Category Archives: Technology

High Altitude Research has inspired a lot of fascinating innovation from vital sign tracking to simulation

Acclimation, Alcohol at Altitude, Altitude Science, Child Growth & Development, Health, High Altitude, High Altitude Training & Fitness, Medicine, Mountaineering, Technology

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

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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!

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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.

Health, High Altitude, Medicine, Mountaineering, Technology

Wilderness Medicine & Medicine for our Wilderness

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Our mission of advocacy and community building continues at our little mountain clinic as the aspen leaves have just begun to turn, and our passion for high altitude research has brought us to a unique and timely junction between the Wilderness Medicine Society‘s conference in Crested Butte, Colorado that Dr. Chris attended, and a recent conversation with the founder of The Sustainable Hiker, Summit County resident and voice of the Wilderness, Tom Koehler.

As health care providers in the high country, we see patients experiencing all kinds of reactions to the extreme altitude, residents and visitors alike. Even those who aren’t out climbing fourteeners or skiing can often experience symptoms of acute mountain sickness. Needless to say, we also see our share of injuries in the more adventurous outdoor-inclined. We ourselves make a point of regularly venturing out into the celebrated Colorado forests to experience this demanding environment first-hand, and it is not always without incident, in spite of our expertise and careful planning, and these past Spring and Summer seasons have been no exception, between hut trips, fourteeners, camping, kayaking, stand up paddle-boarding, cycling, lifting, yoga, and running at 9000′ and above! It is our due diligence and life’s work to share our experiences and the valuable research being done across the globe with you.

Dr. Chris and her contemporaries have returned from the Wilderness Medicine conference this year with some good and bad news. First, the good news:

Dr. Chris receives some impromptu wilderness medicine for a scrape on a recent trip to Harry Gates hut.
  1. There are no brown recluse spiders in Colorado, according to Kennon Heard, MD (although Dr. Chris’s sister-in-law disagreed with this expert’s statement).
  2. Most snake bites do not inject venom, so anti-venom treatment is only indicated if symptoms are noted. The anti-venom is very expensive, but treatment of the wound is important in order to control the cascade of events set off by the venom, starting with a diffuse reaction similar to a severe anaphylaxis, followed by neurotoxic fasciculations of muscles, along with a necrotizing wound causing pain and swelling at the site of the bite and ending in a full disruption of every clotting factor and cell in the body. The clotting disruption does not lead to hemorrhage. In layman’s terms, most snake bites aren’t shown to lead to symptoms, but should you experience any symptoms, things could escalate to life-and-death very quickly.
  3. Another useful talk was given by a specialist in foot care, Patrick Burns, MD, DiMM (Diploma in Mountain Medicine): He recommends wearing two pairs of acrylic socks and protecting areas of friction with paper tape. He rejected the ointments and gels as unproven. Don’t use duct tape, as it damages the skin, and moleskin tends to be too thick. Blisters should be left intact, although consider draining if pain is intense. Healing takes 120 hours.
  4. For accidents and injuries, studies show that irrigating wounds with water is as good as saline, and a well-filled Camel-bak makes an excellent splint for fractures. Pain was addressed by Alex Kranc, MD, FAWN (Fellow Academy of Wilderness Medicine): doses of acetaminophen 1000 mg and ibuprofen 400 mg or Naprosyn given together or alternately are as good as stronger prescription medicines in most cases. A system of acupuncture without needles that is light and compact has been shown to help with pain in combat situations (where, incidentally, many of these techniques and tools are developed). Think of a sticky patch that you apply to a pressure point behind your ears.
  5. Linda Keyes, MD discussed women at altitude, including some helpful tips for dealing with menstruation on wilderness treks: menstrual cups catch the flow and can be washed and used over again; taking the active birth control pills continuously will delay the onset of bleeding. Another piece of good news: bears (and sharks) are not attracted by menstrual blood.
  6. In a discussion about training for altitude events, Aaron Campbell, MD, MHS, DiMM, FAWM reviewed the role of sleeping in hyperbaric chambers or tents, which showed a mild improvement in adaptation. The best way to prepare for climbing Mt. Kilimanjaro, he said, is to climb a fourteener every week for 6 weeks!
A slide on improvising a Camel-bak bladder as a splint at the 2019 Wilderness Medicine conference in Crested Butte, Colorado.

The most exciting and spellbinding parts of the conference, according to Dr. Chris, were the descriptions of rescues from mountains, crevices, and ledges from Alaska to Boulder.

Now for the bad news:

Michael Loso, PhD gave a fascinating talk on the science of glaciology and water acquisition research in Alaska. Poo on the glacier gets buried and frozen, and lasts for years, if not decades, and they have even found traces of E. coli around certain base camps too high for drinking standards. This obviously can significantly compromise water quality, even at higher elevations, where we imagine the water from snowmelt is of the most pristine quality, a subject I also speculated about with Tom Koehler. This is why you should carry a proven filtration system. Tom’s preference, when possible, is an 8-minute boil.

Can you see the Rocky Mountain big horn sheep?

But what about the Wilderness itself? Colorado’s Continental Divide plays a major role in where our water goes, how it gets there, and in what condition. Sixty-eight percent of Colorado’s forests are federally owned and protected, one of the highest in the nation. With the continuing rise in residence and tourism, increased traffic through our precious forests is a double-edged sword.

“Summit County is really a microcosm, but an example of a larger issue facing Colorado: exponential growth, both in permanent population, as well as increase in guests to our land. So that, on a high level, has water managers scratching their heads, wondering, ‘How are we going to deliver the water we need for businesses and human health?’,” explains Koehler. “Summit is unique, particularly in the water issue, because we supply a significant amount of runoff into the Colorado River at the headwaters in Kremmling. And that arguably touches an estimated 40 million people all the way to California,” giving a rough estimate.

“A lot of Colorado is struggling to maintain their trails. We have about 430 miles of trails of all uses. In this county, we have a lot of trails to maintain, and arguably, that’s our first line of defense against erosion into our streams. It’s just a cascading effect (pardon the pun),” he says. “Most every park and forest in the West is under strain for maintenance. We just happen to be the most recreated, visited in the country, with 4.4 million recreational visits per year.”

Koehler’s passion for conservation and preservation of our forests and watershed was fostered in natural forests of Shenandoah Park, where he frequently escaped to while working as a research director for a wealth management firm in Washington, DC, while also dreaming of a career as a competitive skier in Park City, Utah.

“Once the opportunity arose to head out West with a couple of pennies in my pocket, I took it, and my move to Summit County was transformational in that I saw nature first-hand, right outside my door.” It transformed his outlook on how it benefits us all, even economically. He started volunteering with the Summit Huts Association, which provided him with “tremendous opportunity to really be in the backcountry”, the High Country Conservation Center, where he “really carved out an ethos for [himself] of stewardship”, and was even named the Friends of the Dillon Ranger District Volunteer Recruiter of the Year for 2015.

The Sustainable Hiker was founded as a response to recognizing that the efforts on a lot of fronts being made by organizations wasn’t as widely broadcast to both locals and guests. It’s mission: to be the leading voice for protecting Nature.

“I see the Sustainable Hiker as part of a number of organizations from the stewardship to the climate change advocacy groups to the local conservation groups, where you can find out what’s going on with your land and water here in Summit County.

“A healthier forest provides me with cleaner air and cleaner, more reliable water. It’s taken for granted. Kind of like a factory that turns out profits, it has to be maintained to continue yielding as high a profit.” Spoken like a true financier.

Setting off through the Eagle’s Nest Wilderness below Buffalo Mountain in Summit County, Colorado.

So what is one thing Colorado residents can do, immediately, to forward this movement of sustainability?

“Immediately, wherever you reside or are visiting, look at a nature or forest stewardship project, or educational events related to our forest or nature, and sign up.”

What is one thing we can stop doing that will contribute to the preservation and conservation of our forests and water?

“Stop, right now, taking nature for granted. Because we need it.

“Stop relying on your car for everything.

“Stop talking. In Nature … our time in Nature is a time to slow down everything, including our conversations. For two reasons: for the joy and peace we experience listening to the birds, and it gives the wildlife a break, too.”

Below treeline on the way up to Harvard and Columbia peaks outside of Buena Vista, Colorado.

I understand his point. While living in Japan, I learned a word, “shin-rin-yoku” (森林浴), literally translating to “forest bath”. The idea revolving around the practice is that by walking through the trees and water in the forest, you exchange ions with it, providing your body with a balancing recalibration. I believe this is also a vital part of high-altitude health.

The Sustainable Hiker provides insight into Koehler’s mission, at sustainablehiker.com, where you will also find information on organizations, events, and his newsletter, Nature’s Beacon, drawing attention to conservation projects you can get involved in.

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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.

Accessibility, High Altitude, Mountaineering, Technology

Accessibility at Altitude

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How accessible are the places you go?

This past weekend, volunteers from Ebert Family Clinic in Frisco teamed up with the Northwest Colorado Center for Independence for No Barriers, a non-profit program that, among other impactful things, works to empower people with disabilities and bring communities face-to-face with what it means to be accessible.

