What would you do if your doctor said no backpacking?

[Victor K]

Hi all,

Here is the problem. In the august 2006, after my return from the Tien Shan Mountains (where I had done some climbing to the mountains of height up to 4800 m. (16000 ft.)) I had a spontaneous pneumothorax (collapsed lung) and as a result a surgery on my right lung. Doctors said me that I have to stop backpacking and climbing because low pressure in the mountains could trigger another spontaneous pnemothorax.

Well, I didn’t listen to them and continued to make trips. Everything was fine and I returned to my normal life. In the summer of 2007 I did a three-week backpacking trip and then in winter of 2008 I had a backpacking in a quite cold weather conditions. As a result, I got pneumonia (in the right lung) which then gone. But in the july of 2008 I had collapsed lung again. And again doctors said no physical activity forever.

Three weeks after this event I went to the Ural Mountains and then to the Sayan Mountains in the Siberia where I climbed to the the mountains of height up to 3000 m. (9800 ft.), everything was fine. Three weeks after the return from my trip I felt a sharp pain in the left side of my chest. So another episode of collapsed lung.

I wonder if anyone had the same problem. Is here anybody who were said to forget of backpacking because of health issues but still continues to do it?

I can’t live without it! I’m planning to do a two-week backpacking trip in the Altai Mountains this summer.

Now I’m trying to make all precautions, that is I learned how to do needle chest decompression (in theory) and bought 14g cath to treat tension pneumothorax (but the probability of spontaneous tension pneumothorax too small). BTW all my episodes of collapsed lung were small, so I was able to walk around, and they all happened not in the mountains. The second happened when I was asleep, so it didn't matter whether I was active or not. And the second and the third healed on their own.

But still I’m a bit afraid. I’m not afraid of tension pneumothorax (it’s easy to treat), but I’m afraid that would have stop my trip and return back to the civilization. So because of me my companions would have to return too, but I don’t want to spoil the trip.

What would you do if you were me?

[Miguel Arboleda]

I have Type 1 diabetes and my doctor was shocked when she learned I had done the Tour de Mont Blanc two years ago. I couldn't live without being able to get out there, in spite of the constant fear of getting low blood sugar from the high amounts of calories burned and occasional bouts of severe leg cramping that renders me unable to stand up. I am more careful than I used to be, but hiking is part of what gives me purpose in my life. Sitting at home doing nothing just isn't an alternative.

[t.darrah]

Victor,
I have faced a similar situation after a severe back injury. I would recommend the following steps;

1) Select a medical specialist that is aggressive in helping you maintain and or regain your ability to actively participate in what you enjoy. Preferably a medical specialist that enjoys and participates in the same sport or activity.

2) Modify your trips/adventures if need be. You may need to search out lower elevation adventures along with warmer weather. This may include more desert type terrain and weather. You may need to change from high elevation trekking/climbing to becoming a desert rat. You may be pleasantly surprised and challenged with the change. Look at the change as a positive and find motivation in the new challenge.

3) UL gear provides true benefits when facing medical/physical limitations. Lighter weights will result in less stress and more enjoyment. Go lite, resupply more often …, whatever it takes to stay active.

I sought out and found a neurologist that focused his treatment and resulting surgery on my returning to and participating in physically demanding activities. The surgery, physical therapy and follow up were all centered on my being active and strong.

I completely rebuilt my gear with a focus on my back injury and condition. I invested in quality UL gear that allows me to hike longer and stronger then preinjury.

I now focus my workouts on maintaining a strong core along with endurance where as prior to my injury all my focus was strictly endurance oriented.

Do not give up, never give up. I hope this helps.

[Victor K]

Miguel, you are quite right! And I think there are many people who were told to stay at home, but in spite of that they continue their trips. The better life isn’t the long one, but the life which was interesting and full of events. I would lose the purpose of my life if I were sitting at home doing nothing.

Thom, thank you for your recommendations. Backpacking in low altitudes isn’t a way out for me. First, because I like how high mountains look, it’s my favorite place. But now I don’t climb to the heights above 11000 ft. Second, there are some places, for example the Pamir Mountains in Central Asia, where all passes have a height more than 8000 ft. So to get through the valleys there you need to go to such altitudes. Third, I don’t think that high altitudes were the reasons of collapsed lung, since they all happened in low lands (actually two of them happened while I was in a train and one happened when I was asleep). Moreover, in Tibet people live in altitudes higher than 16000 and I’m sure that there are some people who have the same problem, but still live there. So I think high altitudes have nothing to do with a spontaneous pnemothorax.

And we (I’m in Russia) have deserts only in Central Asia, but they are usually located in so remote areas, where you may not find people for many hundreds of miles (for example Karakoram desert).

I’ve already switched to less strenuous trips. Now for me backpacking isn’t a sport (here in Russia it’s official sport with competitions), it’s a way to see new lands and take outdoor photos. I’m learning light backpacking techniques, so to reduce the pressure from a backpack on my chest. And I'm trying to find my own ways to prevent spontaneous pneumothorax such as healthy diet, special breathing techniques, avoiding smoking places.

