GERM
00:00:08.720 – 00:00:10.960
Tashi Delek. My name is Germ.

WORM
00:00:11.200 – 00:00:12.080
I’m Worm.

GERM
00:00:12.320 – 00:00:27.760
Welcome to episode 82 of the Germ and Worm travel health podcast, Staying healthy on the Hill, brought to you by climbing the Seven Summits. It’s a big planet. See it in good health. I’m Dr. Paul Pottinger, also called Germ.

I’m a professor of Infectious diseases at the University of Washington in Seattle.

WORM
00:00:27.760 – 00:00:36.090
I’m Dr. Chris Sanford, also known as Worm, and associate professor in the Departments of Family Medicine and Global Health, also at the University of Washington.

GERM
00:00:36.250 – 00:02:34.830
Well, everyone, this is. They’re all special, but this is a really special episode. Not only because of the 90 minute runtime. Yes, I know you saw that.

But also because it’s a departure from our usual format. Usually here at Germ and Worm, we will gladly answer questions on travel health from listeners across the country and around the world.

But today we’re changing things up a little bit. Recently I was contacted by Caroline Pemberton, co owner of a world class mountain guide company called Climbing the Seven Summits, or ctss.

I’ve known Caroline and her husband Mike Hamill for years. In fact, I’ve been on four big expeditions with Mike Aconcagua in 2013, Everest twice in 15 and 16, and Mount Elbrus in 2017.

Mike is just unsurpassed as a climber and as a guide on these big mountains. Take it from me, and we’re friends.

So it was great to hear from them recently asking whether Chris and I would be willing to hold a webinar on the topic of how to keep healthy during these long, strenuous expeditions.

Questions from CBSS included how to keep the immune system healthy, what steps to take before a trip, and how health habits might change with different phases of the expedition, what to do in case you get sick in the mountains, and pearls of wisdom for keeping a safe, healthy experience.

Coming from us, a couple of grizzled veterans, we were glad to say yes to this invitation and we recently recorded a webinar with them that was really fun for both of us. This episode of Germ and Worm is the audio track from that webinar. You can see the video version if you prefer.

You can find that on our YouTube channel or at the CTSS website. I’ll put a link to both of those in the show notes here. We hope you enjoy and like this episode.

And by the way, whether you’re an experienced mountaineer or whether you’re new to the sport, even if you’re just mountain curious, you really should reach out to CBSS to see whether they might have an experience tailored to you and your aspirations. That’s the CTSS way they focus on a fun and safe mountain experience for everybody.

WORM
00:02:35.230 – 00:02:51.150
Yeah, I really enjoyed doing this webinar and I would say that in addition to touching on issues pertinent to these longer, more adventurous, strenuous expeditions, we made some points too that would be relevant even if you’re just doing a day hike in some local hills near where you live.

GERM
00:02:51.990 – 00:03:08.070
Before we jump in today, here’s our medical disclaimer. This podcast is designed to inform, inspire and entertain, but you should not use this podcast as clinical care.

Before you travel, please see a qualified healthcare professional for recommendations specific to you and your itinerary. With that, let’s roll the tape.

Caroline Pemberton
00:03:08.950 – 00:04:41.000
Thanks, guys. Hi everyone. This is the most exciting webinar that I feel that we’ve done.

And the reason is because on long expeditions like on Everest, most people fail not because of fitness and preparation. There are two of the reasons that we see that create a turnback. Number one is a failure to self care and number two is people succumb to sickness.

Those are incredible lockstep, those two reasons.

And it is the number one reason overall that from Everest to Antarctica, Aconcagua, anywhere in the world, that we see people having to turn around and come back to the mountain again and again. So we wanted to put on a webinar with, you know, that in mind. Staying healthy on the hill. This challenge is totally compounded by altitude.

Altitude steals your sleep, your warmth, your appetite. It basically steals everything that will weaken your immunity. So I wanted to bring in the biggest heavy hitting experts in this space.

And I’m pretty excited to be joined by Dr. Paul Pottinger. Paul, you’ve been incredible in terms of your career, but you’re also a seven summit finisher and a professor of medicine.

Can you give me a quick introduction to you and you know, who you are and your expertise and why you’re coming to this conversation with some passion?

GERM
00:04:41.880 – 00:05:57.210
Yeah, thanks. I’m Paul Pottinger. I am, my day job is a doctor.

I specialize in the prevention, diagnosis and treatment of infections in adult humans here at University of Washington in Seattle. And yeah, my passion, my hobby is mountain climbing.

And so I got into Mountaineering around 2007 and 10 years later had finished the project of the seven from never having put on crampons to standing on top of the seven. So how did I do that? We’ll talk about that. But basically choose the right guides. That includes Mike Hamill and other people of that caliber.

So we’ll talk about how you choose your guides as well. But yeah, my, my day job is infections. My passion is is for mountaineering, and I bring them together through this podcast.

We’ll talk more about that later if you like. But with my partner in crime here, Chris Sanford, we have a travel health podcast I think you can probably see behind me.

It’s called Germ and Worm, and that’s where we talk about both of these things together. So married, two kids, pet dog. He’ll be popping in here on the background in a minute. And normal guy.

And the reason I was able to finish again, because I was smart enough and lucky enough to choose the right guides, I think. Does that sound okay, Caroline?

Caroline Pemberton
00:05:57.210 – 00:06:47.820
And probably stay healthy and well while you’re doing it. Yeah, I think.

Dr. Paul, like, we are just so lucky to have you in the room with your background as a professor of infectious diseases, like, you really are at the forefront of this. Again, that little podcast guys that he’s referring to, German Worm, if you don’t already listen to that podcast, you should subscribe.

It’s super useful. Everything that we cover today in the next hour, hour and a half. These guys have 80 episodes or nearing 80 episodes.

So this is going to scratch the surface. Jump in with them. As you said, your other half, Dr. Worm, Dr. Chris Sanford. Now you’re an author and educator, global health physician.

You know, you’ve got an expertise in travel and expedition, but can you give me a little bit of an understanding of your career, what brought you here and why you’re passionate about this topic? Dr. Chris.

WORM
00:06:48.300 – 00:08:16.410
You bet. Happy to. So I’m a family practice doc, and I’ve been faculty at the University of Washington since 2000, so for a long time.

I work at the residency now, and I think I got the travel bug very young. My dad was a high school teacher. My mom was an elementary school teacher. So we had a big perk. We had summers off.

And so from Southern California, where we lived, we would drive to central Mexico every summer and spend three months there. And so from being a very little kid, I thought it was normal to go to places that were far away. And I’ve traveled a lot ever since.

Paul and I taught in East Africa for a decade at a course going there annually. And I’ve just got the bug. I’ve traveled widely in Latin America and Asia and Africa, so Seattle, where we live, is a great place to come back to.

But I didn’t originally mix medicine and travel. But then I realized maybe 25 years ago. Hey, there’s a subset of medicine which involves travelers.

So I joined the travel clinic at University of Washington where I saw travelers before they went abroad and we talked about things like malaria prophylaxis and vaccines. And then I would see ill travelers when they returned, which is a fun little specialty.

So basically I’ve been able to mix medicine and travel for a while.

And then as you mentioned, I started writing books, one that I edited with Paul for doctors and also I’ve written some books for the lay traveler as well. So I’ve been able to mix medicine and travel in a way that’s been really satisfying for a long time.

Caroline Pemberton
00:08:17.850 – 00:09:41.360
That’s awesome. So you can see by the caliber of the docs in the room, they both have the mountain experience, the travel experience and medicine experience.

So today we’re going to cover over, you know, a quick overview of your immune system.

In a nutshell, pre expedition, during the expedition on the mountain itself, how have all those factors interplay and what you need to be doing, I’m hoping today, my objective, our intention is to leave you with information that you might not have otherwise thought about.

I feel like we got really educated over COVID 19 and we learned the basics of like yes, hand washing but what happens with you know, the compounding effects of altitude, of sleeplessness, of nutrition. Okay, so that’s where we’re going to dive in.

We go, we’ve structured it in pre expedition before you leave home, getting to the mountain and on the mountain itself.

And then we’re going to have time at the end to do a bit of question and answer and a couple of pro tips from the doctors to lead and then we’ll close it out. So let’s start with that pre expedition. What are some of the things that we need to think about before we kind of get there?

I would love if you guys could give us an overview of if we’re like you know, a 15 year old of the human immune system and the basics. So we kind of got a foundation to build on today.

Can you guys give us like what are the most important things we need to know about the human immune system?

GERM
00:09:42.220 – 00:12:17.070
Most 15 year olds don’t understand, most medical doctors don’t understand it. So yeah, let me give you my, I’ll give you my quick overview of the immune system. It’s a miracle. It’s just this incredible.

If you think about what we do in our everyday life. I live in the United States, for example.

If you’re in a so called industrialized society, you can leave the door, walk down the street and you, you’re very, very unlikely to die of an infection. The germs are everywhere. Every breath we bring them in, everything we touch is covered with them. No problem.

Because the immune system, the reason it works is because of our ancestors and all the many generations before us, it has evolved to be this almost inconceivably complex system. And again, most doctors can’t even keep track of it because it has so many components.

And it has those components because there’s so many germs out there.

So the bottom line is when I think of the immune system, I’m thinking about everything from intact skin to keep out germs, from a scrape or blister, to the immune system that we’re born with. Fights off things like tuberculosis, typhoid, things that many of you probably are not, I hope familiar with directly.

And also the things that it learns. It’s very adaptable, it can learn and get smarter over time, gets stronger over time. So we have our integument, but protects us physically.

We’ve got our innate or stuff we’re born with and then we’ve got our adaptive immune system. Most of us think primarily about the adaptive immune system. It’s appropriate.

There’s two different issues we’re going to come to in this nice conversation. Issue number one, you have a certain number of opportunities in your lifetime to assist that immune system.

At one point in time, folks, I’m talking about getting your shots. We’ll talk about vaccines.

So vaccines are one great way to boost that immune system, to prime it, to give it a heads up that something may be coming down the pike and keep you healthy. We all know about that.

There’s also the other stuff that we usually do not talk about that my friend Chris is real expert on and that’s the long term maintenance and the idea that the immune system eats what we eat, it breathes what we breathe. If we take care of ourselves, the immune system will itself generally be very, very healthy.

There’s definitely things we can do that destroy the immune system. Hello, cigarette smoking. There’s other things we can do to take care of ourselves. And it’s what you talked about.