This particular program, called “What’s Your Everest?“, takes place every year at various outdoor venues, connecting people with all sorts of disabilities with their ropes teams who assist them in ascending literal mountains. This year, held at Arapahoe Basin on the Continental Divide, participants navigated narrow, single-track trails over large rocks, through forest, up increasingly steep inclines to reach a summit well over 12,000′ (3657 m).

Volunteers and organizations across the state contributed to this weekend’s success, including STARS, Steamboat Adaptive Recreational Sports, providing a fleet of adaptive equipment to facilitate the ascent.

Some of the adaptive equipment provided at the No Barriers hike at Arapahoe Basin: we saw people on all kinds of apparatuses from hiking poles to one-wheelers to three-wheelers equipped with every kind of pedaling, wheeling, steering and braking device!

I imagine most people associate accessibility with wheelchair access in a restaurant, braille menus, audio signaling at crosswalks, ASL interpreters … this is just the tip of the iceberg. I promise you have never seen gear like adaptive equipment, and even if you have, you haven’t seen all of it.

How do you navigate a wheelchair up a mountain when it’s wider than the trail?

How do you operate or steer a wheelchair if you cannot grip the wheels or handles?

How do you navigate a trail without sight?

One of a fleet of adaptive cycles used for our No Barriers ascent and descent of Arapahoe Basin ski area. This particular apparatus allows the user to steer using pressure against a chest pad while “pedaling” with their hands. You can’t brake while using your hands to pedal!

None of this is easy, and even the current adaptive equipment has inherent flaws. It’s important to recognize that each person’s disability is unique, and can’t always be compensated by the same equipment produced for the next person.

Our ropes team with Leo in a wheelchair engineered for off-road ascents. Handles in the back for pushing, a handle inside either wheel for moving the wheels, steering and braking — but what if your disability prevents you from gripping the handles??

How do you start thinking about accessibility?

Accessibility is about cost. Adaptive equipment is expensive. Custom-making a recumbent bicycle that allows you to pedal without the use of your legs or feet is thousands of dollars, and people who need this equipment to partake in activities everyone without a disability enjoys should not have to pay more for being disabled.

Accessibility is about comfort. After volunteering at this year’s annual Colorado Youth Leadership Forum, where young adults with disabilities are empowered and educated about advocating for themselves and living independently, I realized you cannot expect people to stay focused and engaged in your programming if the room is too hot or the provided meal is unfulfilling. If someone without a disability is distracted by the temperature, you can be sure the attention of someone with autism is long-gone.

Accessibility is about time. Whatever expectations you apply to the amount of time someone needs to put clothes on, eat, use the bathroom, speak a sentence – forget all about it. People with disabilities often need more time. If someone needs more time in the bathroom or walking/wheeling to a destination, adjust your expectations and wait. Your impatience and intolerance is not improving access.

Two teams taking a break half-way up to Black Mountain Lodge at Arapahoe Basin ski area, after navigating some of the narrowest portions of the trail.

Accessibility is about language. Learn sign language. It is just as much a part of our culture as spoken English and Spanish. People with hearing impairments often learn to read lips because they are taught that their hearing counterparts can’t be bothered to learn a form of communication other than one spoken language. And this isn’t just about being deaf. Having a disability sometimes means you have a speech impediment, or that your brain doesn’t organize thought and speech the same way others do. Communicating effectively takes all forms for all disabilities: physical, mental and emotional.

Northwest Colorado Center for Independent Living (NWCCI) Independent Living Coordinator Carlos Santos hauling down the mountain at Arapahoe Basin ski area on an adaptive cycle after making his ascent to over 12,000′ on foot with hiking poles.

Accessibility is about attitude. Sometimes, people with certain disabilities can be very loud and blunt. Sometimes, they can walk, but with a limp. Sometimes, they speak very slowly. This does not mean they are rude, drunk, can’t think for themselves or can’t express their own opinions. Accommodating these situations means being prepared to shift your expectations and perspective.

I’ve been scolded by people sitting behind me at an opera for whispering translations to my blind companion next to me, before headsets with translations were provided. I’ve helped my friend into an outdoor trash elevator to get from the street level to a downstairs bar. And there was still a step onto the elevator platform. I’ve witnessed someone being thrown out of a bar for being “too intoxicated”, when in reality, he was just paraplegic and walked with a limp. And how is someone in a wheelchair supposed to use a port-a-potty at an outdoor music festival?

Is this the best we can do?

Our indoor establishments are barely held to any minimum standard of accessibility. Why are we doing so poorly, and why does access stop when it comes to the outdoors?

Ebert Family Clinic’s team, Medicina Para Montañeros, ascending the final 100 meters at Arapahoe Basin.

I continue to learn more and more about what it means for any particular event, establishment, activity or location to be truly accessible and inclusive, and it is important to me that my friends and family with disabilities are able to partake in the same experiences that I enjoy. I’ve realized that recommending a place that is “accessible” depends a lot on the disabilities present. Determining whether or not someone in a wheelchair can navigate a trail depends on what kind of wheelchair they are in as well as the grade and width of the trail.

12,500′ after hours of hiking, pushing, pulling, wheeling, carrying our way up to the top of Arapahoe Basin, discovering that ‘what is inside us is truly stronger than what is in our way’.

Accessibility is about problem-solving. It is up to all of us as a community to find solutions that enable our friends and family with disabilities to interact as freely with our environment as those of us without disabilities, both indoor and out. I encourage anyone and everyone to start with a simple visual assessment: take a look around you, next time you are on a hike, in a brewery, by the lake, at the farmer’s market, at your favorite coffee shop and ask yourself if your disabled counterparts would be able to join you. Start there.

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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.

Acclimation, Child Growth & Development, Health, High Altitude, High Altitude Training & Fitness, Medicine, Mountaineering, Technology

What’s Going On in La Paz?

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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.

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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.

Child Growth & Development, Health, Medicine, Technology

Technology in Health Care: Interview with Family Nurse Practitioner Tara Taylor

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After over a decade of serving pediatric patients in the high country communities of Colorado as Ebert Children’s Clinic, we opened up our health care practice to serve the needs of the adult population several years ago. As Dr. Chris can attest to, the world of health care has grown and evolved incredibly since she first opened up her practice in Colorado in 2000, and we all continue to learn from the providers we welcome to our team as well as the students we mentor.

Family Nurse Practitioner Tara Taylor.

This past year, we’ve had the pleasure of having Tara Taylor, FNP on our staff. She’s brought a wealth of knowledge and unique experience from having practiced on a medical campus much, much larger than our little mountain clinic, and her insight into everything from patient care to our own high altitude research projects continues to be an invaluable asset to both our practice and our community. She was so gracious one afternoon to have a chat with me between patients:

How did you find yourself in Colorado’s high country health care community?

So, I have actually lived here since 2004, so I’ve lived here 15 years. I came out here for 6 mos to ski, and stayed for 15 years. I found myself loving it, bought my first house and decided to stay out here. I’ve actually commuted down to Denver all this time, because I had originally started in New Jersey in 2002 in Critical Care. So when I moved out here I wanted to be in the mountains, but I also couldn’t do Critical Care up here at that time. So I decided to commute down to Denver for three 12-hours shifts a week, and then live up here four days a week. So I had an apartment in Denver … when I went back to NP school, my goal was to work and live in my own community. I think that’s huge for me … and not only be serving the population of Denver, but to be serving the people of my actual community.

How long had you been practicing in Denver?

Since 2005, because I worked 6 months at Keystone Clinic, so I’ve been in Denver working for 14 years  prior to this in the ICU. And I’ve worked at Children’s hospital in the pediatric ICU, burn ICU’s, bone marrow transplant, open-heart surgery, neuro-trauma, multi-system trauma, all of it.

How is it different working up here, for a small clinic, at that?

This is a huge change … I’m still working down there once a month, so I get to go down and play and enjoy that type of intensity. But at the same time, coming back here, I think that the critical care aspect … it still plays a role here. And in my letter, when they said, “Why do you want to go from [being] an ICU nurse to family practice?” … I said for so long, I’ve seen patients in the ICU [whose] admission or … critical portion of their admission could have been avoided if they had better focus on primary care and had their needs met. If they had been on the right medications, if someone had spent the time — and sometimes it’s because of their own compliance — but with adequate primary care, we’re avoided what I was seeing in the ICU. 

Now, being in primary care, I get the stimulation I need from the independence of it, making these decisions, and I really enjoy finding out what’s going on with the patient, deciding what tests to run, and getting back these results and being able to properly refer them. I enjoy the time that I’m able to have with those patients here at a private practice. So each patient gets the time that they need to be properly cared for. 

And I’m just seeing extremely sick patients. I’m not seeing a lot of sore throats and earaches, unless you’re 2 years old; besides that, the adults have really complex diagnoses that require a lot of thought. And in its own respect, it’s critical to me.

Great segue: what are the greatest challenges you’ve seen practicing up here?

