Category Archives: High Altitude Training & Fitness

What are the challenges and benefits of recreation and training in a high altitude environment? How does it affect your body’s physiology? What are the inherent risks?

Doc Talk: Nutrition & Oxygen as Preventative Medicine

Dr. C. Louis Perrinjaquet has been practicing in Summit County, Colorado’s mountain communities since the 80’s, when he first arrived as a medical student. He currently practices at High Country Health Care, bringing with him a wealth of experience in holistic and homeopathic philosophy, such as transcendental meditation and Ayurvedic medicine, as well.

This past week, Dr. Chris managed to sit him down over a cup of coffee in Breckenridge to talk Altitude Medicine. And not a moment too soon, as PJ is already on his way back to Sudan for his 11th trip, one of many countries where he has continued to provide medical resources for weeks at a time. He’s also done similar work in the Honduras, Uganda, Gambia, Nepal, and even found himself out in the remote Pacific, on Vanuatu, an experience overlapping Dr. Chris’s own experience spending decades as a physician in the Commonwealth of the Northern Mariana Islands.

Experience is everything when it comes to High Altitude Health. I asked PJ if there was any such thing as a “dream team” of specialists he would consult when it came to practicing in the high country: more than any particular field, he would prefer physicians with the long-served, active experience that Dr. Chris has in the mountain communities.

Complications at altitude aren’t always so straight-forward. Doc PJ sometimes refers to the more complex cases he’s seen as “bad luck”, “Not in a superstitious way,” he explains, but in “a combination of factors that are more complex than we understand,” not least of all genetics and hormones.

At this elevation (the town of Breckenridge is at 9600’/2926 m), he’s seen all cases of High Altitude Pulmonary Edema (HAPE): chronic, recurring and re-entry. The re-entry HAPE he sees is mostly in children, or after surgery or trauma, which Dr. Chris speculates may be a form of re-entry HAPE.

He’s seen one case of High Altitude Cerebral Edema (HACE), a condition more commonly seen in expeditions to even more extreme elevations (see our previous article, Altitude and the Brain). In this case, “a lady from Japan came in with an awful headache, to Urgent Care at the base of Peak 9 … she lapsed into a coma, we intubated her, then flew her out.”

How common are these issues in residents?

It’s probably a genetic susceptibility. More men come down with HAPE at altitude, or estrogen-deficient women. Estrogen may protect against this. When I first moved up here, we used to have a couple people die of HAPE every year! The classic story is male visitors up here drink on the town after a day of skiing, don’t feel well, think it’s a cold, and wake up dead. A relatively small number of the population up here has been here for decades. Most move here for only 5 – 10 years; even kids [from Summit County] go to college elsewhere, then move away.

In addition to hypoxia, severe weather and climate are also associated with extreme elevation. Do you observe any adverse physiological responses to the cold or dryness, etc. at this elevation?

Chronic cold injury probably takes off a few capillaries every time you’re a little too cold.

At this, Dr. Chris chimes in, “People who have lived here a long time may have more trouble keeping their hands and feet warm.”

Do you have any advice for athletes, or regarding recreation at altitude?

Don’t be an athlete up here very long. Don’t get injured. You can train yourself to perform a certain task, but that might not be healthy for you [in the long term]. Really long endurance athletes – that might not be good for your health, long-term. I see chronic fatigue often, they kinda hit a wall after years: joint issues, joint replacement, …

We’re observing a relatively recent trend with many high altitude and endurance athletes subscribing to a sustainable, plant-based diet. We’ve also encountered a lot of athletes consuming vegetables and supplements rich in nitrates to assist with their acclimatization. Do you have any experience with or thoughts on these techniques?

Eat a lot of fruits and vegetables, not a lot of simple carbohydrates, not a lot of refined grains. Eat whole grains. I’ve been vegan for a while; it’s been an evolving alternative diet.

Do you ever recommend any other holistic or homeopathic approaches to altitude-associated conditions, healing or nutrition?

Why don’t you get some sleep? Eat better? Don’t drink? Pay attention to your oxygen? Sleep with air? … If you’re over 50 and plan to be here a while, you might sleep on oxygen. I can’t imagine chronic hypoxia would benefit anyone moving here over 50. It may stimulate formation of collateral circulation in the heart, but we’re probably hypoxic enough during the day. It might benefit athletes that want to stimulate those enzymes in their bodies, but even that would be at a moderated level, not at 10,000 ft.

We’re onto something here: Dr. Chris has seen a lot of benefits in some of her patients sleeping on oxygen. If you haven’t already heard, Ebert Family Clinic is currently deep in the middle of a nocturnal pulse oximeter study, where subjects spend one night with a pulse oximeter on their finger to track oxygen levels as they sleep. This will provide more data on whether certain individuals or demographics may benefit from sleeping on oxygen.

In the case of pulmonary hypertension, probably 50% of people who get an electrocardiogram may experience relief from being on air at night. Decreased exercise tolerance when you’re over 50 might be a good case for a recommendation. I don’t think we ever have ‘too much oxygen’ up here; ‘great levels of oxygen at night’ are about 94%. Humans evolved maintaining oxygen day and night [in the 90s], same with sodium, potassium, etc., at a fairly narrow tolerance.

Are there any myths about altitude you find you frequently have to clarify or dispel?

Little cans of oxygen! it’s predatory marketing! It’s so annoying! We’re littering the earth and taking people’s money for ‘air’! Just take some deep breaths, do some yoga for a few minutes … sitting for 30 minutes at an oxygen bar might help. There’s no way to store oxygen in your body, so within 15 minutes, it’s out, but the effects might last, but it gives a false sense of security. 