Let’s come to that in the subsequent slides around sleep around nutrition. The point is good self care is good immune care and that’s important because it is such a very complex and adaptable system. Does that sound okay?

WORM
00:12:17.950 – 00:12:52.570
Yeah.

I will second the thing that impresses me about the immune system is how complex it is with new discoveries every year and it’s not an exaggeration to say that virtually every organ in your body ties into it. So your liver, your kidney, your bone marrow, all are linked. So we’ll get into this in a little bit.

But this suggests that quick fix fixes, eg one vitamin really doesn’t change the big picture. It’s more complicated than that. So be suspicious of any very simple answers for making your immune system better in a hurry.

Caroline Pemberton
00:12:54.810 – 00:13:10.010
That’s awesome.

I loved when you talked about, you know, that it’s a holistic system and when you said, Dr. Paul, you know, smokers, like what are the foundational things that we need to be doing to set ourselves up for success?

GERM
00:13:11.480 – 00:14:32.780
Well, there’s the thing. I mean, my guess is that most of our members of this community have thought about this already.

So the good news, the bad news is that there’s no quick fix.

The good news is that if you’re thinking about a seven summits experience or some kind of adventure in the high mountains, you are already a fitness minded person. What you do for your physical fitness has direct benefits to the immune system. The immune system is complicated.

The white blood cells are what people think of and some of those circulate through the body. Some of them live in our intestines, some of them are in our sk everywhere.

And they all need the same things that we need, which is to eat right, to sleep well, to avoid pollution and cigarette smoke, for example. And that, you know, if we are taking medications for an autoimmune disease, that that balance be done very, very carefully.

I do have friends with, for example, inflammatory bowel disease who’ve been very successful mountaineers. They lead a normal, healthy, productive life because they suppress the immune system.

So the point is that there are special cases where this can be dealt with with your physician. But most of what you do, say it again, most of what you do for your own immune health will be to take care of yourself.

And I think that is the most common sense things. But I want to, in subsequent slides, I want to dispel some myths and of course we’ll answer questions about that in more detail.

WORM
00:14:33.900 – 00:15:12.070
Yeah, it’s a little boring, but most of what doctors said 50 years ago turns out to be true and important.

So if you want to have a maximally strong immune system, mundane things like ongoing regular exercise, regular sleep, maintaining a healthy body weight, not smoking, drinking alcoholic beverages, either in moderation or not at all, is extremely important. It’s a little tedious because you have to do it for a long time over months to years. To have an effect on your immune system.

But actually those things, way before you start attacking the mountain, are among the most important things you can do.

Caroline Pemberton
00:15:13.510 – 00:15:21.750
So it’s kind of like you put. You put credit in the bank with your lifestyle over time, and then you’re able to withdraw that on the mountain.

WORM
00:15:22.470 – 00:15:26.550
Right, right, right. But if you’re broke when you go there, you can’t make up for it as you climb.

Caroline Pemberton
00:15:27.670 – 00:16:08.640
Makes perfect sense.

Let’s dive in to a mountaineer’s specific perspective and have a look of like, what do we need to be thinking about before a climb and how long do we need to be thinking about that? The first one I want to raise.

And again, this, we’re not going to be talking about training as much because we’ve done that on other webinars, but we’re going to kind of dive into those very medicine specific things that we want you to think about. Number one, vaccinations, immunizations. What do you guys. What is your perspective? There’s a lot of noise out there.

You guys were at the forefront of COVID 19 pandemic. What are the things that you want to dispel here? And then what do you advise in terms of immunization and health planning?

GERM
00:16:09.840 – 00:18:37.920
Yeah, thanks, Chris. And I think about things in a very similar way, and this is what we think about for a living.

It’s all about preparation and then getting ready to respond if something goes sideways on the operation. Hey, there’s the stuff that everyone needs. You can hear my voice. You got a pulse? You need these vaccines.

That’s part of what we call our standard immunization schedule.

It’s not to be taken for granted because there are some people who’ve, for whatever reason, have actually not kept up with that schedule because their parents didn’t want them to, or it just slipped through the cracks. They may have grown up in a country where the schedule was different.

So we really want all of our mountaineers, please talk with your physician and make sure that you’ve got the stuff that everybody else needs for urban modern life. And that’s stuff that includes some of the things you see on the screen. No one should catch measles. No one should catch polio. Right.

No one should get, you know, penile cancer from human papillomavirus, these things that everybody needs. Hepatitis B. The reason I’m putting shining a spotlight on that is, number one, we have a very diverse group.

It’s a very globally minded group of people who come to the mountains. They come from different backgrounds, they may have different backgrounds in their immunization practices. Revisit your childhood experience.

Make sure you’re up to date. It’s especially true today.

I always say that it’s especially true today because we live in a society where in my country, the United States of America, we have a madman, reckless person who’s trying to rebuild and basically destroy immunization policy. So there’s a lot of misinformation out there, there’s a lot of falsehoods, etc.

Talk with a board certified internal medicine or family medicine physician and make sure that you are good with that. And indeed one of the things we could offer today can’t take care of individual people.

But if you do have questions about the standard immunizations, you’re hearing things that are confusing, please put them into the Q and A. I’m happy to do that with you and try to make sure that I give you the best information you got. That’s for everybody alive today. And then of course there’s the more specific stuff that really does relate to mountaineering as well.

And that’s because when you’re in that environment, you will be increased risk of acquiring certain infections.

Generally speaking, those are infections that you could either get through the air that you breathe, respiratory infections, or the food and water that you consume. Those are the GI infections. Chris, do you want to give a quick overview please on those specific issues, both respiratory and gi? It’d be great.

WORM
00:18:38.240 – 00:20:10.940
You bet. First, just to back up briefly on vaccines.

A good way to think about them is there’s the routine or domestic vaccines and then there’s travel vaccines. So as Paul said, everybody should get the routine stuff. And this would be the things on the routine immunization schedule.

It’s mundane, but actually the more common things are all on the routine schedule. And this would include influenza, Covid, tetanus, measles, mumps, rubella. So even just for openers, get everything on the domestic local routine.

You know, things including pneumonia depending on age and then travel specific for things that we don’t have in the US would include typhoid fever and some other things that we’ll get into. There aren’t a lot of vaccines for some of the things that you’re at risk for, such as GI illnesses. We can talk about that a little bit.

That’s more a matter of certain practices when you travel.

In terms of what Paul was alluding to in terms of, shall we say, recent policy changes in the U.S. sadly, I’m no longer referring people to the CDC, the Centers for Disease Control and Prevention because their recommendations have started to be policy based and not evidence based. But there are a number of online evidence based places that have good vaccines and recommendations.

This would include American Academy of Family Practice, aap, American Academy of Pediatrics and acog. Acog, American College of Obstetricians and Gynecologists. So those are a few thoughts on vaccines.

And Paul, should we get into a little bit respiratory illnesses and GI illnesses now?

GERM
00:20:11.600 – 00:22:36.260
Right now we can be really specific about it for gi. You can see on the screen recommendation for what’s called a typhoid vaccine. Typhoid is a bacterial infection.

It comes with a certain kind of salmonella and typhoid. It’s not a diarrheal illness, it’s a systemic bloodstream illness. It can be very, very dangerous and it will certainly ruin your trip. You’re done.

If you catch this, you do acquire it by mouth and it’s usually eating food or drinking drink that’s prepared by someone who has defecated, has not washed their hands properly and the germ gets from them into your food or drink. That way this would never happen.

For example, on a high quality base camp experience something like CTSS where everybody is incredibly fastidious with their hand hygiene. But during your transit, if you’re in a city, for example, like Kathmandu, and you go out to get pizza or something like this, that’s the risk.

It’s those urban settings, a lot of people who are not part of your team, they’re strangers cooking for you. You just don’t know how well they washed their hands when they were done. Bad news is we do not have vaccines against all of those dire illnesses.

But the good news is we do have some great vaccine against polio. That’s how people catch poliomyelitis and great vaccine against typhoid. So please get your typhoid shot or pill. It comes in one of two flavors.

My recommendation is usually to do the oral typhoid pill because I think it’s a little bit more effective and the durability is a little bit longer. But if you can’t get that and you can only get the shot, that’s also a good one to do.

That’s one of the specific things if you’re going to a less so called developed nation that I would recommend to all my patients. I also see here a question about pneumonia vaccine. Hey, there is a whole bunch of these respiratory infections.

Everyone needs to be up to date with their flu shot. That’s an annual thing globally that people should do everyone needs to be up to date with their Covid shot.

That’s an annual thing that everybody should do. And then there’s also something called pneumonia. That’s a bacteria, arterial lung infection.

Anyone with an underlying health disorder, immune suppression, chronic lung disease, chronic heart disease, any kind of chronic disease, you need your pneumonia vaccine. And if you are age 65 or older, that’s something that everybody should get regardless of their underlying health issues as well.

So the viral immunizations against flu and Covid, that’s easy. Everybody gets them. The pneumonia shot is exceptional. Most people in this conversation should not get it because you’re probably too healthy for it.

If you’re unclear, talk with your physician about that.

WORM
00:22:36.980 – 00:23:32.390
Couple other vaccines you may have heard of. There is a vaccine for cholera and cholera causes a life threatening diarrhea. Travelers are not at high risk for this in general.

So it’s not a routine vaccination for travelers. We do recommend it. For example, if you were a doctor or nurse going to a refugee, refugee camp, something like that. But your risk is also not zero.

So you might touch base with your travel provider regarding that. Another one that is complex is rabies.

Rabies is a viral illness that’s spread by the bites of dog, cats, mammals, basically your risk is not high, but it’s not zero and it’s a fatal illness. If you are outdoors for a long time, a wilderness setting, certainly if you are out for more than a month, you might consider this series.

It’s a little expensive in the U.S. yes, there’s pros and cons, but you want to touch base with your travel medicine provider and see if you want to get this series or not. Pre travel.

Caroline Pemberton
00:23:32.550 – 00:23:40.550
Highly recommended for any of our climbers going to Everest and the Khumbu region. There is rabies in the dogs and the dogs are very, very, very beautiful.

GERM
00:23:40.550 – 00:23:43.430
And very friendly and bitey.

Caroline Pemberton
00:23:43.830 – 00:24:39.200
Awesome.

One other question that we wanted to raise at this point was like, is there anything in the months before departure, you know, during COVID we all kind of went into quarantine, into isolation.

Is that something that we should be doing before a big and I’m going to use Everest a lot today as our example expedition because it’s the longest and it’s the most expensive and it’s usually the one that people have the most on the line for. They’ve trained for a year, they’re away from family and friends and work for six weeks. You know, it’s circa $75,000.

