TOS on Everest

Reprinted from BJC Today

by Kathryn Holleman

Khumbu_IcefallGosia Borchardt, left, and a fellow climber stand on the Khumbu Icefall, an active glacier at the beginning of the route up Mount Everest. Courtesy photoSwinging an ice axe and being able to carry a pack of gear are essential to surviving on the world’s highest mountains. They’re also two of the worst things someone with thoracic outlet syndrome (TOS) can do to their body.

The most essential survival tool in mountaineering, however, is the mental toughness to keep going over terrain that seems literally insurmountable. And, as Gosia Borchardt found out, that toughness — along with a medical team experienced in treating this difficult condition — can be the key to overcoming TOS.

Borchardt is a Washington University School of Medicine certified nurse anesthetist who has worked in the south ORs at Barnes-Jewish Hospital for the last eight years. She fell in love with mountaineering as teenager in her native Poland, but began climbing in earnest in 2005.

A 2007 climb to the 19,000-foot summit of the highest peak in Africa, Mount Kilimanjaro (“more of a long hike,” she notes), inspired her to try to climb the Seven Summits — the tallest mountains on each continent.

But TOS intervened. Borchardt developed pain in her right arm and shoulder. “It started as a tingling,” she says. It quickly progressed to stabbing pain that woke her at night. “It was just awful.”

She tried to power through the pain during an attempt to climb Russia’s Mount Elbrus, Europe’s highest mountain. But the trip ended in double disappointment. Bad weather turned back her climbing team just short of the summit, and the pain in her shoulder worsened.

A few months later, she climbed Mount Aconcagua in Argentina — at 22,837 feet, the tallest in the Americas. The pain in her shoulder became intolerable.

“I think that was the mountain that totally broke me,” she says.

Back in St. Louis, Borchardt consulted WUSM vascular surgeon Robert Thompson, MD. Dr. Thompson is nationally known for treating TOS, a group of rare conditions involving compression of nerves or blood vessels serving the arm and hand, as they pass through the thoracic outlet — the area at the base of the neck and behind the collarbone. He is director of the Washington University TOS Center at Barnes-Jewish Hospital.

He diagnosed Borchardt with neurogenic TOS, compression of the brachial plexus nerves. Dr. Thompson recommended Borchardt try a conservative treatment, first — physical therapy. But therapy didn’t help.

Surgery was the next step. Borchardt’s initial symptoms indicated that nerves were being compressed in an area called the pectoralis minor space, says Dr. Thompson. He performed a small outpatient procedure to release Borchardt’s pectoralis minor tendon.

Initially, the surgery relieved her symptoms. Several months recovering, she made another attempt to scale Mt. Elbrus. The climb was successful, but her pain came roaring back.

Dr. Thompson found that Borchardt would need a more complete procedure in the area above and behind the clavicle, called the scalene triangle, if she would have a chance at climbing again.

But Borchardt hesitated. Her symptoms had been relatively disabling for a fairly long time. The first surgery only gave her temporary relief, and she knew that in some patients, especially those with long-term symptoms, surgery doesn’t always resolve the problem. But she also knew that if she wanted to continue climbing, her only hope was the more extensive procedure.

The mental toughness kicked in. She decided to do what it took to climb again.

“Dr. Thompson told me that I wouldn’t be able to carry more than about 20 pounds for a long period of time,” she says. “But to climb Mt. Everest you have to carry at least 25 pounds of gear. To climb Denali, in Alaska, you need to carry about 70 pounds of gear plus a 30-pound sled. I knew I would have to do some work.”

After surgery, she restarted physical therapy with Matt Driskill, MSPT.

WU TOS Center therapists at The Rehabilitation Center of St. Louis have some of the most extensive experience with TOS patients in the country, says Dr. Thompson. “They get great results, and they oversee all our physical therapy care for TOS.”

Within three months, Borchardt had worked up to the 20-pound limit. And she kept working. In addition to therapy, she began doing push-ups at home to strengthen her shoulders and arms.

Slowly, she began training with a backpack. She gradually added weight until she could easily carry 50, then 60, then 70 pounds. She was ready to return to mountaineering.

Everest_SummitOn May 18, nurse anesthetist and mountain climber Gosia Borchardt holds the Washington University Thoracic Outlet Center at Barnes-Jewish Hospital banner on the summit of Mount Everest. Courtesy photoFinally, in May, Borchardt fulfilled her dream of climbing Mt. Everest. After weeks of training, trekking to the mountain, acclimating to the altitude and a rigorous climb, she sat on the highest point on the planet.

When it came time to have her photo taken, she unfurled a banner that honored the challenge she had overcome to get there:

“Washington University School of Medicine
Center for Thoracic Outlet Syndrome
T.O.S.
Barnes-Jewish Hospital, St. Louis, Missouri, USA.”

Dr. Thompson was “thrilled and amazed” to see the photo, a copy of which now hangs in the WU TOS Center in Queeny Tower.

“It was wonderful to see how well Gosia had done after surgical treatment and how she had persevered to accomplish one of the big life goals she had dreamed of for so many years,” says Dr. Thompson. “It was also gratifying to know that she wouldn’t have been able to do that without a great deal of expert care to help her get past the limitations she had previously suffered from with NTOS, and that our TOS team had something to do with that! I am sure that Gosia is the first patient to have climbed Mt. Everest following a first rib resection.

“Seeing the picture of her holding that banner has also been a real inspiration to many of our other patients with NTOS,” he says. “It gives them confidence that they too might be able to overcome the obstacles that this condition presents and to help motivate them to reach their own long-dreamed-of goals.”

Support from colleagues at Barnes-Jewish Hospital and Washington University during her quest to climb Mount Everest was "amazing," says Gosia Borchardt, CRNA, right, with, from left, Janelle Holthaus, BSN, RN; Jessica Gray, BSN, RN; and Jayne Wells, BSN, RN.

Staff salutes co-worker with video

Your co-worker climbs to the summit of the world’s tallest mountain. How do you let her know how proud you are? Staff in the pre/post-anesthesia recovery unit (PACU) at Barnes-Jewish Hospital south made a video.

Laura Ehlers, BJH staff nurse, and others in the PACU had followed co-worker Gosia Borchardt’s progress up Mt. Everest through Borchardt’s Facebook page and the daily blog posted by Alpine Ascents, the guide company Borchardt climbed with.

When Borchardt reached the summit, Ehlers and other staff members in the BJH post-anesthesia care unit decided to make a video to congratulate her.

“I think it’s completely awesome that someone I know has climbed to the summit of Mt. Everest,” Ehlers says. “We just wanted to let her know we were proud of her.”

Staff posed with a small dry-erase board on which they wrote well wishes while Ehlers and others staff members took their photos. Then, Ehlers’ father, Ed Scholz, edited the photos into a video, added appropriate music and posted it on YouTube.

Ehlers posted a link to the video on Borchardt’s Facebook page, and when Borchardt made it to Everest Base Camp, she was able to see it, despite a spotty Internet connection.

The video came as a complete, and wonderful, surprise.

“I didn’t realize they were following,” she says of her colleagues. “I would talk about climbing so much at work, I thought they were sick of it. When I saw the video, it was so cool. It was amazing.”

To watch the video, visit http://www.youtube.com/watch?v=jkQS0BdnUQo.