Introduction:

There is a ton of information out there about how to prepare for a Denali trip. There are specific exercise plans, gear lists galore, and route descriptions to no end. But in all of my research, I couldn’t find much about preparing for a trip while living with a chronic health condition. 

And I honestly didn’t expect to find much. Denali is a tough mountain to climb. Having a chronic illness such as Crohn’s Disease or managing a medical device such as an ostomy can be an automatic barrier to entry. I know of one other individual who has climbed Denali with an ostomy (in fact, he’s climbed The Seven Summits), but I haven’t heard of anyone else. 

This is why I wanted to write a blog post about my trip preparations. I’m fifteen years into living with Crohn’s Disease. And I’m nine years into living with an ostomy. So I have a lot of prior experiences that I was able to pull from when planning for a trip of this magnitude. 

I want to shed light on some of what it takes to pursue big mountain climbing (or really any outdoor adventure) despite living with a chronic medical condition. Because honestly, a lot of the preparation is the same as others will experience. But there are key differences that can prevent your condition (in this case, Crohn’s and an ostomy) from getting in the way. 

Medical Preparation: 

I’m going to start out with a gastrointestinal tract anatomy lesson. Because who doesn’t love learning about the GI system or talking about poop while on a mountain trip? Also, my GI anatomy can be confusing to others. But it plays a key role in how I planned for the trip. 

Almost everyone knows I have an ostomy. At least, I hope you’ve picked up on that if you’re reading this blog. So you know I’ve had my colon and portions of my small intestine removed. And rather than pooping out of my butt, my poop comes out of my remaining small intestine. And this sticks through an opening in my abdominal wall and empties into a bag on the outside of my body (my ostomy). 

But what you might not know is that I also have a jpouch. Long story short, a jpouch is a pouch created out of the small intestine that takes the place of the colon and connects to the anus so that you can poop “naturally.” You’re probably thinking, “But Charlotte, you said you don’t poop out of your butt.” And you’re right. Back in 2013 I had my jpouch disconnected and my ostomy created. So while my jpouch is still hanging out in my pelvis, it’s not active.

Now, you might be wondering, “what the heck does this jpouch have to do with preparing to climb Denali?” It has everything to do with my preparation. Because while my Crohn’s and my ostomy are big players in my health, my jpouch impacts me every single day of my life. And it continues to wreak havoc despite being ‘inactive.’

Okay, so enough of the anatomy lesson for now, let’s get into the preparation details.

I’d been unofficially preparing for Denali for years. But I’m going to focus on the preparation that occurred in the 9 or so months leading up to the trip. And just a reminder, we began our expedition in May of 2022. 

Broadly, my trip preparation started off with me meeting with my colorectal surgeon in August 2021. I wanted to create a plan so that my jpouch inflammation would not impact the trip. We created a similar plan when I went to Mongolia in 2019, so I knew what to expect. Basically the plan was that I would have 2 procedures (similar to a colonoscopy) of my jpouch leading up the trip. One would be in the Fall and the other would be in the Spring. These would be performed to check on my inflammation level, to prescribe meds as needed, and to dilate my anus so that any mucus built up in the jpouch would be able to drain and not cause abscesses and fistulas. So fun. I know. 

The next step was to talk to my GI doctor to discuss any medication changes or needs while on the trip. This also involved planning a procedure through my stoma to look at the health of my small intestine. It also helped with planning my medication infusions around the trip dates. I receive an Entyvio infusion every 8 weeks. We ultimately decided that I would be a week late receiving my June infusion while away. This was okay because I didn’t have any inflammation in my intestine at the time that it was examined. And I kept on track with my schedule before the trip.

I also had an appointment with my primary care provider. She was able to prescribe high altitude and other travel related meds.

All of my doctors were super supportive and wanted to do everything they could to support me. 

I did have some unexpected medical issues just prior to the trip, which I was certain would derail everything. In April of 2022, I developed a MRSA infection and had multiple abscesses drained in urgent care and the ER. At the time, I didn’t know that it was MRSA. I was put on antibiotics with the hope that they wouldn’t occur again while out on the mountain. And they didn’t. 

I also developed intense abdominal pain for a week or so and was convinced I had a hernia. Imaging didn’t find anything. I had to back off on my pack training because I couldn’t tolerate carrying a heavy load. Eventually the pain dissipated. My providers and I assume that it must have been an adhesion or a strained muscle. In the end, everything worked itself out in time for the trip. 

Physical Preparation: 

In the Fall of 2021, I also started working with a Physical Therapist. She specializes in manual therapy, particularly visceral and myofascial work. I initially sought her out to focus on decreasing my risk for adhesions or bowel obstructions. But over time, we also focused a lot on my back which I injured in the past. We worked through body mechanics, particularly related to carrying a heavy pack. We worked on strategies to decrease my intra-abdominal pressure to reduce my risk for a hernia next to my stoma. As aches and pains came up through my training program, she was able to help me through those. And I was injury free going into the trip. I worked with her through my expedition start date and followed up after the trip for some minor injuries. 

I began my official physical training program in October 2021. 

In the Summer of 2021, Tyler’s stepmom did some V02 Max and metabolic efficiency testing with me. I found that information interesting, so I decided to learn more and sought out the services of the PEAK Center in Anchorage. I wanted help determining my Heart Rate zones to use in conjunction with my Uphill Athlete plan. I also knew nutrition would be super important for me, so did a Resting Metabolic Rate test to determine my fuel sources and caloric needs during activity. I then took that information and applied it to my training program. I also worked with a registered dietician on ideas to expand my options for fueling during activity because I struggle with this with my ostomy. 