Also,

IV fluids! DRINK WATER! Or go to a place where you can get real medical care. Most vitamin mixtures, or ‘mineral mojo’, is not real. First of all, don’t get drunk! Drink way less. Dr. Rosen, a geriatric psychiatrist, sees a lot of older guys with MCI (mild cognitive impairment), they’ve had a few concussions, have a drink a day and have lived at altitude for a while. He sees more of these guys here than at low altitude. It’s part of my pitch for guys to sleep on oxygen and minimize alcohol. We don’t have the science to take one or two drinks a week away, but just add oxygen.

Do you have to change the way you prescribe medications due to altitude? Has anything else changed about your practice after moving to altitude?

I don’t [prescribe] steroids as much. Even if it’s rare, I don’t think [steroids] are as benign as other doctors. I avoid antibiotics if possible.

Do you yourself engage in any form of recreation at altitude? How has the altitude played a role in your own experience of this?

I didn’t exercise much until I was 40. [Now] I trail run in the summer, which I think is better than road running (‘cave man’ didn’t have completely flat pavement to run on for miles and miles). In the winter, I skin up the mountain almost every morning; [also] mountain biking. 

Ease in to exercise gradually. Exercise half an hour to an hour a day, but do something every day, even if it’s 10 minutes. And don’t get injured.

Doc PJ also has a handout he most often refers his patients and visitors at High Country Health to, here.

robert-ebert-santos

Roberto Santos is from the remote island of Saipan, in the Commonwealth of the Northern Mariana Islands. He has since lived in Japan and the Hawaiian Islands, and has made Colorado his current home, where he is a web developer, musician, avid outdoorsman and prolific reader. When he is not developing applications and graphics, you can find him performing with the Denver Philharmonic Orchestra, snowboarding Vail or Keystone, soaking in hot springs, or reading non-fiction at a brewery.

High Country Healthcare’s Guide to Altitude and Acclimatization

Welcome to Summit County! At the high elevations of the Colorado Mountains, everyone is affected by altitude to some degree. As you go to higher altitudes, the barometric pressure decreases, the air is thinner and less oxygen is available. The air is also dryer and the ultraviolet rays from the sun are stronger. At elevations of 8,000 plus feet your body responds by breathing faster and more deeply, resulting in shortness of breath, especially on exertion. Many people develop mild symptoms of headache, nausea, trouble sleeping, and unusual tiredness, which we call acute mountain sickness or AMS. These symptoms usually go away in a day or two. If symptoms are severe, persist or worse, you should consult a doctor. A short visit to a physician may save the rest of your vacation.

A more serious condition is called high altitude pulmonary edema or HAPE. This condition is recognized by a wet cough, increasing shortness of breath, and the feeling of fluid building up in your lungs. Other symptoms may include disorientation or confusion. If you feel any of these symptoms developing you need to seek medical attention immediately. HAPE is easy to treat but can be life threatening if left unattended.

The effects of high altitude can be decreased by following these recommendations:

  • Increase Fluid Intake – drink two or three times more fluid than usual, water and juices are best; adequate hydration is the key to preventing altitude illness. You should drink enough fluids to urinate approximately every two hours.
  • Avoid alcohol and minimize caffeine on your day of arrival and one to two days thereafter; be very careful if consuming alcohol, and remember, at this altitude, you may be much more sensitive to the effects of alcohol and sedatives (caffeine and alcohol are dehydrating).
  • Decrease salt intake – salt causes your body to retain fluid (edema), which increases the severity of altitude illness.
  • Eat frequent small meals high in carbohydrates, low in fat, and low in protein.
  • Moderate physical activity and get plenty of rest.
  • Medications and oxygen can help you feel much better. Diamox is a prescription drug which prevents the unpleasant symptoms for many people. Recent experience suggests that a small dose of Diamox suffices: 125 mgs in the morning before you arrive at altitude, again that evening, and each morning and night for two days after arrival. It is generally a well tolerated medicine with few side effects. It should not be taken by anyone who is allergic to the sulfa class of medicines. Some people may experience a tingling sensation in their fingers, toes and around their mouth. You may also notice a subtle change in your sense of taste; especially carbonated beverages may taste flat. As with any medication, take only as directed and discuss any potential side effects with your physician.
  • Studies have shown that spending 1 -2 nights at a modest altitude of 5000 – 6000 feet decreases symptoms when you go higher.
  • The effects of the sun are also much stronger at high altitudes, even in cold weather! Be sure to use sunscreen of at least SPF 15 to avoid sunburn.
  • Have fun and enjoy the mountains!

**This was taken from a handout provided by Dr. C. Louis Perrinjaquet at High Country Healthcare in Summit County, Colorado.**

Dr. Chris’s Tips for Staying Active Through the High Country Winter

Welcome to another Winter in the High Country! We’ve already had a series of snow storms in record-breaking cold temperatures across Colorado. On one hand, snow conditions are excellent! On the other hand, it’s sometimes cold enough to make you want to stay inside! One of the most effective ways to warm up is from the inside, out. Don’t forget about all the little opportunities you have to move your body and get your blood flowing, before, after, and even in the middle of a work day. Dr. Chris always has some valuable insight that she shared in a recent chat:

What keeps most of your patients from being more active during the Winter as opposed to the Summer?

Except for sledding and ice skating, Winter sports around here are very expensive. Not only is the equipment expensive, but having enough free time to actually go out and do something that takes more than one hour is very difficult for many of our families who are working two or three jobs, since Winter is the busiest season. Also, many of the parents did not grow up in a climate with snow, and came to Summit County for jobs, but not necessarily for recreation.

Is an hour your recommended duration for exercise?

