 We're back. So today I want to talk about high elevation and travel. And so we're going to be joined by one of our favorite guests, Dr. McQueen Yvette. We had some live streams in the past where she came in and shared her knowledge about traveling, health and travel to be specific. And so if you give me one second, I'm gonna bring her in and we'll get started. Got a little clickety-clack down on the ground here. Hi, Dr. Yvette. Hi, how are you? Yes. Perfectly. Okay, great. Awesome. How are you? I'm great. How was all your traveling around Europe? Oh, it was fun, but Europe is so busy during the summer. So I prefer to do it in the fall, but I still had a great time. Okay, awesome. All right, well, welcome. And thank you for joining us today. So we'll start with the quick introduction if you want to go ahead and introduce yourself and talk about what you do, and then we'll take it on there. Okay. Hi, everybody. Thank you for letting me be on your side. I appreciate it. So I am Yvette McQueen, indeed. I'm an emergency physician and travel doctor, a global physician, on a mission to educate about health, travel wellness and disease prevention. I'm gonna go ahead and apologize about the lighting because I am sitting from a hotel and I'm trying to get the window lighting. There's a light in front of me, but it doesn't wanna move. So I actually assist travelers like yourselves to stay healthy and safe while they're traveling with my travel medicine advice, my books, I have book travel 911 tips and follow me and you can stay safe while you're traveling. Awesome. I like the book travel 911. I was gonna grab a copy, but I forgot, but I have a copy of it, but it's really nice. I highly suggest it to anyone who's watching to really get some general tips about traveling in general, whether you're just a new traveler or you've been traveling for a while, super helpful. Well, thank you. Thank you, Dr. Yvette for joining us today. I'm really excited. So we wanted to do this live stream in preparation for the group trip that we are doing to Peru. And it's going to be mostly about hiking the Inca Trail to Machu Picchu. And just to give some background to everyone who's watching today, the city of Cusco, where this adventurous traveling is located at about 11,000 feet. So one of the big challenges for traveling to Cusco and when the Inca Trail is high elevation. And so that's why we wanted to get some advice from Dr. Yvette to share with us things that we should know about high elevation, things that we should do and things to avoid. So maybe we'll get started. And if you want to help us understand first of all, what it's like to be at elevation and then from a medical standpoint, how does the body react? Why is it hard to be at elevation today? So yes, thank you. So like she said, high altitude. In your Peru, wonderful place to go travel, but you can also experience it even if you're hiking in the mountains, even here in the United States. So high altitude, your body responds if there's a change, we say 5,000 feet. Yeah, I can't forget how translate that. And someone can translate that in meters for me. So it's like if you go any change of 5,000 feet, your body's gonna respond to the elevation. And it's basically your lungs and your heart are infected. So your lungs are used to whatever altitude that you're to live at. So if you live at sea level, so even if you're in Lima, okay, Lima, Peru, you're at sea level, the beach is right there. And then you're going up to Cusco is actually higher than Muchibuchu because you go up to Cusco and come back down a little bit. But it's the air's thinner. So the cells in your body, I won't be too scientific, the cells in your body actually will receive the oxygen a little bit less. So that's why one of the best things they tell you is to acclimate. So one of the good things, if you're hiking, you're only taking so many feet per day. Is that what you're gonna hike on or are you just going straight to Cusco? So the adventure starts from Cusco, which is 11,000 feet. And then the trek itself starts at around 8,000 feet. And then we climb all the way up to 13,000 feet. I believe that's what it was. Yeah, the famous pass there is called, well, it's called the woman's pass for reasons that they will teach you about on the trail. But about a 5,000 foot elevation gain over the course of the hike. How many days is the hike? Four days. See, that's a wonderful pace. You don't try to do it in the same day. So that's the one thing. So when you go from like, from zero to 11,000 feet, you need sometimes the hours to acclimate it. So that first day, when it starts in Cusco, you're gonna just rest. And that's what they tell other people. One of the things is to acclimate when you have that change of pace. At first of all, you rest. You don't try to do any strenuous the first day and let your body kind of adjust and say, hey, I'm here, new altitude, new air. Give me a few hours to adjust. And then as you hike, and if you go over four days, you're doing a nice slow pace. You're not rushing and your body can adjust to that. Okay, awesome. I know one of the things that I noticed when we got there was that the Airbnb's or guest houses, they would offer us a coca-tea. And they say that it helps with the high altitude sickness. I'm wondering what are some other things that we can do to at least alleviate some of that pain that we get from being on altitude? Okay, so the first thing