Archive for the ‘The Altitude Experience’ Category

The 2013 Everest ‘Fight’

June 15th, 2013

In the spring of 2013 there was a well-publicized incident between Western climbers and Sherpas on the slopes of Mount Everest. Here are some links to the many new stories on this incident:

Alan Arnette (and read the links inside)

New Yorker piece

Ed Douglas (with links)

Rather than discuss the individuals involved and judge their actions, I want talk more generally about why such incidents occur (specifically the initial incident that sparked the more salacious events afterwards). If the issues were confined only to Mount Everest it frankly wouldn’t be all that important. But tactics used on Everest are spreading to other high peaks and other countries, so this problem will arise again. And the lessons of this incident can be applied in other situations.

You can’t understand the problem unless you understand the system on Everest and the parties involved. If you already do, skip ahead.

How it all works

On the standard routes on Mount Everest there are three groups of people: climbers, guides/companies, and staff. For over 20 years, the climbers on Everest have fallen into two groups: the vast majority are tourists with little or no mountaineering background and a small number are experienced climbers who are capable of climbing the mountain without guidance.

Climbing the normal routes on Everest goes like this:

1. Tourists pay tens of thousands of dollars to a guide/company.
2. The guide/company hires sherpas to do the manual labor and work with tourists.
3. The companies pool their equipment and manpower.
4. Sherpas install ropes all the way up the mountain and establish intermediate camps.
5. Guides and tourists ascend the ropes to the summit and back.

Tourists get their summits, guides and sherpas get their money and build a reputation.

There are three main actors in this drama: The high-altitude porters (sherpas), the elite climbers (Rockstars), and the guiding companies (who cater to tourists).


The sherpa stereotype  is the happy, smiling, hard-working, high-altitude load carrier. In reality sherpas are no different than any other group of people – some are jovial, some are quiet, some are aggressive, and there are some real jerks. Note: since many high-altitude porters are not of Sherpa ethnic heritage I use the lower case ‘sherpa’ throughout.

As indigenous highlanders, sherpas have adapted to the thin air and they generally perform better than lowlanders at altitude. They have also adapted to the huge influx of hard currency brought about by the Disney-fication of Everest. Everest is the place where sherpas make the big money. They are rewarded based on performance: how high they go, how many loads they carry, and how much they please their clients. Their money comes from the tourists. A successful high-altitude sherpa can become a trekking leader and have a long career away from the hazards of mountaineering.

Sherpas work very hard in dangerous conditions. They all have friends and relatives who died in the mountains. A growing number are well-trained climbers who do not need a Western climber to make decisions for them (as happened in the old days).

European Rockstars

European climbers practice their craft in a very crowded and ‘urban’ environment. The Alps are filled with cable cars, huts, and humans; they are totally unlike our North American mountains. Speed is safety in the mountains, and European climbers are accustomed to doing whatever they must to climb past the ever-present slower parties.

The crowds mean that your typical European climber will act more like he is on a crowded city street than on a mountain — he will hike or climb past you without even a look. And he probably won’t move out of your way on the trail or mountain. The most vivid example of this behavior that I’ve seen was in Pakistan, where two Italians wearing only Speedos walked down the trail side-by-side and forced porters carrying 50 pounds loads to detour around them.

The elite climber in Europe is treated like a rock star and will be a household name. These elite climbers are well known because they succeed on previously unclimbed routes (which by definition are not crowded).

Rockstars travel with a retinue of photographers, videographers, and Internet technicians to deliver gripping media coverage to the public. This same public seldom questions how the cameraman got above the Rockstar to photograph him boldly climbing up that ‘unclimbed’ route…but I digress.

It is important to note that the Rockstars in this case were not planning on climbing the normal climbing route, but they were climbing parts of it to acclimatize to low oxygen levels.

Guiding Companies

The companies who take tourists up Everest have one goal — to make money. This requires maximizing summit success and minimizing injury and death. Primarily of clients, as they get the most press. The best way to do this is to keep clients off of the mountain as much as possible. Much of the acclimatization needed to physiologically adjust to altitude can be done at base camp, and some companies are only having their clients sleep on the mountain for a few nights before attempting the summit.

The other method is to remove as many of the climbing obstacles as possible. This means installing a continuous ribbon of rope from bottom to top of Everest. On crowded mountains there may be two sets of ropes, one for ascent and one for descent. On Everest all of the work is done by sherpas.