Many studies have shown that 30 minutes a day of movement, whether it’s walking, running or dancing, can lead to adequate fitness. Personally, my goal is 14 hours a week. There are so many things that I want to do, and I want to do them fairly well and fairly intensely, so an hour a day isn’t enough for me to feel like I’m pursuing a maximum fitness level.

Aside from the obvious downhill skiing and snowboarding, what are some healthy activities you recommend during the Winter?

Shoveling snow, snow shoeing, hiking trails that are packed down, on Yaktrax “ice cleats” (inexpensive and very healthy, very good workout), hut trips (gives you a destination, which adds variety and camaraderie to your exercise; carrying a pack adds to your aerobic workout; on your way up, you’re getting the extra workout, but on your way home, it’s almost always downhill (and your pack is lighter), sledding, building snowmen or snow forts …

Do any of these activities provide benefits especially advantageous at altitude?

By doing any activity at altitude, you are increasing your cardiopulmonary fitness (heart & lungs). 

If you’re just getting started, aim for 20 minutes a day, and add five minutes every week. Listening to podcasts, books or music makes everything less painful and more fun. Get a buddy to engage in these simple activities with you. Wear layers for the weather. Being outside doesn’t have to be uncomfortably cold, and you’ll be more inclined to exercise longer if you’re not freezing.

Pay a little more attention to how you can anticipate your hunger throughout the day. I try to keep some nuts, cheese, grapes, small chocolates at my desk, in my pocket, in my car for quick snacks. A smoothie or coffee in a portable cup really cuts the hunger over a good amount of time.

Take advantage of down time to do a few stretches wherever you are. This opens up circulation, allowing your body better access to the nutrients and oxygen your blood delivers.

Be on the lookout for The Doc, cross country skiing on snow day streets, sledding at Rainbow Park, or getting a good stretch in just about anywhere. And let us know if you have a favorite activity that’s easy to fit into a busy or cold, indoor day that you’d recommend!

robert-ebert-santos

Roberto Santos is from the remote island of Saipan, in the Commonwealth of the Northern Mariana Islands. He has since lived in Japan and the Hawaiian Islands, and has made Colorado his current home, where he is a web developer, musician, avid outdoorsman and prolific reader. When he is not developing applications and graphics, you can find him performing with the Denver Philharmonic Orchestra, snowboarding Vail or Keystone, soaking in hot springs, or reading non-fiction at a brewery.


Sickle Cell Anemia at Altitude: a Case Report

Martin, a 27-year-old African American male, presents to a rural mountain hospital with complaints of left upper quadrant abdominal pain. Martin arrived at altitude (9,400 feet) two days ago from Oklahoma City after a 12-hour drive. Shortly after arriving to his condo in the mountains, Martin developed a dull aching pain to his left upper quadrant. The pain is constant but radiates to his L flank intermittently. Martin tried snowboarding today but had to end his day early because the pain became too severe. Martin cannot identify any aggravating or relieving factors and states that ibuprofen “didn’t even touch the pain.” Martin denies associated nausea, vomiting, diarrhea, constipation, urinary symptoms, fevers, chills, enlarged lymph nodes, or fatigue. His medical history is significant sickle cell trait without active disease. He has a negative surgical history, takes no daily medications, and has no known allergies. *

Differential diagnoses considered include kidney stones, pancreatitis, gastritis, diverticulitis, splenic enlargement, an infarcted spleen, or mononucleosis. Laboratory tests ordered include a complete blood count, reticulocyte count (indicator of immature red blood cells production), lactate dehydrogenase (an indicator of red blood cell destruction), haptoglobin (a binding protein that binds free hemoglobin after red blood cell destruction), a complete metabolic panel, and a urine analysis. A CT scan of the abdomen with contrast was also ordered and performed. 

Martin’s results showed an elevated white blood cell count, sickled cells on his blood smear, mildly elevated reticulocyte count and lactate dehydrogenase, low haptoglobin, and an elevated bilirubin. The remainder of his blood work was unremarkable. The CT scan showed a 40% infarction of his spleen. Martin was treated with oxygen, fluids, and IV pain medication and was promptly transferred to a larger hospital at lower elevation. 

What caused all of this to happen? 

Sickle cell anemia (SCA) is a mutation of the HBB gene that affects the development of normal hemoglobin, the major oxygen transporting protein in the body. SCA is an autosomal recessive genetic disorder which means that two copies of the abnormal gene have to be passed on from both parents in order for the disease to be active in the offspring. So, in other words, if both parents are carriers of the abnormal gene, their offspring have a 25% chance of developing the active disease and a 50% chance of becoming carriers themselves. 

http://www.healthnucleus

The hemoglobin protein is made up of four subunits, 2 alpha-globin and 2 beta-globin. Sickle cell carriers will have a mutation of one of the beta-globin units, resulting in no clinical manifestations of the disease. These individuals live normal lives and are virtually unaffected by the mutation, as seen in Martin’s case. Individuals with active disease will have a mutation in both of the beta-globin subunits, creating sickling of their red blood cells. Sickling of red blood cells makes them less flexible in maneuvering through the vasculature, ultimately resulting in a blockage of blood flow to various tissues in the body. This is cause of severe pain that many individuals experience when in crisis. Sickled cells are also more prone to destruction leading to an anemic state and are inefficient oxygen transporters. 

https://www.flickr.com/photos/nihgov/27669979993

The sickle cell mutation is typically found in certain ethnic groups which is thought to be related to the protective quality of sickled cells from the development of Malaria. The ethnic groups most likely to be affected include African Americans, Sub-Saharan Africans, Latinos, Indians, Individuals from Mediterranean descent, and those from the Caribbean. 

But if Martin was a carrier without active disease, why did he develop sickle cell anemia?

