Medical examinations & Everest dream

My Everest dream is still alive and when I recover financially from my recent attempt, then save up some money then I hope to go out and attempt Everest again but with a different oxygen strategy.

I mentioned in my previous blog post about attending Raigmore hospital in Inverness to see an Ophthalmologist who concluded that I had suffered from High Altitude Retinopathy (HAR) when I was at 26,000′ on Everest. I am now waiting to have a field of vision test performed as well to determine whether I have done any lasting damage to my eye sight.

I received a letter today from Raigmore hospital stating that they had been in contact with an Ophthalmologist based in Cardiff (Dr Dan Morris) who has considerable experience in high altitude related eye problems and they had relayed my symptoms and their ocular findings to him. He was very helpful to them and said that stories such as mine are not uncommon in high altitude mountaineers.

The letter said “He feels there a number of underlying possibilities to explain your symptoms. The first possibility is of hypoxia or reduced oxygen levels affecting the part of the brain that processes vision. The second is high altitude retinopathy related to hypoxia with haemorrhage or swelling involving the central part of the retina, although he feels this is probably less likely as your symptoms recovered so quickly. The third possibility is of corneal swelling or swelling of the window of the eye. Dr Morris has suggested a number of other investigations…” and went onto say “He also recommends an MRI scan to examine the visual pathways in the brain…” then concluded “The results of these investigations would guide advice about further high altitude ascents.”

To me, it sounds like they are being really helpful at trying to get to the bottom of what caused my vision issues on Everest and I am really appreciative of this. These investigations should hopefully also show that there is nothing non-altitude related that could have caused the loss of vision in the low oxygen environment. I am pleased that they are taking this matter seriously and helping inform my decision making process on the way to hopefully achieving my Everest Dream.

Another person who has an “Everest Dream” is Ellis Stewart from Hartlepool in Teesside. He is trying to raise funds to pay for an attempt on Everest next season (i.e. Spring 2014). He is doing a range of activities to try to raise money to pay for his trip including selling Everest Dream T-shirts and other clothing. Please consider purchasing one of his products or participate in his trade up activity or make a donation to support his dream.  He also wants to raise money for charity during his attempt to climb Everest. The charity that he is fund raising for is the NSPCC so please consider making a donation to support his chosen charity. Thanks.

I will keep you all updated on the medical assessments that hopefully give me the answer that I want to hear, or at least informs me of the additional risks to be encountered & mitigated, as part of achieving my Everest goal.

 

Specialist consultation about my eyesight and future Everest plans

My doctor had given me a referral to see the specialist Ophthalmologist at Raigmore Hospital in Inverness and I attended this appointment on Thursday 27th June 2013.

This appointment started with seeing a nurse in the eye clinic who measured the pressure of each of my eyes. The pressure was “normal” and pretty much in the middle of the range for normal which is good. She then applied anaesthetic eye drops to dilate my pupils. My vision began to become blurry upon the application of the eye drops and after about 20 to 30 minutes my pupils were very expanded and the lights in the hospital seemed very bright. The dilation of the pupils was required to allow the Ophthalmologist a chance to have a really good examination of my eye.

In my previous blog post I mentioned that my doctor had “noted a patch of about 0.5mm x 1mm on the retina of my right eye that he thinks may be an indication of a haemorrhage having taken place but it could be an abnormality that I have had for years that I did not know about.”

During the examination this patch had disappeared and hence haemorrhaging of the retina had occurred and has now cleared up.  In some cases of retinal haemorrhages there can be a permanent loss of part of an individual’s field of vision therefore there will be a follow up consultation to assess whether I have done any permanent damage to my eyesight during my attempt on Everest.

It is perhaps not surprising but Raigmore hospital does not often have patients who have suffered retinal haemorrhages from exposure to high altitudes. In fact I was the first patient that the Ophthalmologist had ever seen with this causation factor.

We had a good discussion about the signs and symptoms experienced at the time of the loss of vision in my right eye at 26,000 ft on Everest. I also showed her a series of pictures that were taken of my eyes at the time.

She diagnosed that I had suffered “High Altitude Retinopathy (HAR)”.  Retinal haemorrhages are one of the things that happens in High Altitude Retinopathy.