I tell people is stay hydrated. That's my number one tip to any traveling whatsoever, but definitely for adjusting is to stay hydrated. That keeps your blood moving, pumping. You won't get any sluggish feeling of stay hydrated. Yes, some of the Airbnb's and hotels, they actually have oxygen tanks I've heard in some rooms where they give you some oxygen. So if you feel yourself winded, the first thing is to stop and rest. Stop and rest. If you need a little bit more assistance, they will give you oxygen. Cocoa leaves or coca-tea, we don't know the mechanism. I'm gonna be honest. We don't know the science behind it that helps you do it. It's just one of those things that the local people, the native people of Peru knows that it works. So they know it works, do it. If you want to prepare ahead of time, talk to your physician. Before you leave or hike like that, you need to talk to your physician and say, hey, I'm gonna go into high altitude. Can my body take it? And certain people with certain disorders, particularly if they have lung disorders, people with asthma, COPD, which is like chronic pulmonary disease, people that if you have any blood disorder, like sickle cell, because your red blood cells carries oxygen. So you're having trouble already with your red blood cells because I know a football player that can't play in Denver because of his sickle cell. So, right, so they always have to sit that game out. So, yeah, so talk to your doctor ahead of time. They may give you some medicine. There's different types of medicine they can give you just in case you experience any high altitude sickness. And I'll go over those symptoms if you want me to. Yeah, I think that would be helpful to know what the sickness is. Okay. So there's, there's difference ones that I'm reading. This is like she said in my book, here you go. Travel 901. And actually I'm gonna read it straight from here. So the least severe one we call it is acute mountus sickness. So you would get a headache. A lot of people say you get the headache. And you just get that pounding headache that won't get away. You can get a loss of appetite. You can get very nauseous. You just feel like, oh, I feel, it's almost, I'm not gonna say flu-ish because you don't get achy, but you just get that headache. You get that irritability. Some people have trouble sleeping and just fatigue and exhaustion. And that's why they tell you to acclimate. If so, just acclimate, hang out. Don't go any higher because the higher you go, it'll just start to kick in more. So that's the first thing. So you use your cocoa teas, your medicine they give you or the oxygen. The next set, if you start to go higher and we get what we call high-altitude pulmonary edema where your lungs is not being effective, what happens is your lungs start to fill up water. Edema means water. So what happens is your lung used to, your heart's not pumping as effectively, pushing water back into your lungs. That's where you really puffy and puffy. If you can't go 50 feet and not struggling to breathe and you can't actually make a full sentence while speaking, you need to stop. And sometimes they tell people to descend or go back to the level where they felt better because your heart and your lungs will just start to fill out water. So you need to go back and get some oxygen. You might start to feel a little bit better. The most severe one is when it affects your brain. So you first of all, you get your headache, you nausea, you fatigue, and then your lungs start to fill up the water. You need to go back to a level that you felt better. The most severe one, that edema, it starts to accumulate on the brain and that one you don't want. So if you're hiking and someone starts to be, and I don't use this word lethargic very lightly, lethargic is basically, you're out of it. If I poached you right now, you would not respond. You just like, or you're not making sense. You're mumbling. You just incoherent and some people actually go into coma. That's a true actual emergency. They need to take you down immediately and see a doctor immediately for that one. Now I know when I've had different medicines in the past, I think the first time, Habib and I went to get a physician to prescribe us something, some of the side effects included sun sensitivity. And I think one of the primary differences between the drug Habiba was given and what I was given initially was that sun sensitivity. Are there any other side effects of note or any reason to prefer one particular medication over another for length of time you're above altitude or how high it is or how confident you are that you might be able to deal with the altitude or are they all same drug at the end of the day just for different people? This is what you did in Mount Kilimanjaro, right? Yeah, if I remember you saying that. Yeah, it's- Oh, I'm repeating myself. That's okay. So make sure you, when you talk to your doctor, first of all, I'll be honest with you, all doctors don't understand high altitude sickness, okay? So you might actually need to go to a travel clinic or a doctor that's used to that. Also, one of the medications, if you're allergic to sulfur drugs, you can't take. See the, see the solomite, A-Z-E-T-O something, something, something, something. See the solomite. If you are allergic to sulfur drugs and that's the one of ones we give people, you can't take that. So that may be a situation that happened. Yes, there can be