Attitude versus Altitude

The power of suggestion is strong.

I had an admin asst who got terrible migranes for days after we'd get the carpets cleaned over the weekend.

So we stopped telling her.

Problem solved.

I've understood this for a while. Not as a researcher, but as a parent. Tell a child that something will be trouble and they'll start worrying about it. Act like it's no big deal and they'll step up and happily follow.

The first time I took my son over a 12,000' pass in the Sierra at around age 10 I intentionally neglected to tell him there would be any effects from the altitude. He was fine. He assumed he was winded only from the incline and just kept plugging away.
I'll be doing a similar trip with my 11 year old daughter this summer. I won't be mentioning anything about altitude sickness to her either.

It reminds me of all the stories I've read that Bob Gross has posted about leading people up Whitney for the first time and using a pulse oximeter on them throughout the climb. I respect the fact he's so diligent in taking care of people in his party, but frankly, as a beginner, that would probably really psych me out and cause undue anxiety over my breathing and the elevation.

Sometimes I'll tell a patient that what I'm about to do is exactly what will fix their problem: tada – it works!

There are also PLENTY of studies out there that show if you pay cash – and a lot of it – for a medical procedure, it will be far more effective than if your insurance company paid for it.

As clinicians we have to be VERY careful about how we portray things – tell a patient they have damaged discs in their back, or are bone-on-bone in a knee or hip, and they are GUARANTEED to have longer lasting and more intense pain than if you simply told them that they have age-related changes in their spine and joints.

"It reminds me of all the stories I've read that Bob Gross has posted about leading people up Whitney for the first time and using a pulse oximeter on them throughout the climb."

Craig, I think that you got some stories scrambled.

–B.G.–

The power of suggestion alone can be strong enough to heal — or kill. Here’s a good BBC article on Nocebo.

double post.

My apologies if I'm wrong about that Bob. I swear I've read you talk about using an oximeter on Whitney, maybe I am scrambled up.

Craig, yes, I have been up Whitney 39 times. Yes, I have led many others up there, and I've seen how the altitude affects them. Yes, I have used a pulse oximeter up there on myself, but only for the last three years. Yes, I have applied my pulse oximeter to others who reached the summit. However, those are mutually exclusive things, and they did not happen all at once.

–B.G.–

Despite the dangers of suggestion mentioned above, I make a point to inform hiking partners (I'm usually alone, tho) that at high elevation (I don't leave the ground so absolute altitude is zero;) I'll be watching for mumbles, grumbles, fumbles, stumbles, and tumbles in their behavior as an early sign of sickness. I ask them to monitor the same in me. Remnant behavior from a long ago NOLS WFR cert.

“It reminds me of all the stories I’ve read that Bob Gross has posted about leading people up Whitney for the first time and using a pulse oximeter on them throughout the climb.”

Here it is. Bob wrote about wanting some way to measure people objectively when hiking up mountains. He took readings of himself hiking up Whitney — not sure if he measured others. Regardless, I missed this thread the first time — gadget seems interesting and useful.

I read through that old thread. Yes, the little gizmo works, but you really need to practice with it for a while until you can see the trends. The first year that I carried it was 2012, so I've used it three times on Whitney. There were some newbies that were scheduled to go up with me that year, but they bailed on me. I've seen strangers on the Whitney summit who weren't doing so good, so I used the gizmo on them, just to get a handle on their condition. Some people say that they feel fine, and the gizmo shows very bad blood oxygen saturation. Other people say that they feel like crap, and the gizmo shows moderate saturation. Go figure.

Alternatively, my little test card works to show if the subject is impaired. However, it takes one person to score the test on the subject, and it can't be self-administered.

–B.G.–

Some of us are just not very good at self gauging — be it alcohol, blood sugar or oxygen — and next thing, we are impaired past the point where we don't know anything anymore! And for newbies who have no frame of reference, it's that much harder.

Too bad the gadget is hard to use. Hopefully that will change. Objective feedback can be of great use among newbies — or even the more experienced among us.

There are probably some people better off w/ample info and others who do better not knowing.

Another parenting example: About possible hazards — I have to use a feather with my son and a sledgehammer with my daughter given their different temperaments.

But I know my kids far better than potential hiking partners.

"Too bad the gadget is hard to use."

Those are not quite the right words. You can use the gizmo with only a few seconds of practice. Staring at the digital displays, you can see the numbers quickly, but you really want to practice with it for a while until you can understand what is really going on. As I had reported earlier, you might see the blood oxygen saturation numbers varying by over 5% just in the first half minute that you are staring at it. But once you've seen its normal action, you learn how to interpret what it is really saying. So, I would guess that it gives meaningful results within a minute. Just don't jump to hasty assumptions with the results of the first ten seconds. Of course, pausing for a minute when you are up that high is not a bad thing.

