Being A Quadriplegic In The Mountains
So what are the implications of being a walking quadriplegic in the mountains?
On the face of it mobility is the obvious issue but actually that’s not even scratching the surface..
Let’s start with mobility though. My spinal cord injury has left me with about 10% power down the left side of my body, from my arm and hand down to my foot. This obviously has the biggest implication on my walking. I cant lift my left leg up to clear much more than an inch from the floor and foot drop on that side makes walking on uneven surfaces or slopes extremely challenging. I combat this to a certain extent through my AFO’s (artificial foot orthosis). In the mountains I have been using a turbomed attached to some La Sportiva approach shoes for the majority of the trekking and then a flexible in boot orthotic once i have to switch to summit boots.
The advantages of the turbomed are that:
- It’s flexible allowing me to get my whole foot to the floor for grip despite the gradient.
- It’s an external orthotic that doesn’t take up space inside the shoe which is generally more comfortable.
- It’s durable; I am constantly smashing it into rocks, getting it caught in gaps and stressing it in all sorts of directions but yet it lives on. I did manage to crack the calf plate a few months ago which when i spoke to them had apparently never been done before but it was a quick fix.
- It is best secured to shoes via cable ties through the eyelets and given the big stresses i put it through it has a habit of eventually destroying the shoe. This also makes it a pain to transfer from one shoe to another however i just have one permanently attached to my walking shoes. (It’s best to go with boots or shoes that have strong eyelets).
- Although it is light, like most AFO’s it takes up a lot of space which isn’t ideal when space is at a premium. Unavoidable unfortunately + Can be attached to outside of pack.
I have been using the Turbomed for a while now and am yet to find anything that rivals it in the hills. The shoes I’m using however are a recent addition to the kitbag. The idea is i need something light, durable and waterproof. So the initial thought was walking trainers or cross country running shoes rather than boots to limit weight. I spent a decent amount of money on some waterproof North face trekking trainers which worked well for about four days in the mountains before a combination of my foot splint and me dragging my foot through the hill rather than over it resulted in them disintegrating. I invested in a second pair thinking it may have been a one off but sure enough i buggered them up pretty quickly too. I tried a few different options but nothing seemed to work. I was starting to think that the combination i was looking for didn’t exist until one of the climbing guides we were with in Chamonix recommended approach shoes. I had actually never heard of approach shoes at the time but the idea is that they are a crossover between a trekking trainer and mountaineering boot. They are light enough to walk long distances in but have one solid toe piece to assist with foot holds when climbing on rocks, one solid toe piece that might be able to put up with the abuse i would give it. Chamonix is an outdoor wear Mecca for shopping so i was in the right place to go looking for them. They weren’t cheap by my god they’ve been a good purchase. Hardly a scratch on them after 20 days of abuse in the Himalayas. Unbelievably comfy, light, fully waterproof and they even look decent. I can now say I have finally settled on the AFO / Shoe combo i will using moving forward for the trekking element of these trips.
The mountaineering element is still a work in progress. I went to visit London Orthotics a few months ago as i wanted to present my issue to them regarding how to best incorporate some sort of orthotic with a mountaineering boot, fair to say it wasn’t a problem they had been asked to solve before. After some deliberation they fitted a flexible carbon fibre orthotic inside my boots. After some tampering we got it comfortable and i was happy with the result even if it is only a temporary solution. The issues weren’t realised until we reached the mountain though. I have some Asolo mountaineering boots which are great but actually turned out to not be warm enough from Mera Peak so needed some insulated gators over the top. At altitude your hands and feet have a tendency to swell and due to the inactivity in my left ankle and foot they were both now pretty chubby. Combine that with the compression of the gators and the indwelling AFO and when it came to putting them on for the first time at 5000m we had a problem. Despite the effort there was no way that my left foot was getting in that boot so I had to rent some larger ones which were far more accommodating but much heavier… This definitely chucked a spanner in the works as every gram counted up there for me, especially when i hardly have the strength to lift my bare left foot up.
I have to say that the larger boots were helpful for warmth as it allowed me to get two pair of Marino socks on but the added weight was tough. Despite the extra effort i managed to get up there and I’m coming back with all of my toes so problem averted. Moving forward though with the help of London Orthotics I am going to look towards a more permanent solution for future climbs.