There’s a lot on the line, not getting sick On Everest, I’m going to use Everest as the example.

But when we talk about any expedition, you know, depending on whether it’s Everest, Denali, Vincent, Aconcagua, Ecuador, even a Mount Baker, three day over, you know, a long weekend trip, it all, you know, it’s all relevant. So if you hear about me talking about the Khumbu, Everest, Nepal, you know, you can translate that to everything else.

But is there something we should be doing in the month before departure?

WORM
00:24:41.280 – 00:25:25.700
NASA puts its astronauts in isolation for, I think it’s a couple weeks before flights because they don’t want them to get a head cold from being around a child or someone else. Paul, I’ll let you comment in a minute.

If there’s a strict protocol you’d recommend, I’ll just say the more you’re around people, the more the odds are you’re going to pick up something such as a head cold. The more you isolate yourself, the lower that risk could be. But that may not be realistic with your lifestyle.

I would say perhaps for the month before you leave, avoid crowds, don’t be around little kids too much if you have control over that, and certainly avoid sick people. But given that you have to have a life and probably a job that may or may not be realistically attainable, try your best.

GERM
00:25:26.160 – 00:26:31.620
And it’s just so that was my experience too. You just don’t want to get sick when you get there.

Now, the most intense respiratory transmission experience will be this expedition itself, the travel there and time in country. So may feel like you’re just scratching the surface when you’re home. I can only say you don’t want to go high. If your lungs are, are not well, you.

You won’t have a good experience. So that’s something you can control. But I am very mindful in my. Just reflecting on my own experience doing this. I want to be gone for two months.

I mean, I want to see my kids. There’s a lot of time that I want to have socializing, be. Be smart about it. And so you don’t need to isolate in the basement like a hermit.

But you should make it ultra clear to your friends and family that if they are sick or they think they might be getting sick, they need to do it by zoom. They need to reschedule. Don’t get me sick. I. You mentioned training for a year. That’s adorable. I trained for seven years.

I mean, it just about killed me getting ready for this. This is the one shot you got. It’s not true. There are many shots you have later, but you don’t want to blow it because of a respiratory illness.

That’s, I totally agree.

Caroline Pemberton
00:26:33.620 – 00:26:54.000
Awesome. Moving on. We see a couple of other things compounding before people even start to travel to the mountain.

And one is around physical exhaustion and over training. Is over training actually a thing? And can it affect, does your physical, physical training output affect your immune system?

GERM
00:26:55.360 – 00:28:41.060
Oh, totally. I mean like anything in life, there’s too much of a good thing. So you want to be healthy, you want to be fit.

That’s true for your cardiopulmonary performance, it’s true for your strength. We all think of ourselves climbing the mountain, holding on by our fingernails or you know, pumping out our gastrocs, our calves.

This is much, much more of an endurance process. It is not a sprint.

And so yes, I, it absolutely is possible to overtrain, not only to get an overuse injury, obviously that’s an issue, but just exhaustion, just sheer bald faced exhaustion is terrible for many reasons. You do need to sleep well because you will not sleep well up high. I mean if you do, let me know your secret. Nobody sleeps well up high.

It’s a problem. We’ll talk about strategies for this. But as your sleep is impaired, the immune system is impaired as well. The stress hormones training is stressful.

That’s good. You have too much stress. You’ll have too much of a stress hormone. That’s cortisol in that family. That is a directly immunosuppressive experience.

So the immune system needs energy and it needs not to be crushed by our own endocrine system. And overtraining can do this. How do you know if you’re overdoing it?

You know, you should feel the burn, you should feel sore, but you should not wake up in the morning dreading getting out of bed. If you’re too damn tired because you didn’t sleep well the previous night, you need to take a few days off.

Talk with someone who has been up there before consulting with an actual trainer so that they get this. My personal trainer doesn’t have me work out more than four days a week. I’ll sometimes say I want more.

Don’t overdo it because that recovery time is crucial. He’s thinking about my muscular skeletal health. It’s also true for the immune system as well.

Caroline Pemberton
00:28:41.380 – 00:28:59.460
Dr. Chris, anything on that and stress and how physical and maybe even mental stress play out to our immune system as we get so anxious, a lot of our climbers, we see them, their mental anxiety starts getting more and more and they get a month out from expedition, they’re like, I’m not fit enough. I’m going to go really hard.

WORM
00:29:00.520 – 00:30:14.640
There’s only so many hours in the day and it really depends how much time you can dedicate to this.

If it was me, if I was preparing for an Everest trek, I would pretend that I was an athlete on my city’s one of the professional teams like the Seahawks and I was getting $10 million a year.

Therefore I’d better make my health a priority and anything dangerous in my life, I would stop doing and I would realize that it would need to be a goal. I would think about every day with my eating, with my sleeping. That’s not consistent. Suppose I was working in it and I’m working 80 hours a week.

That’s impossible. There’s no way you can train and get adequate sleep with that kind of lifestyle.

So you need to cut some slack in your life so that you have room both for the real world, for work and family, but also a significant amount of time for training a couple people to assist you in this. Paul mentioned personal trainer. That’s a good idea because we can all, we’re all type A personalities, we can overdo it.

Sometimes you need to pay someone to tell you to back off and go to bed. Also see your doc, especially if you have a chronic illness. Questions would be what’s my ideal weight?

What’s my ideal maximum heart rate when I work out? It’s good to get input from somebody.

GERM
00:30:14.640 – 00:30:47.250
Else on this and we’ll talk more about stress and, and work, life balance as things come up. But this is a good preview. You just, yeah, no one knows if they’re going to summit. You don’t know.

It’s this endless stress people are constantly thinking about that does not help you get to the top.

You just have to be confident in yourself and make sure you’re doing the things that are getting you lined up to be able to be focused and enjoy your time when you’re there instead of looking back over your shoulder. Doesn’t feel like an immune boosting experience, but I promise you it is.

WORM
00:30:48.520 – 00:31:21.580
And you know, I’m a traditional western trained medicine, but there’s some benefit with things like meditation and mindfulness. Also, I would plan to take something on the mountain that’s going to take me to my happy place.

And whether that’s a teddy bear or a music player or a journal or a piece of fabric that I rub between my fingers. We all get stressed. And it’s good to have a little routine that centers you, that calms you and different people have different items.

But plan ahead for some high stress times and what you’re going to do other than just just freaking out and sitting there and shaking from worry.

Caroline Pemberton
00:31:22.540 – 00:31:45.980
Beautiful.

And then once we actually start traveling, that seems to be where everybody underestimates the risk, but where a lot of people might succumb to getting sick. So the next section. Travel and trek. Getting to the mountain, getting there. How risky is are our travel days?

WORM
00:31:48.060 – 00:32:35.230
Travel days are among the riskiest time for picking up infections before your trip. Again, it’s all about exposure to people. Jets themselves are pretty safe. Jets have really good filtration systems.

But you got to go through the airport in those long tubes where you stand and breathe. Everyone else’s coughing in are fairly high risk. There’s some things you can do to bring your risk down. One is what we mentioned before.

Get vaccinated for things like COVID 19 and influenza. There’s benefit with frequent hand washing. Soap and water on your hands will remove germs. There’s benefit with wearing a mask.

But you can’t bring your risk down to zero. And unfortunately the sad truth is a lot of people pick up respiratory illnesses when they’re flying through various airports.

GERM
00:32:36.110 – 00:34:12.460
And let me put even a finer point on that because I agree. And let’s talk about air travel in particular. You mentioned mass as you have it here. Does wearing mask help? It helps a ton.

If you have a good fitting N95 or KN95 mask that you wear, you are not going to get a respiratory illness. I mean your risk is dramatically, dramatically reduced. When it comes to the air travel.

I for example, because I like to be in the mountains, I keep a beard because it keeps some of the sun and wind and snow off my face. So I do currently do not have a tightly fitting seal. And I think that’s fine for mountaineering context.

I would still, if I were going on this trip, I would still wear best mask I could. Especially in the terminal and getting onto the plane at cruise because the bleed air is coming from our high atmosphere. They have HEPA filters.

I usually take it off at cruise. But getting on and off the plane, you know, I just went to DC for work the other day.

I did not wear a mask if I were going up one of the seven summits. It takes time and money. If it’s precious to me, my precious, like yes, I am gonna put on a mask for that experience.

Please consider doing so for hand hygiene. Alcohol based hand rubs are your friend. Please use them. Purell is the brand. Use In America, those alcohol hand rubs are very good.

They do not work against everything and they do not work if your hands are nasty. So soap and water is the best. If you can’t get to soap and water, keep one of those little bottles of Purell around.

Use it early and often and that can dramatically reduce your chance of respiratory and GI illness.

WORM
00:34:13.900 – 00:34:55.290
Another tip I would throw out there if you have the time to do this is versus taking two or three jet rides back to back and arriving jet lagged and sleep deprived and miserable. Take the first jet to Europe and sleep. If sleep for a night, night. Then take the second jet and sleep for a night and take the third jet.

It’s a little more expensive and it’s slower, but I’ve done that. When Paul and I taught in East Africa, I would take three jets back to back over 26 hours and I would arrive feeling like hell.

And you know that’s going to ding your immune system. So if you can go more slow and adjust slower to the local time, that is going to help your, your jet lag and your overall immune. Immune system.

Caroline Pemberton
00:34:56.650 – 00:35:22.510
Yeah. I really want to like ask about jet lag, but I. Before we go on from the airport, I read that the number one germ hotspot is not what you think it is.

It’s the airport security trays that you put your passport and everything in before you go through the X ray machine because they never get. Everyone touches them and we get sanitized. What do you guys think? Like what about surfaces and which surfaces should we watch out for? And other.

Is that a myth or is that real scale?

GERM
00:35:22.990 – 00:36:11.040
If you swab. If your goal is to say where are the germs? The answer is easy. It’s your phone in your pockets. The nastiest spot in the airport is your own phone.

Anything we touch with our hands is the worst. And you’re right. Those crazy plastic bins, they’re never sanitized.

So that’s covered with, it’s covered with the feces of everybody who’s been there before you. So yeah, I. The world is covered in stool. The only question is how deep. And on those X rays platforms the patina is thick. So I think that’s right.

When you are done getting through security, please just go to the lab, wash with soap and water and then you’re done with that piece. Surfaces are a potential risk.

I think that’s less of an issue for the people here in this community because you’re going to be hand hygiene minded and you’re going to Take good care of yourself that way.