I think some of the biggest challenges that I have seen up here is limitation of services. That’s why this clinic is bringing up Nephrology, … [expanding] mental health services here, and then, to bring in … pain management specialty, and give them a place to practice … It’s really hard for these additional specialties. We have Cardiology up here, we have Pulmonology, but some of the smaller things like Rheumatology for rheumatoid arthritis, for osteoporosis and kidneys … how do you establish your practice up here? So hopefully, as focused as [Ebert Family Clinic] is in the community about being able to provide the care we want for our patients …  we’ll be able to get that door open for those specialties and help them establish their practice up here, which is our goal.

How do you get connected to these services like Genomind?

[This patient] came to me with Genomind. I had not heard of that before. He said, “I got on the right medications because this genetic testing gave [Compass Health] the ability to treat me properly.” [Certain health care providers in Denver] require it, almost, for every patient walking in their door as a prerequisite to help them make medication decisions. 

Genomind is a swab in the cheek. I think it’s huge, because we’re not able to “draw” neurochemicals. We’re not able to draw your blood and say, “oh, look, you’re deficient in serotonin.” Because that’s not an option, what’s the best way for us to figure out what’s the best medication for you? Because medications are very specific to what they’re treating. So the only thing we’ve been able to do for the last decade is to guess; to put you on something, and if it doesn’t work, then we know that’s not the thing. And that’s a terrible process, because it leads patients to trying five medications, over a ten-year period, and finally we get them on the right thing. But how frustrating that is for patients; they lose confidence in their providers, they lose confidence in the system, they feel neglected, they feel frustrated. And to have that stamina to even go through that process … I think we have a lot of patients drop off. [They] end up saying, “Forget it. Medications don’t work for me.” Then [they] become non-functional … their quality of life is hindered by their [unwillingness] to spend ten years trying five medications.

That is not the best process. And I think the people that went ahead and engineered Genomind said, “What else can we do? What if we went back to genetics? What if we went back to genes?” We can swab a 1-day old infant or a 95-year old man, and we are going to get their genetics. And when they did the Human Genome Project, and we got our entire genetic profile as human beings, the science behind Genomind was they were able to take anyone who’s been diagnosed with schizophrenia, people who are known bipolar, generalized anxiety disorder, major depressive disorder, took their DNA … laid them over each other, and said, “What gene is predominant in all these patients?”

So they were actually able to use hundreds of thousands of mental health patients to establish what genes these were that led to the cause of their mental illness. So now we’re able to send off DNA with a swab in the cheek. It’s not a perfect science, but it’s what we have.

Is this better than nothing? There’s so much controversy about this test. How can you think this is controversial when you come from a science background as a provider, as a physician. You’ve got this, or you have nothing to guide you for the mental health of these patients. If we have this over nothing, I will take this.

[Genomind testing] is not only [about] mental health disorders, but also [for] people [suffering from] eating disorders, difficulty losing weight, ADHD, alcohol addiction and propensity for opioid addiction. It would identify what patients we may never want to start on narcotics if at all possible. It tells us, “Don’t start this patient on this particular drug because they’re at risk for gaining weight with this drug, like as an atypical antipsychotic.” It would tell us which medications an alcoholic would respond to best, if they were wanting to quit drinking and needed medication assistance. We have a lot of kids who seem like they’re ADHD, but really they have signs of anxiety and depression as well. And it’s our job to distinguish [whether] it’s the ADHD that’s causing the depression and anxiety, or it’s the depression and anxiety that’s causing the inability to focus? It’s absolutely fascinating! I want the community to know that we’re offering that here at the clinic.

Is Genomind available to children?

We can test anyone of any age. We can swab the cheek of a one-day old. I actually had a mom in here that said she was tested positive for both genes for the lack of ability to metabolize L-methylfolate, which causes bipolar disorder or mood instability. She came in here with her 4-month old son and said, “When can I get him tested to know?”

So I actually asked Genomind, and Genomind said you could test a brand new newborn baby, which at some point may be the standard of practice!

But at this point, it’s hard to want to test that child, because we’re not able to treat that child [without symptoms]. Once that child becomes 6 or 8 years old, and they are having mood instability, they are showing signs of some sort of mental illness, we do realize we are able to identify this in children. We don’t need to wait until people are 18 to say they must have a mental illness. We are identifying that in the behavior of hyperactive two and three year olds, and we’re seeing them grow up to be bipolar adults. So we are seeing early signs and symptoms of mental illness in these children. 

Could we test a 6-year old who is showing signs of something and have them be positive for these genes and be able to supplement them with L-methylfolate or an approved psychiatric medication in the pediatric population based on their genetics? This is absolutely going in that direction. Genomind said they’re 100% approved for adult and pediatric testing.

How do you find balance for yourself and maintain a healthy lifestyle?

Tara with Dr. Chris (center) and Kristen Duffy, A/GNP, at Ebert Family Clinic.

Working at this clinic actually provides me with the exact hours I need to have good work-life balance. That’s extremely important to Dr. Chris Ebert-Santos. When I started working here, she said, “What are your husband’s days off?” And I said, “Sunday-Monday,” she said, “Okay, well you’re not working Sunday-Monday then.” I just honestly couldn’t believe it, that my happiness was that important to her. I work reasonable hours. [Dr. Chris] provides me with the days off that will match my husband’s. I have great quality of life due to my husband. He’s an amazing person, wonderful and spirited, and we get along great. So we have that, and we have our two dogs, and we live a comfortable life up here. We love to do all the great stuff that Summit Countiers do: snowboarding, hiking, biking, camping, just getting outside in general together and playing with our dogs. And that’s what’s most important.

What have been your greatest takeaways from working in Summit County so far?

I think it’s running into that patient at the supermarket who, I know in the back of my head I have their diabetes controlled. To know that I’m specifically helping patients in my community. That I’m doing yoga next to someone [whose] blood pressure is controlled now because of me. I think that’s something really special and it’s not something that I had before when I worked in Denver, and I would come home and I would never see those people again. And then, having the opportunity in this clinic to deal with so many pediatric patients, since this was originally a pediatric clinic [before] expanding to adult services as well, which is amazing. But the amount of pediatrics in this clinic really improves both my exposure to every age group. I love kids. To have patients hug me in this office who have had a very challenging diagnosis … that “thank you” from patients is something I cannot replace.

Tara continues to be a passionate advocate for mental, women’s and sexual health, and a valuable resource as a health care practitioner. Ebert Family Clinic is proud to have her.

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.

Acclimation, Child Growth & Development, Health, High Altitude, High Altitude Training & Fitness, Medicine, Technology

Portrait of a High-Altitude Athlete: The Ultra Mountain Athlete

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Yuki Ikeda has been a professional cyclist for the past 10 years. He’s won titles in both Japan and the US. Interestingly enough, however, he come to Colorado to study at Metro State in Denver in order to play pro basketball. He is now known as an Ultra Mountain Athlete, not only biking, but running races up to 100 miles at altitudes over 10,000 ft. Over some decaf coffee on a warm Sunday afternoon at Gonzo’s in Frisco, he tells me he tried out every semester for the college team and failed. He had never really explored outdoor recreation growing up in Japan, because he had been so focused on a career in basketball.

He started taking some classes on outdoor sports while he was in Colorado, at Metro and then at Red Rocks Community College: rock climbing, cycling, backpacking, kayaking … He ended up staying in Colorado after graduating from Metro. “At that time, I was so into mountain biking,” he says. “I decided to pursue my career in mountain biking.”

He started racing in 2002. It took him five years to accumulate sponsors and become a full-on pro. “After every season, I sent my resume — racing results and what I do — to so many teams [to see if] they [would] accept me or not.”

Ultra Mountain Athlete Yuki Ikeda

But he started to get burned out. While he was still improving his stats, he was noticing that he couldn’t maintain the lead against some up-and-coming younger racers. “I was mentally very tired the last couple of years. I was kind of frustrated. Last year, after the season, I was so bummed out, I didn’t want to ride my bike, and I didn’t feel like starting training for the next year, so I stayed away from biking. I didn’t even touch my bike for a month.”

“But I still wanted to do some exercise. I just followed my wife, running, then I kind of joined the local trail running community. They showed me where to go and where to run, and I just loved it. I was so into mountain biking only, I thought doing other sports might cause injuries and effect my career. But it was the opposite.”

His new love for running turned his career around. “Physically, I don’t know [if it has improved my biking] yet, but mentally it helped. Now, my training is still 60 – 70% cycling, but not all the time. When I get on the bike, my brain is still fresh. Before, I rode my bike every day, pushing hard every day. It burned me out.”

Last month, he ran his first ultra running race, 50K. “Last October, I got sore from just running only 5K. Now I an run 50K, so that’s awesome.” He won.

Ultra Training at Altitude

I ask him how he trains for these races. Every summer, he comes to Colorado, staying in Frisco or Breckenridge to train in preparation for a series of races at altitude. It usually takes him 10 days to almost 3 weeks before he can do the same workouts he does at sea level in Tokyo.

Threshold power key. Threshold power is the maximum power you can sustain for about 60 minutes. He has a power meter on his bike that measures the power he exerts in watts. Recently, he has also been wearing a similar device on his shoe for when he runs.