I asked her about whether this could happen again and she gave me the answer that I expected which is that I am predisposed to this condition and that I am likely to have a similar loss of vision if I am exposed to the same causation factors again. The principal cause of High Altitude Retinopathy is hypoxia (lack of oxygen) and hence a different oxygen strategy could provide the solution to getting me to the top of Everest.

I asked the eye specialist about whether using more oxygen could get me up Everest without loss of vision and it seems like this option may be viable. She certainly did not say “No – don’t try again” therefore I got the outcome that I wanted from the consultation. I now know what has caused it.

Following the appointment my eye pupils were still high dilated and I was almost blinded as I left the hospital from the bright light outside – although Inverness was overcast and drizzly I could barely see as I walked back to the railway station. Anyone that I spoke with must have thought that I looked stoned due to the massive size of my pupils.

On the train home I could not read anything and just had to wait for my eye pupils to contract again. Upon arrival in Forsinard I could see well enough to finish the journey home in my car.

Now knowing of the condition High Altitude Retinopathy (HAR) I could research it a bit further at home. It is not a term that I was familiar with. I had not previously heard it mentioned in warnings about altitude travel or altitude medicine.

During my internet browsing I found several medical papers that discussed the condition. These papers needed careful reading to determine whether they were discussing comparable scenarios to the one in which I had experienced.

One study (e.g. Goswami B L. High altitude retinal haemorrhage. Indian J Ophthalmol 1984;32:321-4) showed that retinal haemorrhage occurs in about 5% of subjects staying at high altitude (less than 20,000 feet). Another paper (Ophthalmology. 1999 Oct; 106(10):1924-6; discussion 1927) mentioned that nineteen of 21 climbers in their study who had ascended above 25,000 feet developed HAR of varying severities.

Therefore the likely chance of retinal haemorrhage appearing is strongly related to the height. I had no issues with my vision on previous expeditions to over 20,000 feet such as on Denali and Aconcongua but until my attempt on Everest I had never been above 23,000 feet. From the literature searches it appears that there is a high incidence of retinal haemorrhaging occurring but many individuals are not aware of it as it did not significantly affect their vision at the time.

According to various papers (e.g. “The Eye in the Wilderness” in Wilderness Medicine (Auerbach, ed Mosby publ)) there appears to be a link between the incidence of retinal haemorrhages with symptoms of acute mountain sickness (AMS) but when I had my loss of vision I had no other signs or symptoms of AMS. Strangely I had no headache, had a great appetite and was feeling really good apart from having loss of vision in one eye. This paper went on to mention that “Although High Altitude Retinal Haemorrhages (HARH) are often not associated with acute visual symptoms, they may result in a loss of visual acuity or paracentral scotomas. There is a reported case in which further ascent after the development of HARH resulted in additional lesions. HARH that results in decreased visual acuity should be a contraindication to further ascent.”

Without knowing it we had heeded the advice of this paper and I had not ascended further. It is likely that my eyesight would have got worse. Loss of vision high up on Everest could lead to a fatal fall due to the difficulties in climbing and perhaps due to attaching oneself to an old deteriorated rope or simply moving so much slower that all of the supplementary oxygen is used up and severe exhaustion sets in. Severe exhaustion, due to lack of oxygen, has taken the lives of many Everest mountaineers as they have just sat down on the route and fallen asleep never to wake again.

The papers say that High Altitude Retinal Haemorrhages resolve themselves over a period of 2 to 8 weeks after the altitude exposure is terminated and my eyesight recovery seems to be compatible in with this information.

The literature indicates that high altitude hypoxia causes dilatation of retinal vessels, which increases the retinal blood flow, subsequently damaging the retinal vessels and increasing the capillary permeability leading to various grades of retinal haemorrhages.  The haemorrhages tend to be flame shaped and blotchy scattered all over the base of the eye.  These effects are more in subjects who have stayed for a longer period at high altitude. Most probably the continued hypoxic stress causes more damage to retinal capillaries.  With an Everest expedition you spend prolonged periods at high altitude and are more likely to encounter this issue.  As it is related to hypoxia, the use of higher flow oxygen should help to reduce the probability of occurrence.

The most recent scientific paper on this subject, June 2013, concluded “The pathophysiology of high-altitude retinopathy remains obscure, but it appears that the physiological limits of the vessels involved are exceeded, and factors other than hypoxia may be involved, such as physical exertion, coughing, and the Valsalva effect,” (Reference: JAMA. 2013;309(21):2210-2212. doi:10.1001/jama.2013.5550).