WORM
00:36:12.080 – 00:36:34.470
I will point out though, there’s a difference between a high bacterial count on a surface and you getting illnesses from that surface. What’s known as how many bacteria is there? But we don’t really care about that. What we care about is the risk to you, and we don’t really know that.

However, despite that ignorance, I agree with Paul. It certainly probably helps to wash your hands regularly and just bring down the bacterial count.

GERM
00:36:35.990 – 00:37:09.110
Unless you wash too much and end up with dry skin, chapped skin, and then, you know, that was my experience. We’ll talk about the lack of humidity up high in a minute, but.

But please do consider if you’re on any of these expeditions, bring a small amount of emollient hand lotion because the hands in particular, they’re so brutalized by ultraviolet radiation. Cold, wind, the dry. That’s one of the biggest things I have seen. Everybody brings chapstick lip emollient. But think about the hands.

Think of the hands. If you wash them, it’s good. Just keep them moisturized when you’re.

Caroline Pemberton
00:37:10.550 – 00:37:36.470
And then once we hit the ground. Now imagine we’re doing our approach track up to base camp, whether that’s on Aconcagua or on Everest.

And you’ve got these long days on the trail and then you may or may not be in camps, frequented camps, mountain lodges, tea houses. Tell us about that. What do we need to be armed here? Everybody talks about the GI bugs that you pick up on the trek.

WORM
00:37:36.550 – 00:38:49.720
You bet. And one thing you skipped, one step that I want to touch on briefly, which is your urban environment.

Before you start the trek, you have to get from the airport to the city somehow. You know, most international travelers do great. I’m a big fan of international traveler traveling.

But when we do studies on the occasional bad thing, the biggest cause of death of healthy young travelers is actually nothing we’ve talked about so far. It’s cars. Cars and motorcycles and trucks and buses. And so I wouldn’t be overly focused on infectious things.

Realize that among the highest rates risk thing you could do would be to ride a motorcycle at night after a few drinks. That dwarfs the risks of some of these other topics. So I would. A few general rules I would have in the city before you start the trek.

I would avoid travel by motorcycle. I would try to have a seatbelt on in your vehicle. I would avoid the roads at night. Don’t do what we all do in Seattle.

In Seattle, everybody dresses in black all the time so that if it’s raining at Night, you’re invisible to driving drivers. Be bold. Sacrifice fashion. Put a yellow reflective sash around your chest.

But don’t neglect these mundane things as you’re thinking about all of the more exotic things that comes up on the trek.

GERM
00:38:50.680 – 00:41:16.370
I agree. In a way, the answer is the same to this question of food safety, which is you choose your company wisely.

If your transfers are handled from airport to hotel, they’re going to have a the right driver in the right vehicle. You’re going to be safe.

Likewise, if the company you’re with knows what they’re doing, they will have pre selected the tea houses that they know are vetted for food and water safety.

So there’s a big difference between doing this independently, coming to a new country for the first time, and really sampling the culture, sampling the, sampling the feces. Having said that, are there other things you can do to enhance your food safety? Yeah, totally.

We’ve talked about hand Washington soap and water before and after eating and definitely after coming out of the lavatory. This will be an outhouse. A pit latrine is usually the way it goes. Although some places actually have flush toilets. Actually, that can happen.

But you should make sure you’re very careful about soap and water coming out of those experiences. The water itself, that’s a risk. So what do you do about this? So, number one, bring it to a rolling boil.

It doesn’t have to boil for 10 minutes, just has to be a rolling boil and you’re good to go. That’s not something that most of our mountaineers and trekkers will do. That’ll be handled by the team that’s serving the water.

If you don’t know, because you haven’t watched them bring it to a rolling boil, and I know you won’t. The other thing you can do to protect yourself is to treat the water before you drink it.

I am a very big fan of ultraviolet sterilizers, UV sterilizers. SteriPen is one brand that’s great.

If, number one, the water is clear and you just hold it up in your Nalgene, your platypus, whatever, and just say, is it looking clear? If you don’t see bits of feces and toilet paper, then you’re probably good to go.

But if you want to stick that UV wand into a clear Nalgene of water, that’s fine. That’s actually very, very broad spectrum. That’s what I do. Number two, you got to keep it charged.

And so you have to make sure that you’ve got good recharging access.

For most of the experiences that we’re talking about here, people will have a, a power brick with them and keeping those things charged, they work for many, many, you know, cycles. That actually is one good way to go. There are other techniques you can use bleach, you can use iodine, chlorine dioxide.

There are other treatments you can do in addition to getting it boiled.

That’s my recommendation when you’re on these tricks, for example, the Kumbu, just to be double sure that you’re not going to drink a dose of diarrhea when you take your drink of Water. Water.

Caroline Pemberton
00:41:16.370 – 00:41:25.730
Dr. Paul, you said something interesting then. You said it has to be transparent. So if I put my UV steri strip into my coffee that is already made, won’t work.

GERM
00:41:26.050 – 00:41:28.730
That’ll do nothing. Unless you want to just use it as a stirring stick.

Caroline Pemberton
00:41:28.730 – 00:41:37.650
But yeah, so do it before you make the coffee. Do it before you make the cup of herbal tea. Do it before you put the electrolyte sachet in there.

GERM
00:41:37.890 – 00:41:47.200
Right? You got it only works for clear water. Correct.

Otherwise the light is scattered, bounced and blocked by those little particles of, of vitamins or tea or whatever you got.

Caroline Pemberton
00:41:47.760 – 00:42:02.160
And then people always talk about the food, right? What about like eating pastry? We saw a question in the Q A. What about like eating pastries in the Kumbu? That’s where I get sick.

I’m eating bad chicken and I’ve got food poisoning. What actually causes the GI bugs?

WORM
00:42:02.320 – 00:43:06.600
You know, it’s what causes a GI bug is a microorganism in your food or drink.

And the frustrating thing is because of the incubation period, which can be as little as the 30 minutes or as long as three days or even longer, you never really know with certainty what meal did it to you. However, what we all do, and I do this too, is we always assign a villain.

So if I get an upset stomach, I say, oh, it was the coffee at the bus station. But you don’t really know. There is traditional wisdom for what to avoid and what to avoid. Traditional wisdom would be raw fruits and vegetables.

Ice doesn’t kill most microorganisms. Tap water, however. Frustratingly, when we do studies on who gets travelers diarrhea and who doesn’t.

Most studies show that cavalier eaters who eat and drink everything have the same rate of diarrhea as cautious people who boil it, peel it, cook it, or forget it. So I agree with Paul about the hand washing and boiled water only.

But at least in the studies we do, we can’t show a Lot of benefit from actually doing that.

GERM
00:43:07.240 – 00:43:18.160
It was, it was probably the coffee at the bus station. That’s a bad choice. You gotta choose your chef and your tea house in advance and then trust those people. You’re exactly right.

WORM
00:43:18.160 – 00:43:18.920
You have to eat.

GERM
00:43:19.240 – 00:43:19.640
Yeah.

WORM
00:43:19.640 – 00:43:20.480
Things that you have to eat.

GERM
00:43:20.480 – 00:44:10.670
What do I avoid on these treks? You know, I’m not, unfortunately, I’m not usually eating raw vegetables because I’m just not clear that it’s easy to wash them as well as I can.

So there are. Can be other sources of fiber. You got to get your fiber, otherwise you get constipated and everything turns into a shit show.

But raw vegetables is one place that I would tend to avoid cooked foods. Rice, eggs, pasta, and yes, meat as well. You mentioned meat. That’s all fine, generally speaking.

And it also has to be something that’s appetizing to you. Generally speaking. Your issue is going to be, can I get enough calories inside of me to fuel my immune system and fuel my legs to get up there?

So I think with those simple things, if you’ve chosen the right outfitter, the right group to take you to the right place, you’re. You’ll usually be fine.

Caroline Pemberton
00:44:11.070 – 00:44:21.870
And what about, like, tips for the tea houses? Like, our guides have a very strict rule and it sounds quite random, like you are not allowed to put your drink bottle on the table. Why?

GERM
00:44:23.470 – 00:45:25.810
Yeah, that’s a good one. And that’s because if we’re thinking about the Kumbu experience in particular, because those, those bottles are never washed. Right.

And so you’re, you take a break, you’re on the trail, you put it down on a stone. What is that stone? That stone is covered with yak dung. So that’s. And yak and nak and zodung.

In other words, these, these pack animals that are going up and down, back and forth right next to you. There are no roads in the khumbu. It’s just by foot or hoof or air. There is that things get there. So it’s filthy, it’s covered with animal feces.

And yes, there are some infections that can jump from animal to human. Hello. Cryptosporidium. There are. And these are can be really nasty forms of diarrhea. So I like that one. I think that’s good.

It is random and most outfitters don’t do that. But that does make sense. You don’t want something that’s been on the trail to get to the table.

So just as we said, if you’re going to wash your hands before you eat if you want to wash your Nalgene bottle, fine, then it is good to go. But most people don’t do that. I think that’s the issue, Caroline.

Caroline Pemberton
00:45:26.530 – 00:45:57.300
Yeah, definitely. And we definitely see, you know, you’re sharing space with a lot of trekkers that are just doing the EVC trail. They might not know.

They’re not as stressed. It’s not a bigger deal. People go to the toilet, they come back with their water bottles, carrying them and things like that.

Now, you mentioned something interesting. Interesting to me, Dr. Paul, in one of our prior conversations, that most of the time it’s not the chicken. It’s oral fecal contamination.

And I just want to hang there for one disgusting poopy minute.

WORM
00:45:58.500 – 00:45:58.900
What?

Caroline Pemberton
00:45:59.620 – 00:46:06.020
Like what? No, we wash our hands. I use hands, Sunny. Like, what are you talking about? What is under my fingernail?

GERM
00:46:06.020 – 00:47:13.410
I’m not worried about you or anybody on this call. It’s the chef. Right. So we had this experience. The most famous example was in the United States about 100 years ago.

Know a cook called Mary Mallon, Typhoid Mary. And she cooked for people because she was a great cook and was apparently made very tasty food. But she had an infection in her body. It’s typhoid.

We talked about this before. And because back 100 years ago, she couldn’t wash her hands adequately, she spread the typhoid to other people. So it’s about that person.

You can’t see what’s happening in the kitchen. You don’t know what they’re up to. That’s why you need to choose the right kitchen and the right team with the right ethos.

But I’ll say it again, the world is covered with human stool. The only question is how deep. You want to choose a place where it’s being dealt with. Yes. Everybody should wash their hands.