Individuals with the sickle cell trait can cause their cells to sickle under extreme stress including during strenuous exercise, severe dehydration, and when at high altitude. The resulting consequence is the manifestation of all of the symptoms of active disease. Although Martin had never had any symptoms related to his sickle cell trait, he was now in full sickle cell crisis that required immediate intervention. 

What are the implications? 

Individuals from any of the ethnic groups listed above should be tested for the sickle cell trait to ensure they are not carriers. A carrier must exercise extreme caution in ascending to high altitude, should stay well hydrated, and avoid strenuous exercise to prevent the development of a sickle cell crisis. 

*Case scenario is not based on any individual patient rather a compilation of varying presentations seen in the emergency department. 

Liya is 3rd year Doctor of Nursing Practice Student attending North Dakota State University. She lives in Breckenridge, Colorado and works as a registered nurse in the Emergency department. Liya was born in Latvia and moved to the United States in 1991 with her family. She grew up in the Washington, DC area until she moved to Colorado in 2012.  She is passionate about helping immigrant families and other underserved individuals gain access to basic healthcare services. She hopes to work in Family Medicine in a federally qualified health center in the Denver metro or surrounding areas. In her spare time, Liya enjoys hiking, snowboarding, biking, and camping. 

References

Adewoyin A. S. (2015). Management of sickle cell disease: A review for physician education in Nigeria (sub-Saharan Africa). Anemia, 2015. doi:10.1155/2015/791498

American Society of Hematology. (n.d). Sickle cell trait. Retrieved from https://www.hematology.org/Patients/Anemia/Sickle-Cell-Trait.aspx

Mayo Clinic. (2018). Sickle cell anemia. Retrieved from https://www.mayoclinic.org/diseases-conditions/sickle-cellanemia/symptoms causes/syc-20355876

U.S National Library of Medicine. (2019). Sickle cell disease. Retrieved from https://ghr.nlm.nih.gov/condition/sickle-celldisease#inheritance

Yale, S.H,, Nagib, N., & Guthrie, T. (2000). Approach to the vasoocclusive crisis in adults with sickle cell disease. American Family Physicians, 61(5), 1349-1356. Retrieved from https://www.aafp.org/afp/2000/0301/p1349.html

The Legacy of the Mountain Guru: Prof. Dr. Gustavo Zubieta-Castillo

We’ve published a series of accounts from Dr. Chris’s recent attendance at the 7th Annual Chronic Hypoxia conference in La Paz, Bolivia , conducted by Dr. Gustavo Zubieta-Castillo. He is one of the world’s leading experts of altitude medicine and Dr. Chris’s collaboration and contact with him has added literally phenomenal insight into our own high altitude research.

Dr. Chris “en Teleférico” with fellow altitude researchers Vanessa Moncada, Diana Alcantara Zapata, Dzhunusova G. S., Oscar Murillo, and Alex Murillo. Photo courtesty of Dr. Zubieta-Castillo.

There is something literarily romantic about the scientists who are compelled to remind you, “I’m not crazy!” Dr. Zubieta-Castillo has held soccer games at 6,542 m (21,463′), proving the remarkable adaptability of the human body. He maintains a high altitude training lab, called the Chacaltaya Pyramid, at 5,250 m (17,224′). In his recent video (below), he illustrates the connection between longevity and elevation, where citizens of the highest cities in South America live to be well over 100.

It’s notable that a city known for its wine at 2,790 m (9,153′), called Chuquisaca, boasts some of the oldest residents. Not surprisingly, our research has led us to some speculation on the relationship between alcohol and the body at altitude. Additionally affirming is Dr. Zubieta-Castillo’s father, nicknamed “El Guru de la Montaña”, who began his legacy of altitude research and medicine by examining the hearts of dogs at altitude (sound familiar? See our article on Dogs at Altitude), as well as Dr. Zubieta-Castillo’s own testament that asthma can be and has been treated by altitude (see Asthma at Altitude).

His latest correspondence with Dr. Chris and their mutual colleagues reads like letters written by history’s greatest scientists, beginning,

Dear Colleague Scientists:

The 7th Chronic Hypoxia Symposium, thanks to your outstanding participation was a great success !! We shared great scientific, friendship and enthusiasm from 16 countries, along with travel and conferences in fascinating environments, all at high altitude.

The letter ends with an invitation to all colleagues to contribute their own research to the first chronic hypoxia-dedicated issue in a top medical journal, so be on the lookout for Dr. Chris’s contribution (which we will be sure to share here).

The video below is a fascinating look into some of Dr. Zubieta-Castillo’s latest research, including his theories and recommendations on conditioning humans in space with hypoxia, a dissertation that was initially dismissed as irrelevant, then subsequently published. Enjoy!

robert-ebert-santos

Roberto Santos is from the remote island of Saipan, in the Commonwealth of the Northern Mariana Islands. He has since lived in Japan and the Hawaiian Islands, and has made Colorado his current home, where he is a web developer, musician, avid outdoorsman and prolific reader. When he is not developing applications and graphics, you can find him performing with the Denver Philharmonic Orchestra, snowboarding Vail or Keystone, soaking in hot springs, or reading non-fiction at a brewery.

Can Living at Altitude Alone Improve Your Health?

There has been a lot of speculation among all the locals and visitors up here, even the students who do rotations with us, on whether merely living at altitude can yield health and/or fitness benefits. And this is a conversation that has been going on for quite some time.

At our clinic, what we’ve been finding over these past two decades of our practice and research is that the way individuals respond to altitude is not so simple. Yes, in many cases of acute mountain illness we see, the remedy may simply be more oxygen, whether that means being hooked up to an oxygen concentrator or descending in elevation. But the answer to whether living at high altitude will improve your health and/or fitness in itself is much more complex.