Yes, I have seen enough newbies above 14,000 feet over the years. Some do fine. Others, not so much. If I am walking directly behind somebody in distress, I can see it in their walking gait. If I ask them a simple question and I get kind of a dazed look for a reply, I will know that they are not processing correctly. I've seen people stumbling down from 22,000 feet, and they are not all there, so to speak.

If I don't have a pulse oximeter with me, and I can't use my printed test card on myself, then the only way I can judge my status is by trying to do something complicated with the menu on my camera. Ideally, I can find something about three layers deep in the menu. As my mind fades from hypoxia, I will only be able to do the first two layers. When it gets totally bad, I can only handle the top level menu, and that is it. That's when I need to retire from high altitude and get a rocking chair over at the old folks home.

–B.G.–

I second Kevin Buggie's approach. I'd rather people I take up be informed and risk false alarms than miss real alarms.

I think the real topic here is how to manage group moral and soothing/treating panic attacks/shock in comrads.

When skiing, hiking or backpacking above 7,000 ft. I take three NO2 tablets to dilate my blood vessels and help carry more O2 from my lungs to my screaming geezer muscles.

At least that's what I tell myself – and it WORKS!

NOTE: Interestingly (to me at least) altitude figures into long range rifle shooting when hunting. It affects trajectory in distances over 400 meters and that's why experienced long range hunters carry a tiny Kestrel weather station/ballistics computer and a good laser rangefinder.

Very interesting study.

It is nice to see solid science on a phenomenon that has been observed many times, and that the effects were proven to be genuinely physiological.

"I think the real topic here is how to manage group moral and soothing/treating panic attacks/shock in comrads."

I was leading a climb, and the group had gotten up to high camp. During the night, I was summoned to a tent nearby. One person was feeling like he was going to die, and the tent mate was guessing that the problem was high altitude illness. I checked the symptoms and concluded that the victim was having a panic attack. So, I had the victim take one special pill and some water. The victim was able to sleep and then felt OK in the morning. The pill was a salt tablet (as a placebo).

–B.G.–

"I think the real topic here is how to manage group moral and soothing/treating panic attacks/shock in comrads."

I was leading a day hike up Half Dome and along with my usual posse were a few newcomers. One young women, who really wanted to get to the top, was also agoraphobic (specifically, wide-open places. The section on the cables can give you a very fly-on-the-wall feeling). She started up the cables three times, white-knuckling it. And turned around each time. She made it over halfway, twice. She'd done more climbing and descending on those cables than anyone else that day, but she hadn't made it to the top. I tried to console her, told her that rock has been like that for over 11,000 years and there'll be other chances. And, jokingly, said "With 10 mg of Valium, you'd have no problem." The next time I saw her in the Wilderness Supply, she said, "I did it! I got to the top of Half Dome. I did what you said, took 10 mg of Valium, and went right up."

Practicing medicine without a license. Oops.

Bob's story makes me wonder, what if I'd slipped her a Tic Tac and TOLD her it was Valium?

the nice thing about pulse oximeters–other than that they're very light–is that they provide objective information. I first started using a heart rate monitor (tho not an oximeter) at the gym years ago because I wanted to insure that I kept my rate up. It soon became evident that my mood (psychology) and biology weren't always in synch. Some days I felt like crap but my heart rate was rock solid, and vice versa.

Having developed some issues with afib I found that anxiety–especially at altitude, where I was thinking about heart rate–could both bother me emotionally and itself cause a rise in heart rate. Using the oximeter gives some reality to my judgement about how well I'm functioning. But it takes time to learn what's normal for yourself; as Bob says, you need experience with the device in order to properly evaluate what the numbers are telling you.

Of course, an oximeter can't tell you if a rapid pulse is the result of anxiety or altitude. that's why it may be prudent to take periodic checks as you ascend–to avoid anxiety if everything is tracking. Of course, for most people, this is all a non-issue.

So an oximeter can have the equivalent of a placebo effect, except that it's based on actual fact. Better, it can aid in confirming that someone might be in trouble.

Jeffrey, perhaps you need a pulse oximeter with an extra feature. If your meter numbers start trending too wildly, it automatically ejects a pill for you to take. That pill would be one of David's Tic Tacs.

–B.G.–

Then you'll recognize me on the trail by my calm demeanor and minty-fresh breath!