like sensitive, which same thing with one of the drugs from malaria is like sensitive, but you gotta be somewhere that's like, you're gonna be in the mountains. It's gotta be that light, you know? Even though it may be cloudy, that UVA, UVB is still coming through though. So it's like sensitive. So it's just how's your body's react to it. So one of, let's see, what did I say here? So you plant it, you stay hydrated, avoid intense exercise immediately, particularly if you get short of breath and fatigue. They say eat a high carbohydrate diet. So all of those that avoid carbs, this is the time to eat it. Because you want that energy, 70% of the meals should be carbohydrates. At least once to two days prior to making that high person. I think we lost your audio there for a moment. I think we just lost you, Dr. Yvette. This is my nephatapine is, nephatapine is a what we call a calcium channel blocker. We give it for hypertension, you may see that medicine. And the other one they may give you is a steroid, dexamethasone, or decadron. It's a plus and minus whether the steroid's helping out, it definitely helped with edema. But then if you already have edema, it's too late. So sometimes they put you on ahead of time. If you're diabetic, be careful with taking the steroids. This is only increasing your blood sugar. And that's another thing, other conditions. Like if you're diabetic, you may need to adjust your medication, what you eat or your insulin, because you're using extra energy and your sugar may drop a little bit. If you are having heart disease at all, definitely see your doctor before making this hike and they will let you know whether it's appropriate or not. So the imperu, the cocoa leaves, they either chew it or make a tea. It sometimes would actually be what they call, go away. They actually will say it's an appetite suppressant too. So if you're drinking the cocoa leaves or chewing the cocoa leaves, you may not feel like you wanna eat as much, but continue to eat. And then your cheeks will become numb because sometimes they have a little numbing effect, but it's not addictive. It is not cocaine. So a lot of people will say, oh, I gotta go back and do a testing for work. Don't worry about it, it's not gonna show up. Can I ask you a question then? We've talked a lot about what's gonna end up happening if I have one of the high altitude illnesses or ailments that might come. But what are the sort of things that I could do if I wanted to send my red blood cells to the gym and prepare them for this particular trip up? Are there like a climatization hikes I can do well in advance as part of my training that will get my body prepared for that? Or is the discipline strictly showing up early and just giving yourself time once you're on the site? A lot of that, well, showing up early and giving your time on the site. But second of all, you have to also let your blood know that you're gonna be doing exercise. So if you're a couch potato and you go, say, hey, I'm at the Peru and you haven't been in the gym and forever. Yeah, I would advise to do some training ahead of time, at least six months ahead of time. And that's why that hike, particularly the way you're doing it is not for the lighthearted. Because I know a lot of people just say, oh, I'm gonna go to Peru and they get on the plane and they go up there. But then they're taking the train or going up to the Inca or even the rainbow mountain is even, was it rainbow mountains? I think 14,000, if I remember correctly. 16, I think it's way up there. It's either higher, yeah. So yeah, that's for the faint of heart. And some people, I know someone that did and she's like, I took the donkey. I did not try to walk it up there. So I'll put on donkeys on their trail, so. Yeah, so, but I would say train for it. And I know that I have a group that's going in December and I'm not a gym person. But I have started going to the gym and gonna start ramping it up, at least doing the walking, walking and doing the incline. Or taking myself, I've considered, sorry, taking myself to Gord, I live at sea level in Georgia, Florida. And I plan to make a few trips to New Mexico and Colorado within the next six months so that my body starts to get used to some of that. Cause I did used to work in New Mexico. And as soon as I got up there, I knew I would start huffing and puffing. So just to acclimate my body that no, hey, no, there's gonna be a change at least once a month. So exercise, get your body in tune to stimulating breathing more or actually your lungs breathing more, having that blood flow breathing more. But just do some burgers walks. Yeah, I think even when I talk about the group trip, that's what I try to tell people. I mean, it's not impossible, but if you are committed, then you have enough time like with our group trip right now we have five months until the group trip. And if you really go out there and train and prepare for it and then even understand because I feel like a lot of people don't understand even what the symptoms of high altitude sickness. And that's why we're trying to explain that through the live stream. But if someone, you don't have to be an experienced hiker in order to do this, you just have to be knowledgeable about what's going on and then prepare and train properly. Exactly, exactly, exactly. I've heard as well that there are people that'll run long distance marathons, other things like that that'll go up to