I'll do everything in order not let the disease to spoil my life.

[Doug Johnson]

Hi Victor,

I feel your pain. This is really tough and it would be very difficult for me as well.

Remember, life has many facets and making decisions that could cut life short or leave you disabled will cause you to miss many of life's pleasures (family, children, career, etc.) I agree that being aggressive medically is a very good idea. But you may also want to allow yourself to love different backpacking adventures- at least for a while.

There are many incredible backpacking options around the world that don't require 11,000 feet. For example, here in the NW US we have incredible sub alpine climbs and routes that are between 4000 and 7000 feet. Or the deserts of Utah- ever tried canyoneering? Or coastal trips. Now, I know the US is far away and that makes things much more expensive, but maybe there are options in Europe or Asia that are similar? Trekking in Norway, for example.

So do what you can but you can also rethink and try some new things during medical treatment. I love the high mountains too, but there is more to life than just that.

Best wishes,
Doug

[James Ennis]

Victor:
Spontaneous pneumothorax affects nearly 9000 people here in the US every year. It seems to affect tall, thin people between the ages of 20 and 40. One of the most aggravating causes of this is smoking.
I agree that you should find a physician who can relate to the type of activities that you do and one who can help manage your condition, while, hopefully, enabling you to continue to hike.
Good luck,
Jim

[Elliott Wolin]

We love backpacking but cannot get away very often. Two years ago we discovered kayaking and kayak camping, and we try to go paddling at least a few hours every weekend. Fortunately we live in a great area for kayaking, the Tidewater area of lower Virginia.

Kayaking is a godsend to many people who cannot walk or carry much of a load. It can be strenuous at times…I don't know if it would aggravate your lung condition.

We find kayaking complementary to backpacking, but if I couldn't backpack I'd do lots more kayaking.

[Sean Walashek]

Most doctors shouldn't be intrested in your activities, instead on keeping you alive. If you take others advice and find a doctor who understands that inactivity is not an option for you, you will get better advice suited to keeping you out and having fun. Not knowing your current state of health I can always suggest getting a healthy balance in terms of diet, cardio fitness, hydration, stress managment, and sleep.

[Walter Carrington]

Viktor, I'm sorry you have this problem. I have asthma which sometimes limits my activities, but mainly in polluted cities not in the mountains. I think I would continue hiking but do more photography and less climbing if my doctors told me not to backpack.
It would be very hard to stay at low elevation living near the Tien Shan (Mountains of Heaven). It is so beautiful there — I've trekked near Karakol, Kyrgyzstan.
I would recommend consulting other doctors who specialize in respiratory problems. If you have several doctors telling you the same thing, I would stop backpacking.
Standard recommendation for pneumothorax:
"Patients suffering from this condition should be advised to discontinue smoking and avoid high altitudes, scuba diving, or flying in unpressurized aircrafts to prevent the recurrence of pneumothorax."
http://www.lungusa.org/site/apps/nlnet/content3.aspx?c=dvLUK9O0E&b=4294229&ct=3052603
This makes it sound like high altitude is more dangerous than exercise.
Find a very good respiratory doctor sympathetic to your backpacking/climbing and follow his advice.
I found more info that I'll PM to you.
–Walter

[Walter Carrington]

For those who have never been there, the Tien Shan are absolutely beautiful. Russia and the rest of the former USSR have many great places that we have never been.
Check out Victor's pictures on his website:
http://vbphoto.files.wordpress.com/
I like this one:
http://vbphoto.files.wordpress.com/2009/04/daliniy1.jpg

Also, some pictures of Khan Tengri in the Tien Shan:
http://www.summitpost.org/mountain/rock/150339/khan-tengri-tengi-tag.html

–Walter

[Victor K]

Thank you all for replies!

Doug, I like different types of backpacking. It’s just the feeling that I’m restricted to visit remote areas.
As I said the problem isn’t in high altitudes, it’s that I can’t go to remote areas, which are far away from civilization.

James, you are right, I’m very thin and young (hope that I won’t have this problem when I become 40 years old, but it’s painful to feel yourself restricted when you are in the most active ages of your life). However, I don’t smoke.

Elliott, unfortunately I live in the flat area, there are no even hills. And the nearest mountains are thousands miles away, and I can go to the mountains only two-three times a year.

Sean, that’s right, it’s what I’m doing right now.

Walter, I’ve already switched from climbing to backpacking through the valleys. Now one of the main reasons why I do that is photography. So I switched from conquering the mountains to taking photos of them. And like you I had problems with my lungs only cities, it seems that stressful life in a polluted city causes more damage to my lung than high altitudes. Thanks for PM, I checked the link but it’s what majority of doctors say, but they say that because they were told so when they studied. And actually there was no any research on how high altitudes can cause collapsed lung, it’s one of the assumptions.
In the former USSR there are really a lot of different mountains. Unfortunately, I’ve never been in Khan Tengri, but a friend of mine was there when he was climbing to Marble Wall – spectacular place. This summer I’m going to the Altay Mountains, they are near the border between Russia and Mongolia. They aren't so high as the mountains in Central Asia, but still beautiful, here some pictures of them: http://pohodnik.info/foto.php

[Roger Caffin]

Hi Victor

Your photos are magnificent!