Studies have been and continue to be conducted all over the globe, not surprisingly in other countries with high-altitude communities like India, Nepal, Argentina, and Bolivia (you may remember Dr. Chris’s accounts of the Chronic Hypoxia conference she attended earlier this year in La Paz). An article in Berkley Wellness from 2014, Are Higher Elevations Healthier?, cites some speculation that appetite may be suppressed at higher elevations because of the effect it has on hormones like leptin, and that the added physical exertion required for your body to function in an environment with lower oxygen may also require more calories.

Sure. This is consistent with some of our own speculation at Ebert Family Clinic. But there is so much more to it.

Hiking rations up to one of Colorado’s remote mountain huts.

Altitude does demand a lot from the body. Bodies born and raised up here tend to be more well-adapted. Bodies not born, but raised up here certainly have a great chance at achieving more advanced levels of acclimatization. Healthy bodies that come up to altitude on occasion may experience little to no symptoms of mountain illness. But as soon as a pre-existing respiratory or cardiovascular condition comes into play, all bets are off, and the high altitude can become more of a threat than an asset.

On the other hand, we’ve also seen some recent studies (and personal accounts from patients and readers) that indicate certain conditions may experience relief from various symptoms at higher elevations (see Altitude As Asthma Treatment or Increasing the Altitude to Decrease the Symptoms of Parkinsons). And there are many other variables here besides the elevation, like air and water quality or culture. Summit County’s population is consistently rated among the healthiest, most long-lived in the country. But how much does the culture of outdoor activity influence that? And how does the popularity of craft beer and marijuana use affect that? Is there a “typical” diet up here?

Somewhere in Eagle County, CO.

The way each individual body acclimatizes depends on so many physiological factors and fine processes. Very generally, the better your body carries out these processes, the easier your life at altitude will be. With this in mind, it might seem that those who thrive at altitude are already in good shape, while those who are prone to the most difficult transitions may very well be fighting other inhibiting factors already.

It would seem that for every accommodation your body makes at altitude that may benefit its function at sea level, there are other compromises. We’ve heard from more than one athlete that muscle training at altitude may not be as effective, because your cardiovascular and respiratory capacity will max out before you reach the limit of your strength. We’re also finding that blood oxygen saturation levels may be lower at altitude for many people while sleeping. While lower oxygen may stimulate some beneficial transformation in the body (increased red blood cell counts, for example), it may also very quickly complicate body function under certain conditions. In addition to all that, there is a strong genetic factor to an individual’s response to altitude that we still have much to learn about.

robert-ebert-santos

Roberto Santos is from the remote island of Saipan, in the Commonwealth of the Northern Mariana Islands. He has since lived in Japan and the Hawaiian Islands, and has made Colorado his current home, where he is a web developer, musician, avid outdoorsman and prolific reader. When he is not developing applications and graphics, you can find him performing with the Denver Philharmonic Orchestra, snowboarding Vail or Keystone, soaking in hot springs, or reading non-fiction at a brewery.

Mt. Shavano & Tabeguache Peak

This past weekend, we ended Dr. Chris’s birthday week celebration with an ascent up Mt. Shavano, at 14,229′ (4337 m). We didn’t make it to the summit of the neighboring Tabeguache Peak, but I’m including it in the title of this piece because it was very much a part of our experience on this particular trek.

The standard summer route up Shavano and Tabeguache starts at 9700′, outside of the town of Salida. Up to the summit of Shavano, there is a 4400′ elevation gain over about 4.2 miles. If this is hard for you to imagine, know that it is formidable. Additionally, the trail increases in difficulty the further you progress, and the last .6 mile to the top is one of the most challenging ascents I’ve ever done without a heavy pack. In a previous article, I mentioned anticipating an inner dialogue about turning around before summiting. This inner dialogue didn’t involve me turning around so much as just passing out on a rock and staying there forever. But I did manage to summit after a 5.5 hr ascent, which included a 2-mile detour past and then back to the very first sign indicating the trail, in the dark of the early morning, at the very beginning of the hike. As obvious as the sign should have been, I’m relieved to say we weren’t the only ones.

This is the wooden sign indicating the Colorado Trail and the trail to reach Mt. Shavano and Tabeguache Peak.
The sign, .1 mi from the trailhead, that we somehow missed in the dark of the early morning.

And this is precisely why you should bring several resources to help guide you. In spite of all the trail descriptions with mileage that we brought, the only sure indication we had passed the turn-off from the Colorado Trail were the actual GPS coordinates of the sign listed in one of our resources (14ers.com). Pro tip: you can enter GPS coordinates into your Google Maps app (assuming you have service); leaving off the capital letters for cardinal directions (N, S, E, W), the first number will be latitude, the second longitude (in our case, we entered “38.60218, -106.19594” to find the sign we had initially passed).

Another learning experience on this particular trek was regarding our camp site. We had chosen the Angel of Shavano camp site, close to the trailhead, which is outside the town of Maysville, past Salida (about two hours from Frisco). The site is right at the foot of the mountains in that area, quite small (20 spots, first-come-first-serve, $20 per night for two vehicles). I was expecting a lot of other hikers, going to bed earlier than us, to wake up and start their ascent earlier than us, with more expensive, specialized gear, but was surprised to find all our neighbors partying until hours after we had retired into our tents.

Icing these puppies in a beautiful river along the Angel of Shavano campground.

As it turns out, there is a Winter route up Shavano, and the trailhead for the standard Summer route was about a 30-minute drive back toward Salida from the Angel of Shavano campground. So that explains why we didn’t encounter any other early-risers there. The good news is that Angel of Shavano campground is gorgeous, right off the Colorado Trail, along a beautiful river that, this late in the summer, was flowing shallow and slow enough that I could set a chair in it and soak my feet in the icy water (before putting them through hell the next day).