After a lot of research on a variety of training methods, I decided to purchase the Uphill Athlete 24 Week Expeditionary Mountaineering Training Plan to provide more direction with training. I enjoyed the structure of the program and it definitely kept me on track. I made some changes to the plan to accommodate my lifestyle and physical limitations. But overall, I found it quite effective in giving me a baseline fitness level to keep pace on the mountain. 

When I looked at the Uphill Athlete plan and started to do some of the strength programming involved, I knew that that portion wasn’t going to work for me. My core hasn’t fully bounced back from my ostomy revision in 2020, and I knew that most of the strengthening exercises would increase my risk for a hernia or a stoma prolapse. So I decided to seek out a friend to help. 

My friend Meg was a trainer at the local Midtown Anchorage F45 gym. I originally sought out her guidance on my lifting technique, but after discussing my goals, she said that she could sponsor me through the gym. This led to me committing to two strength workouts a week from November until April. I’ll tell you, I enjoy strength training, but that group provided me with an immense amount of motivation (which was demonstrated by my commitment to the 6am class on Thursdays). I credit my ability to haul big loads on Denali without major injury to the strength that I gained by working with coach Meg and the rest of the team at F45. 

I took a little break from training in November to go to the Florida Keys and enjoy the sun and vitamin D while visiting with Jeanine and JP. And then a quick break for Christmas in NH. But once January hit, I was in full on training mode. 

I spent the Winter on the stairmaster at the gym on days where it was more difficult to get outside, skiing at the resort and in the backcountry, Nordic skiing around town, and going on adventures with my big pack. As long as I was getting in lengthy mileage and keeping up with my strength workouts, I wasn’t too strict on what type of activity I was doing. I enjoy getting out with friends, so being flexible with my training was important to me. 

In February 2022, I took a week-long trip to visit Jeanine in Colorado. I was able to spend more time at altitude to see how my body would respond to skiing and longer adventures (although most of the time, we were not that high, around 8,000-9,000 ft). I figured some altitude was better than being at sea level all the time at home. 

Once I returned to Alaska in February, I spent the rest of the Spring, skiing and enjoying the sunshine with a quick trip to New Hampshire in April to visit the family. My mom and dad joined me on some local hikes to make sure that I was keeping up with my elevation and pack training. 

Other Odds and Ends: 

Glacier Travel

Before our springtime trips, Tyler and I typically brush up on our glacier travel/crevasse rescue skills. For Denali, I wanted to make sure that we were consistently reinforcing those skills, so beginning in November, we started a once a month training with friends. We worked on rope management, ascending, haul systems, and a variety of other skills. I find it’s more fun to brush up on skills with friends, and we were able to incorporate a friendly St. Patrick’s Day competition into the mix.

Tyler and I also spent some time out with our sleds, especially practicing pulling them downhill. I’m not sure this really helped me and I definitely have some sled tips for others if carrying skis down the Polo Field. 

Boots

Most of the 9 months leading up to the grip was spent finalizing gear choices and making sure that our systems were working well going into the trip. I spent many hours breaking in my climbing boots, even while I was in NH where there was no snow. Ultimately, my bunions caused me too many issues when my feet were swollen at altitude, and I ended up using my ski boots the majority of the time on the mountain. I definitely recommend sizing up even more than you think you need if you have bunions. I halso have neuropathy in my feet from Crohn’s medications I’ve been on in the past and impaired sensation from my back injury, so I ended up purchasing electric socks on the recommendation of a friend who climbed Denali a few years ago. Because we didn’t get above the 16 ridge, I didn’t end up using the socks much, but I can see where they would come in handy if attempting a summit in cold temperatures or waiting behind large groups for long periods of time in the cold. 

Ostomy Supplies

Preparing my ostomy supplies took quite a while to figure out. I ended up bringing one bag change per day for 21 days (i.e. one wafer, one bag, one barrier ring, one adhesive remover wipe, and two skin prep pads, stoma powder, paper towels, disposal bags, medical scissors). I change my ostomy bag every other day, but wanted to have extras in case my pack and sled weight caused me to need daily changes. Because of the mucus drainage from my jpouch, I wear a pad at all times, so I also brought 3 pads per day for 21 days. I organized these supplies with packing cubes and they took up quite a bit of space in my duffel. Any poop on Denali is supposed to be disposed of in a biodegradable bag in a Clean Mountain Can. We received a few at our orientation and then I picked up some extras from the basecamp manager. I also purchased my own as backups prior to the trip, so that I wouldn’t run out. I considered purchasing my own Clean Mountain Can as well, but turns out, the Park Service is happy to provide plenty of cans. We utilized 3 on the trip. 

We got pretty down to the wire on meal prep, but a co-worker came over and helped get everything organized. Because of my Crohn’s, I follow a gluten free diet. And because of my ostomy, I have to avoid foods that will cause bowel obstructions, so I had to be very careful with meal planning. We ended up bringing very bulky/heavy food (mostly real food with only a couple of dehydrated meals). This added a lot of bulk to our sleds and we ended up really having to par things down in our caches while out on the mountain. But, neither Tyler nor I had any major digestive issues on the mountain which definitely made the added weight/bulk worth it. 

Conclusion: 

That’s all I’ve got for now!

Preparing for a Denali expedition is a big undertaking. Planning for a Denali expedition with Crohn’s and an ostomy is a bigger undertaking. But there’s a ton of information and resources out there, so it is very much possible to pull off a trip without getting too overwhelmed. You’ll be amazed at what you’ll learn and the skills that you’ll develop in the process. 

-Charlotte