For People with Amputations and their Providers
Mountains carry risks for all climbers. Obviously those risks are compounded with someone who has lost both legs above the knee. It gets more complicated when you attempt climbing multiple peaks. When one of those peaks is Mt. Everest, it becomes totally crazy. This section takes a look at Hari’s considerations for climbing with prostheses.
Hari’s Prosthetic Choice
Prosthetic Equipment and Supplies
People with bilateral (both legs) above knee amputations, often referred to as BAKs, face greater challenges in regaining personal mobility than other amputees. The loss of knee function dramatically increases the rehabilitation effort. Many find adapting to two prostheses too stressful and physically draining. Others find it impractical. Conventional wisdom says that only the strongest and most determined can master ambulatory control with two prostheses.
Hari wants to prove to himself that capability is about his mind, not his legs. That’s what this climb is about.
Learning to use prostheses is all about agility, balance, endurance and stability. It also requires additional metabolic energy, which increases respiratory and oxygen demands. The planned training climbs will be testing those attributes as the team learns to work together and adapt their respiration to altitudes so high, additional oxygen will be necessary.
Hari is very proficient with prostheses. He was the first recipient of the Ottobock Genium in the United Kingdom. Prior to that, he wore the C-Leg for three years. For running, Hari uses the Ossur Flex-Foot Cheetah.
During his travels, Hari hopes to use the Ottobock X3 prostheses. The advanced design was collaboration between the U.S. military and Ottobock. Its purpose is to help veterans who have lost a limb return to an active lifestyle.
The X3 is computer controlled using microprocessor technology. It has angle sensors, a gyroscope and an accelerometer like you would find in the Nintendo Wii™. Its software manages data from all the sensors to enhance sophisticated changes in mobility, like running, walking backwards or climbing obstacles. It is also completely submersible, a major asset in the mountains.
The X3 is made of corrosion resistant materials that include titanium, anodized aluminum, stainless steel and a coating to protect it from rain, snow, mud and dust.
The X3 is perfect for international travel and hiking in the foothills. But for the real work of climbing Mt. Everest, it may not be practical. The X3 has a battery that must be recharged and the environment (of course) is beyond any testing microprocessors have undergone.
For climbing and hiking, Hari uses stubbies, which are shortened prostheses. He was custom fitted for his, with the rocker bottoms modified for the demands of the mountains. The short height of stubbies enables them to function without an articulated knee joint or even a shank. They use his standard socket. The design lowers the center of gravity, which improves balance and stability, which is why they are effective in the mountains. Hari’s will be adapted for the best combination of height and the motion of his gait. Clinical studies suggest that Stubbies require less energy and can reduce both the heart rate and oxygen demand by as much as 23%. At the same time, studies have shown that Stubbies can increase walking speed by 25%. These figures are meaningful to Hari as he plans his climbs. The concern is that Stubbies have less of a range of motion than conventional prostheses. It can make hills and stair-steps much more difficult. They are also suspended using waist bands and suspenders. We don’t know how effective they will be when climbing all day. The training climbs will give the Team a chance to evaluate the options and how they affect Hari’s ability to climb.
During the training climbs on Mt. Rainier and Mt. Blanc, Hari will be testing different feet and various heights for his Stubbies, depending on the condition.
He will determine whether the benefit of different prostheses justifies the exertion of changing feet or legs in a harsh climate where respiration is difficult. During the trials, Hari will compare:
Walking on rocks
Walking on gravel
Hiking with ice clamps
The feet Hari finally selects must be very hard wearing. They must withstand the cold, wet environment while undergoing sustained and repetitive stress. During the trials, Hari must ascertain whether he needs to replace his feet after each climb.
Prosthetic Equipment and Supplies
Equipment he will need to carry with him for his prostheses includes
Ottobock X3 for Travel
Stubbies for Climbing
Optional or Replacement Feet
Spare parts and tools
Hari will have his socket fit tested prior to his field work in January.
The bodies of many climbers who died on Mt. Everest are visible along the trail. The environment is too harsh to remove them. These were healthy, fit people who were prepared for the effort. The risks we face are very real. For Hari, they are even greater. Here are some of the considerations Hari and his medical advisors are addressing in preparation for this Expedition.
Maintaining the health of his residual limb
Hari’s thighs may change size, or volume during the climb. This is a concern, because the fit of his socket over his residual limb is how Hari controls his prostheses. If his limb expands at night, as fluid builds, or reduces during the day as activity drives the fluid from his limb, Hari may have trouble with the fit of his socket.