For me to make a future attempt on Everest, this recce has taught me that I need to try to reduce the hypoxia experienced by using a higher flow rate of oxygen above about 25,000 feet and hence I will need to have more cylinders of oxygen available for my use.

I can not do much about the physical exertion as I have to physically haul my body up the mountain but I can reduce the amount of weight that I am personally carrying by paying for personal Sherpa assistance. When my vision started to deteriorate on the way up to the camp at 26,000 feet I was load carrying (food, sleeping bag, camping mat, extra warm clothing, etc).

It was interesting that the recent study mentioned coughing as a possible causation factor. I had been suffering from the dreaded Khymbu cough for many weeks at the time of my summit bid.  The Khymbu cough comes from the bronchi in the lungs being dried out in cold, mountain air.  I will need to investigate to see if there are ways to prevent, or at least reduce the severity of, this horrible debilitating cough. The other person on the expedition with me who had had a similarly bad cough lost their vision in descent from the summit so there could be a link here.

The Valsalva effect is when you are trying to exhale against a closed airway, as when blowing up a balloon or holding one’s breath while lifting weights. I don’t recall having any issues with exhaling when I had my oxygen mask on but it always felt easier to breathe when I didn’t have it on. I wouldn’t rule this out as another causation factor in the loss of my vision on Everest.

The literature (Reference: Am Fam Physician. 1998 Apr 15;57(8):1907-1914) also suggests that maintaining a good fluid intake helps to reduce hemoconcentration and this can help resolve High Altitude Retinal Haemorrhages.  Other literature states that the treatment for HAR is treatment with oxygen, steroids, diuretics and immediate descent.  At the camp at 26,000 feet after the vision issue had started I had cranked up my oxygen to 4 litres per minute (from 2 litres per minutes), drank plenty of fluids and popped some dexamethasone (which is a steroid) incase of High Altitude Cerebral Oedema (HACE) and this combination probably explained the significant recovery that I had achieved by the morning.

I am keen to find a solution to the loss of vision in my right eye on Everest so that I can safely reattempt to achieve my third life goal.

Mont Blanc took me two attempts and with Everest being so much harder I would have been really lucky to have got to the summit on my first attempt. I consider my 2013 expedition to Everest as a really good recce of how my body copes at exceptionally extreme altitude and now I can learn from this experience to improve my chances of success next time.

I will now need to investigate the costs associated with increased oxygen available, use of a personal Sherpa and which side of the mountain to reattempt Everest from.  Perhaps attempting Everest from the easier south side, despite the increased objective danger lower down the mountain in the Khymbu icefall, may be a better option due to less time above 8,000m.

If I lost my vision on the south side it is less difficult technically so there would be a better chance of getting down alive. One friend completely lost his vision at the base of the Hillary Step during his summit bid but was able to be helped down and started to regain vision as he approached the South Col.

I will also need to discuss with my doctor about the use of Dexamethasone or other steroids as a prophylactic drug to help prevent the occurrence of High Altitude Retinopathy. The down side of using it prophylactically is that it could mask the symptoms of the fatal condition of HACE but perhaps experience to date has shown that I have not been susceptible to it so the risk of the condition being masked may be minimal. There are no easy answers and no easy way to attempt Everest but I think that the possibility of achieving my third life goal is still a real possibility one day.

I take great encouragement in the fact that in one paper I read that it said “Several climbers who have had clinical cases of HACE or HAR have returned to summit 8,000m peaks” and I will follow their advice of “We suggest that climbers who have experienced significant retinal haemorrhaging in the past should use caution when considering a return to high altitude” (Reference: High Altitude Medicine & Biology, Volume 4, Number 4, 2003, Clinical Review of “Going to High Altitude with Preexisting Ocular Conditions”).

So the Everest Dream is still very much alive. I have had a really good recce, been much higher than I had ever been before, now know more about my body and can start planning for another attempt in a few more years time.

Chris Bonington didn’t get to the top of Everest until his fourth attempt so I shouldn’t feel too bad about having survived Everest intact and able to attempt it for a second time. Nine people died on Everest this year and I was glad not to have added to that statistic, which could have happened, had I pushed on towards the summit on the existing oxygen strategy.