The companies also know that they will be called upon to aid any person in need on the mountain and they are the ones with the manpower to do it. I’m Exhibit A for that unwritten rule!

Lhotse Face

Looking up the Lhotse Face. Camp 3 is directly above the two highest climbers and about halfway to the rock above. The whole thing is much steeper than it looks.


Lack of oxygen affects people in different ways. Neither climbers nor sherpas had climbed so high on Everest in this case, so they were probably all affected to some degree. Severe fatigue is the norm; mood swings and decision-making difficulty go hand in hand with fatigue.

To acclimatize to the reduced oxygen levels it is normal to move up and down the mountain to gradually expose the body to the thin air. At the altitudes involved here (about 7000 meters or 23,000 feet) bottled oxygen is not normally used.

The Situation

I’m not going to rehash the incident on the mountain; you can read the ‘he said, she said’ drama elsewhere.

Lhotse Face

Looking down the Lhotse Face from well below Camp 3.

Causes of the Initial Incident

The sherpas’ (and guide /companies’) viewpoint was that the sherpas’ job was to climb the mountain and fixed the ropes. This had been agreed to by all of the companies and it is traditional (but only on Everest) that no other climbers interfere with this process.

The Rockstar viewpoint was that climbing below, alongside, and above other climbers is normal and that their superior skill and conditioning would prevent mishaps that might occur to less skilled climbers.

Mix in the mind-altering effects of altitude and fatigue and you have a Confrontation. Both sides were perplexed because each group’s actions (on the mountain) were entirely consistent with their normal approach to climbing, and each could not understand why the other group would behave so inappropriately (from each group’s perspective).

 The Larger Picture

As a climber I find the transformation of Everest into a high-priced thrill ride quite appalling. Unfortunately the tactics are spreading to other high peaks (notably K2), where sherpa teams are brought in to pave the way to the top for under- or un-experienced ‘climbers.’

While on Everest I would have happily carried some token loads to help with the rope fixing process, but I realized that the best thing to do was to let the sherpas earn their money – my help would not be appreciated. I think that Western climbers must realize that the normal routes on Everest have a very different set of rules to play by. The Rockstars in this case did not understand that distinction.

Most climbing sherpas have a very narrow viewpoint of what ‘climbing’ is. The are primarily exposed to tourists on Everest, Cho Oyo, and Shishapangma (the three easier 8000 meter peaks) and seldom spend any time consorting with qualified climbers. The sherpas need to realize that they must coexist with real climbers and that the rules on other mountains are not necessarily those of Everest.

The companies need to realize that the independent climbers on Everest (not just the Rockstars) may need some special attention and guidance concerning the unwritten rules of Everest because these rules are unique. If the independent climber fails to heed this advice, then frontier justice will prevail on the mountain – just like it always has.

My $0.02 concerning this incident (as it has been reported)

If you have any comments, please email me (address above) and I’ll be glad to address substantive comments in the blog.

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Three additions to your medical kit

March 11th, 2011

Disclaimer: I’m not a physician. You should discuss the recommendations below with your physician and make sure you understand the side effects and contraindications for these medications.

Expedition medical kits should contain drugs and equipment that people know how to use. So there’s no way to come up with a “standard” kit. In the book I discuss a number of different drugs that might be useful. I want to point out three drugs that might not be on your radar screen for your next trip.

Tinidazole is used to treat Giardia infections and amoebic dysentery, both of which are common visitors in an expedition. I recommend this drug because it replaces metronidazole (Flagyl), which has been the standard treatment in the US for many years. A single dose of Tinidazole is all that’s needed to treat Giardia. It will be much cheaper to buy it abroad. Buy enough to treat dysentery.

The Advair inhaler literally got me to the top of Mount Everest. The circular, purple plastic case contains powdered steroids that you inhale. The steroids then directly affect the respiratory system without having the nasty systemic effects of other steroids. It’s most effective against the dry, hacking high-altitude cough that often strikes on bigger peaks. It’s not for pulmonary edema or ‘wet’ coughs. It’s not needed on trips to the USA or Canada and one of these is enough for a small expedition. Take along an albuterol inhaler as well. You should buy these in the USA. The Advair is not cheap but you won’t care about the cost if you actually need it. Both require prescription and unfortunately you won’t find any scientific research to back up my recommendation.