The team needs to be take care of themselves.

My own practice was that we would wash with soap and water before we ate, and then we would let our hands dry, and then we would apply Purell on top of that. We actually did this boot and suspenders approach, belt suspenders approach. And I can tell you we had no issues on my.

I was guided by img, and they were very fastidious about this. CTSS would be the same, for example.

Caroline Pemberton
00:47:14.610 – 00:47:51.470
Absolutely. Okay, so imagine we’ve. We’ve managed to navigate the airport, the plane before our trip, the trek, and we’ve got to the mountain.

Generally, one of the common denominators of mountains is they’re really high and there’s altitude.

What are the factors that we need to start, start thinking about once we start compounding just the stress that’s on our immune system from the dailies with the mountain. Why is altitude even a thing? What is it doing in our bodies? Why does it affect us? How does it change our immune system?

And where does it start taking effect?

GERM
00:47:51.950 – 00:51:03.580
I mean, there’s so many components to this, right, Chris? One of the things that comes to me is the low relative humidity. And actually you don’t need to go high to do that.

Any place where there is a very dry air. Arctic plateaus. I was just in Antarctica actually a couple weeks ago. We didn’t get high, but holy smokes, it was dry.

So anything that withers, your mucosal moisturized lining of your sinuses, the, the lining of the nose, the back of the throat, this is a problem because it hurts, it’s unpleasant, it can trigger a cough. Sometimes we call it the Kumbu cough. And not just the kumbu, anything that dries your cords and your upper airway is unpleasant.

But it’s also dangerous from an infection perspective because believe it or not, that lining of mucus, we all have normal saliva and mucus. That’s what this lining of our, we actually call it the mucosa that lines our airway.

It weeps out small amounts of water, not just water, but also defensive factors, sugars and proteins, immune cells, including antibodies. And these antibodies, they don’t work if they’re just stuck to a dry Tutankhamuns back of the throat.

You need something that’s moist and healthy that way. And every time you breathe in these very low relative humidity environments, of course we lose moisture like that.

So it’s a very high risk issue for sinusitis, sinus infection, very high risk for pharyngitis, back of the throat infection, laryngitis, which is your vocal cords. You need to try to put back some of that moisture that you’re losing. I found that I did this in two ways.

Number one, I liked breathing through a buff or some kind of loose membrane over my mouth that would trap some of that exhaled moisture. The problem is if you do that with an actual tight fitting, elastic type of buff, it feels like you’re getting waterboarded. It is not a good feeling.

You really are trying to breathe. So you need something that’s loose but not too loose. For me, it turned out to be a balaclava made of silk, which I would never have thought of.

I only found it in Namche Bazaar. That worked. So pro tip, get A silk loose silk balaclava. Try it.

But also there’s that idea that when we’re done climbing that we soothe, rest and soothe our airways. Hot tea is wonderful this way. Anything that will deliver humidity to the airways is good.

Being in a tent with someone boiling ramen soup, soup, you know, steam in the air is good. I am a fan of putting back moisture with a saline spray.

This is not Afrin spray, oxymetazoline, but just simple saline spray because that’s just putting back what was there before. There is a brand. We’re not sponsored by anybody, but there’s a brand called Air A Y R and Ayr makes both the saline spray and a saline gel.

So if you’re lying down for bed and you know that you’ve got a sore throat every morning when you wake up up, that your nasal passages are swollen shut, try that air gel. It’s a water soluble gel that you squirt in there and it helps again to soothe that.

So I think that’s important to emphasize the Kumbu cough nasal passages. It feels bad, but it also is bad from our immune health function perspective.

Caroline Pemberton
00:51:03.820 – 00:51:06.940
We had a great question in the chat. Oh, sorry, Chris.

WORM
00:51:07.020 – 00:51:31.640
I was just going to add, you were asking about how does altitude affect your immune system. Paul’s entirely correct about the low humidity. And I would just add you tend to have a decreased appetite, so you eat less.

Many people don’t drink enough water, so you get dehydrated, you’re exhausted, and then you don’t sleep very well. And all of these things can have a deleterious effect on your immune system. So it’s multifactorial.

Caroline Pemberton
00:51:32.840 – 00:51:49.660
And we had a great question in the chat about someone who actually broke their ribs, ribs on their last rotation on Everest from the cough. That’s what I want to go back. But they’re concerned about, like, how do I keep my lungs safe.

GERM
00:51:50.380 – 00:53:54.670
Yeah, I feel you. I broke my ribs too, on right before I summited. It was sort of a bummer, but can be done. I think a lot of us actually summit with broken ribs.

It’s kind of a crazy thing. That’s. How do you break a rib? Because the cough is so severe that you can actually contract the muscles between the ribs to, to bruise or break them.

So. And it’s most painful thing I’ve ever been through. It took me six months to get over that. It’s really a bummer. So, yeah, try not to do that.

If you’ve had that experience before, it does not mean you’ll have it again. I think it’s the opposite.

I think you’re now armed with this information so you know that you’re extra susceptible to Kubu cough and that your cords are more twitchy, that your airways are more twitchy, if you will. So what can be done about this? I would say a couple things.

First of all, try your very best to again protect those airways from a humidity perspective.

If you’ve got humidity recovery system, a buff, a balaclava, something like this, play with that, experiment with that to find what is the most enjoyable to you. You may be one of those people who really needs a formal, legitimate recovery system. There are. I don’t own one, I’ve never used one.

But there are balaclavas that actually have a plastic valve. It almost looks honestly like a supplemental oxygen mask. It’s not. It’s just a valve that allows you to hold on to more of your air as you breathe in.

Do not just try this when you’re up at altitude. This is something to try in the winter time at low elevations or a smaller mountain. See if that’s something that you like.

But my point is that can make a real difference.

I would also be rigorous about and ruthless about absolutely staying hydrated with hot drinks and breathing in that extra humidity not only at mealtime but also at bed.

So I would urge you to please take work with your guiding company to see if you can take a small amount of the thermos of hot drink into the tent and open that up and let it just fill the tent with that humidity. That should, I think, soothe the issue and may help to alleviate it.

Caroline Pemberton
00:53:54.750 – 00:54:57.360
On Everest, we actually have little humidifiers so you can buy tiny little USB rechargeable humidifiers. They’re really cheap on Amazon. Highly recommend. Absolutely great. We provide them on in some of our tents. But there’s something that you can grab.

They’re not very heavy and you can just fill them up and off they go. During the night, you know, you can see how much air, what you’re breathing out when you wake up in the morning.

Has anyone had that experience where you look up the tent and you have a layer of ice. As soon as the sun hits the tent, you’re literally being rained on.

That is indication of how dry it is and the humidity that you’re losing every night that you have to get back in. What about cold stress?

Like, you know, you have that old adage, I do it to my 4 and 6 year old kids, like, you can’t get out outside and get cold you’ll catch a cold. Is that true? Like is is the cold and the temperature of the environment also suppressing our immune system?

GERM
00:54:57.600 – 00:54:58.560
What do you think, Chris?

WORM
00:55:00.000 – 00:55:12.640
Not directly. Outside of extreme cases, you know, if, sure, if you get frostbite, that’s a bad thing.

But no, in general, infections are caused by microorganisms, not by changes in temperature.

GERM
00:55:13.280 – 00:55:52.160
I think those microorganisms. So why. And yet we do have more respiratory infections in the winter because we’re crowded inside together.

And I honestly think the humidity thing, I know I’m harping on this, but I think that’s part of it too. Those potentially risky microorganisms, they’re around, they’ll maybe back in our nose, the back of our throat.

If we have a healthy nose and throat, they won’t do too much. It’s when the mucosal layers get dry, I think that these organisms have a chance to breach, hold on and start to reproduce and infect.

So healthy airways is part of this issue as well. Regardless of the temperature, it is harder to do that good self care in colder temperatures. I think that’s true.

Caroline Pemberton
00:55:52.960 – 00:55:54.320
What about Diamox?

GERM
00:55:55.280 – 00:57:52.060
Tell us about Diamox. Diamox is the trade name for acetazolamide. It’s a carbonic anhydrase inhibitor.

So it’s used, it’s used in the United States by medical doctors, by prescription for a number of different issues. Use. It actually has a number of benefits.

One of the things it does is it reduces the PH of your blood, gives you a slightly, very slightly acidified bloodstream. When your bloodstream is acidified, that’s a trigger to the brain that you need to breathe more.

Because the way we balance the PH and get To a true 7.4 ph is by breathing off that extra acid, it comes out as carbon dioxide. So the reason this is a big deal is that when we are at high altitude, for some people more than others, it is individualized.

Some people just don’t, just don’t breathe enough. We tend to hold our breath and breathe very shallowly when we are up high. And why is that? Because there’s less oxygen.

So when there’s less oxygen, your body has a stimulus to breathe. But then what we do is we breathe off too much of our carbon dioxide. That’s actually the biggest stimulus to breathe.

And so we get into this funny imbalance where we’re breathing a lot because we need more oxygen that gets rid of the carbon dioxide. And therefore one of the stimulus or triggers to breathe more is lost.

And this is why some people may go through panting and panting and then long pauses. Ever had this? When your tent mate stops breathing, it’s creepy as hell. They, they usually start again.

But the point is Diamox can help balance that out. And so my own personal recommendation is pretty much in line with what you’d see from the Wilderness Medicine Society.

But I can tell you, you know, number one, your dose may be different from mine. Number two, don’t play with this on a high mountain.

Do it on a smaller mountain, climb Tahoma, go up Pikes Peak, something like this and figure it out.

Caroline Pemberton
00:57:52.130 – 00:57:52.330
Out.

GERM
00:57:52.330 – 00:58:34.719
But for me personally, it’s 62.5 milligrams, one quarter of a 250 milligram tablet, a quarter. And I’ll do that at bedtime, only for three days. For those first three days, I’m at a new sleeping elevation. So how do we acclimatize?

We climb high, we sleep low, but eventually you got to sleep higher.

So when I get to that new sleeping elevation, I’ll take a quarter of a tablet, 62.5 milligrams, I’ll take it at bedtime and I’ll do that for the first three days and then I stop. Because if you do more than that or longer than that, you can get into trouble with certain side effects.

They’re not usually dangerous side effects, but it’s just, it’s not. Not necessary, not required. Chris, what’s your, your acetazolamide?

WORM
00:58:34.719 – 00:59:15.540
Yeah, just first briefly, full disclosure on side effects.