“In Tokyo, my number is 310 watts, but here, it’s almost 270 to 280. I just did a threshold test last week. So that’s almost 10 to 12% lower. But still, if it’s within 10 to 15%, that’s very good for this altitude. But I usually take the test after a week or 10 days after I get here. I cannot push myself hard enough [before that]. Even [if] you’ve adjusted to this altitude, your power number is still lower than at sea level. I feel like I’m weak, but you have to accept it. That’s just how it is.”

His next race is part of the Leadman series, consisting of 5 mountain biking and trail running races in Leadville, Colorado. This next one is 42 km. Originally, the trail takes the runners over Mosquito Pass, which is at over 13,000 ft. But this year, there is still so much snow that the trail has been re-routed, so the runners aren’t sure what to expect. But the race starts at over 10,000 ft.

To train for this, he’s been running and biking six days a week. Every morning, he measures his blood oxygen saturation using a pulse oximeter. The first morning he arrived in Frisco, it was at 92. After a couple weeks of acclimation and training, it’s pretty reliably at 96 every morning.

Pacing

Yuki claims the most difficult part about running these long races is pacing. His coach encouraged him to run “negative splits”, increasing his speed toward the end of the race. “At my first 50 km race, even though I won it, I could have paced myself better. I just went too hard at the beginning [to] take the lead and paid for it later in the race. I was so trashed after the race, I couldn’t even stand and walk.”

“My coach is saying to be careful about [hitting the wall] at altitude. It’s so hard to recover. It takes almost five times longer than at sea level. I need to pace myself, especially for running 100 miles,” Yuki says, referencing the Leadville Trail Run in August he is also preparing for: 100 miles at altitude. “I’m so excited, but at the same time, I’m so nervous. Even finishing is questionable at this point.”

Acclimation

His secret to acclimating comfortably and quickly is actually movement. He says he feels the affects of the elevation more when he’s sedentary. In order to get more oxygen to his body, he has to get his circulation going. “The first week, I feel better when I exercise than when I just sit [around]. “

Also, beets. And red bell pepper. And arugula.

He eats a limited portion of these every day he’s at altitude. These vegetables provide a lot of nitrates, which your body processes into nitric oxide, facilitating blood circulation. At altitudes over 8000 ft., where you have access to about a third of the oxygen available in the air at sea level, the key to supplementing the oxygen your body requires is increased blood flow. After a certain amount of time, your body starts creating more oxygen-carrying red blood cells to counter the deficit, so getting the blood moving is literally vital.

According to high-altitude growth and development expert Dr. Christine Ebert-Santos, nitric oxide is often the way newborn babies with complications at altitude are treated. Hypoxia (the state of receiving less oxygen than is normal at sea level) causes pulmonary vessels (in the lungs) to constrict. Putting these infants on nitric oxide gas dilates the pulmonary arteries and improves some types of respiratory distress.

There are powders marketed to aid the food version of this nutrition, including BeetElite, Yuki’s product of choice, which he’ll add to his sports drinks in addition to consuming about an ounce of roasted beets. But portion control is also important, as too much nitrate can also have a negative effect on the body.

Running Recovery

Yuki is learning that he has to deal with an interesting phenomenon when it comes to his ultra running races: it’s tough on his guts. When it comes to his diet, he doesn’t typically change anything for recovery after a long event. “But I think my guts are more tired, because your body is bouncing so much from running.”

When running these incredible distances, he fuels his body with an energy gel every 20 to 30 minutes while running. “It usually has about 100 to 120 calories. It’s a dense energy. Then you take them for five hours, continuously, so it also tires out your guts. During the race. You have to maintain your blood sugar and keep your muscles moving. My muscles are tired, but also, my intestine and stomach are tired.”

“Even water is hard on my stomach [after running a race]. I’m kinda worried about running 50 and 100 miles. I’m not only worried about my legs, but even my stomach. I’m not used to [consuming] energy for 20 hours, eating and running at the same time.”

In Japan, hot springs and bathing are also a huge, sacred part of the recovery and health ritual. He takes a hot bath almost every day, “especially in winter,” he says. “It helps me to sleep at night.”

Sleep

The first week he spends at altitude in Colorado, he finds it harder to fall asleep. “I used to take one or two melatonin capsules every night, but it’s hard to tell if it helped. I just go to bed early, like 8 or 9, even if I cannot fall asleep. I just take the time to lay down and recover. [I try to sleep] at least 7 to 8 hours a night, but sometimes it’s hard. If I can’t get that amount of sleep, I usually take a nap after training.”

This may sound obvious, but sleep is when your body does most of its recovery, both mentally and physically. Sleep experts and studies have proven that the body and brain visibly deteriorate after so much sleep deprivation. And at altitude, with less oxygen available to supply a body in constant motion, sleep may be more important than ever.

Plant-based Nutrition

Yuki isn’t the first high-altitude athlete I’ve spoken to who advocates for a plant-based lifestyle. In a recent blog, skier and duathlete Cierra Sullivan also tells us about how a plant-based diet seems to make a big difference.

“When I used to like and eat animal products a lot, my recovery time was slower than now. It was hard to digest animal fats. I believed that they had a lot of good protein, but it was so hard on your body and digestive system,” Yuki says. “It took time to change my diet, but I now feel more comfortable with my plant-based diet, physically and mentally.”

Live High Train Low

Another recurring theme among high-altitude athletes.

“One of my sponsors has an altitude tent. They leased it to me before the competition, so I used it about a month. I slept in the tent, set at about 3000 m, then I train at sea level. I think it helped a bit, but it might be too short to tell. It tired me [out], though. I think I needed to do it longer before the competition, like, two or three months. I couldn’t train well, because I felt tired all the time. But I think for altitude training, I think this elevation is almost too high. Because you cannot push to your maximum potential. For example, for cycling, I can push up to 1000 – 1200 watts at sea level, but I cannot hit that number here, so I cannot train in that range here. I can lose that high power if I stay longer here. But it depends on your [goal]. My [goal] is winning the Leadman series, that’s why I’ve come here to train.”

This is partly why Yuki will lift weights once a week when training at altitude, “to maintain my high power.” With such limited access to oxygen, athletes up here can’t reach the same “punching power” that they can at lower elevations, so lifting may help maintain that power. “Very short, maybe 45 minutes, once a week, just to maintain. Weightlifting is still supplemental for your specific sport, so I don’t want it to affect my training on my bike or running. For race week, I don’t lift weights, because lifting weights takes time to recover.”

Keeping It Fun

“My trick to keep going — the best way to improve yourself,” Yuki adds, in a final reflection, “is to keep it fun. If you’re not having fun, I think that’s not good. Last year, I almost lost my motivation as an athlete. I almost thought about quitting racing, but I still love the sport. Trail running helped me mentally and physically, and my motivation came back, even for cycling. Having fun is the key to keep going.”

Ultra mountain athlete Yuki Ikeda with high-altitude researcher and writer Roberto Santos at Gonzo’s Coffee in Frisco after an insightful afternoon interview.

Thank you, Yuki. I completely agree. And best of luck with that 100-mile trail run at 13,000 ft.! Keep track of Yuki’s race schedule, social media and stats at http://yukiikeda.net/

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.

Acclimation, Health, High Altitude, Medicine, Technology

Nocturnal Pulse Oximeter Study

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    “I’ve never had a patient with a normal overnight pulse oximetry study,” said Tara Taylor, Family Nurse Practitioner at Ebert Family Clinic. She has been a provider there for a year, after 14 years working as a nurse in the intensive care unit at Swedish Hospital. Of course, the study that tracks oxygen and heart rate during sleep is usually performed on patients with symptoms such as snoring, fatigue, poor-quality sleep, attention deficit, depression, or high blood pressure.

    What is normal for healthy adults at altitude? When would sleeping on oxygen help cure or prevent some of these symptoms? Do we even notice when we’re being deprived of oxygen while we sleep?

These are the questions addressed in a new investigator-initiated research trial at Ebert Family Clinic. The catalyst for the study was a conversation between Dr. Christine Ebert-Santos and Annette Blakeslee FNP at the 7th World congress of Chronic Hypoxia in La Paz, Bolivia in February. Annette is the provider for the US Embassy staff at 12,000 ft elevation. State department officials spend months or years on assignment there, and Annette wanted to know when she should be concerned. Local residents living at altitude for generations are adapted, while people living in La Paz and Summit County for months or years are acclimatized but still at risk for conditions caused by the low-oxygen environment.

    The study, called “Overnight Pulse Oximeter Study at Three Altitude Sites”, will recruit healthy adults ages 20 to 65 years. Participants will fill out a health questionnaire, take home a simple monitor worn on the finger and wrist to wear during sleep, and return the monitor the next day. Ebert Family Clinic staff will download the data for further analysis. Participants will be notified by a provider regarding the results of their study. De-identified data will be transferred to Excel spreadsheets from which graphs and charts can be generated.

