Mt Everest Medical Q&A by Larry Rigsby MD

Q.) In the course of your expeditions, have indigenous peoples taught you any remedies, treatments or precautions that seem to work for specific high-altitude ailments?

A.)  Not really. I wish I had asked more questions to that effect of the locals. I did observe the Sherpas closely and their practices and diets. I think they eat pretty healthy. I noticed they don't eat much sugar. A Sherpa friend convinced me that I should drink Sherpa tea which is made with Yak butter and milk. It tasted very salty and is a taste you have to cultivate. I thought it helped me at altitude but it might have been all in my mind.

Q.) Hello.  I was wondering if you could answer a question for me about fitness for Everest.  I am at the moment  I weigh 250 pounds, 6' 1" tall and I have a body fat composition of around 30 (I'm pretty sure).  I want to grow up and climb Mt. Everest.  At the moment I am working to become more physically in shape.  I was wondering what is the best condition to be in for Everest and other high altitude mountaineering? 

A.) You did not give me your age, but you must be fully grown at 6' 1" ! Actually a little extra body fat would be helpful at high altitude. Elite athletes such as Ultrarunners with very little body fat have no reserves to draw on and sometimes do not do as well.

I think it is good to try and approach ideal body weight and eat a very nutritious diet.

To climb Everest or other 8000 meter peaks, you should be in excellent physical condition. Ideally you should be evaluated by your physician and make sure you can undergo a rigorous training program. You need a great aerobic base with aerobic conditioning such as running, biking, swimming etc. After you build a base you can get more specific such as doing hill work on a bike or running and doing some speed work to get your heart rate up.

Weight lifting also helps. As you approach your climb, your training should simulate the climbing you are going to do. I will do long hikes with a loaded backpack or climb stadium steps. Some of my most fun with mountaineering is the training and preparation. Good Luck.

Q.) Indeed to have a fairly low % of fat or should I keep it up a little for other particular reasons?  Any help would be greatly appreciated.

A.) A very low % of body fat could be to your detriment on a prolonged high altitude expedition. Body fat definitely declines significantly at altitude. During Operation Everest II, where they tested climbers in a hypobaric chamber for 40 days and simulated a climb of Everest, the climber lost an average of 7.6 Kilograms(16.72 pounds) or 9.2% body weight. This represented both fat and muscle mass.

I believe a low body fat composition is healthy but if you plan to be at high altitude for prolonged time it probably would be advisable to add a few pounds. Thanks.

Q.) Probably not a question they will print on EverestNews.com but Dr. to Dr. I would like your opinion [well we can with some editing of names!]. On Everest last spring a climber was dragged (literally) into camp on N.Col. He was in extremis, had been at 8.3 for 5 days. Gave him all the usual meds but he was somewhat lucid and O2 sat. OK so I doubt HACE or HAPE was the problem, not hypothermic.. I think he was primarily dehydrated and needed about 4-5L of fluid. He was unable or unwilling to drink.  Sherpas were able to lower him down wrapped in sleeping mats but suppose weather had been worse and we was stuck. My question is: how much benefit can be gained from fluid via enemas. Could have been given with camelback. I have read in Kamler's last book of this being done at sea. What do you think.

A.) What a dilemma. I can understand your reasoning and I would think in theory this might work. The colon certainly will absorb water. I guess a concern would be if they are that dry, they are shunting blood from the gut. Would it be worth it? I did speak to a Nephrologist and he did not think it would be helpful. Let's hope we have plenty of NS available if we should be faced with that situation! Thanks

Q.)  I live just outside Burlington VT and am going back to school in the medical field. I’m writing a report on frostbite and wondering if you could give me any info on the subject. I’ll cover the physiology of this cold injury and some of the latest treatments. Can you offer info on how you treat on the mountain? Any other details will be greatly appreciated. Thanks so much. Good luck to you in all your great work.

A.) Good subject and I hope this response finds you in time to pull these references. Syme D. Position Paper: On site Treatment of Frostbite for Mountaineers. 2002. High Altitude Medicine and Biology, Volume 3,Pages 297-298.

Foray J. Mountain Frostbite, current Trends in Prognosis and Treatment. 1992. J. Sport Med. Volume 13, Pages 193-195.

There are also a number of excellent texts on Wilderness Medicine which cover this subject.

Q.) I know the extreme altitude of the mountain alone is enough to cause health problems, let alone the cold. I was wondering if perhaps you could give some of the specific effects that the altitude and temperature have on the processes of the human body. Also, I've read that many climbers experience sleeplessness and a severe loss of appetite; I'm not quite sure what causes this, so if you could explain that I would be much obliged.

A.) Please refer to my recent article on High Altitude Illness. I think you will find some answers there. The main effect of high altitude on the body is caused by the lack of oxygen and this can effect every organ system. The sleeplessness you referred to is very interesting and very important. High altitude can cause sleep disturbances from insomnia to disordered breathing and sleep. Climbers can develop what is known as periodic breathing or Cheyne Stokes respirations. This is a pattern of rapid and deep breathing followed by a period of apnea or no breathing. This can cause frequent awakenings and  prevent a deep level of sleep. I believe that this lack of sleep is a major factor determining performance on the mountain. Thank You. Larry

Larry Rigsby MD is an Internal Medicine physician who practices in Chattanooga, TN. He is a Mountaineer and has a great interest in High Altitude Medicine and Physiology. His expeditions include Denali, Everest, Ama Dablam and Moose's tooth.

He plans to do a series on mountain medicine to help promote safety in the mountains and keep climbers and trekkers up to speed on the latest medical info available. The first in the series is on Travel Medicine with subsequent articles on Altitude illness, hypothermia , frostbite etc. These will be updated periodically

Travel Medicine for Trekkers and Climbers in the Himalayan Region By Larry Rigsby M.D.

HIGH ALTITUDE ILLNESS By Larry Rigsby M.D.

We ask you to consider giving or helping with: The dream is to build a series of clinics across Nepal. (Larry myself helps supports the clinic financially!)

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