These would include increased urination, a change in taste sensation so you can’t tell if something is carbonated or not, and sometimes what we call paresthesias, which is tingling in your hands and feet. However, these are all more rare at the low dose that Paul is recommending. I think it’s a cheap, benign drug.

A lot of people not only get the benefit of breathing more deeply, but it brings down the risk of symptoms such as headache and nausea that so many people get when they climb rapidly. So overall it’s not a mandatory drug, but a lot of people feel better when they’re on it.

It’s a nice combination of doing most of what you wanted to do and not having many side effects for most people.

Caroline Pemberton
00:59:17.060 – 00:59:41.530
A lot of people come through with their medical forms and we see a sulfur allergy.

Now I was doing some research on that when I came across it for the first time and found out it’s one of the most over diagnosed allergies to medicines worldwide.

It’s so useful as a tool for mountaineers, would you suggest people who believe they have a sulfur allergy to actually get retested for that as an ad?

WORM
00:59:42.720 – 01:00:31.520
Anything around that you know, not necessarily. Acetazolamide is not a sulfa drug, but it’s related structurally. So there’s this theoretical concern.

However, when I talk to my travel and mountaineering colleagues, never in my life have I encountered one person who has seen a cross reaction between a sulfa drug and Diamox. So what we’ve decided and Paul, please chime in after I state this.

As a general rule, if your reaction was only a skin reaction, your history of reaction, because you’re right, because there’s a lot of false reporting of this allergy. If it was only a skin reaction, we still prescribe the Diamox.

But if you actually had anaphylaxis to a sulfa drug, that is difficulty breathing, tightening of the throat, then we avoid it. But as you said, one option would be to actually go see an allergist and get skin tested for it.

GERM
01:00:31.680 – 01:00:40.810
Agree. Sulfa allergies often reported, rarely legit, potentially dangerous, important to talk with the doctor.

Caroline Pemberton
01:00:40.810 – 01:01:12.500
About and then like, what other factors are there? I want to bump through these fairly quickly. I’m cognizant of our time together. But like what about mental health and stress?

Because what we see is a pressure cooker environment on these mountains. As I said, there’s so much on the the line for people.

They’ve trained really hard, they’ve taken the valuable PTO and time off work and they’ve invested a ton of money and they’re all up in here all the time. How does that play out on our immune system?

GERM
01:01:13.940 – 01:02:52.790
No, I think the impact is very real. As we talked about before with physical stress of over training, there’s also the immune price we pay with overthinking thinking. Chill the F out.

If you are super stressed, your immune system will not like that. Right? Because those stress hormones, including cortisol etc, they’re cranking along, you’re not going to sleep well.

And we know that sleep is critically important. We don’t really understand why, but it’s no question you gotta sleep. And that’s the one thing that we talked about for oxygen reasons is hard.

Now your mind is churning and burning. You may be worried about the ultimate question. Well, I to go up and come down safely. You may be looking over your shoulder thinking about home.

Did I say the right thing to my kids before I left? Am I fighting a divorce? Is there an illness in the family? If your mind is back there in a bad way. You will not sleep correctly.

And that does have an immune impact for sure. So I really encourage people to get things right with their mental health and stress. Climbing these tall mountains is stressful.

That’s part of the challenge and the joy. You can’t take that away, but make that the challenge. If the challenge is, am I here for the right reasons, what mess did I leave at home?

I can only share my personal experience having done this. And again, I’m a mountaineer, but also a medical doctor, so I do like to talk to people.

It’s a common problem when I talk to people about why they didn’t summit. There’s often something wrong at home. Take it for what it is. Please make sure that home is right before you step on the mountain.

And that way you can focus on the challenge and not the decision that you made to come here in the first place.

WORM
01:02:53.830 – 01:03:18.690
One thing I would not do for stress and anxiety is pop a drug such as Xanax or Valium. So if you’re taking those, say for sleep or stress, I wouldn’t do it.

It has a lot of deleterious effects on your breathing at night when you’re sleeping. And actually it’s dangerous. So almost any hypnotic I can of think, think of to aid sleep, with the exception of Diamox, I’d recommend avoiding 100%.

GERM
01:03:19.890 – 01:03:34.690
Obviously, I think everybody knows this. Alcohol is at the tippity tip top of things that you do not do when you’re up there.

You can have a beer once in a while, but it will absolutely destroy your sleep. You’ll have to pee, your sleep architecture is ruined and it will not help with any of these issues.

Caroline Pemberton
01:03:36.370 – 01:03:46.860
Let’s talk about that sleep as it’s so critical, but it’s just so elusive. Why, like, why does our body not sleep at altitude?

GERM
01:03:47.660 – 01:04:50.710
I think it’s all these things. You’re exhausted and yet you’re anxious. The oxygen isn’t there, there’s just nothing to breathe. Right.

So you may over breathe, which then you lose your carbon dioxide and you lose that chain of breathing. So that’s your chain stokes at altitude where you pant, pant, pant, and then stop. That will make you wake up.

So you have a lot of, you know, arousals in the night where you’re waking up and that ruins your deep sleep. We’re also listening to sounds that aren’t normal. Right. It’s just I remember listening to those avalanches coming down every night.

There’s just a lot going on. There’s many reasons why people don’t sleep and each of them is completely remediable. Having the experience of doing this before, trust yourself.

I’ve done this, I’ve slept at altitude. I can do this knowing that you’re there for the right reasons. My family is with me, I’m here and I have a good mental situation.

And then those simple things for the noise. Honestly, make sure you’re sleeping with earplugs, for God’s sakes. Chris likes wax. I’m a foam earplug guy. Bring earplugs and bring backup earplugs.

That makes a huge, huge difference.

WORM
01:04:52.390 – 01:05:19.200
Also I would throw out. If you’re not sleeping well, don’t beat yourself up over it.

Your brain likes oxygen and your brain is aware when there’s not enough oxygen and you don’t have control over the oxygen at altitude. So cut yourself a little slack and if you’re awake for several hours, life goes on. And don’t start to panic.

That happens to everybody and it’s normal. And if it’s normal and most people do well on the hike, you’re probably going to do well too.

GERM
01:05:19.600 – 01:05:40.160
I think this is so key. I’m going to say it again. Again. You are still getting benefit to lying flat and resting even if you’re not truly asleep.

So there is physiologic and immune benefit. If you’re, if you’re horizontal and is the worst thing you can do is say, oh my God, I’ve got to sleep, I’ve got to sleep.

Then you’re, then you’re screwed. So relax and enjoy the, enjoy the rest.

Caroline Pemberton
01:05:41.040 – 01:05:44.720
What about like melatonin? Allowed? Not allowed.

GERM
01:05:44.960 – 01:05:45.920
What do you think, Chris?

WORM
01:05:46.640 – 01:06:21.550
You know, some people get benefit. Melatonin is a hormone. It’s made by your brain, by your pituitary gland.

I think it’s not good to take chronically for years and years, but some people report benefit with short term use. My overall gestalt of the literature is it probably doesn’t cause harm.

Some people get benefit and it’s got a benefit over say Xanax or Valium and that I’m not aware that it messes with your breathing at altitude. So experiment first at low altitude. But if you get benefit from it, I, I would, I don’t really see a downside. Paul, what’s your take?

GERM
01:06:22.750 – 01:07:02.900
It’s been hard to overdose on melatonin, although you could. The way you’re meant to take it is at, at dusk. So it’s. Their pineal gland is seeing the darkness. You’re trying to augment that darkness response.

If you lie down at bedtime a few hours after dusk, it’s not going to work as well. One of the great luxuries of these expeditions is man, you’re getting into that sleeping bag early. It’s the joy of getting horizontal.

I don’t see a lot of people playing cards late in the night. You are worked and so you’re getting into bed.

So generally speaking, what I’m trying to say is at dinner, that’s when I think most people would benefit from a 5 milligrams of melatonin.

Caroline Pemberton
01:07:04.260 – 01:07:18.990
And then what if we’ve done everything right, but it just doesn’t. It’s just lying there like, I just can’t do it. Like, have you guys got any sleep strategies that like.

Like we can employ anything that you think works for us at home?

WORM
01:07:20.830 – 01:07:51.000
There’s nothing that works for everyone. Some people get benefit with meditation or tapes. So I would say if something works for you at home, it may work at altitude.

But there’s a rule in medicine which is if there’s a million suggested cures for something, like there is for hiccups or insomnia, that means that nothing works for everybody. And that’s the case with insomnia.

So I find some benefit with meditation, But I also, either at altitude or not at altitude, have spent some long sleepless nights. So, no, there’s nothing that’s a lock or a guarantee.

Caroline Pemberton
01:07:52.040 – 01:07:58.200
What works for you at home might work for you here though, right? Dr. Paul, do you drink warm milk?

GERM
01:07:59.000 – 01:08:41.990
Ah, it’s just the idea of milk at all. I am not a milk guy. No, I would never do that, but somebody else might. No caffeine, period, no alcohol, period.

And personally, I do recommend no screen time. Some people really do well with reading. But if you’re reading off a lit screen, that’s sending mixed signals.

So to me, that’s where an actual book, you know, made of paper, they still make these like a book. And if you have a headlamp to read that, that can help to. That’s a soothing way to do this.

For me personally, it was looking at photographs of my kids when I had insomnia I just had on my photo album on my phone. You’re not supposed to do that because it’s a bright, glowing screen. But I found that to be very soothing. That’s what I would do here at home.

Caroline Pemberton
01:08:43.190 – 01:09:37.580
Awesome. And we touched on chain stokes a little bit. I just wanted to reinforce the chain stokes and diamox correlation.

If you’re Someone that has had chain strokes before and you have not been taking Diamox, we often give that advice in the back office at climbing the seven summits.

That’s a great strategy to try, as Dr. Paul said, on maybe a low amount first to see if, you know, maybe go and get tested if you think you have a sulfur allergy and you’re getting chain strokes just to see if Diamox could help you because it definitely seems to even out that breathing response. Okay, sleep. What about supplements? We see a lot. And look, I’m, I’m a full proponent of taking a multivitamin every day. I never get sick.

I give them to my kids sometimes. I have an Australian brand I love called Armor Force, which is full of, of olive leaf extract and echinacea and all sorts of things.

Do they actually work?

WORM
01:09:39.020 – 01:10:44.770
They do. They’ve been providing profits to companies that make them for some decades. My thought is the best place to get nutrition is this stuff.

The technical name is food. And for most healthy people, my opinion is no. I don’t even take a multivitamin.