A half-moon over Angel of Shavano campground.

We ended up at the trailhead for the Summer route the next morning at 5:15 am. Pitch black. Here’s another pro tip: if your headlamp is dim, it needs new batteries.

Be aware that this parking lot is referred to as the “Blanks Trailhead Parking Lot” on signs on the trail, and this sign is the only one that reads “Mount Shavano Tabeguache Peak Trailhead”.

Other than missing what would have been a very obvious sign in the daylight, the rest of the trail was pretty much straight up. Even the switchbacks were steep enough to make me think, “Would it be much steeper if we just went straight up?” If you’ve ever climbed Peak One in the Ten Mile Range above Frisco, it’s like that (or any portion of that) times a hundred.

The dawn breaking as we backtrack toward the sign we missed.

It’s also significant to note that this was the second time in my life I’d ever wished for hiking poles. The steep grade had me pushing off my own thighs constantly as I trudged up the incline, and my quads were burning the entire hour-and-a-half it took me to get back down. Yes: 5.5 hours up, 1.5 hours down.

The water in my Camel-bak was all I’d brought on the trail (after drinking from a couple Nalgene bottles I’d brought in the car), and I ran out just before getting back to the trailhead. One of us ran out of water in her Camel-bak on her way up to the summit. Fortunately, another one of us had packed an extra gallon of water.

As far as snacking went, we had plenty of jerky, pistachios, bananas, nut butter, and electrolytes between us. I may even have had a chocolate-covered Twinkie. But we didn’t finish all of that, and as I’d expected, my body didn’t really crave food so much as liquids, until I’d reached the end of the hike, at which point I promptly finished all traces of food in the car.

Dr. Chris taking a break on the saddle below the summit of Shavano.

All-in-all, I’d say that was a successful excursion, and even the mistakes we made affirmed that even experienced hikers should take extra care. My main takeaway: don’t rush the start of the trail. It is worth hours to be sure where you are headed, even if it means standing in one spot, double-checking all your resources, entering GPS coordinates for 20 minutes.

The treacherous terrain up the last .6 mi to the summit of Mt. Shavano.

Also notable: we started back on the right track toward the beginning of the hike just before 7 am, at which point it was already bright out, and I reached the summit at 11 am. By 11:15, all the distant clouds had amassed into huge thunderheads, and the first rumble of thunder had us packing up pretty quickly. And this isn’t the first time I’ve seen this. No matter how far away you think those clouds are, it takes mere minutes for them to travel. And as white and interspersed as clouds may seem, they can collect into large, grey, stormy masses very quickly. So, beer in hand, I started a quick descent from the peak. I’d already run for my life down a fourteener in a lightning storm once, and I don’t ever plan to do that again. Furthermore, the summit area of Mt. Shavano is little more than a huge pile of rough boulders, a type of terrain requiring your hands as well as your feet to navigate, called talus. The trail is neither clear nor safe, and there is no way you are running down it.

Do you see a trail here?
Neither did we.

Finally, the weather was the main reason we didn’t make it to the neighboring Tabeguache Peak. A local we talked to on the trail who had made the ascent numerous times advised us to budget at least an hour each way to and from Tabeguache. It’s only about a mile away, but it’s a rocky, narrow ridge. And sure enough, on our way down, it started hailing along with the thunder (and in my experience with fourteeners this time of year, it always does), rained lightly twice through the forest, and then poured torrential rain toward the bottom of the trail.

Would I recommend this trek? Definitely. It is a true test of fitness, and even more so, stamina. As with any other trek, and as I always strongly advise, be wise and pre-emptive about how far and how fast you go. Elevations above 8,000′ are when your body’s reaction to the altitude become exponentially more dramatic, so you can bet elevations above 10,000′ put you at much higher risk for all kinds of symptoms of altitude illness. The faster you ascend, the greater the risk. And remember, our party set out well before daylight at 5:30 am. In the future, should I plan to summit both of these beasts, I would certainly start no later than 4 am.

Other than that, do your homework and prepare accordingly, and you’ll be in for the time of your fitness-challenging, self-motivated lives! Happy Trails!

Beer and jerky time, 5.5 hours later, atop Mt. Shavano at 14,229′.
robert-ebert-santos
Roberto Santos on an epic powder day at the opening of The Beavers lift at Arapahoe Basin ski area.

Roberto Santos is from the remote island of Saipan, in the Commonwealth of the Northern Mariana Islands. He has since lived in Japan and the Hawaiian Islands, and has made Colorado his current home, where he is a web developer, musician, avid outdoorsman and prolific reader. When he is not developing applications and graphics, you can find him performing with the Denver Philharmonic Orchestra, snowboarding Vail or Keystone, soaking in hot springs, or reading non-fiction at a brewery.

Climbing a Fourteener: An Insider’s Abridged Guide

Some of your friends have done one or two and a couple are on their way to having ascended their 20-something-eth peak over 14,000 ft. You’ve heard the views are breathtaking, the sense of accomplishment is riveting, and it makes you that much more secure in calling yourself a Coloradan.

Climbing fourteeners has become a popular quest for so many residents and visitors to Colorado, and as I prepare to take on another one myself, I thought I’d share my process of preparation for anyone looking for insight. There are a lot of very practical guides out there, everything from maps to trail descriptions. Hopefully, what I have to tell you is some less-than-obvious, experience-driven advice.

Every fourteener is different. Elevation in itself is a poor indicator of the level of difficulty of any trail. Mt. Evans, at 14,265 ft. (4348 m.), has a paved road all the way up to the top. Mt. Princeton at 14,196 ft. (4327 m.) took me several hours to hike and I was on all-fours to climb any set of stairs the next few days.