altitude and we'll just struggle. And there's no way really around that. There would be some people who are otherwise not entirely active and they just handle altitude better and it's on a per person per person basis. Is that a true statement? I just want to make sure that I understand that correctly. Right, it's all about your own physiology, how your own blood works. So we all have different, so your blood is made up of two different cells, white cells and red cells and it's the red cells that carries the oxygen. So that's why I mentioned like certain, if you have blood disorder, sickle cell disease, thalassemia, some people with lupus sometimes have a problem that your blood is a little bit thicker and you don't make it think it's like, I don't want to say it's the difference in water or syrup but your blood's a little bit thicker which means it moves a little bit slower or then it won't carry the oxygen as well and it's all how everyone's made up. Okay, I think I'm reading a question here. How many days should you acclimate in Cusco before you start the hike? They say anywhere between, most people acclimate six to 12 hours and be honest with you, six to 12 hours. You go up there and you rest. You rest, you start breathing the air. You can take a walk around the little town, a little square, so you know, but don't go say, oh, I'm going running as soon as I get up there. I'm gonna take my morning jog. You may not be able to do that. So six to 12 hours. But if you start to hike, once again, the first thing you start to feel is the headache, that fatigue, that sluggishness and make sure you try to sleep even if you do have insomnia. So some people are prescribed some sleeping pills. That's up to you. There's different things you can take for sleep like the melatonin. Some people take Benadryl or they can take a prescribed one by your doctor. I remember when we arrived to Cusco because we were very excited. First time in Peru and we just was like, oh my gosh, we're gonna get there. We're gonna go out and see the city and go around the Plaza de Armas and explore. But we were so beat up with the headaches even taking the stairs to get to the second floor of our guest house was a pain. Right, and near the historic district, which is where we've learned a lot of people go is very hilly. So if you are walking down towns of some of those squares and plazas and such, you will be, you'll be working also. And this is why for the group trip that we're leading in November, I tried to plan it in a way that, okay, we're gonna arrive to Cusco and the first night we're just gonna have a group dinner and then the second day is gonna be walking around the city, not doing too much. And then the third day is an acclimatization hike. And then by that time, we will be ready to start the in control. So hopefully we'll do, the body would have adjusted to it. And I think that's a wonderful schedule. That's a wonderful schedule. Can I ask a little bit of an outside question then for a moment? I know some people that I've seen on the mountains training you some of the oxygen deprivation masks. And I've always seen them and I've been very curious as to what it would be like to have one or what they would even feel like doing. Are they a reasonable way to try to train your body for being an altitude as well if you can't get away from your natural altitude? Or are they more commercial show? That's interesting. I'd be honest with you, I've never had known anyone that does it, but I guess it's trying to train your body to say you don't have enough oxygen, how are you gonna react? Sure. But I would say definitely be having a control situation. Yeah, I don't know anyone that's used it. So I wish I could answer that question for you. They remind me of the mask that you would see Bane wearing in the Batman movies and such. There was a notorious man in Arizona that we would see going up and down the, what's the one, Camelback Mountain right in the middle of Arizona. And he would use the mask all the time and he became very, he was very recognizable. Okay, Camelback is only about 4,500. Is that, that's not that high though, right? It's not that high, but it's a popular hike to just train in general. So some people would wear masks to reduce the level of oxygen in them. Yeah, but it was just very interesting because even if it's not high, it was a difficult hike but people would do that as a way of training. Yeah, cause someone said try short hikes at first before going to the higher altitude. Right, so try those short hikes. And that's why I say I do like either go to New Mexico or Denver cause you know, that's like me changing. And as I can say, if there's any change of 5,000 feet if anyone would calculate that in meters, you can't but there's any change of 5,000 feet your body knows the difference. Okay, so I have a specific question about the trail. So we do everything that we can when it comes to training and preparing and we are hydrating following on the rules. And now for a person who's already hiking on the Inca Trail, we will have guides and usually they know how to assess the situation if somebody's not feeling well. But I wanna understand like at one point do you distinguish between okay, this is me pushing myself harder than I'm used to and this is the point where I should know that my body is not handling this, I should go back. Like what type of symptoms or indications can help us make that