The Khumbu cough in action above Dingboche, Nepal

I mention Viagra/Cialis in the book. You should carry some in case somebody develops high altitude pulmonary edema (HAPE) and you don’t feel comfortable administering Nifedipine. Nifedipine can cause a catastrophic decrease in blood pressure and the patient must be properly monitored as the drug is given. Viagra and Cialis don’t cause this systemic drop in blood pressure but still may reduce pulmonary pressures. Unfortunately at least 20% of the population won’t respond to Viagra/Cialis so it’s not a magical cure. Definitely buy these drugs in the USA/Canada.

There are other medications for high-altitude illness, gastrointestinal infections, respiratory infections, etc. etc. so this is not a complete listing.

For these and any other drugs you carry, keep them in the original containers with your name on it if your transporting it to another country. Package to drugs carefully as transport can turn pills to powder. And ask the pharmacist for the original instructions that came with the medication—not the printout that they normally give you these days. The original sheet will have all of the side effects, contraindications, interaction warnings, and so on.


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A mystery solved/ exercise tip

February 13th, 2011

I found out a few weeks ago that I had giardiasis, an intestinal parasite. I have no idea where I got it or how long I’ve had it. Maybe since this fall, or this summer, or since I’ve been back from Everest, or from K2—who knows? It certainly wasn’t a typical case; most cases of Giardia start ‘explosively’ but about 20% don’t follow the standard symptoms. One dose of drugs (Tinidazole 2 grams) took care of it and I feel like a new person. I’m thinking that I’ve had a subclinical case for quite some time. I blamed my constant fatigue on the frostbite injuries, but maybe the little critters deserve some credit as well.

My big project right now is the revision of my rock climbing guidebook. Once that’s done in June I’ll likely have some surgery to improve my fingertips. I have a bunch of topics in mind to talk about here so I’ll do my best to get started on those.

Today’s tip

Here’s one little thing that I know I’ve touched on before. If you’re going to work on any stationary aerobic machine other than a recumbent bike, don’t read! I see people every day trying to read on an elliptical machine or treadmill and their biomechanics are completely screwed up. Put away the books and magazines, and while you’re at it, turn off your phone and quit fiddling with your music player. Keep your head up and look out at eye level. Your whole body will respond positively in your workout will be much more effective.

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Boots and crampons for high altitude

November 1st, 2010

I write about what I use, and I buy what I use. No freebies or sponsorship. Other gear might work as well or better for you.


The Olympus Mons (left) and Trango Extreme (this model discontinued)

In 2005 I was climbing unroped with a 40 lb. load, heading for Camp 1 on Broad Peak. After climbing a couple of 40 degree sections of water ice, I was glad to set foot on snow again. At that precise moment, I felt something rattle on my one foot. I looked down and saw that one crampon had fallen apart, the two pieces dangling from the straps. A nearby climber gave me a hand and it was soon fixed. The problem? The quick release mechanism (which adjusted the length) popped open when used on my very big high altitude boots. If this had happened 20 feet lower on the water ice… That’s when I got serious about building a boot/crampon system that was bombproof yet light and precise.

The Petzl Sarken crampon. Other bindings available.

On both K2 and Everest I used a two boot/ two crampon system. At lower altitudes, the Trango boot and Petzl Sarken crampons were a nice combination of warmth, durability, and technical agility. I must admit that on Everest I actually used M10 crampons as my previous Sarkens had been recalled. Petzl anti-balling plates are far superior to the Charlet plates on the M10s. The vertical front points on the Sarkens climb ice as well as a technical crampons, at least when using both the heel bail and toe bail binding. I would have used the Sarkens up to Camp 3 on K2 with warmer boots.

Once above 6700m the Trango boots simply aren’t warm enough and I switch into my La Sportiva Olympus Mons boots. I’ve used both these boots and the Millet Everest boots and prefer the Olympus Mons. They fit my feet better (the most important consideration), they are not nearly as bulky, and they allow me to do more technical climbing. Both crampons mentioned above fit these boots though you may have to whittle the heels down a little bit if you use a lever style heel bail. The lacing system on the Olympus Mons is unique but functions quite well as long as you don’t try to figure it out at 7500m. The outsole is quite fragile (in an effort to save weight). If you travel on rocks you’ll chew it up quite quickly.

Camp XLC Nanotech crampon with a replacement strap

The Camp XLC Nanotech crampons are aluminum with steel reinforcement under the front points. They are amazingly light and about as durable as you would expect for such a soft metal. They worked well on the Olympus Mons and I wore them from Camp 2 to the summit and back on Mount Everest, and from ABC to C2 and back on K2. They wear down very quickly if you have to expose them to rock; they would probably make one round-trip on K2. Of course weight is the primary issue and saving a pound on your feet is worth the price in this case. But you couldn’t use them as your everyday crampons in an expedition situation. For a single ascent without much technical climbing they will do just fine.