Oops …..

Access is everything. I mentioned there are ample resources out there, including regularly updated printed literature as well as online accounts. Take it from me: read them all. Many of these peaks have several approaches, and trails sometimes intersect. The difference may be hours! Some friends and I set out to climb Mt. Harvard (14,423 ft., 4396 m.), in the Collegiate Peaks outside Buena Vista. When we got to the top (after a few hours of hiking), the small cardboard sign tucked under some rocks read “Mt. Columbia 14,078′” (4291 m.)”. Imagine our surprise.

You can’t always rely on your phone, either, so take maps, print out trail descriptions (including any of trails you don’t plan to take), and check them often during your ascent.

Timing. Timing, timing, timing, timing, timing. You may have heard this already, and any Coloradan will tell you that no matter how clear, sunny and calm the first part of the day is, the weather can change in an instant. Even if it remains calm at the base of a 14er, these high peaks will rake in the clouds. Shortly after we summited Mt. Columbia (as in, within five minutes), we noticed some grey clouds in the distance. Then we started to hear the crackling of static all around us. Then lightning. Then we proceeded to run all the way down that rocky mountain questioning every decision we’d ever made. During the 30 or 40 minutes of very dangerous running and leaping back down to the tree-line (an ascent that took us hours), all I could think was, “So this is how it ends. My family won’t even find out for days.” Luckily we made it down, and my companions couldn’t tell I was crying because we were soaking wet from rain and hail.

Start early. Before dawn if possible. I’m not exaggerating.

Anticipate every climate. There is often still snow on Colorado’s highest peaks, even at the height of summer heat. You will be sweating all the way up, but as soon as you stop to rest, the biting wind toward the summit will prompt you to unpack every layer you shoved into your tiny Camel-bak.

Pay attention to distance and elevation gain. Ascending 2000 ft. in 8 miles is a vastly different experience than ascending 2000 ft. in 4 miles. If you can’t imagine what either of these feels like, definitely try some lower summits before attempting a 14er. Peak One, just over Frisco, in the Ten Mile Range summits at 12,933 ft. (3942 m.), but the elevation gain is almost 4000 ft. in less than 5 miles. I’ve done this hike several times, and I always, always find myself debating whether it is totally necessary that I reach the top.

This weekend, I’ll be headed up Mt. Shavano at 14,299 ft. (4337 m.), outside of Salida. It’s a 4600-ft. gain over almost 5 miles, so this tells me I’ll be having that inner dialogue about turning back early at least a couple times on my way to the summit. It’s been 95 degrees (F) at 7000 ft. during the day recently, so that tells me I’ll be in all my layers, including a hooded jacket when we set out on the trailhead before daylight, I’ll strip all the way down to shorts when the sun rises after an hour or two, then put it all back on when we reach the top.

One piece of advice on water and snacks: lots of water, lots of snacks. I very personally prefer to give my body some extra calories the night before we set out on the trail, and I don’t expect to consume a lot of weight on my way up. However, as soon as I’ve reached the top and all I have to worry about is the (often less-intensive) descent, my muscles start craving nutrition and hydration.

Remember, turning around is always an option. If someone in your party is struggling or the weather looks like it will be taking a turn for the worse, don’t wait until it’s too late to head back to safety. These mountains aren’t going anywhere fast. Other than the above-mentioned, maybe lesser-known details, don’t forget the usual: sun protection, sturdy and comfortable shoes, some basic first aid, and a plan to maintain communication with those in your party.

If you’ve had any close calls hiking fourteeners in Colorado or any additional wisdom you’d like to pass on, please do share them in the comments! In the meantime, stay tuned for a follow up on our Mt. Shavano ascent, and Happy Trails!

robert-ebert-santos
Roberto Santos on an epic powder day at the opening of The Beavers lift at Arapahoe Basin ski area.

Roberto Santos is from the remote island of Saipan, in the Commonwealth of the Northern Mariana Islands. He has since lived in Japan and the Hawaiian Islands, and has made Colorado his current home, where he is a web developer, musician, avid outdoorsman and prolific reader. When he is not developing applications and graphics, you can find him performing with the Denver Philharmonic Orchestra, snowboarding Vail or Keystone, soaking in hot springs, or reading non-fiction at a brewery.

What’s Going On in La Paz?

The 7th Chronic Hypoxia Symposium was held this year in La Paz, Bolivia, in February and March. La Paz, sitting at 11,942 ft. (3640 m), is home to one of the world’s leading researchers of the effects of chronic hypoxia, Dr. Gustavo Zubieta-Calleja, with whom Colorado’s own Dr. Christine Ebert-Santos was able to meet with during her attendance of the symposium. You can refer to her previous article on the gathering of experts from over 16 countries for her own account of Dr. Zubieta-Calleja’s impressive work.

Below is the renowned Dr. Sanjay Gupta’s own account on video of his introduction to the experience of hypoxia and altitude with Dr. Zubieta-Calleja.

Always keep in mind, there are many physiological reactions going on when your body and brain are at altitude, and the higher the altitude, the more extreme the effects. Benefitting from a hypoxic environment isn’t as simple as staying hydrated. When we talk about chronic hypoxia, we are typically referring to a population who have spent many years in a high altitude environment.

robert-ebert-santos
Roberto Santos on an epic powder day at the opening of The Beavers lift at Arapahoe Basin ski area.

Roberto Santos is from the remote island of Saipan, in the Commonwealth of the Northern Mariana Islands. He has since lived in Japan and the Hawaiian Islands, and has made Colorado his current home, where he is a web developer, musician, avid outdoorsman and prolific reader. When he is not developing applications and graphics, you can find him performing with the Denver Philharmonic Orchestra, snowboarding Vail or Keystone, soaking in hot springs, or reading non-fiction at a brewery.