    Besides dividing participants into three different altitude ranges between 7,000 and 12,000 feet, data will be analyzed by age groups and symptoms. “Everyone responds to altitude differently,” states Dr. Ebert-Santos. “There are hundreds of chromosomes that affect our ability to adapt. Many studies show the benefits of living in a low-oxygen environment, but a small percent of us will do better sleeping on oxygen. We are hoping this study will establish normal values and suggest who should be evaluated further.” — Dr. Christine Ebert-Santos

For more information, or to become a participant in this sleep study, residents of altitudes 7,000 ft. or above in Colorado for at least 6 months and between the ages of 20 and 65 years old should call Ebert Family Clinic at (970) 668-1616.

Acclimation, Doc Talk, Health, High Altitude, Medicine, Technology

Kidney Function at Altitude: An Interview with Nephrologist Dr. Andrew Brookens

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How much do you know about the role your kidneys play? Does elevation affect their function? How do your kidneys help you adjust to high altitude environments?

The remote mountain communities have a new hero. Altitude Kidney Health just opened their practice at Ebert Family Clinic in Frisco, Summit County, Colorado this week. Dr. Andrew Brookens, a native Coloradan, grew up in the Denver suburb of Englewood, and spent years living at twice the altitude in Bolivia with the Peace Corps before dedicating his career to bringing his current legacy of accessible kidney health care back to Colorado. His passion for providing service to the Colorado high country and beyond and his appreciation for his cross-cultural heritage is powerful in a recent talk between patients and publicizing.

What do you want people to know about you and your background?

I was born in Englewood, Colorado, and I knew pretty early on that I wanted to be helping people, in health care. But the first job I took was as a waiter. I thought that was just great.

God bless you! I know just how valuable that is.

But it’s funny, because I don’t consider serving patients too much different than waiting tables and serving clients there. So, what I did was I had to sort out whether I truly wanted it. And I went to college out East, and I decided to do the coursework for medicine and medical school. But I decided at the end of medical school, I think there’s more to life than just going straight through and being a science junkie. So I got a degree in Public Policy and Spanish, and I lived in South America and did the Peace Corps for two and a half year.

I went to Cherry Creek High School in Englewood. I went to Duke University in North Carolina. I went to Bolivia [for the Peace Corps], which was great, because a second goal was to learn Spanish fluently. My grandfather is from Puerto Rico, my grandmother’s from Dominican Republic, and a lot of family speaks Spanish only, and I decided, you know what, I could just go straight on through and be a science junkie, or I can learn a little bit about the world, you know, some of this cross-cultural reality that is in my family. And I decided I just need to figure some stuff out for myself first.

And I’ve heard Bolivia is another undiscovered gem in South America.

Yeah, exactly. Bolivia is one of two landlocked countries in South America. And it has three main areas from the high plains — they call it the altiplano — but it’s up at about 12,000 – 14,000 ft. It’s intense. And it’s totally flat land, as you look out across the landscape. It’s like the Great Plains of the States, but flatter. And then there’s the mountain valleys and then there’s the Lowlands, which are tropical. And so I lived in the mountain valleys at 10,000 ft. And it’s beautiful, and I of course went there to learn Spanish, and I got placed in a village where Spanish was the second language. The first language was Quechua, so I had to learn Quechua to survive!

I did two and half years there doing youth education and local economic development. I worked with women weavers to help them sell their weavings, and market it in the cities. And I worked with the tourism committee to help bring more tourists to their lands, because agriculture was a declining economy, and we wanted to help them develop ways to generate income in their own villages.

I loved the service work abroad, but wanted to anchor myself to somewhere closer to Colorado. Back at home, my brother helped reopen my eyes to considering the long-term career I’d once dreamt about as a child: medicine. And so while working as a consultant and waiter again, I applied and was accepted to medical school at CU in Denver, and we were the first class to transfer out from the Denver campus to Aurora. It was a wonderful experience: the peer group, as well as experiencing the new campus and all of the things they had to offer afforded a variety of learning opportunities.

During that experience, I got to travel to the mountains of Colorado and do a clinical rotation in Steamboat [Springs], which was fascinating for me. Because it was about seeing the community and not just seeing the next test and my studies. And as a guy who’s from CO, going out there and seeing what the mountains were like and what the needs were like … one of the docs who I worked with, who’s still in practice there, is this fascinating doctor who trained himself to do some specialty procedures because otherwise he had to send patients down for these procedures who couldn’t afford to spend the night in the city, and it was just complex. And he has pioneered the offering of some specialty services in addition to his general medical practice in that part of the state. It just opened my mind to this reality of what the need is in parts of Colorado and in many states, frankly, that don’t have access or aren’t right next door to a major medical center.

Was he a nephrologist as well?

No, he was a general internist, and he was doing gastrointestinal procedures: colonoscopies and things like that. So that kinda sparked a flame, and I decided to follow my soon-to-be-wife to Seattle where I finished my training. I did Internal Medicine residency, and then kidney, or nephrology, fellowship in Seattle, Washington. And at the end of five years there, my wife, who’s also from Colorado, and I had made a decision … we decided to go back to Colorado. And so we moved back to Colorado in 2016, I took a job with a large Nephrology practice in West Denver. I loved my job, it was a great group of colleagues, and yet I still felt like there was more to pursue, going back to that same experience that I mentioned, which is we could be doing more for our patients who live in the far flung areas of the state.

To ask a patient to come in, driving six hours or five hours from Craig, for a 15 minute visit with me, it felt like the greatest disservice. Why would a patient conceivably wanna lose a day or two, trek all the way down here, pay me to see me, and then maybe return home, maybe not necessarily better off. I just didn’t feel like that was making sense. I don’t wanna be naive about it, but it was my deep-seated belief that we could do more to bring health care to Coloradans everywhere, no matter where they are. And that’s why I decided this is the time. So in late 2018, I decided to resign my position and set out to make this company, which is Altitude Kidney Health. This is the dream that I’ve had all the way back to the days when I thought I wanted to just help people and started waiting tables. I felt like creating a practice that delivers health care to Coloradans like I can no matter where the Coloradans are is … I feel like the luckiest guy in the world.

So as I go through the community evangelizing our new Nephrologist, a lot of people don’t know the term “Nephrology”. What are some things about Nephrology that affect more people than they realize?

I love that. It’s a great question because a lot of providers don’t know some of the things that are most intimately related to Nephrology, too. The kidneys have their hands in tons of pots in the body. Not only do the kidneys clean your blood — so when you pee, that is a fluid that’s made by your kidneys and stored in your bladder until you pee it out. And what it does is it gets rid of waste products and toxins, everything from the breakfast burrito you had to the glass of wine you’ll have tonight.

But in the same way that it cleans toxins out of your body, it’s finely tuning electrolytes. If you watch the Gatorade commercials about electrolytes and things, the kidney has the job of balancing those electrolytes so finely that they really shouldn’t vary more than a couple iotas off normal, and that’s thanks to the kidney. Everything from potassium to acid levels in your blood, sodium levels and the amount of water that’s in your body.

When you feel thirsty, because you haven’t drunk, or because you just had this delicious, massive pizza, or you’re working out, that is your kidney in that signaling process. Kidneys help you understand that you’re thirsty and it’s time to drink.

In addition, kidneys control many functions. Up here at altitude, we know that patients make more blood cells. The kidneys are one of the first steps in the creation of blood cells, which are made inside your bone marrow. The kidneys signal that. We see patients with kidney disease not only suffer from imbalances of electrolytes and a build up of toxins as kidney disease progresses, along the lines of those two main functions I mentioned, when your kidney disease progresses, I see patients start to lose blood cells. They make less and less, and that’s because signals weaken coming from the kidney in patients who have kidney disease. I also see patients develop weaker bone structure or musculoskeletal disease from kidney disease, and that’s something that’s intimately regulated by the kidney because it helps to balance minerals like magnesium and phosphorus and calcium in your body.

And in addition, I think the kidney has its hand in a really key element that most providers are aware of but maybe patients not: blood pressure. Your blood pressure’s regulated in a tight range, and the kidney allows that; it’s the one that determines how long that leash is. How long can it go, how high can it go? Outside of that range, there may be other factors. If you’re truly dehydrated, maybe your blood pressure drops. Or there are other things that can cause your blood pressure to elevate, including aging, and this stiffening of your arteries. But even so, despite all these other processes, the kidney is the main determinant of your body’s blood pressure.

One of the key features I ask all of my patients is about blood pressure. It’s also one of the things we discovered we can do better for patients with because many times we’d ask patients to check their blood pressure, but they either didn’t know how to, didn’t have the system, or didn’t have the time to send the data back to us in the clinic. So that’s one of the things that we’re also [doing], in addition to trying to reach more patients: using a clinic in the mountains and Telehealth, so that we can see any patient any day. We also have a blood pressure recording system, so that way, patients who get one of these kits from us can simply step on a scale or record their blood pressure, and instantaneously, that data point is sent by bluetooth to our clinic.

