Dreaming of mountains

A couple of days ago, Lois and I met up with old college friends who were passing through Portland. We hadn’t seen Linda and Ron for years, so there were lots of things to catch up on. Somehow the topic of mountain climbing came up. One of their neighbors is a 50-something woman who is devoted to mountain climbing.  She has climbed most of the highest peaks in the world at least once, and at home she sleeps wearing a mask that mimics the oxygen levels of high altitudes keeping her body ready for the next expedition. This got me thinking about my own dreams of mountain climbing. Beginning in 2008, I made annual trips to Kilimanjaro Christian Medical Centre (KCMC) in Moshi, Tanzania, to help teach medical students and medical residents about neurology. The KCMC campus is in the foothills of Mt. Kilimanjaro. At 19,341 ft in altitude, Mt. Kilimanjaro is the highest mountain in Africa. There are five hiking trails to the top of varying degrees of difficulty, and the roundtrip hike usually takes six to eight days. Although none of the routes require technical climbing, there are hazards, and on average, 8-10 people die each year, usually due to altitude sickness, other medical emergencies like myocardial infarction, or falls. One climber was killed by lightening a few years ago. About 40,000 climbers attempt the hike each year. I loved spending a few weeks each year in the shadow of Kili, but I couldn’t carve out the time to spend a week or more hiking.  During most of those trips to KCMC, I was still a practicing neurologist in Portland. By 2015, I was starting to have some measurable mild cognitive impairment (MCI), and I was fully retired. In October 2018, Lois came with me for a trip to Tanzania to see old friends and do some sightseeing.  I had recovered from my episode of severe ARIA in late 2017 and into the first few months of 2018, and by that October I was feeling good. In addition to a wildlife safari, we did a Kilimanjaro day hike to the first hut on the Marangu Trail. This part of the trail is below the tree line so we shared the rain forest with monkeys and birds. It took us nearly four hours to reach the Mandara hut.  If we had been going on to the top, we would have stayed there overnight and then headed for the next hut in the morning. Coming back down was a lot faster, but it led to different aches and pains in our legs. We agreed that it had been a special experience, but Lois added that going up had felt like climbing stairs for four hours!

Soon after coming home, I began to dream about climbing to the top of Mt. Kilimanjaro.  I knew it would require some physical training on my part. A Portland friend who had a lot of hiking and climbing experience laid out a plan for hikes in the Columbia River Gorge ranging from two to eight miles.  Every month or so, we would take on a different trail, but my favorite was the hike to the top of Beacon Rock. I fell in love with Beacon Rock, and I have hiked the two-mile trail from the river’s edge to the top of the 850 ft peak with friends and family many times. Much of the trail crisscrosses a sheer cliff of basalt rock made accessible by 52 switchbacks. On one of these hikes, I had an epiphany. The many trails in the Columbia River Gorge are every bit as beautiful as Mt. Kilimanjaro, except for the absence of monkeys. More important was my realization that with my history of severe ARIA (bleeding and swelling of the brain), I likely have a condition called cerebral amyloid angiopathy, a vasculopathy in which beta-amyloid invades the smooth muscle of small blood vessels in the brain. My brain would probably not tolerate the extreme altitude resulting in high altitude sickness and possibly death.  I’ll keep Mt. Kilimanjaro as a pleasant dream while continuing to hike the trails closer to home as long as I am able.