Earlier this year the British Mountain Medicine Society launched the BMMS Dr Jim Milledge Mountain Medicine Bursary. This award is designed to support those in the early stages of their career who intend to undertake a project in mountain medicine. Further details can be found here. The winners of the 2021 Lucky Jim Award are Ffyon Davies, Christopher Lewis and Diggory North. Last month we spoke to Ffyon and her interview can be found here. Next up is Christopher Lewis...
Thanks Chris for taking part. Can I start by asking you to tell us a little bit about yourself and what winning the award means to you?
Having based myself in the Scottish Highlands for several years, I now live on the edge of Snowdonia and am working as a Clinical Fellow in Anaesthetics, Intensive Care and Mountain Medicine at Ysbyty Gwynedd, Bangor. It is no accident that I continue to live in such close proximity to the hills! I completed the Diploma in Mountain Medicine in 2019 and am now undertaking the Mountain Medicine MSc through UCLan.
I had the pleasure of meeting Jim during the first module of the Diploma in 2018. He spoke with extraordinary clarity about his pioneering work in furthering our understanding of high altitude physiology, almost sixty years after the famed Silver Hut expedition. His charisma, enthusiasm and dedication to the field serves as an inspiration to us all. It is a privilege to be supported by the BMMS in my own research, mindful of Jim’s exceptional contribution and legacy.
Dan Martin's work at Mt Everest Base Camp highlighted for the first time a fall in sublingual blood flow that occurs in lowland residents who ascend to high altitude. This is likely to represent a much wider reduction in blood flow throughout the body’s arterioles and capillaries that may prevent oxygen being delivered to a range of different tissues
Tell us about the project that you won the award for. What questions are you trying to answer?
The biological mechanisms which allow highland Sherpa populations to tolerate high altitude remain the subject of considerable scientific interest. It is thought that the microcirculation, the smallest blood vessels in the body which are responsible for tissue perfusion, may play an important role in this. In addition, the importance of microcirculatory dysfunction in critical illness, including septic shock and traumatic haemorrhage, is being increasingly recognised.
Sublingual video microscopy allows non-invasive assessment of the microcirculation, producing real-time images of the capillary bed. The feasibility of obtaining measurements has been demonstrated in the high altitude setting. Previous work, including at Everest Base Camp, has shown differences in microcirculatory flow between lowlanders and Sherpas travelling to high altitude. There are numerous unanswered questions. I am particularly interested in learning about the timescales involved in the development of microcirculatory dysfunction on ascent, and exploring the physiological mechanisms which underlie this phenomenon.
The sublingual circulation can be visualised by using video microscopy. From work conducted at Mt Everest Base Camp, lowland residents experience a significant fall in sublingual circulation on ascent to high altitude. Meanwhile, volunteers from high altitude populations, such as Sherpas, see little or no change. This may go some way to explaining differences in physical performance at high altitude
How will you go about answering the question?
There are two parts to this project: a small pilot study at the University of Birmingham’s hypoxic chamber, and some field research in the Himalayas. For the latter, sublingual data will be collected from study participants at various points in the ascent and acclimatisation process. Despite dynamic travel restrictions, there is currently cause for optimism about the possibility of obtaining field data over the coming year.
The best research is often done through collaboration, who will be working with you on this?
The pilot studies in the hypoxic chamber, and field data collection in the Himalayas, will be undertaken with the Birmingham Medical Research Expeditionary Society (BMRES). The group has been influential in high altitude research for some forty years - and, on a personal level, an unwavering source of support and encouragement since my initial involvement as a medical student.
I will also be working under the supervision of David Naumann, a military surgical registrar with an academic interest in trauma care. Dave mentored me through various projects at university, and sublingual videomicroscopy data formed an integral part of his PhD in haemorrhagic shock. I am extremely grateful to benefit from his robust guidance and technical expertise, and consistently humbled by his unrelenting work ethic.
Willing participants! Members of the 2019 BMRES expedition to Sikkim. Find out more about BMRES here
How will you present the results?
Unfortunately the data won’t be ready in time for this September’s BMRES/BMMS conference, however I hope to present the work at a future event and submit the findings for peer review. I have vague aspirations of a PhD by publication, but that’s a little while away. One step at a time!
What are you hoping to learn along the way?
I’m excited to further my research skills, to gain experience in the acquisition and analysis of sublingual videomicroscopy data, and to discover more about mechanisms of microvascular alterations at altitude. Altitude research is fascinating because it allows fit, healthy individuals to be subjected to an acute hypoxic challenge. It's not a huge leap to wonder whether the findings of this project may have some relevance to other hypoxic disease states. The world does seem to be rather excited by these at the moment.
Outside of the sphere of strict academia ... One of the many profound, immeasurable joys of expeditions is the quality time spent with interesting people, away from the internet and other 'real world' distractions. The BMRES is full of wonderful, fascinating and highly accomplished characters at various stages of life and career, whom I consider friends as well as colleagues and mentors. The depth of experience and wisdom within the group is immense. Sometimes the most valuable lessons we learn are not those we seek!
Thanks Chris and many congratulations!
Jim Milledge's autobiography is serialised in this blog. Posts can be found here.
The Birmingham Medical Research Expeditionary Society (BMRES) and the British Mountain Medicine Society (BMMS) have joined forces to organise the 2021 Altitude Research Conference. The face-to-face event will take place in Birmingham on the 11th September. Speakers will include Peter Bartsch, Jo Bradwell and Chris Imray. There will also be presentations from members of the UK's leading research groups as well as ample opportunity for researchers, young and old, to present posters and short talks about their work.
Further details can be found here.
If you would like to find out more about mountain medicine why not join the British Mountain Medicine Society? See this link for details.