Other necessary pieces of equipment include poles and gloves. I have a tendency to go through poles like matchsticks for the same reason i destroy shoes. I rely heavily on my upper body, effectively moving around everywhere on four limbs rather than two. On the way up as well as adding stability, the poles give me the chance to tense my upper body with each step, activating the left side of my core and often resulting in improved leg lift. Coming back down, they are merely there to save me from falling on my face more than obligatory amount; which is still quite a lot… I grip the poles quite hard so it’s important i look after my hands and wear gloves. At the higher altitudes it’s not a problem as you need them on anyway for the cold but even in the warmer times a pair of half finger gloves go a long way.
As you may have seen before i lose hand function pretty quickly in the cold, something that has posed some interesting challenges this last few weeks. As well as my hands become weak quickly they actually both end up as clenched fists when my tone increases so keeping them warm is a constant endeavour. Every morning on the mountain we were well into the minus figures even in our rooms or tents so my partner in crime Rich literally had to become my hands every morning. Putting gloves on, doing my sleeping bag up, tying shoe laces, even unbuckling my trousers to go to the toilet, it would have been almost impossible without his help. On summit day my hands were a lost cause, i could neither feel them or move them making rope or harness work almost impossible. On the plus side they had clenched around my poles so i just hung on and prayed that I wasn’t going to lose any to frost bite. Despite the fact i cant feel my fingers hitting the keys right now i think I’ve avoided the worst but it has highlighted the importance of a good pair of gloves (open to suggestions). I know a go to at those temperatures of -20 to -30 is often mittens but due to my decreased hand function they are impossible for me to do anything in so ideally i need gloves…
I went into this having done a lot of training and preparation and there was one thing i knew for sure it was that getting enough calories in was going to be a real challenge. My inefficient movement requires a lot of energy. It’s common sense that would be the case but I’m sure it is because I’ve monitored it quite carefully over the last couple of years. There are two pieces of tech I use to do this:
- Oura ring… Worn like a normal ring it constantly monitors heart rate, heart rate variability and body temperature. From doing this it can not only work out your energy output but how recovered you are from the previous days activities. Where it really sets itself apart though is monitoring sleep (which I will get onto in a bit).
- Suunto traverse watch + HR strap monitor…. The suunto traverse is a GPS watch used for trekking/climbing/hunting etc so I use it to accurately track the routes we’re taking but also it comes with a heart rate strap so I can more accurately record high intensity exercise.
The watch and ring already have my vital stats; age, weight, height etc so against those they can work out my calorie expenditure.
The information coming back confirmed what I assumed, I was burning over 10,000 kcal a day, one day as much as 15k. Replacing that amount of calories is pretty much impossible on a long expedition in the mountains, you would have to carry a huge amount of calorific food with you and be eating all day which just wasn’t feasible. The food at every village, tea house or camp is pretty similar. Dal bhat is the staple dish which consists of a bowl of lentil soup, potatoes, a few greens and a lot of rice. The form is to chuck it all in together, mix it up, add some chilli sauce and stuff it down with your hands. Spoons were provided for us weird westerners. Other common options were sherpa stew which is a potato and veg broth, and mixed noodles. The portions were big and if you order dal baht you tend to get free refills so there was plenty of opportunity to replace some calories, but not 10,000! Every stop had snack shops as well where we would try and claw some of the deficit back through biscuits or chocolate bars but as we got higher the luxury items got more and more expensive so the focus was on rice and lentils. The sherpas love the saying ‘dal baht power, 24 hour’ and it doesn’t take long to work out what they mean by dal baht power. A diet of lentils and rice lends itself to jet propulsion from the rear end. Now you might think that would be a benefit whilst trying to climb long distances but the problem is that you’re climbing long distances in a line so inevitably someones rear end is right in front of you… anyway enough on that. The diet lacked protein and greens and although I felt like I had plenty of energy on the carb heavy diet I knew that I should supplement to make up for that. The two supplements I took with me were:
- SF Nutrition Supergreens powder: This replaces the plant micronutrients I was missing in my diet to help restore ph balance and aid recovery. I would mix one scoop in my drink at the start of the day and then one with dinner. It’s easy, light and has a big effect.
- SF Nutrition BCAA + Electrolyte powder: The BCAA’s help support muscle retention and growth whilst the electrolytes aid with hydration replacing the salts I was loosing through sweat. I would have one scoop mixed with my water at all times.
Hydration was another massive factor as through the jungle I was losing a lot of fluids through sweat and carrying enough water for the day was tough as it was heavy. Dehydration is a big contributing factor to altitude sickness so we were all being conscious to get enough in. After the first few days I worked out that to stay hydrated I needed on average 1 litre of water per hour, which is a lot! Fortunately two of the team (Wyn and Arron) kindly offered to carry my extra water bottles as every kg counted if I was going to make it to the top! On summit day hydrating was difficult as it was so cold and everything was frozen. We had liquids on us but the camel packs were frozen and your brain really isn’t working properly so digging out the water bottles doesn’t cross your mind often enough. I was so dehydrated and tired on the decent I was hallucinating. Giant purple crystals were coming up out of the snow in front of me as I staggered down the mountain towards high camp, a strange experience and one that highlights the importance of keeping hydrated.