I think that’s something, because what I’ll find is patients who don’t necessarily have known kidney disease, but they’ve maybe dealt with blood pressure for years, and they’ve found it harder and harder to deal with or control over the years. Those are patients who would greatly benefit from a kidney analysis or kidney care and blood pressure management. That’s what we can do.

Good segue: I wanted to ask you more about the tools that you use as a Nephrologist that might be distinct to your practice. Up in the mountains, we’re obsessed with pulse oximeters, because we’re constantly watching blood oxygen saturation. Is there anything else that you use specific to your practice?

The pulse oximeter is something we use also, especially because it relates to the oxygen-carrying capacity of the blood or how much blood you have. And it also relates to how the kidneys are balancing and helping manage what your respiratory status is. So we look at that.

The blood pressure is the most important vital sign for me. Weight is the second most important vital sign for me. The reason that’s second most important is because many patients who get blood pressure or have heart disease, and patients who have certain types of kidney disease, will get swelling. I’ll sometimes see my patients gain 5 lbs. in a day or two, and that’s all from salt in the diet and swelling. So weight and measuring your weight, especially if you’re a person who’s swelling, is a big deal because these are patients who — we especially see it after a big barbecue or holiday meals, where food is delicious and salty — those are the patients who are most vulnerable. We’ll see those patients have a much higher risk of having blood pressure changes and even becoming sicker to where they are hospitalized. With close monitoring of their blood pressures at home, we can often take patients who’ve been in and out of the hospital once, twice, or even ten times in a year, and we can help them stay out of the hospital, just through close monitoring and prevention.

So what we do is our nurse at the clinic will often be in touch with the patients, monitoring their blood pressures and weights, and if the patients don’t notice it, she may notice and … reach out to [them] and tell them, “I’m concerned about the 5 lb. weight gain you’ve had in the past few days,” and then talk through it. If a medicine change is needed, we can make it there on the spot, or whatever else.

In addition, communication and close contact to patients. The Telehealth system we use allows patients to take a kidney appointment from the comfort of their living room couch or office. Or they could go to their local doctor where they live and get on the computer screen with them and have what is a video visit, kinda like FaceTime, and they can dial right into our clinic and access us. And that tool isn’t a clinical tool, but it is an access tool. Access is maybe half the battle. Using that and the remote vitals monitoring collapses the distances between us and our patients to minimal or no barrier.

Is there anything distinctive about how high altitude changes the physiology when the kidneys are concerned?

Love it. So, the kidneys balance acid in the blood. Many patients up at high altitude not only have lower oxygen levels, they may have higher blood counts in order to improve their oxygen-carrying capacity. Especially your typical person who comes up for a ski trip and they’re not used to the altitude. It takes a few weeks for your body to make the blood cells to compensate for that. So those people especially may struggle to survive or breathe up here at altitude. And so the pulse oximeter is helpful.

What happens is when the body breathes faster to get more oxygen, the kidneys compensate. So what you end up doing is … breathing more quickly to get more oxygen, and it also lowers the carbon dioxide and the acid levels in your body, so we end up often seeing that the kidneys … adjust the level of bicarbonate. And bicarbonate is simply baking soda, dissolved in your blood. That’s a kidney response. As you breathe more quickly, you get rid of acid, and then the kidneys will adjust by peeing out some of the bicarbonate or the baking soda.

When you breathe out acid, which is carbon dioxide in your breath, your body becomes more basic. Your body becomes more full of baking soda.

In addition, we also see the kidneys responding through blood pressure changes. I think blood pressure will often fluctuate. It’s probably varying by individual, but we see many patients’ blood pressure increase at altitude. And the kidneys are constantly adjusting and titrating that, too.

So, that being said, what do you advise in general to maintain kidney health?

A lot of patients who don’t have advanced kidney disease are advised, appropriately so, to hydrate well. Many patients might be told to drink more water, and I think, in general, that’s a great recommendation. Many patients who are constantly light-headed or dizzy or dehydrated or don’t drink enough water, they could know it because they’re feeling [that way], or even had an episode where they blacked out or passed out and fell down. These are patients where a little bit more water — I’d even add that saltwater, so broth or a soup — is a great way to treat that, by giving yourself more salt and water, which helps to elevate your blood pressure.

Now, the caveat is patients who have swelling and heart problems would be well-served to avoid extra salt. If it gets more tricky, and patients are thinking, “… this is really too confusing,” that’s where we often recommend having a chat with your regular doctor, and if need be, with a kidney doctor to sort out a personalized recommendation.

The converse recommendation is also true. In patients with advancing kidney disease, hydration is good, but minimizing salt is the most important thing you can do. For patients who have known kidney disease that’s moderate to severe, minimizing salt intake is the number one recommendation.

The number two recommendation for patients with known kidney disease, as well as for patients generally, is “less is more”. I have a number of patients that come into the office who take two Advil or two Aleve, … and maybe they take it two times a day or four times a day. And unbeknownst to them, they’re scarring their kidneys down. Just from taking regular over-the-counter pain relievers. Tylenol has its own risks, but it is far safer as a pain reliever than Advil, Ibuprofen, Neproxin, Aleve, and Motrin and things like that.

Along those lines, many patients will come into my office and I ask them all to bring pills that they take. They may come in with a grocery bag full of twenty supplements, because they go to a naturopath … not to knock on naturopaths. I’m a person who deeply believes in the value of some of these alternative therapies and non-Western therapies. But at the same time, I often see patients in my clinic who, by the time they’re taking more than a couple supplements, are putting themselves at big risk of the two supplements or multiple supplements interacting with each other, or interacting with their life-saving vital medicines that they take, prescribed by a provider. The more pills you take, the more chance there is for a bad reaction. So in general, I find that [with] patients who come to me with kidney disease, I often find myself recommending that they reduce or eliminate supplements. Because some of these supplements are known toxins to the body or kidneys, even though they may help you with cholesterol or libido or something like that. But most supplements are not proven, not tested, and they’re definitely not signed off by the FDA. And that is risky to patients.

Speaking of medications, we often advocate for people who are prone to altitude sickness to be on Diamox pretty regularly. As far as we know, it’s very low-risk as far as side effects go. Does it pose any particular risk when it’s taken often?

The two things Diamox does, that I understand, to help you with altitude sickness is it gets rid of fluid — it’s a diarrhetic — and it also gets rid of bicarbonate, the baking soda in the body. It actually helps that process of adjusting the body in response to going up to altitude. For patients who hydrate well and don’t have that risk of falling down from low volume or depletion, commonly known as dehydration, Diamox should be fairly safely tolerated There are not a lot of known allergies.

Recently, I’ve come to know a couple people who have lost or donated a kidney. Have you ever encountered patients with “phantom pains” where a kidney used to be?

That’s a great questions for a couple reasons. Phantom pains occur. There are some rare cases where patients who get phantom pains from surgical removal of an organ would be well-served to return to the surgeon, or a provider that they trust, and discuss about whether they would benefit from repeat imaging.

It’s possible that a fluid bubble, what’s called a seroma, or a complication, like an infection … could arise in that space. Most of the time, phantom pains are things we don’t have a good response for. Again, I think a “less is more” approach is good. And that’s actually why I recommend complementary therapy. In addition to taking the Tylenol, I have many patients that find their pains relieved by acupuncture or massage or other things that don’t put yet another pill in their body.

But it brings up another important topic: patients who progress along the spectrum of kidney disease to more severe kidney disease, where their kidneys start to shut down and are no longer working enough to support them, need some sort of advance therapy known as dialysis to treat them. And not everybody wants or needs dialysis, but for those who do, transplant is a great option. So we often refer patients promptly for transplant evaluation, because the waiting list for transplant is often many years. Standard around the country would be in the order of 3 – 6 years, and in some states, it’s going to be closer to 10 years.

But live donation of an organ, a kidney, is one of the future visions I see for patients with kidney disease. Dialysis is a therapy that is truly invasive: timewise, personally, personal space, blood … it’s really hard on patients, but it’s something that like any skill you learn, like riding a bike, can be learned. I can imagine a world … [where] most of us will be able to donate a kidney and will never know we lost a kidney. We won’t feel it. We won’t suffer the medical consequences of it. And the national transplant registries have changed the order of prioritization of organs such that if you are a person who donates a kidney, in the future, if you suffer a kidney failure yourself, you have a higher priority level for receiving a transplant, because of the gift you gave earlier in life. And that’s really important because a patient who’s facing years of dialysis on that wait list for a transplant, if they ask their friends and family members whether they’d consider being tested to see if they’re a candidate to donate their kidney, I imagine a future world in which few or no patients are on dialysis. The moment a patient is seen to be heading toward needing dialysis, they are prepared for a live kidney transplant, and then they get paired up with somebody across the country or even somebody in their own backyard … who can donate. Once you get a transplanted kidney, you have to be on medicines that control the immune system, but you never have to spend a day thereafter in a kidney dialysis center. And that’s a really useful thing, because many patients don’t have the time, or they risk losing jobs or spending time with their loved ones because of the amount of time they spend on dialysis.