Retailers are quite happy to sell you way too much boot, pricewise. Know the worst condition you can reasonably expect to encounter and buy appropriately. If you’re stomping up Aconcagua or an easy trekking peak, a pair of plastic double boots are generally sufficient (and half the price of the specialized high altitude boots).

The front points are reinforced and hold up well. The points are worn down to nubs after K2 and Everest!

Make sure your crampons fit your boots! This may seem a no-brainer, but there are a lot of folks who don’t discover this problem until it’s too late. You may have to trim the boot heel a bit. The type of strap/bail system use use will depend on the boots and crampons you have, as well as personal preference.

Finally, make sure you have the tools needed to adjust your crampons, as well as replacement bolts etc. On Broad Peak I removed the quick-release clamps and bolted the suckers together. No more crampon disintegration.

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It’s fast and easy

September 17th, 2010

The workout facility that I use has magazines lying around for those using bicycles etc. the beauty/fitness magazines plaster their covers with the same things every month–promises of great results quickly with little effort. I picked to cover at random to show you what I mean: Get it now! Do it fast! Guilt free! Not boring! Easy! These are the messages that people want to hear, so of course the magazines will oblige. And I’m not just picking on the women’s magazines, but they are probably the most extreme.

a typical fitness magazine cover Guess what? It takes time and effort to truly improve. Most people will take several years to reach their potential in endurance activities such as marathon running and alpine climbing. Showing improvement in simpler activities (losing weight, gaining strength) will still take months of dedicated effort.

As I watch the many overweight people doing their aerobic workouts and reading these magazines, I wonder what sorts of psychological damage these messages cause: ” If it’s really so easy, fast, and not boring, then why am I bored, why is it so hard, and why aren’t I losing weight? I must be a failure!”

In The Altitude Experience I spend a lot of time talking about how we are all different from each other. No matter how much you want to, you may not be able to go faster/get stronger/be more confident/lose more weight. And this is where the dark side beckons; steroids, weight-loss drugs, and human growth hormone have trapped many with the promise of results without effort.

So you need to set realistic goals, research the best ways to accomplish them, and be willing to put the time and energy into reaching those goals. At some point you need to readjust your goals up or down, depending on your progress.

And ignore the siren’s song from the six pac abs, airbrushed hips, and silicone chests of the magazine covers when they whisper “it’s easy, it’s fast.”

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Updates on altitude illness

August 10th, 2010

Most folks who travel high are rightly concerned about altitude illness. Here are some new resources for you. You can download the Wilderness Medical Society Consensus Guidelines for the Prevention and Treatment of Acute Altitude Illness for free. This contains the latest medical recommendations (though in real life one might vary from some of these recommended approaches, but I’m not a doctor and can’t give medical advice). Anyway, lots of good info here.

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.

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Question: going really high

July 28th, 2010

I was recently asked for any tips, tricks, or suggestions that would help this person successfully climb Everest in 2011. The facile answer is “read my book.” But most of us (including me) will look for the shortest and easiest way to get the information we want, and there is a lot of information in the book that doesn’t apply to this person’s question. So with the caveat that this post is incomplete and certainly doesn’t contain everything you need to know to climb Everest, here are a few tips for the climber going to extreme altitude.

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.

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Decision making link

December 31st, 2009

Best wishes to all in 2010! Be happy, be safe.

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.

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Farewell Charlie

October 13th, 2009

Dr. Charles Houston died recently at the age of 96. I first started learning about high-altitude physiology from his book Going Higher. He was the godfather of high-altitude medicine and climbed in Alaska and Asia. My book wouldn’t have been possible without the research he conducted and inspired over the years.

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

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Does Ginkgo biloba prevent altitude illness?

September 11th, 2009

There have been a number of studies that examine the effectiveness of Gingko biloba extracts in preventing acute mountain sickness (AMS). A nice paper by van Patot and others in the spring 2009 issue of High Altitude Medicine and Biology summarizes the results of these studies. They suggest that the main problem is the lack of standardization of extracts, leading to different amounts of the various chemicals being present in the pills. Until the various individual compounds are tested, we won’t really know what benefit gingko might have.

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.

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