I think if you’re healthy and you have a well balanced diet, my opinion is most people don’t need supplements. As I say, most of your immune system is set by your chronic practices and not by, you know, taking a particular vitamin at a particular time.

With all of these vitamins, it’s true you do need these micronutrients such as vitamin A. However, you only need a certain amount and most people get that amount from food. Take. Taking more doesn’t help.

It’s like if your car takes two, two quarts of oil, it doesn’t need four quarts. That does no benefit for your engine. So put me down overall, if you’re eating well, as skeptical.

Having said that, if you want to take a multivitamin once a day, especially when you’re climbing, I don’t see much downside in that.

GERM
01:10:45.250 – 01:10:55.490
Dr. Paul, if you have a vitamin deficiency, you should know that because you’re living with cystic fibrosis, for example. That’s a different context. Next. For most folks, one multivitamin a day should.

Caroline Pemberton
01:10:57.250 – 01:11:08.050
Okay, so there’s no advantage into like taking my emergency or my like, you know, specifically designed for adventure supplement. I’m just making expensive.

WORM
01:11:08.050 – 01:11:10.930
We, I, I try to put it more tactfully, but yes.

Caroline Pemberton
01:11:13.010 – 01:11:24.410
Okay, what about micronutrients? Like do, are we getting those from our food anyway or, or is there something like anything that can help here? I’m digging for an answer.

WORM
01:11:25.530 – 01:11:36.970
You know, it’s Tedious to sleep well for a year before you climb and to exercise regularly. But no, there’s no. Let me put it this way. Health does not come in a pill.

Caroline Pemberton
01:11:39.370 – 01:11:58.820
I think that’s fair. Advice. Advice. Okay, so what about nutrition? We know that eating at altitude is tricky, right?

So what can we do to make sure that we actually have enough food in our system? We’re feeling good. Like, anything to help us stir on that appetite.

GERM
01:12:00.340 – 01:13:12.800
Yeah, I think some people are like me, you know, the seafood diet. I see food, I eat it like it’s. I’ll eat anything. I’m easy. Some people are just super picky and some people are in between. So.

So to me, my goal when I was on Everest, for example, was mentally trying to get to about 4,000 calories per day. Wasn’t quite able to get there because your appetite is definitely suppressed. Just like your immune system can be suppressed. It’s a problem.

You need to know what you work well with, what doesn’t work for you. Trying different foods is smart. Generally speaking, we want saltier foods. Generally speaking, we want foods that are more aromatic.

Your taste will change, your appetite will decrease.

This is something where I, I don’t have an easy answer except to say you need to be with a company that is very, very food focused, that will work with you to try to make sure that the food is fresh and tasty. A company that has experience with this. If it’s just going to be ramen. Well, nobody climbs Everest on ramen.

I mean, yet you need a company that is very culinary forward, not just for food safety, but the tastiness. And definitely those macronutrients. The cow.

Caroline Pemberton
01:13:13.120 – 01:15:14.460
Yeah. And just piping on that. This is a great opportunity for us to blow our own trumpet.

We have that marginal gains philosophy where we do hone down into things like this. Like, we all know that we don’t eat at altitude.

And most of the operators on Everest, sorry, Paul, we’re still, they’re still eating spam and rice and dehydrated meals. And you’re eating that for four to six weeks. It’s going to take its toll on your body. People lose a lot of weight.

The way we combat that as a company is we actually just employ a really red hot chef. And they’re a chef that their, their brief that we give them. Literally, we kind of came up with our own cookbook.

We have over 100 CBSs, Everest recipes. And in them is about taste, nutrients, calorie heavy.

So this is the opportunity now to like, eat what you wouldn’t normally eat at home because it’s decadent and it’s calorie loaded and it’s high energy. Right? So big pasta dishes. And we’ll cook to appeal to all appetites. And we’ll cook, cook really tasty.

The advice I give our Everest climbers when I talk to them one on one is if we just had Thanksgiving in America or Christmas lunch in the UK in Australia, and I had to bring out one dish that would tempt you even if you were completely full, what would it be? Pack that request that I like to be able to make it. We want you to eat when you’re not hungry because you’re so tempted, because it’s so yummy.

We’re bringing in helicopters, you know, twice a week with fresh food drops, fresh fruit, fresh veggies, well prepared, big, hearty meals. This is not the time to try to lose weight team.

So many of my Everest base camp trekkers, my Kiliman Kajari climbers, like, yes, I’m gonna lose so a couple of kilos this many pounds. I’m gonna feed you, baby. You’re gonna be so full rolling up that hill, and I need you to be because you cannot get into a calorie deficit.

Here, eat, eat, eat. Please eat.

GERM
01:15:14.700 – 01:15:15.100
Yeah.

WORM
01:15:15.100 – 01:15:53.860
And a corollary of that is you need to watch your water intake and not rely on thirst only. If you wait until you’re thirsty, you may get dehydrated. And there’s a few good barometers for your overall water intake.

Probably the best is urination. Like a marathoner, you want your urine to be fairly colorless, close to water, and you want to be urinating fairly frequently.

Also, a dry mouth is a bad thing. So if you’re lightheaded, there’s a lot of potential reasons for that.

But if your mouth is dry and you haven’t urinated for eight hours, one reason may be that you’re dehydrated. So again, don’t rely primarily on thirst. Is an indicator for how much water you should drink.

Caroline Pemberton
01:15:55.220 – 01:16:17.390
Super helpful. Okay. We’ve talked a lot about not getting sick and doing the best we can to arm ourselves. What happens if we do get sick?

What should we be doing if we get sick or we hear our tent mate coughing and it. It sounds a bit more productive than a dry kombu cough or, you know, how do we cope with this? And what’s your advice?

GERM
01:16:18.750 – 01:19:19.870
Yeah, I appreciate this a lot. It’ll happen. Illness will tend to come to larger, longer expeditions. There’s two parts to it.

The first is how, whatever it is, how to keep it from spreading around. And so you really need to work with your expedition team to follow their protocols.

A reputable team will have a protocol for a respiratory syndrome and for a GI syndrome. And basically it means isolation. And it feels like the Middle Ages. But don’t spread that around. And so it comes back to number two.

Number two, which is what to do for the individual mountaineer. It’s actually, I think, Caroline the same. It’s that self awareness and the communication forward.

The self awareness in my own personal experience is extremely impaired. Scared. I personally had no idea how flipping ill I was because I couldn’t see myself. I got a respiratory illness. This pentultimate rotation.

That’s when I broke the ribs and all that stuff. Had no idea that I was that sick. My guides knew because it took me 11 hours to get from Camp 2 to Camp 3. What the hell?

Like you’re gonna go down, period. It wasn’t even a discussion. My guides, who I knew trusted sage, said, you will descend to Namche. And that worked a treat.

And I came back and did fine. So you may not have that insight, but I want to plant the seed of self insight. Checking with yourself, am I really up for the next rotation?

And then, for goodness sakes, talk to the guides. There’s this concern I have that people will be worried that they may be getting sick or weak or not adapting properly.

And they want to hide it like a wild animal. They always say it always hides its illness so it doesn’t get picked off by a coyote or something.

You know, they’re not going to pull you off the mountain because you’ve got a headache. Tell your guide, I have a headache. They’re not going to pull you off the mountain because you got, you know, the trots. You have to talk to the guide.

What will be a problem is if you do hide things and everything becomes manifest above 8,000 meters. You don’t hide anything above 8,000 meters. The mountain will lay you bare there.

And the question is now, are you optimized for that experience or are you putting your guides and teammates at risk? So it’s the communication piece. Honestly, there’s an individualization around when am I too sick to continue?

And that’s a little bit different for each person. But it really comes down to an assessment. What’s your breathing rate? What’s your pace? How are you looking to the guide?

I know that sounds squishy and you may be. Well, there may be engineers among us. I know there Are. Are.

I love you guys, but you drive me crazy because you want to have a parameter for everything. This is a gestalt. And you have paid the best guides in the world for their expertise, their ability to assess you.

You have to listen to them and trust them, too. That may mean turning around, may mean descending and coming back. It may mean the expedition is over. I don’t know.

But please, for goodness sakes, do not hide that from your guides. If the communication is clear, I think this will become an easy decision for everybody.

WORM
01:19:20.900 – 01:19:52.410
I think it’s important that the guide is the decider and not you. Because if you lose your judgment, by definition, you’re not the best person to decide if you go up or down.

And as mountaineers say, the mountain will always be there. And if you start hiding things, that will increase the odds of a bad outcome. So trust your guide.

Listen to your guide and let your guide be the adult in the room. And don’t try to by force of will ignore the guide. That that’s one way to lead to a very bad outcome.

Caroline Pemberton
01:19:53.530 – 01:21:43.820
I think as a guide service owner, reinforcing that. And from our perspective, you can sometimes salvage these trips.

But if you don’t talk to us and we don’t know, and you’re three or four days advance before you say, actually, I’m really struggling because you think that we’re going to kick you off. Like, let’s talk about everything. Everest. Everest. $100,000. Yeah. You’ve paid that much. You’ve got an amazing guide.

You’ve got all the things amazing, right? And you don’t tell us and it really sets root, then there’s not much we can do for you yet.

If you tell us early, then you’ll hear Mike, you’ll hear me, and we’ll go get your butt on that helicopter. It’s going to cost you a bit, but get your butt on that helicopter. You’re going to Kathmandu. You’re sitting in high ox environment.

You are quarantining in a hotel room. You are getting better. We have an amazing lady who has finished the Seven Summits. Julie, I hope you won’t mind me sharing your story.

And she got pneumonia. She got seriously, seriously sick. Yet she came into the season early. We have a very early schedule on Everest.

We come in, we use the entire season partly for this reason, because it is salvageable at some points, Right? She got sick early. We sent her home. She got. She was down in Kathmandu seven to 10 days.

She had a clear chest X ray, and we were able to bring her back up, up. And she summited on the last day of the season in a perfect environment, beautiful weather, no crowds. Nailed it.

It does not mean it is game over if we can intervene early, right? If we can’t because you didn’t tell us, then there’s not going to be much to salvage.

And even worse, if you really hide it and you get really sick and then you go really high. Dr. Paul, Dr. Chris. What’s that going to do to the human body? Like we’re not just playing with, oh, I felt a bit sick here.

WORM
01:21:45.740 – 01:21:47.420
Potentially a very bad outcome.

GERM
01:21:47.420 – 01:22:25.750
Let me say tactfully, that’s true the correct. And that’s true for that individual and everyone who is there to take care of them. Mountaineering is the ultimate team Sport.