So, the kidney phantom pains are an issue, but truly patients who donate organs are patients who have given the gift of life, and most of the time don’t suffer a single side effect or consequence of that donation. And they should feel like they have the right to follow up with the surgeon or the team that helped them facilitate that to get their needs met or their questions answered, including phantom pains. Because often, that’s something worth looking at.

What do you enjoy doing in your freetime?

I am father of a four-and-a-half year old, so there’s nothing better than spending time with my wife and my son, who I’m now trying to teach to play tennis and ski, because those are my two favorite activities.

Last question: do you have a favorite ski hill?

I don’t. I used to. I grew up skiing Vail and Beaver Creek, but these days, we do everything we can to avoid the I-70 ski traffic on ski weekends. And if that means going to a Front Range ski area, or a ski area off the beaten path, we love exploring the deep reaches of the state. Any day I’m not on my skis or with a tennis racket, you can find me on a road cycle if I’m not at work.

We’re excited to be here. We’re a growing company and have hired another Nephrologist in our practice (Dr. Eileen Fish), so we are always looking to see how we can help communities solve their needs for kidney health.

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.

Acclimation, Child Growth & Development, Health, High Altitude, High Altitude Training & Fitness, Medicine, Technology

Athletes vs. Amateurs: Observations of an Altitude Expert

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Ski America is a company that has organized accommodations and itinerary for international athletes and vacationers at ski areas around Colorado since 1988. The Omori family, Ski America’s founders, lead their clients on tours of Colorado’s most renowned mountains, including Aspen (8,040 ft.), Vail (8,120 ft.), Beaver Creek (8,100 ft.), Copper (9,712 ft.), Keystone (9,280 ft.), Breckenridge (9,600 ft.) and Arapahoe Basin (10,780 ft.).

Ryoko and Jimi Omori

Jimi Omori started Ski America as a tour operator for Japanese skiers and snowboarders. Ryoko joined in 2005, and now Ski America’s service is more than tour operating, assisting from first-time skiers of age 3 to professional racers. With over 30 years of experience guiding amateur skiers and international athletes alike, the Omori’s have made some fascinating observations of how people adjust to the high altitude environment of the Rocky Mountains.

The other day, Ryoko shared some of their valuable insight and experience with me over a cup of tea:

How long do your clients typically stay at altitude?

So we have two different kinds of customers. In November until early December, we have a lot of Japanese racers from Japan. They are high school kids, college students. They stay two to four weeks here, in Frisco or Copper Mountain. Then, from December to April, we have clients from Japan who stay in Vail or Aspen. Most of them are senior skiers, over 60 years old. They stay about a week in Vail or Aspen. Six nights is very average.

How often do you get repeat customers?

Quite a lot. Not all of them come back every year, but more than once. I would say, 70%.

Do you see new customers every year?

Yes.

How do you advertise in Japan?

Word of mouth.

How do you prepare your customers for the altitude?

When I set up the reservation for them, I send them the lodging confirmation and shuttle confirmation, how to get to the Colorado Mountain Express counter at Denver International Airport. With that information, I also send how to get ready for this altitude by e-mail to every customer: Don’t stay up all night before coming over here, don’t overwork before coming here, most importantly, don’t catch a cold before coming over here. That’s the most important thing. And keep yourself hydrated on the flight and on the shuttle. You can always stop at a restroom on the way from the airport to get here. Do not drink a lot [of alcohol] on the flight, and especially on the first night staying here. I encourage them to drink two liters of water a day.

They are so excited to be here, so they tend to forget about the altitude, because there are all the trees, it’s not above the tree line here. In Japan, [this elevation] is way over the tree line. So I always remind them, “You are going to be almost [at the elevation of] Mt. Fuji. So, move slow the first and second day of staying here.”

What about conditioning, physical exercise to prepare? Are they athletic?

They’re pretty much athletic. They’re avid skiers. They ski in Japan regularly. So I do not give them any athletic advice in Japan.

Do they come straight from Denver up to elevation, or do they stay in Denver a certain amount of time?

No. The flight arrives at 12:30 or 1 pm, so it’s very convenient for them to get on the shuttle in the afternoon, and they will be here before 5 or 6.

Do they ski the next day?

Most of them, yes.

What about oxygen or medication? Do you ever tell them to bring ibuprofen or anti-nausea medication?

No. But if anything happens here, I recommend taking [something] for a headache, like Advil.

What is the earliest sign that something might be wrong or that they need medical attention?

Headache. Or sometimes nausea. We had 150 racers last November, and out of 150, I took 5 kids to the clinic for altitude sickness symptoms.

Is it at the beginning of their stay?

Very beginning. [Typically] the second day of skiing. They are okay on the first day. They do not notice anything on the first morning, so they feel, “It’s okay, let’s go skiing!” and spend the day on the mountain, and they have jet-lag, and they can’t sleep well on the second night. And on the second morning most of them notice the symptoms. Those are the Copper clients. And I have 350 guests from Japan staying in Vail and Aspen. Last year, I didn’t see anyone get sick. So it’s only in Summit County, because it’s much higher.

Do you think there are any other correlating factors, like their age or where they’re from?

Age. The racers are from middle school to college, so they’re young. Their hormone level is not stable. And they are staying with their other teammates, apart from their parents, so it could have some emotional factors affecting them, too. But at the same time, the racers have a lot of muscle that needs a lot of oxygen. The higher metabolism that younger kids have [make them] more prone to high altitude sickness. The clients who stay in Vail or Aspen, they are much older, like, 40s, 50s, 60s. And they’re not as athletic as the racers. They do not do any training. So their basic metabolism is low, so I believe they do not need as much oxygen.

Does anyone come from a high elevation in Japan, or is it mostly sea level?

Mostly sea level. Only some of them are from Nozawa, it’s about 1000 m (3,280 ft.), so it’s much lower than Denver.

Nozawa, Japan

Is there a difference between the guests that come from Nozawa and the guests that come from sea level?

No. Whenever I see the doctor in the ER, or the Copper clinic, they always say it’s dehydration. No matter how much we tell them to keep hydrated, it’s not enough.

So what does the ER or clinic often give them besides fluids?

Oxygen. And they say it’s okay to take over-the-counter headache medication.

How long is their visit to the hospital? Is it just a couple hours, or do they stay overnight?

Just a couple of hours, or less than that.

Do they ski the next day?

Most of the time, the doctors say not to ski the next day. We carry a pulse oximeter in our office. We have 20 of them. We do not do this for the Vail clients, because they don’t get altitude sickness. So we only do this for the guests staying in Summit County. When we [check them in], we distribute pulse oximeters, one per room. We encourage them to measure [their oxygen level] every morning. Then, after the doctor’s visit, the doctors say it’s okay if your oxygen level is over 90%, 20 minutes after getting off oxygen.

What’s the lowest you’ve seen the oxygen level on any of your skiers?

38. [He was] 15. He was at the ER. He was transferred to Denver by ambulance. He was there about three nights, and he went back to Japan.

Was that the only time somebody had to go back to sea level?

Yes. But it sounds like he had a heart issue, which we didn’t know [about].

Have you witnessed any other factors that help them acclimate more effectively?

I encourage them to eat carbohydrates instead of getting a lot of oily foods. If you have a lot of french fries, it’s very oily, it will take more time and blood to get to the stomach. So the blood flow doesn’t go through the brain [well].

What about caffeine or other holistic remedies?

No. We have some repeating guests who had … symptoms in past years, and we encourage them to visit a doctor in Japan [who] can prescribe … Diamox. One of the ski coaches [from Japan] … has to be here with his team. He has no choice. And he’s [had] a lot of altitude sickness in the past. So we told him, “You should see a doctor and get Diamox prescribed, and start taking it before leaving Japan,” and it’s been working great.

A young skier shreds her way down a snowy back bowl on a powder day.

Is there a routine that your clients do to prevent feeling this sickness?

Just check blood oxygen level every morning.

Of the clients that come here regularly, do they acclimate quicker each time?

They learn. We always see lower numbers of altitude sickness patients, because they learn what they need to do, like drinking a lot of water and checking their blood oxygen level. And only the numbers can tell. Even if they feel good, if the numbers are bad, if they go skiing, they will have a problem. Especially for the young kids. They [don’t] trust what you say. As the years go by, the coaches will learn, and the kids will learn what they can and what they cannot do.

Is there anything different about the philosophy of treatment in Japan vs. the US?

You know what, we do not have altitude sickness in Japan. Only if you climb up Mt. Fuji, in one day, it could happen, but not everyone does that. The highest elevation of one ski area in Japan is about 2000 m (6,561 ft.). No one has experienced high altitude sickness in Japan.

When I climbed Mt. Fuji, I saw a lot of people with cans of oxygen that you can spray. Do you ever use or recommend that?

No. I don’t think it works. If you breathe it for five minutes, it will work for five minutes. So I guess it’s very effective if a ski racer uses it right before the start [of a race]. I believe some of our Vail clients [have seen] the bottle and have purchased it, but I’ve never heard anything about it, good or bad.