Coloradans on the Annapurna Circuit

One of our nearest and dearest, Shelbie Ebert, a certifiable high country local born at Vail Valley Hospital, has been an adventure guide for the last decade. She is currently working on her nursing degree, and is an Emergency Medical Technician. While she has done some multi-day backpacking in the past, she says her recent trip to Nepal was her “most ambitious journey to date.” I was able to sit down with her and her mother, Karen, and hear all about the literal ups and downs on the Annapurna Circuit, in the central mountain region of Nepal, where they reached the highest point at 17,769 ft (5416 m)! They were in Nepal from April 17th to May 17th.

This trek is of international fame, and there are many resources to inform those looking to embark on this historical, spiritual, mental, and physical adventure. All in all, they spent 14 days on the trail. But I was so curious what it was like for those more familiar with the unique challenges posed by Colorado’s high altitude environment.

Did you do anything different from others you observed on the trail?

Most people had porters; we decided not to do that. Even those who didn’t have porters hired a guide.

Having been born and raised at a higher elevation than most, did you notice a difference between your own process of acclimation and that of your colleagues?

I did get sick in Nepal, but it was mostly stomach sickness. No headaches or anything like that. Mom didn’t feel a headache until we got pretty high up. We noticed a lot of people dropping; a lot of people bused into Manang, and from there, it’s a two-day hike up to the base camp, and from there you cross the pass. They got on the trail from there. Manang is at about 10,000 ft. Those people definitely struggled more. 

A father and son hiked the trail side-by-side with us. They didn’t hire porters. Shortly after we got over [Thorung La Pass], the son got really, really sick. The pass tops out at about 17,200 ft. When we saw him at the top of the pass, his lips were bright blue. I think he started to get sick on the ascent. I think he was probably about my age, and he was a doctor. He had some drugs stocked up and he felt pretty confident about doing the hike. 

They started their hike at about 2600 ft. above sea level. In a matter of 10 days, they would climb to over 17,000 ft. over 70 miles.

How long did you take before you started hiking?

We flew into Kathmandu, spent two days there, then took a long bus to the city where we started hiking, and we started hiking as soon as we got off the bus. We did take an acclimation day in Manang, at 10,000 ft. We hiked to it, then we spent an extra day there, about 48 hours. 

What was the greatest challenge about this excursion?

How much constant up and down it was, with the altitude gain. The day that we went over the pass it felt like a good day to me, because it resembled hiking in Colorado. But those days of up and down prepared us well for the pass. 

Did you do any training in particular in preparation for this excursion?

No, absolutely not. I read a lot of blogs so I knew what to expect. I tried to have just a really good plan for what we could and couldn’t do, and when we got to Kathmandu, I stocked up on all kinds of drugs, because anyone can buy them. Diamox. I think I maybe only took one once on our ascension day, just to get ahead of the game. 

Did you change or adjust your diet at all to prepare for this excursion?

I thought I did. I looked up some Nepali food online and tried cooking it at home to prepare my stomach for the type of food that we would be eating, but I found it was nothing like actual Nepali lentils and rice. 

Learned some hard lessons about food. A lot of the lentils in Nepal made me sick. Luckily they have a lot of potato-based dishes. 

[There was a] surprising amount of good snacks available, [lots of pre-packaged cashews, nuts, cookies and snacks]. I would recommend for anybody to bring five or six cliff bars for the harder days.

Also kept some sugar on me: Snickers, chocolate, gummies … I forced Karen to eat some sugar when she wasn’t feeling well, and that seemed to improve her condition.

Karen did experience some symptoms of altitude sickness as they ascended the highest point of the trek, Thorung La.

In retrospect, is there anything you would have done differently in preparation and/or on the trail?

I would have packed a lot less. We had about 35 – 40 lbs. in our bags, and that was way too much — and totally unnecessary. Less is more on the trail. We did end up hiring a porter to carry my mom’s pack on our big day, and that was an excellent decision. 

Did you notice anything different upon your return to a much lower elevation?

I felt really strong! I was really grateful for my body. I think it was mostly a mental shift. I felt more capable doing most activities, whether it was mental or not. I started taking better care of myself. I started running in the mornings before school, which is something I never would have felt before. 

I thought, “I hiked 17,000 ft, I can probably run a mile and be okay in the morning.”

Any other advice you’d give in particular to other travelers intent on similar excursions?

You know what, go for it! It’s not as hard as you think. I came to a country I’d never been to before with a book in my hand, and we did it! I think anybody can really do it.

Shelbie is honored to have shared this experience with her wonderful, strong mother. And this isn’t the first or last adventure they will have been on together. True backcountry buffs, I can always find them on all types of gear on the snow, on the river, or on the trail.

Shelbie and Karen victorious at the height of Thorung La Pass.

If you’d like to read more details about their Annapurna Circuit Trek, Shelbie maintains a blog where you can find all kinds of tips and recommendations on backcountry gear at lahlahdesigns.com.

robert-ebert-santos
Roberto Santos on an epic powder day at the opening of The Beavers lift at Arapahoe Basin ski area.

Roberto Santos is from the remote island of Saipan, in the Commonwealth of the Northern Mariana Islands. He has since lived in Japan and the Hawaiian Islands, and has made Colorado his current home, where he is a web developer, musician, avid outdoorsman and prolific reader. When he is not developing applications and graphics, you can find him performing with the Denver Philharmonic Orchestra, snowboarding Vail or Keystone, soaking in hot springs, or reading non-fiction at a brewery.