovered. Otherwise, she would have had to go back down. I would call the Everest about the most exhilarating had thing I've ever done.

Health Matters: Yeah, people that do it are just incredible. And, they have to be in great shape, huh? So, tell us about the whole experience. You fly in, and is it a trek to get to where the base camp is?

Dr. Thurmer: That's true. From Kathmandu we flew to Lukla, which is quite an adventurous landing in and of itself, and then...

Health Matters: What's the elevation there when you land at Lukla?

Dr. Thurmer: It's roughly 10,000 feet.

Health Matters: Can you imagine, I mean, you're flying 10,000...And, what, what kind of plane are you flying in?

Dr. Thurmer: Oh, some small 2-engine, I hope I get out of this alive...And, they have had quite a few crashes there, but, anyway, then you trek 35 miles to base camp.

Health Matters: Base camp, altitude?

Dr. Thurmer: It's 17,500 roughly.

Health Matters: And, what do you have on as far as like, you know, pack and how heavy it is?

Dr. Thurmer: Fortunately, most of the gear is trekked in by yak and Sherpas or porters, so your pack at that point is still pretty light.

Health Matters: He's turning into the coolest guy I've ever talked to in my entire life.

Health Matters: Basically you're trekking in 35 miles to 17,000 feet, right? Is that what you said?

Dr. Thurmer: Yes.

Health Matters: And, your wife had some pulmonary edema. Tell us physiologically what's going on, who gets it, and how do you know you're gonna get it, or maybe you don't know you're gonna get it.

Dr. Thurmer: That's really a good question because before anyone goes to altitude no one knows who is going to get it, and people can get it, I had it in South America once, relatively lightly, but never again. I have been fortunate I haven't had to use any meds, haven't had to descend because of illness, whereas many others, they'll get sick just going to Camp Muir, for instance, 10,000 feet, on Mt. Rainier, and they just, feel terrible. But as long as they don't ascend further they're not gonna get worse.

Health Matters: Now, feel terrible. What symptoms are we talking about?

Dr. Thurmer: Sure, headache. You feel a little bit like you're hung over, weak, tired, somewhat dizzy or lightheaded, nauseated. If you're not nauseated, you may not feel like eating, and that's part of it. People don't drink enough fluids, they get dehydrated along with this whole process.

Health Matters: So, that's the body's response to lack of O2, oxygen, basically.

Dr. Thurmer: Yes. You think about it, the higher you go there's less oxygen available. I mean, there's still 21% in the atmosphere, there is just a lot less atmosphere.

Dr. Thurmer: So, your body breathes faster, a little deeper, heart rate goes faster, and the process is when you breathe faster you blow off a lot of carbon dioxide, so your body becomes alkalinic, and then, really, you have to pee out some of the alkaline substances, bicarb, to restore your acid-base balance. That's the whole process of acclimatization right there. And, so, if you don't drink enough fluid you get dehydrated, you get more headachy, and you feel terrible.

Health Matters: Back to Everest at base camp, what's the weather going on? What time of year is this?

Dr. Thurmer: That's April and May. This is the season and they wait for the winds to leave, or, I should say, the winds on top to shift north, and before the monsoons come in. There is a small window of 2-3 weeks to hit it. And so, when we were there, I think there were 3 or 4 summit days.

Health Matters: What's your total commitment? I mean, you have to have a little bit of vacation time here. You're talking several weeks at base camp at 17,000...

Dr. Thurmer: Two months, at least.

Health Matters: Two months. So you're at 7 weeks at base camp, what's the next camp…or?

Dr. Thurmer: From there, you go through the ice bowl to Camp One, and it's a sequence of events. We went up to Camp One and back, then we went to Camp One, spent the night, go to Camp Two, back to Camp One, back to base camp. Then...

Health Matters: Wow.

Dr. Thurmer: .. you do that again and stay at Camp Two, go up to Camp Three, and then back down to base camp.

Health Matters: Now, there's training involved in this. You just don't go to the elliptical at the YMCA for a week and then go climb Everest, right. How do you train?

Dr. Thurmer: Run and bike and carry a lot of weights. Preparing for that, one scenario I would carry a backpack of 65-70 pounds eight miles, then I would bike the same eight miles, and then I would run the same eight miles.

Health Matters: Obviously, the conditioning is important just because of the amount of exercise or strenuous exercise you're gonna do. But, really, at the top when you get above that, what do they call that, kill zone or 20,000 feet, where, I mean, your body's, just a step is strenuous, I mean, just a small step. How do you know you're gonna be able to do it and how do you know you're not going to get altitude sickness?

Dr. Thurmer: Well, no one knows if they are really going to make it, unless they have been there before. But, interestingly, Sir Edmund Hillary, he summited Everest, the first man to do so, and he was never able to climb another high Himalayan peak after that, he became ill each expedition he was on. So, it's a curious thing. One success doesn't mean you will be successful in the future, but then, being sick one time doesn't mean you will be sick all your other times, you just don't know.

Dr. Thurmer: And, it doesn't matter about physical fitness. In fact, those who are driven and highly fit, they may be more at risk because they are going to expend themselves further, go too high too fast, and that's the bottom line, it's too high too fast.

Health Matters: Any medication, anything you can do prior to the climb?

Dr. Thurmer: Diamox, it's the brand name for acetazolamide, is a very good drug and to just take one pill of 125 or 250 mg twice a day a day before you go and a couple of days while you're at that new altitude will help you acclimatize. It is the only drug that actually helps you acclimatize because it helps you get rid of fluid and that bicarbonate, so it speeds it up.