Smiles and high spirits all around

In closing, I asked Ryoko if she’d noticed a change in her own physiology since living at high altitude, to which she replied that she is always impressed by her increased stamina and speed when she steps on a treadmill back at sea level. I asked her if she ever experiences symptoms upon coming back to a high altitude from sea level. “No,” she says, laughing. She doesn’t typically engage in any strenuous activity the first day or two after travelling, “because I’m lazy,” she says.  

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.

Acclimation, High Altitude, High Altitude Training & Fitness, Medicine, Mountaineering, Technology

Packing for a Spring Hut Trip

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Another winter has come and gone, and now Spring is in Colorado. Which means Winter will be back a couple more times before the snow all melts.

We’ve organized a team of friends from San Francisco, Denver, and Colorado high country for a backcountry excursion to one of Colorado’s 10th Mountain Division huts. The Benedict huts, our dwelling for two nights tucked into the wilderness outside of Aspen, are almost 6 miles from the trailhead, with an elevation gain of over 2000 ft. : a formidable trek, even for the experienced. And experience in wilderness trekking is one thing, but altitude is a game-changer. We will be well over 8000 ft. long before we reach the huts, so preparation for such an undertaking requires as much attention to mental, physical and physiological condition as much as clothing, gear and rations.

Weather & Conditions

This has everything to do with the weather, so it’s important to be on top of tracking all the resources available to you. At the top of my list in this region is the Colorado Avalanche Information Center. They provide up-to-date reports for high-risk areas around the state according to a comprehensive and easy-to-understand rating system. When considering this information, I always remember that our trek will take us through several types of terrain, and thus, several types of conditions: in and out of trees, varying steepness and exposure (to sun, wind, precipitation, etc.), all kinds of microclimates and environments (wetlands, scree fields).

The Colorado Avalanche Information Center provides no shortage of visuals to aid your risk assessment.

As far as incoming weather patterns are concerned, one of the most popular and reliable forecasts endorsed by people who play outside in Colorado is Open Snow. Founding meteorologist Joel Gratz updates local forecasts regularly, and provides information on what to expect with the outdoor adventurers in mind.

For our upcoming hut trip, it looks like the storm we’re expecting will be warmer and milder than recent systems, with most of it heading toward the northern mountain region. That being said, however, I’m keeping in mind that any projected weather system can be just a few degrees colder, a few inches wetter, and a few miles closer and change conditions dramatically. So let’s talk about how we can anticipate this with …

Gear & Clothing

The Commute

In any season in Colorado, there are essential comforts I always pack to get me to and from any hut that requires a hike, and to keep me happy while I’m enjoying the site. Dead of Winter, Height of Summer alike, the sun and glare is liable to be more intense than anything you’ve ever experienced at sea-level, while at the same time, the temperature and lack of humidity can cool your body significantly, night or day. Depending on how strenuous the commute is or how active you intend to be even after arriving at your destination, you may be constantly shedding, then adding, then shedding, then adding layers, so keep it all very accessible.

For this particular trek, I’ll be in snow gear. Basically anything I’d wear snowboarding: snow pants, outer shell on top, hat, gloves. I want it to be warm and waterproof on the outside. Underneath this shell, I want layers that I can strip down to as soon as I start moving and sweating with a 40 -60 lb. pack on. Unless the storm turns out to be much more intense (in which case, I’ll keep the outer layers on), I expect my skin to be steaming, so I won’t want to be in much more than warm compression tights, a t-shirt, and a light pullover. Your outer shell is for blizzards and water-proofing, so whatever you are stripping down to should be significantly lighter. Also, sunglasses or goggles. The glare from snow is significant. I bring both, because goggles get way too hot while I’m trekking uphill.

Here’s the tricky part: What are you going to wear on your feet? This is where the weather forecast comes in. This time of year, after such a snowy winter, I’m expecting most of the trail to be covered in snow, and the storm moving in is likely to bring more. I will be scoping out the trail pre-storm, which will give me a much better idea of what to expect, but I’m preparing to have snowshoes or a split-board and skins strapped to my snowboard boots. Of course, skis with skins are another alternative. There is a very slim chance most of the snow on the trail will be melted down, in which case I would probably opt for waterproof boots instead, which I would expect to get pretty muddy.

Avalanche Gear

Whether it’s on the commute or while you explore terrain around the hut during your stay, there are some essentials you can pack for the worst-case scenario. I’ve gone into more detail in a previous blog, but standards that I will be keeping on me are a shovel, probe and beacon. But these tools are only a small part of avalanche preparedness. More important than the endless supply of technology you can invest in is knowing what conditions and natural phenomena to be aware of during your trek, and the Colorado Avalanche Information Center is a great place to start familiarizing yourself with these.

Cabin Comforts

There is only one limiting factor to this list, but it is considerable: how much you can carry. For six miles. Uphill. In snow.

Most of the huts in the 10th Mountain Division hut system are equipped with soft mattresses, small pillows, and blankets. The kitchens are stocked with utensils and dishes, there is toilet paper, paper towels, hand sanitizer and dish soap, as well as ample supplies of wood for burning in the wood stoves. So most of your weight will be food and drinks.

I always pack a sleeping bag and extra pillow, because the guaranteed warmth and comfort are worth it when you’ve spent your day being intensely active outdoors. And keep in mind you’ll want warm, dry layers to change into that you haven’t been hiking and sweating in all day. What do you want to be wearing when you’re lounging around the cabin reading, cooking, eating, playing cards, etc.? For me, this looks like socks, long underwear, a pullover and slippers that I can crush into my pack. And then what are you going to throw on when you have to go back outside into the dark cold of night to use the outhouse? Your Colorado uniform: a hoodie.

There won’t be running water, so you can’t expect to shower. When you’re in the wilderness for a long time and need to be discerning about how much weight you carry that isn’t food and water, bathing is of low priority. But for a short trip like this, I don’t mind bringing some form of wet wipes; they’re light-weight and take up very little space. Toothbrush and toothpaste should be obvious, though.

Medication & Acclimation

From climbing Mt. Fuji to Colorado’s 14er’s, I’ve noticed a lot of people bringing pressurized cans of oxygen. High altitude research has taught me just how temporary and unnecessary this trend is. Often, the most effective remedy for altitude sickness is 5 – 10 minutes on oxygen. I’m pretty sure you’ll blow through a whole can of gas-station aerosol oxygen before it does you any lasting good.

Avoid this by giving yourself time to acclimate before you get to extreme elevation. Ebert Family Clinic in Frisco, Colorado, specialists in high altitude research, always recommend keeping track of blood oxygen saturation with a pulse oximeter, and this is something small, inexpensive and very portable. Our team will be spending at least 24 hours at altitude before we embark on the trek to the hut. This way, members from lower elevations will have access to an oxygen concentrator to facilitate acclimation.

Physician and high altitude expert Dr. Christine Ebert-Santos recommends packing the following mediations for hut trips: Acetazolamide, Benadryl, Ibuprofen, an EpiPen, Acetaminophen, and topical antibiotic oinment. Of course, be aware of any allergies to medication in your party. It is also helpful to be aware of what symptoms you may expect to experience, should you start having trouble acclimating, including dizziness, nausea, hyperventilation, and fatigue.

Food & Water

This is where most of the weight you pack in will be. Again, no running water at the hut, so expect to boil all the water you need for drinking if you run out of what you bring. There are lots of compact water purification systems you can easily pack as well. For our six mile trek to the cabin, I will have a Camel Bak and a couple Nalgene-sized thermoses full of water tucked into my pack.

You don’t want to have to cook everything you bring, so snacks you can easily access and eat are essential, especially for the trail. For this particular hike, I expect to burn more calories more quickly than any other average day, so I want lots of nutrients per gram: pistachios, energy bars, jerky … And don’t underestimate the power of sugar and caffeine, this is precisely the kind of work your body acts quickly to convert these nutrients to energy for. And yes, I mean chocolate. (Fruit also contain a lot of valuable sugar, I’m told.)

While we’re at the cabin, we’ll have access to a propane stove, so we’ll be able to cook some hearty meals. Bacon, fruit, yogurt, bagels and cream cheese are all easy breakfast foods to pack. If you are fortunate enough to be on a hut trip with Dr. Chris herself, you will have pancakes at least once. It’s also easy enough to bring fixings for the most epic sandwich you’ve ever had: guacamole, sprouts, turkey, ham, greens, tomatoes, bread; and remember, it’s a good chance to justify all the calories you get from mayonnaise and mustard.

And speaking of calories and sugar, I feel like whiskey and beer were invented to accompany the warmth of a fire in a remote, mountain cabin. The good news is that you are sure to be carrying less out than you did in. The bad news is that hangovers are exacerbated by high altitude, so pay more attention to your consumption than you would at any lower elevation, and be sure to have plenty of drinkable water at hand.

Am I Ready?

Hut trips in Colorado are mentally and physically challenging, even in the best conditions. The more time you give yourself, the better. Know before you go and don’t go alone. And don’t be intimidated. I’ve successfully guided friends from sea-level who don’t consider themselves athletic to destinations well above the tree line without incident.

Always be checking in with your body, your team, and your environment.

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.