| Lee's Patients Soar Five Miles High |
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Make no mistake: Richard Lee's primary assignment was to help three climbers in his care successfully summit Mt. Everest. But there was also time to observe the efficacy of drugs designed to help climbers at extreme altitude - and fix a generator or two.
Before he set off, Lee asked what kind of doctor was useful on an Everest expedition. Climber/patient Charles Corfield jokingly replied, "One that can fix generators and trouble shoot electronics and other things." Lee rose to the electronic challenge, and when he wasn't doling out medicine and advice to the climbers, he spent his time fixing communications equipment and tending power supplies. Lee remained at the 17,500-foot base camp in close communication with the climbers, who picked their way to the 29,028-foot summit. At that daunting elevation, the air has one-third the amount of oxygen available at sea level, and people at rest breathe three times the normal rate, said Lee, who is an avid recreational climber. Besides the team that included Lee and climbers Corfield, Pete Athans and Bill Crouse, 15 other Everest expeditions were clustered on the mountainside in the last three weeks of May, the climbing season on the world's highest mountain. Lee said he saw 200 tents jostled for space in an area equivalent to that of three city blocks. Fortunately, Lee had no extreme medical emergencies to deal with as he focused on issues that fit climbers can expect at high altitudes. He reported encouraging results using an oral leukotriene inhibitor (Singulair by Merck) to keep respiratory problems - often called "High Altitude Hack" and "Khumbu Cough" - at bay. "I believe I was the first to use it for actually treating high-altitude ailments," Lee said. He noted that common asthma inhalers, namely albuteral with an "ozone safe" propellant and common or inhaled steroids with freeze-resistant propellants "weren't quite enough in my experience to turn things around" for climbers facing respiratory difficulties common above 22,000 feet. The summit climbers "recorded peak airway flow rates that improved by at least 25 percent, bringing them back into the normal range," Lee said. A Canadian physician climber, Dennis Brown, didn't go for the summit but raved about the drug for preventing his asthma at base camp, Lee noted. Two other medications worked well to prevent the climbers' problems, said Lee. Atrovent nasal spray (ipratropium bromide) was used to control oxygen mask-clogging mucus and Propulsid (cisapride), commonly used to prevent gastric reflux, was put into service to prevent the common problem of drastically reduced GI motility at high altitudes. Lee also helped climbers from neighboring expeditions who were suffering from diarrhea, infected frostbite or other skin conditions. Much of the medicine used at base camp - some of which had been donated by pharmaceutical companies - reflected the list Lee and Corfield had devised. Lee also brought additional drugs. "I tried to think about what everyone else would bring and then fill in the gaps," he said. Extra supplies could be requested through e-mail to Kathmandu, where a relay of porters would be dispatched to deliver them within two days. Six days is considered a speed trek to base camp, and Lee's group took nine days to walk the distance safely and comfortably. Other than a bout of gastroenteritis, Lee didn't experience any health problems himself, but he was aware of the stresses on the human body at such high altitude. "You don't have the energy and you don't have the same quickness and confidence. Simple tasks take so much more concentration up there," he said. He found himself double-checking everything and handwriting all his instructions to patients. "When you don't have the energy, you want to make sure that you don't make mistakes mentally as well," he said. It was Corfield who invited Lee to participate in the Everest Millennium Expedition, which was largely funded by National Geographic and the Boston Museum of Science. "We invited Dr. Lee to base camp because of his original ideas on high-altitude issues, which have proven useful in previous expeditions, both in managing deleterious effects of altitude as well as improving performance," said Corfield. The two have been friends for three years, since Corfield first became Lee's patient. During Corfield's previous Everest expeditions in '97 and '98, Lee administered to him via e-mail from Palo Alto. When Corfield returned to California, he and Lee would brainstorm solutions to some of the high-altitude medical problems he or his team members had experienced. "He was my guinea pig basically, and it was time to put [my advice] to the test," said Lee. In addition to reaching the summit, the climbing team had several scientific goals, one of which included the installation of a global positioning system marker on Everest's peak. The marker will help National Geographic and Boston Museum of Science researchers determine a more precise altitude of the Earth's grandest mountain. For Lee, the trip was an exhilarating once-in-a-lifetime experience. "It was an honor to be there," he said. "It was definitely a learning experience for me, and I think some good will come of it from what I gained in treating these people." |
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Lee, a staff physician with Stanford Family
Practice, recently returned from Mt. Everest where he served as medical advisor to a
climbing team. Lee said all three climbers in his care not only conquered the world's
highest mountain, but two of them threw in an ascent of neighboring Nuptse for good
measure.