So you’re at altitude and you feel lousy–do you have altitude illness? To help diagnose acute mountain sickness (AMS), physicians and researchers have developed numerical scoring systems which use your symptoms and the observations of others. These are known as the Lake Louise Consensus Scoring Systems (the name will help you to search for more info). I included a version for both adults and children in the book, and have finally formatted them for easier use in real life. You can download the adult version and the child version from my home page.

Keep in mind that there are two other important types of altitude illness: high altitude pulmonary edema (HAPE) and high altitude cerebral edema (HACE). These scoring systems don’t diagnose these serious illnesses, so make sure you read Chapter 5 to become familiar with them.

Physical conditioning. You should be in decent shape, able to keep moving for eight hours at a stretch, uphill and downhill, carrying a 30 pound pack. In Chapter 12 I lay out the general rules of the training program. If you are traveling with a guided party you will likely get some specific training advice from your guide. The most highly stressed muscles in your body at extreme altitude may be your breathing muscles–not your heart, not your legs. Train those breathing muscles! And being in good shape doesn’t mean you’ll necessarily do well at altitude.

Technical skills. Practice ascending fixed ropes and rappelling prior to the trip. Practice with mittens on, in the dark, in the howling wind. Technical skills must be ingrained into your brain so that this ‘muscle memory’ is available when you’re hypoxic, cold, and half asleep.

Psychological skills. While the previous two skills may seem to be the most important, failures on Everest and other big peaks are more likely to be caused by other factors. In my discussion of physical performance in Chapter 3, I list a whole series of factors that affect performance, and in many cases performance (= climbing Everest in this case) will be strongly affected by psychological factors. Figure 21 summarizes these factors and how they affect performance and judgment. Examples: are you a control freak? Prepare to be stressed, because a guided expedition means you relinquish control of almost every decision once the airplane lands. Get bored easily? Can’t stand sitting around for days on end? Then you’re going to have trouble on expeditions unless you are prepared to cope with it.

Social skills. Your relationships with fellow climbers, guides, and staff will have a major effect on your emotional and psychological well-being, which affect performance. When I wrote the book, chapter 9 (Interpersonal Relations) took on a life of its own as I realized how critical it was, especially on expeditions. On a guided trip you will be insulated from most of the backroom politics among expeditions, but you’ll still have to deal with people on your team. Zen-like detachment is the only way to go.

Even if you’ve been to Denali and Cho Oyu, don’t assume that you have the expedition game all figured out. You can expect things to happen a certain way, but don’t get frustrated if they don’t! On the other hand, if something seems screwy, speak to your guide or Sherpa privately and reach an understanding. Of course any life-threatening situation needs to be dealt with openly and immediately.

Even if you are surrounded by guides and Sherpas, things happen. Know what can go wrong and think about how to deal with it if suddenly you are in charge. Chapter 11 discusses decision making and accidents and will acquaint you with the major types of problems you may face.

Know the primary symptoms of altitude illness and thoroughly understand any drugs that you might use (Chapter 5). Along with that, know the major changes that take place during acclimatization (Chapter 4). If you wake up gasping for air, at least you’ll know why.

You might be surprised that I’ve left out the vast majority of the biology of altitude (Chapter 2). If you’re interested, go for it, but frankly you can climb any peak without understanding the basic science. Okay, maybe you should read the summary statements in the page margins of Chapter 2. It’ll take you about two minutes.

Finally remember that you haven’t paid to climb Everest. You’ve paid for the opportunity to climb Everest. And return safely. If you do so, you’ll return home and still be essentially the same person that you were, with the same problems, the same opportunities, and the same family and friends. Don’t expect Everest (or any mountain) to change your life.

I have reformatted and added to the photo galleries and will be posting videos on YouTube starting this week. I’ll post info on how to find the video when it’s available.

On a personal note, I’m mostly healed up. I’ve been running, biking, and climbing since the beginning of the year and things continue to improve. I did a double crossing of the Grand Canyon in May (check out the photos) and climbed South Teton a week ago. Frankly, my typing has suffered more than anything else, which is the main reason I haven’t been posting.

Feel free to e-mail me with your questions; I’ll try to answer as long as the volume of questions remains manageable.

Here’s an interesting article from Wired Magazine on the science of screwing up. Since proper decision making is critical at any altitude, I thought you might enjoy it.

Read a fitting tribute by journalist Bill Moyers. Watch the 1953 K2 film there too!

So I continue to suggest that taking gingko is ok, but acetazolamide (Diamox) is still the go-to drug for AMS as long as you’re not allergic.

Link to abstract

Citation: Martha C. Tissot van Patot, Linda E. Keyes, Guy Leadbetter, Peter H. Hackett. High Altitude Medicine & Biology. Spring 2009, 10(1): 33-43. doi:10.1089/ham.2008.1085.

At long last I’ve finished a report on what happened to me on Mount Everest. You can read the report here. If you have any corrections please contact me at info@TheAltitudeExperience.com and I’ll revise the document as needed.

I’m now nearly 3 weeks out from surgery. I had all 60+ stitches removed last Thursday. It wasn’t fun but now I can wear shoes and socks for the first time in three months. This helps with walking considerably. I’m wearing some lovely Isotoner gloves on my hands to help reduce fluid retention. My knuckles are still swollen and my fingers are very weak; my forearm muscles have disappeared over the months. So I spend a lot of time flexing my fingers and working to get my range of motion back. My thumbs did not undergo surgery but they still have scabs at the tips.

I’m doing a lot of things very slowly. Between the shortened fingers and the gloves I really have to think about what I’m doing. I’m back on the exercise bike and will be doing as much non-impact aerobic activity as I can to get my general level of fitness to where I can put in a full day’s work.

I’m not going to post any photos of my hands and feet; I’d rather deal with my injuries in terms of what I can do rather than how I look. While I will occasionally mention a significant milestone in my recovery, this pretty much ends my 2009 Everest expedition account. I thank you all for your wonderful support and best wishes over the past few months.

Here’s a photo of me with Bernice Notenboom and Walter Laserer in Kathmandu. They found me at nearly 8400m and took precious time out of their ascent to care for me, for which I will always be grateful. See my report for a full listing of those who helped me.

Thanks again for your support. Surgery went as well as could be expected.