Maybe high altitude is not the cause – I hope so!

Cheers

[Dean F.]

Why are you getting sponaneous pneumothoraces? Have you ever had a CAT scan? If a CAT scan shows apical blebs then you could have them resected by a thoracic surgeon. This could be done thorascopically, with no thoracotomy incision. If you are desperate you could have a pleurodesis- which is basically inciting your pleural cavity to inflame and scar yor lung into place. As you can imagine this makes any future chest surgery quite difficult, so if you are a smoker you shouldn't do it, so that your lung cancer can be resected thirty years from now. :-)

After multiple pneumothoraces you shouldn't have trouble convincing a surgeon to do either procedure.

Why did you have surgery on your lungs after a pneumothorax? That is very unusual. Is that some odd Kyrgyz/Kazakh/Chinese thing? Or do you just mean that you had a thoracostomy tube (chest tube)?

[Richard Lyon]

Victor,

Wonderful photos! I just put Siberia on my "must hike" list. I did a trek through the Tien Shan in 2000, just after the authorities opened it up. No climbing but we did take a helicopter flight to the Khan Tengri base camp, and the pictures linked above brought back fond memories. In ten days through the mountains we saw three other people, all the while surrounded by magnificent scenery. Hope you can keep visting these places and sharing your photos with us. Cheers, Richard

[Walter Carrington]

The following article reviews research on altitude and lung disease. The good news for me is that asthma actually improves for many people at altitude. For me the biggest problem would be traveling through polluted cities on the way to the mountains.
For pneumothorax, it sounds like a temporary restriction from going to high altitude is needed. Again, find a good respiratory doctor for a second opinion. In the USA, medical schools are good places to find the most knowledgeable doctors. You might even email the authors.
http://erj.ersjournals.com/cgi/content/full/29/4/770#SEC8

–Walter

[Victor K]

Dean,
When I had my first pneumothorax I got a CAT scan of my lung, yet it didn’t revealed any blebs (as it turned out there were some blebs). I had a surgery (it was in Russia) on my lungs after a pneumothorax because doctors first tried to do needle chest decompression, but it didn’t help. So they decided to do a thoracoscopy during which they spotted two small apical blebs, which were removed, also they did a mechanical pleurodesis (it wasn’t a total pleurodesis). However, as you can see this surgery was unsuccessful since after it I had another pneumothorax on the same side.

I don’t need to convince a surgeon to do these procedures. Actually, when I had my second pneumothorax, a surgeon tried to convince me to do a thoracotomy arguing that thoracotomy has less recurrence rate than thoracoscopy. But I denied, for many reasons. First, thoracotomy it’s a big gun surgery and after it there could be many complications, so I could forget about backpacking at all (after thoracostomy I’m still having some complications such as different sizes of my pupils and malfunction of my blood-vascular system). Second, conditions in the hospital were awful – old equipment, rude personal, smoking people everywhere. Third, as you mentioned it’s difficulty in case of lung cancer.

Richard,
Apart from popular places such as Altai or Tien Shan mountains there are lot of beautiful places where man has never set foot.

Walter,
Thank you, that article is a really great. It says: “Patients with bullous disease can travel to high altitude but those with a recent spontaneous pneumothorax should wait 2 weeks following radiographic resolution before undertaking such travel”. That is what I was saying, high altitudes aren’t the reason of spontaneous pneumothorax.

But still, the trouble is that it’s unpredictable and may happen in the mountains. So if it happens there, my trip will be spoiled.

[Dean F.]

OK, tracking…

Well, that is a really annoying problem, but basically the same as anyone else with a potentially dangerous medical condition who is trying to decide if they can continue to travel to remote and austere environments. It seems like you are prepared to do a needle thoracostomy on yourself if you need to. Your last option- if you really want a definitive solution badly enough- may be a chemical pleurodesis. This would require chest tubes and a few days in the hospital. But this is not without risk, too.

Do you hike solo? Can you carry a PLB? A life-threatening recurrence is a low-probability event, but the possible consequences are extreme.

So this is really your call.

Personally, I'd carry a PLB and find trustworthy hiking partners, or join groups that include a doctor or a фельдшер. But I think I'd keep hiking.

Увидимся.

[Victor K]

Dean, it seems you know some Russian words 
I’m not sure about chemical pleurodesis, some studies suggest that mechanical is more effective than chemical. But I’m not going to do a surgery (at least now).

I hiked solo only once in my life, it was in summer of the last year. I did it in the area which is quite popular, so there were many other hikers. I think I can hike solo in popular and not so remote areas without any uneasiness.

Yes I’m prepared to do a needle thoracostomy on myself, I asked my surgeon how to do it, read some tutorials, BTW in the youtube there are lots of video on how to a needle decompression.

I haven’t a PLB – it’s too expensive for me (at that moment). Thank you for your encourage, I’ll continue to do backpacking trips.

[Author]

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