The hard thing for me will be to find the money for another attempt and putting my family and friends through yet another worrying time but achieving your goals is never always straightforward. Keep trying to achieve your own dreams and keep following my adventures towards the top of the world !

Post Everest and eyesight update

Thursday 13th June 2013 – I’ve been back in the UK for almost two weeks now and I have travelled the length and breadth of the country. In total I have clocked up over 3,000 miles on the UK roads since returning.

I am still playing catch-up on reading and responding to all of my mail and email. I am also trying to catch up with various friends and family members. It takes a while to readjust to life in the UK after so long overseas. I have been enjoying the food here. The Everest diet worked well for me and I lost over 8kg (over a stone) in weight but I have probably regained a little weight since returning. The Everest diet has helped for getting ready for my wedding later this year.

It has been nice returning to see various people and I have been greeted with welcome back banners in a few places and a wonderful cake from some other colleagues.

I saw the Doctor this afternoon about my eye. He has given me the referral that I need to see the specialist in Inverness so hopefully I’ll get a second opinion soon.

My doctor noted a patch of about 0.5mm x 1mm on the retina of my right eye that he thinks may be an indication of a hemorrhage having taken place but it could be an abnormality that I have had for years that I did not know about.

He could not see all areas of my retina – he thinks that the patch he saw may be related to my loss of vision on Everest – his observation ties in with the fact that I have not fully regained vision yet (still at about 95% recovered and this could be some minor permanent damage).

His observations and thoughts are that I could have had a High Altitude Retinal Hemorrhage (HARH) rather than anything else. He recommended not going that high again as I could do much more significant, possibly permanent, damage. I need the expert opinion – perhaps the easier south side is beckoning despite the risks of the Kymbhu icefall??? (after all a blind person has summitted from that side).  I am now hoping that the eye specialist comes up with a different diagnosis and gives me the all clear to continue to work towards achieving my third life goal and completing the Seven Summits.

Thank you to everyone that has made a donation to my chosen charities. Over £2,500 plus gift aid has been raised which is great. Thank you.

Further updates will be issued after I’ve seen the eye specialist. Will be off out to Assynt Mountain Rescue Team training this weekend – it’ll be good catching up with the team. Have fun out there.

Finally home

Friday 7th June 2013 – It has been a long and very interesting expedition in which I pushed my body to the limit but didn’t push it too far so that I didn’t break it.

I have finally reached home for the first time since March and it feels great to finally reach this ultimate destination.

I collected my fiancee Sarah from Glasgow on route and we relaxed during the drive to the north coast however we didn’t enjoy being delayed at the Kessock Bridge road works at Inverness for over 45 minutes this afternoon.

The final section of the drive over Glen Loth, where we saw loads of deer as normal, and onwards up Strath Halladale were especially enjoyable as we knew that we were reaching journey’s end.

Upon reaching home it was nice cooking for ourselves and tonight it will be back to some sort of normality as we will be going to the monthly village pub quiz (and hopefully winning). It will be good seeing my neighbours and local community again tonight.

As for the beard, as it is the end of the expedition has it gone already or should it go or should it stay?????

My eye sight has still not returned 100% in my right eye (it is 95-96% ok now) and will need specialist assessment by an Ophthalmologist to see how much damage I have done and whether there is anything that can be done to prevent a re-occurrence of my vision loss at extreme altitude as I still want to achieve my third life goal of reaching (and safely returning from) the summit of Everest before the age of 50.

Although I did not reach the summit of Everest on this occasion the charities whom I am trying to raise funds for should not be penalised – I tried my best but medical constraints prohibited me summitting. So if you have enjoyed following my Everest adventure, and have not yet done so, then please consider making a donation to one or more of my chosen charities by clicking on one or more of the links below and make an on-line donation:

Alzheimer’s Disease International

Assynt Mountain Rescue Team

Society for Radiological Protection Benevolent Fund

Thank you for showing your support through your donation(s) to these worthy causes. In total over £2,300 (plus gift aid) has been raised, shared between the three charities so a huge thank you to everyone who has donated their hard earned cash.

There will be follow up blogs to let you know how I get on with the eye specialist, future plans for Everest and to report the outcome of my cosmic radiation measurements.