Sleep is obviously key when your putting yourself through the equivalent of two marathons a day of energy output but getting it wasn’t easy for me. The tea houses aren’t insulated so it’s into the sleeping bags from day one which was fine as they’re actually pretty cosy. The issue is that you’re lying on a plank of wood essentially so quite quickly parts of you are going numb from the pressure and constant rolling and repositioning ensues. We were in two person dorms most of the way but the walls were just a piece of plywood or corrugated iron so it felt like we were all in bed together and every noise reverberated through the building. Despite some snoring and sore body parts, sleeping at the lower altitudes wasn’t too bad, as we got higher and the air got thinner though things got a bit more tricky. At high camp for example the oxygen level in the air was at less than half of what it would be at sea level. You account for this by breathing harder or going slower when you’re awake but when you sleep your body falls into its normal breathing pattern and as a result you wake up gasping for air every 30 mins. Over time you will acclimatise to this hence why the sherpas can all sleep like babies but it was a lot harder for us. One or two days of not much sleep is manageable but the accumulation over weeks would really take its toll. My Oura ring was telling me after 4 days that I was 7% recovered and I need 3 days off, amusing. How physically tired I was after each day helped me get to sleep but there were certain other aids I relied on:
- Earplugs and a hat pulled over the eyes came in handy.
- ZMA tablets / zinc and magnesium help maintain deep sleep. I’m not sure if these are a placebo but who cares they seem to work!
- Vivify CBD oil / I use CBD oil regularly as i quite simply it works… I seem to not only sleep much better but it works amazingly as an anti inflammatory managing swelling and joint pain. I have tried plenty of them out but vivify sent me some samples to test over there and they were great. Not available to buy yet as still in testing but keep an eye out for them.
Ones and twos
Right here comes the spinal cord injury special, if this doesn’t effect you or you’re eating your breakfast then its not compulsory to read on but hey you might find it interesting.
I still use condom catheters and leg bags reasonably regularly, well whenever im out and about and not sure where the nearest toilet will be. If not at hone I will also use them at night to save the embarrassment or admin of an accident. This meant I had to take a months supply of bags and convenes to Nepal and although they aren’t too big or heavy, when there’s strict weight restrictions on the mountain airlines every little made the difference. The main aim was to not lose them as they would be impossible to replace up the mountain. Obviously when out walking in the wilderness bags aren’t necessary as you can go to the toilet where you want but an accident in my sleeping bag would have been a nightmare given that I only had one so I had to wear one every night. Summit day was different though. I knew that due to it being -20, my hands not working and the amount of times I would have to go the toilet it would be easier to put a day bag on…and it worked well. I had to empty it once on the decent which was tricky whilst I was hallucinating but in hindsight it should have been more than once if I was hydrating properly. I think that part of the reason I wasn’t drinking as much is because I knew how hard it would be to go to the toilet which is something that I need to work out moving forward if i’m going to continue going to high altitude.
In terms of shall we say ‘bowel movements’ the story of the trip was blockage. I’m not sure if it was the diet or the altitude but everyone was having a similar problem in lightening themselves over the precarious long drops, but for me it was particularly bad given that my bowel now moves slower anyway. The holes in the floor often had nothing to hold on to and holding a deep squat isn’t the easiest to hold with only one functioning leg so a couple of times the boys helped me rig up a handle using ropes and a walking pole. Despite our best efforts things weren’t working and I actually things got a bit concerning when I ended up going five days without being able to go to the toilet, no amount of coffee or jumping seemed to make a difference. As we descended from the mountain things got easier but definitely a lesson learned there…remember your laxido and/or suppositories…
There were so many elements of this trip that were unknowns and there were so many reasons not to go but sometimes you can over think things. I put myself in a situation that was outside of my comfort zone and made it work. Now guess what, it’s no longer outside my comfort zone. Whether it was through effort, intuition or help from others there was always a way around the problem. I’m keen to show that adventure doesn’t have to be for the able bodied. A lot of these challenges that I face medically are more common than you might think and any one of them can be enough to put someone off. For me they add to the adventure, they’re part of who I am and I won’t let them stop me doing the things I want to do.