And above 8,000 meters, you better be on the same team. If you’re not, someone will not come home. I don’t want to be maudlin. This is not about that.

If you choose the right company, you talk to your guides and trust them, you’re gonna have a great experience. We’ll be safe and fun. It’s supposed to be fun. We do it because it’s fun, right? And.

But it’s only when you try to hide things, I think that things go, go sideways and sideways, unfortunately, can mean very, very catastrophic situations.

Caroline Pemberton
01:22:26.150 – 01:23:59.770
One more final note on that, please. As you climb with us or anybody else, if you get quarantined, don’t take it personally. This is what we’re going to do.

You’re going to find out you’re sick. We’re going to isolate you into your own tent. Meals are going to be brought to your tent.

Every group scenario is going to be taken away from you for a period of time. If you don’t get better and the symptoms are completely gone, you will be asked to descend, descent, get better.

Maybe there’s time to salvage your expedition and come back up when you’re well. Because even if you go up, up sick, you’re not getting very far. Team. There’s no point in hitting your head against the brick wall.

If you get quarantined by us. It is not personal. Please, please, please know that that’s what’s going to happen and it’s fine.

If it’s a shorter expedition, you don’t have time to salvage it. Okay, let’s admit when the mountain has told us to turn around, do not continue to infect your teammates. Illness spreads.

We know why we’re immune, suppressed. Right? Please rely on your trip insurance and try again. The mountain will Always be there. That is what you, your trip insurance is for.

That is why you’ve spent so much money on it. Do not take a shortcut there. We’ve seen so many climbers, Everest and elsewhere, use it, rely on it. That is what that purpose is.

It’s why we harp on about it. It’s to give you guys the mindset of, you know what, it’s not my time this time. The mountain is always there. I can come back.

Please come back if you need to come back and. All right, we got a couple minutes left. Went a little bit over time, but I feel like we got a lot of the questions answered as we went.

GERM
01:23:59.840 – 01:24:00.080
When.

Caroline Pemberton
01:24:00.080 – 01:24:07.760
But have you guys got some final pro tips and some advice? Are there any more questions in the room that we should be answering today?

GERM
01:24:10.480 – 01:25:57.430
I’ll give my amateur tips since I’m an amateur mountaineer. My amateur tips are three. Number one, pay your way. Mountaineering, in my experience is about being a dirtbag.

Doesn’t matter what you look like or smell like or sound like. Anybody can do it. That’s the joy of being outside, not the seven summits. They are different. They are tall. They are foreign. Do not.

Well, you get what you pay for. And I’m not saying everybody should go with one company or another.

I’m just saying if you find someone who’s cut rate and they can try to save you some money, please, please reconsider. I mean, I’ve seen that come to grief many times. Pay your way. Number two, pay your dues.

Make sure you do the prep work, train, get the experience, get the mental headspace case. Correct. The time to figure out if you like mountaineering is not on one of these super tall mountains.

You need to spend more time in the mountains as well. And make sure that you’re paying your dues so that you’re ready to go and give it a safe shot. And finally, pay respect.

Just pay respect to the mountain guides who are there laying it down. This is their profession. You’re paying them, but they’re also putting their life on the line.

And not only the people who are there with you on the mountain, regardless of whatever country they are from, but those who came before. There are brilliant mountaineers, stronger than you, more accomplished than you, who will remain forever on the mountain because they made a mistake.

Understand the pattern of errors that have happened previously and put yourself in that scenario. Oh, this person died because they were stuck in a windstorm. What would I do if that happens to me?

This person died because they unclipped what would I do if I were on the Kumbu phase? So think about those scenarios. So pay your way, pay your dues, and pay your respect. Those are my three pearls of wisdom, I might add.

WORM
01:25:57.750 – 01:26:27.820
In addition to getting your body in shape, a little bit of research about the country that you’re going to is a good idea. Different places have different ideas for what is polite and impolite or forbidden behavior. You want to be respectful to the local people.

Also, for goodness sake, learn at least, least 20 words in the local language so that you can say hi, goodbye, excuse me, talk slower. Most importantly, where’s the bathroom?

A little bit of research will make you a better traveler, will make you a more popular person wherever you’re going.

Caroline Pemberton
01:26:29.180 – 01:26:38.900
I had one question that came up when we started putting this webinar out there. Does hand sanitizer actually work in the cold? Does it function?

GERM
01:26:38.900 – 01:27:02.650
Oh, it works better. I mean, it dries. How does hand sanitizer work? The alcohol will dehydrate as it evaporates, will dehydrate any germ that’s there.

So yeah, it works great. Just, dude, don’t get any frostbite when you apply this in the wind. But yes, it absolutely can work.

If your hands are not visibly soiled, you look under your fingernails and you can see the feces. You got to get to soap and water. No amount of alcohol is going to fix that.

Caroline Pemberton
01:27:03.210 – 01:27:10.480
Is there any question that we should have asked you today that we haven’t anything we haven’t touched on? Any final and closing thoughts?

GERM
01:27:10.560 – 01:27:28.880
I didn’t hear any women ask how to, how to, how to urinate, but hopefully you’ve figured that out already.

There’s different funnels that can be used and you just what I’m told by my friends who are women mountaineers is just do it at home first, in the bathroom, in the shower, because eventually you’ll get it exactly right. They work well, but there’s different brands, so figure that out on your own.

Caroline Pemberton
01:27:30.320 – 01:29:09.940
Definitely. I’m a high just on that. We do have a women’s webinar. Check it out.

I’m a very big fan of the now gene up flush in the tent and a P funnel on the trail. They’re great. And then just be aware, you know, that there are a couple of other complications.

And I would talk to your healthcare provider and your doctor before leaving home.

One of the things that came from conversation with you, Dr. Paul and Dr. Chris, when we were working through this webinar that I really took away as great wisdom was Essentially, look back to what you have used in the past 12 months. This was Chris’s advice. Look back into what, into your medicine cabinet. What have you pulled out? What have you used?

Because if you get UTIs at home, you’re probably going to get one on the trail. If you get migraines at home, you’re probably going to get one on the hill.

So, like, think of that as you pack and as you go to your doctor before your expedition, as to what you need.

And I know there’s a couple of female considerations there, too, so just be aware of, like, what you use on a daily basis at home or of the past 12 months, you’ll probably use on the mountain. Be armed, be aware. Okay, finally, these guys, we have spent an hour and a half together. They’re excellent, as you can see.

If you want more of Dr. Paul Pottinger in your life and Dr. Chris Sanford, you need to jump on the German Worm podcast. They’re not. They’re not paying us for this.

It’s not a sponsored post, but I definitely want to hop on about it because it’s one that I. I listen to and it is really, really useful. As you’re hitting the gym, just plug them into your phone. You can get their podcasts anywhere from Spotify or Apple, wherever you get your podcast.

And it is really useful. And you guys do cover some pretty interesting topics, for sure. I’ve really enjoyed getting into it. You’ve got, what, 80, 80 episodes now?

GERM
01:29:10.180 – 01:29:11.460
80 and counting.

Caroline Pemberton
01:29:12.100 – 01:31:12.440
So you can get on tap. You can get the doctors on tap in your. In your headphones every day. Very, very useful advice as we head out, out traveling and around the world.

Thank you very much. If you guys want to connect with us, we are very easy to find. You’ve obviously found us on YouTube, social media, Facebook, our website, our email.

We’re super easy to find if you’ve got specific questions, specific goals. You can also scan that QR code on your screen. It’s going to bring up a calendly link and book a consult call with myself.

Sometimes I forget to update it. So if we need to reschedule, I will. But that’s a really great way to get a hold of us and ask about our, you know, specific climbs.

You can tell climbing seven summits. We’re pretty proactive with medical screening, vetting our clients, giving us conversations. I don’t want you to hide anything from us.

When you do fill in that physician’s assessment form or that first application form, please be honest. Things don’t necessarily discount you from being on expedition. We’re not going to to deny you.

We’re going to bring in experts into the room like our expedition doctors, Dr. Brenton Sistermans, Dr. Emily Johnston.

Hey, if I can go to the big guns and call up Dr. Paul, Dr. Chris, I will so, you know, make sure that you tell us what you’re facing and what you’re planning so we can help you navigate your world way to the top of some of these most beautiful peaks in the world. And that’s it. That’s it from us. Thanks so much for joining us, guys. If you do like the webinar series, we’ve got our next one already launched.

Launched. It’s on speed ascents. Just hop on our website climbing the7Summits.com webinars.

This one’s pretty interesting and kind of, you know, progresses from this conversation about, you know, speeder Sands, does xenon gas work. So if you want to jump on that one, it’ll be really great.

We’ve got Mike on that one with founder of Hypoxico, the at home acclimatization systems, and a senior performance specialist from the Altitude center in London. So. So there’s more coming. All right, guys, thank you very much for your time. Enjoy the holiday.

GERM
01:31:12.440 – 01:31:15.160
Thank you for the invitation. So fun. Great work.

WORM
01:31:15.160 – 01:31:15.680
Thank you.

GERM
01:31:15.680 – 01:31:18.360
And have a great time in the mountains. I’m excited for all of you.

Caroline Pemberton
01:31:18.680 – 01:31:20.120
Awesome. Take care.

GERM
01:31:20.600 – 01:31:21.640
Thank you. Bye.

WORM
01:31:21.640 – 01:31:21.960
Bye.

Caroline Pemberton
01:31:22.040 – 01:31:22.520
Bye.

GERM
01:31:32.200 – 01:32:02.340
Few, you made it. Thank you for sticking with us on this extended cut of Germ and worm episode 82.

As always, please contact us with your travel health questions, your stories or tips for success or request for clarification of something you’ve heard here on the podcast.

You can get us at our website germandworm.com or send us an email germandwormmail.com if you’ve enjoyed this episode, please consider subscribing, rating us favorably on your device and spreading the word with friends, family, family and on social medias. Those are free ways to support this podcast. I’m Germ.

WORM
01:32:02.340 – 01:32:05.420
I’m Worm. It’s a big planet. See it in good health and we’ll.

GERM
01:32:05.420 – 01:32:26.460
See you next time. This podcast is designed to inform, inspire and entertain.

However, this podcast does not establish a doctor patient relationship and therefore it should not replace your conversation with a qualified healthcare professional. Please see one before your next adventure.

The opinions in this podcast are Dr. Sanford’s and Dr. Pottinger’s alone and do not necessarily represent the opinions of the University of Washington or UW Medicine.