If his limb shrinks, he may have trouble with shear forces that cause blisters or worse, open wounds. It could pinch sensitive skin at the perineum. A loose socket also means less control of the prosthesis which could affect Hari’s speed and endurance.
Hari could wear a pressure garment at night to keep the leg from swelling. But it might not be realistic to remove the garment during the climb each day.
We’ll need a strategy to maintain the fit of Hari’s socket throughout the climb.
Friction on his stump
We’ll hike into the Base Camp at Everest. Then we’ll climb two other side peaks while our bodies acclimatize. Then we’ll climb Mt. Everest. It is a lot of walking every day. It is important that we avoid friction on Hari’s sensitive limbs. We can’t afford pressure sores. Hari is experimenting with various Silicone gels to protect the sensitive skin from the sustained activity.
Research studies have shown that the circulation for people with amputations is equivalent to the circulation of non-amputees. Hari will be testing that wisdom. The concern is that if Hari’s circulation is compromised, his limbs could be more susceptible to frost bite. He is aware that a vacuum socket improves circulation. Stubbies however, are suspended using with a waist band and suspenders.
Insulation from the Cold
Of equal concerns is that the socket fits snugly beneath the prostheses fiberglass shell. There is no room for an insulating layer. We believe that the same cold weather gear other climbs use will adequately insulate Hari, too. Still, we are exploring techniques that will keep the residual limb safe in extreme temperatures.
Walking uphill is difficult for people that wear prostheses. It is difficult because without an ankle, your foot doesn’t dorsiflex, or articulate upward. Without a gastrocnemius muscle and Achilles tendon, you lack the power to lift your body and push it forward. Hills make it more difficult. Visualize walking stiff-legged with your ankle locked. Now imagine doing that for sixty straight days in bad weather and thin atmosphere. One idea we’re exploring is changing the alignment of the foot to the hill to make walking uphill more comfortable. Prosthetists don’t usually train their patients to do such alignments, but it is a consideration.
Without the calf muscle and the muscles in running through the foot, people with amputations have trouble leaning forward, walking downhill. Oftentimes people in prostheses will walk down hills sideways. It avoids the awkward difficulty of their feet not plantar flexing, to drop the toes down. This can make walking down hill like stepping into holes. It can be very hard on the hips and the back. Like aligning the foot to walk uphill, Hari is exploring the idea of aligning the foot to be slightly plantar-flexed to walk downhill. It would require training.
It would also require a few extra screws to replace the ones dropped in the snow.
As Special Forces veterans, the team knows every alignment in the field adds a risk of losing a small part or breaking something.
There are points on the climb that require vertically climbing ice or frozen snow. The Khumbu Icefalls. Lhotse Face. Hillary Steps. We’ll be wearing crampons to help us dig into the ice. But crampons require power to penetrate the ice. We use our quads for that power. We’ll bend our knee to stretch our lower leg way back for momentum, and then power it forward with our quadriceps. Hari has no knees for additional reach and momentum and no quads for power. He can still kick his crampons into the ice, but it will be as if he is swinging a short baseball bat. When possible, Hari will substitute his upper body strength to get things done.
Deep Snow and the Hip Joint
Hari will be wearing Stubbies for the climb. The square shape of the foot means Hari will trap snow, making each step heavier. People with above knee amputations rely on their hips to power their gait. Hip and lower back pain are common for people with amputations. The effort of the climb will be stressful to Hari’s hips. The added weight of snow with each step will be an additional challenge.
High altitude climbers often use ladders to cross deep and dangerous crevasses. For many, this can be unnerving. They must step on the narrow aluminum struts, while wearing crampons. There are no handrails to steady you. A non-amputee’s heels typically remain about two inches apart. A bi-lateral amputee maintains a wider stance. Their hips tend to rotate with each step. This can add excessive lateral movement in the gait. When crossing crevasses, Hari will need to concentrate on carefully placing his feet and maintaining his balance. Obviously the safety ropes will help, but the effort will add to the stress.
Assessing the Risk
Hari is fully aware the risk that he is taking. His wife and two young sons know what he is doing. Growing up in the shadow of Mt. Everest, he understands the challenges and that the climb will be a struggle with every step. He is aware that he may lose other limbs from frostbite. He could wind up in a chair the rest of his life - or even not return.
Still, Hari says, "This is my dream. It is possible with the right attitude and team."
How to Join Us
We hope you will become part of this attempt to put the above knee double amputee on top of the world. We'll need all the help and encouragement you can muster.
So follow our efforts on Facebook.
Leave us notes with your thoughts and encouragement.
And hopefully you can spare a few dollars to help us climb.