Health Matters: Just the change in altitude. Seattle to Everest. When you go from Camp Three…

Dr. Thurmer: From Camp Three we would go to the South Col Camp, which is Camp Four, and there's about 3,000 feet from there to the summit.

Health Matters: How hard is that 3,000 feet?

Dr. Thurmer: It’s really hard.

Dr. Thurmer: And, you get to the South Summit, and then you look at the Hillary Step and you say, "Oh man, I have to do that now?" Because it's steep and it looks ominous. You have to expend a lot of energy.

Health Matters: One step at a time, huh?

Dr. Thurmer: Oh yeah.

Health Matters: You're not climbing? Are you like using the little picks and stuff, and the...

Dr. Thurmer: On some mountains, yes. In fact, we will be going to Denali later this year, and that's exactly what we will be doing. But, on Everest they have fixed ropes.

Health Matters: Let's talk about locally here, because everybody's dream or goal is to climb Mt. Rainier. It's a very climbable mountain...How hard is Rainier at 14,000?

Dr. Thurmer: Every mountain I respect, and it's really difficult, and I wouldn't say, "Oh, I've done something higher, so it's nothing." You still have to respect the weather and the mountain, the glaciers, the crevices. It still can be very dangerous. Many people die up there.

Dr. Thurmer: But, most people up to 8,000 aren't going to get sick with hardly anything. You get above that too quickly, and most people climb up to Camp Muir, it's 10,000 feet from here in Seattle, and they will have some of those symptoms. Now, if they use acetazolamide, as I mentioned, they can avoid most of those, okay. If they climb up to the summit the next day, which is the usual scenario, as long as they come back down they shouldn't have any ill effects at all. It's really the sleeping altitude. So, if they were to go to the summit at 14,000 and sleep, the next day they are gonna be really sick, and they are gonna feel badly, unless they have been used to altitude.

Health Matters: Does anybody on Rainier, does anybody sleep on the summit.

Dr. Thurmer: Some might for practice, but I've never done it and I don't know anyone who has.

Health Matters: So, if I'm a novice climber and I want to climb Rainier, let's say, cause they are climbing Rainier usually in July and August…How many months should I start preparing for that climb.

Dr. Thurmer: I think it depends on your underlying conditioning, but if you're pretty fit, I'd say 2-3 months should be adequate if you work out hard. If you come from a position of really not being in very good shape and not having done a lot of athletic things, 6-8 months would be more appropriate, I think.

Health Matters: I have more Everest questions. So, when you got to the, you got to the peak, what did you do, I mean, what were you feeling? Did you cry? Did you plant the 12th man flag up there? What?

Health Matters: He put The Everett Clinic flag up there.

Dr. Thurmer: I did, actually.

Health Matters: Did you really? How fun is that. (Laugh)

Dr. Thurmer: I really felt quite exhilarated. It was a lifelong dream come true. And, in fact, I had created this shirt, and it says, "Living the Dream, Boys," and that was my Seattle homage, if you will.

Health Matters: How many people were with you as you reached the summit?

Dr. Thurmer: There were about 15 people up there. And, from all different groups. There was one man from our group. He was there about a half hour before me, and then one gal from our group came up a half hour after me.

Health Matters: My understanding is you can't sit up there and relax and enjoy it cause you've got quite a climb coming down. I mean, that's, is that where most people or most the problems occur, coming down? Why is coming down the most difficult part of that?

Dr. Thurmer: There are a couple of reasons. One, you're more tired than on the way up. Two, you've achieved your objective, and, unless you're really cautious, psychologically it's easier to make a mistake. But then, you're really trying to get down quickly and beat any bad weather that might come in, so you are hurrying.

Health Matters: I think your objective should be to stay alive.

Health Matters: What are the highest peaks you've climbed? Have you climbed all the big ones in the world? Dr. Thurmer: Oh no, not yet. Health Matters: Not yet. Health Matters: Never had altitude sickness, I take it.

Dr. Thurmer: I did, actually, in Chimborazo. That's in Ecuador.

Health Matters: He kind of reminds me of the, of the most interesting man in the world. And, you're a doctor.

Health Matters: We're talking about altitude sickness going up. Do you have to be careful coming down, not physically, you know, falling and hitting your head, but coming down for altitude sickness. Kind of like scuba diving?

Dr. Thurmer: That's a great question and the answer is no. If you're sick at altitude and you come down, that is the primary treatment for all forms of altitude sickness. You don't get any of the scuba diving problems of rapid ascent or pressure problems on descent, even.

Health Matters: Is it fluid in the lungs that ultimately kills you if you don't get down?

Dr. Thurmer: Well, think of it like this. People talk about AMS or acute mountain sickness, and then there is high altitude cerebral edema or HACE, and that is kind of the end spectrum of acute mountain sickness. We actually end up with fluid inside the brain, increased brain pressure, and that's why people don't walk well or they are not thinking clearly. High altitude pulmonary edema really has a different kind of mechanism that those, it's formed by fluid, you get high pulmonary artery pressures in different patchy areas in the lung, and so the fluid, the blood pressure inside the arteries, pushes the blood into the lung, or the serum into the lung.

Health Matters: Kind of a pneumonia?

Dr. Thurmer: More like a congestive heart failure. But, it's not really the heart causing it. It's this altitude problem.

Health Matters: And, it's all related to pressure.

Dr. Thurmer: Or lack thereof. Lack of atmospheric pressure, and that response is a high pulmonary pressure in the arteries of the lung, and then you get pulmonary edema. Both pulmonary edema and cerebral edema will kill you in hours if you get them, and that's why a rapid descent is lifesaving.

Health Matters: Dr. Richard Thurmer, thanks so much for comin on. You definitely have to come back.