I have uploaded over 100 pictures from the expedition to the Bob Kerr – Prospective 7 Summitteer Facebook page. I hope that you enjoy looking at these and I hope that you enjoyed following the adventure!

Back in Scotland via Manchester

Thursday 6th June 2013 – Twenty one years ago today I completed the first of my three life goals (ascending Ben Nevis before the age of 16) during a trip out with the Marr College Hillwalking Club that was led by my physics teacher Mr Adams. I remember that it was a gorgeous hot, sunny day and reaching the summit via the Carn Mor Dearg arete was a big achievement for me at the time.

I am getting closer and closer to home now, but before I reached bonnie Scotland today I stopped off in the Manchester area to meet the poet W.T. Stringfellow who had written a poem for me titled “Mountain of Kings”. I felt honoured to have had a poem written for me and I recited this poem from Everest in an audio blog. The poem that had been penned for me is as follows:

Call of the mountain,
Lured many a man.
In awe and wonder,
Vocations began.
Season upon season,
All weather and terrain.
The mountain around,
Being never the same.
Consuming, bewildering,
Many times they’d return.
For the mountain holds secrets,
Few men can discern.
Mysteries,belief,god,
And all known things.
Revered be the man,
On the mountains of the Kings.

The poet Wayne Thomas (W.T.) Stringfellow is a good friend of Ron Dearden who works for Mirion Technologies. Mirion Technologies have been very supportive of my efforts to make cosmic radiation measurements on Everest and I will be sending back their detectors to California for processing as soon as I get home. When I get the results back then I can start producing my scientific paper on high altitude radiation exposure of mountaineers. I look forward to getting the results back and analysing the data.

Upon arrival in Southern Scotland I headed over to Troon to see my parents for the evening (and collect my car which they had got MOT’d and re-road taxed for me whilst I was away – Thanks Dad!). It was nice seeing them after a few months away and getting a nice homemade meal from my mum.

Is it time for the beard to go as I am coming to the end of this expedition? Keep following the adventure.

On route home via Wales

Wednesday 5th June 2013 – I am still on route home from Everest but gradually getting further north and getting closer to home.

I started the day in London town and made sure that my fiancee Sarah got on the tube in time to head to work before I left. I drove up the motorway then over to Welshpool in mid-Wales to meet up with Myrddyn Phillips.

To date Myrddyn had filmed 8 interviews with me about my adventures, the Seven Summits and did a pre-Everest interview.

Fresh off of Everest, still with beard intact, it was only right that we should do a follow up post-Everest interview.

We headed over to the Marilyn called “Carnedd Wen” (523m) in Wales and nipped up to its summit. During the descent we found a sheltered spot and Myrddyn conducted the interview in his usual manner. This interview will be put onto his YouTube channel in the next week or two once he has had an opportunity to splice some of my photographs into it. I hope that you all enjoy the interview when he releases it.

Hopefully tomorrow I’ll get back into bonnie Scotland. Keep following the adventure.

Keeping promises

Tuesday 4th June 2013 – There has been quite a bit of interest in my attempt to scale Mount Everest and I had received some questions from pupils at Landscove Primary School in Devon whilst I was out there.

I had sent a response to their questions whilst at Doha airport during my return journey and today I had the privelege of meeting those that had posed the questions.

About 60 of the 107 pupils at Landscove Primary School (years 3, 4, 5 and 6) were gathered for morning assembly and I spoke for a short while about my experiences of Everest and the goals that I had set myself at age 12. I then opened up the session to the pupils and numerous good questions were asked – e.g. how did you get water to drink? What temperature was it? What wildlife did you see? What type of boots did you use? Etc. The questions kept coming but after 30 or so minutes their headmaster had make them return to their classes. I enjoyed speaking with them and hope that this has inspired all of them to have a dream and start working towards it. Anything is possible if you put your mind to it.

After I had been to school today, Sarah and I had a quick cup of tea with the team from the Society for Radiological Protection (SRP) then headed off to Torquay. Before heading out to Everest I had promised that I would try my best to come back intact from Everest and that upon my return that we would buy our wedding rings for our forthcoming wedding.

I was able to keep both of these promises and within a couple of hours of being in Torquay the wedding ring type and the necessary size for both of us had been found and ordered. It was nice keeping this important promise as my fiancee has had a stressful time worrying about me whilst I have been away.

