High Fashion : John B West

John B West

Bowties are cool. Even more cool : bowtie doctors talking physiology , from the perspective of decades with boots on the ground , on the worlds highest mountains. John B West talks us through a medical expedition to Mount Everest , casually mentioning climbing icefalls etc , and then goes in to the physiology :

” So if any of you are thinking of climbing Mount Everest , you might want to go along to the local hospital and measure the the ventilatory response to hypoxia ..If it´s low , give up any hope of reaching the top , and take up another hobby like gardening. “
West is a giant already in respiratory physiology in general , with a widely translated textbook , and hundreds of published articles. One is a brilliant description of how Ibn Al Nafis , an Islamic scholar , gave the first correct description of how the blood moves from the heart to the lung , back to the heart and out to the arteries. Western medical tradition maintained for centuries after that the venous blood moved directly through the thick wall between the left and right heart. In hindsight this should have been easily refuted in any big kitchen at the time .

Also featured in the video : Peter Hackett , another rising star in high altitude physiology , making a solo summit
climb of Mt Everest , more succesful than wise. The video is. the final part in series of respiratory physiology lectures , shortlinked at http://korta.nu/westresp

 

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Highly Rational ?

A recent study in Journal of Travel Medicine from Cusco on travellers advice and behavior makes one doubt both sides of the patient doctor relation.

 

.One out of four that had actively sought out a doctor before travelling could not recall any advice at all given in how to deal with high altitude.Seems hard to fault the travellers with this , or not looking first towards the GP group as an explanation.

.Two out of three remembered being adviced to use Diamox , an option that was promptly rejected by the majority.

. Gradual ascent is the proven most effective way prevent AMS : this option was recalled by one in twenty , less than unproven methods like hydration and near identical to the number that were adviced to use coca. By chance or from good sense travellers did a bit better than advised in this respect : one out of ten made a first stop at a lower altitude than Cusco first , and fared better from this. /p>

..So what was the outcome of advice and behavior in this group of tourists ?

A bit worse than web lore would have you believe: half of the group scored their own symptoms as AMS score three (mild AMS ) or higher , median score..five. One in six had severe AMS , highest score thirteen – that would have been the one person that evaced out of Cusco with a pulmonary edema…

!Typical outcomes were a lot less dramatic : one in six confined to bed , and one in twenty had to cancel tours.

Predictable results : those with a gradual ascent , that were older, or took Diamox had less AMS. On the mildly surprising side those that used coca reported AMS more often. Coca users also seemed to be unaware of the risk of being tested as positive for cocaine after returning home.