I am now back in London, having visited a lighthouse on route, and will be continuing to gradually drift northwards towards home tomorrow. Keep following the adventure.

On route home via Cornwall

Sunday 2nd June 2013 – it was a lovely sunny day in Devon and it was a shame to waste it by travelling so Sarah and I went out to the coast to enjoy it.

We visited Bull Point lighthouse and Foreland Point lighthouse before we then nipped up two Marilyns (relative hills of Britain with 150m or more of prominance) on the North Devon coast. Whilst being by the coast in the sun it would have been criminal to not have an ice cream so we induldged – thankfully we had burned off enough calories during the day to have earned one each. The day concluded with the good old British favourite Fish and Chips for dinner in the seaside town of Bideford.

Monday 3rd June 2013 – As we were in Devon anyway we planned to call in and visit the head office of the “Society for Radiological Protection” (SRP) as I had been raising money for their Benevolent Fund during my attempted ascent of Everest. Sarah had been liaising with the SRP staff and it was planned that we needed to arrive for 17:30.

This meant that we had the rest of the day to fill and as Sarah had already visited all of the Devon lighthouses we headed along the coast to Cornwall to tick off some of the lighthouses that she had not yet bagged on Cornwall’s north coast. After a flying visit to two of these outstanding lighthouses we shot back over to Devon to get to the SRP office.

Upon arrival there I was greeted with a “Welcome back Bob” celebration. This was a nice surprise and some of the staff had brought in their family members to meet me and ask about my Everest experiences. I was happy to share my recollections with them.

Whilst I had been out on Everest I had been awarded the “Founders Medal” by the Society for Radiological Protection. This was principally due to my efforts to restart the Scottish Regional Group of the SRP, helping take a lead role in the running of the first ever SRP schools event where about 1200 school pupils from across Scotland learned about radiation and radiological protection, and for helping raise the profile of the SRP Benevolent Fund. As I knew about the award in advance I had recorded a special audio blog for them from Everest which was played at the SRP’s 50th anniversary conference in Harrogate and I am told that this was well received.

I was honoured that one of the society’s past presidents and the only remaining living founding member was at the SRP office today and he, Bernard James, formally presented the Founders Medal to me. The Founders Medal is not given out by the society often so it was a privelege not only to be considered worthy of receiving it but also to receive the medal from someone who has dedicated their life and career to radiological protection.

Throughout the expedition to Everest I was making cosmic radiation measurements and I’ve been asked to present these results and discuss them at the SRP’s scientific meeting in Southport in 2014. I look forward to doing that.

I am still on route home from Everest so where will I end up next? Keep following the adventure.

On route home via Devon

Saturday 1st June 2013 – I am back in the UK and spending some long overdue quality time with my fiancee Sarah.

We nipped to Devon yesterday in a hire car from Heathrow and made it to Ilfracombe for a nice Italian meal with some wine.

Today we jumped onto the MS Oldenburg and cruised over to the island of Lundy. It has been great for my recovery to be down at sea level and I have been enjoying the moist maritime air which has been helping to decrease my mucusy cough/cold that I had been suffering from for the last 5 or so weeks.

We enjoyed the sunshine and not only did we bag all 3 lighthouses on the island but we also scaled the island high point.

I think that I must be missing Nepal/Tibet as this evening we seemed to have ended up in a Nepalese restaurant munching on momos and other food stuffs of Nepal. The expedition is not over till I get home so keep following the adventure.

Back in the UK

Friday 31st May 2013 – The long journey from Kathmandu to London via Doha commenced as planned late on the night of the 30th and passed without incident. I was unable to sleep on the flights but arrived back in the UK surprisingly untired.

I was greeted at Heathrow by my fiancee Sarah who came bearing gifts. It was nice to be met by her there. The last few months have been very hard for her so it was great to be reunited finally.

We then picked up a hire car so that we could head away for some quality time together. The first thing that I had upon return to the UK was a pint of milk and a Gregg’s sausage roll. I had not had any milk since March. It is surprising what you miss to eat and drink when you are away for so long but it is so good to enjoy them upon a return.

We dropped off my expedition equipment at Sarah’s sister’s house in Southampton and then headed off to Devon for a long weekend of quality time together. When will the beard go or should it stay?