decision? Okay, yeah, so one said water is necessary, so hydration. So the difference is your body, you're struggling. The difference is like if I'm walking, say if I'm walking, as I'm walking I'm starting to breathe different and my steps are getting shorter and I really can't breathe. I mean you, the difference is, I'll be walking up the hill. Okay, walking up the hill versus. And you really, I mean you really take those deep breaths you can't go 10 feet without actually stopping. Your head starts, you just start to swim. You start to feel like you can't think or actually function. You just need me to stop. Your body lets you know when you can't go on and you really do need to listen to your body and it's not just, I haven't walked a mile in a day and it's a little exhausting and I'm just exerting myself. This is actually where you actually struggling. You're struggling to breathe and you know and it's almost like a suffocation because that's what happens when water gets in your lungs you actually start to feel suffocating. Did that answer your question? Yeah, absolutely. I think it's just sometimes because I know when I started hiking and especially hikes like this that I wasn't used to at first I always question, oh my gosh, like is this just me trying to persevere and be strong? Or is it the point where I should just turn back? So sometimes it's not clear to just listen to your body and make the right decision. So Alan just mentioned about minimizing backpack weight without risk and that 30 pounds of altitude can feel like 50, 60 pounds and that's totally true. Okay, yeah. So I don't know how you're doing but people are taking the backpack. I know sometimes you guys hike with the water backpack okay. Yeah, so. So for the NP trail for this particular hike, the way it goes all you really have to carry with you is your day pack which is 30, 35 liters usually and you just throw in water, snacks, poncho, rain jacket, some layers and you know just the essentials for day hikes and then you have the option to hire porters which thank God they are there because they do help any excess gear that you don't need for the day hike. And when we did the track, we made the mistake of packing everything on our own which was not a good idea because like Alan said, just 30 pounds can feel like the double when you are going uphill. And you're trying to prove something. Yeah, and two let's go, you always gotta remember if you're coming from North America going there it's the opposite season, right? Yeah. People have to remember it's the opposite. Yeah, yeah. So you think oh I'm going in November, December and it's gonna be where it's gonna be cool and I'm gonna be, but yeah, like you say layer clothing makes a difference because if you, there'll be a difference between am I doing this because I'm overheating because I have too many clothes on and I can just like do a little peel off and then add to it or versus if my body's responding. Now I was gonna ask as well then, I know for people that want to go up this high there's usually a different type of travelers insurance that might come with that as well. Are these things that would fall under the purview of a conversation about medicine like this or is that one step too far removed for me to ask questions of? Okay, so travelers insurance, buy it. I'm just gonna go and buy it. But there are different ones, particularly like you guys are experienced hikers, you hike everywhere and I don't know what type of travel insurance, but there is different ones for people that do say if they knew they were gonna be doing the bungee jumping or whatever, what they call adventurous ones. If this is just an average trip, which, you know, people go to Machapuchu all the time. You know, it's considered a tourist spot. The regular travel insurance should cover it. What I will tell you is make sure it has a medical component. So it's not like when you get your airline ticket and you just check that extra box. That's gonna cover the airline. Sometimes it doesn't cover medical insurance. Make sure you are going to an actual company that does medical, that does travel insurance and it says the medical on there. Like you have, it'll cover you by 5K. It'll say 5K is covered if you need to be, you know, seen by a doctor. It covers evacuation, at least 25K because if they need to, for some reason, you get sick enough that they need to put you on a plane and take you back down to Lima. You know, you want that 25K coverage for them to put you on that medical airplane to take you back down. So. So yes, to travel insurance. Yes. We always suggest travel insurance because you just never know. By the end of the day it's a personal choice but I think it's always a good idea. I know some places require a high altitude insurance as well. I don't think that proven across is the line though. So I don't think that anybody would need to consider something that high. Now, that's like Mount Kilimanjaro. That's you forcefully saying, I'm gonna hike Mount Kilimanjaro. I'm going up in the Himalayans that where Peru, like I said, that's just your normal tourist spot that I don't think you need to specialize one for that. Okay. We have a comment here about yoga and breathing exercises and if they can be helpful in this case. Exercise once again. Don't go from being couch potato to doing this but it's, that's gonna help you with yoga. Of course it's gonna help you mentally. Yoga is gonna help you with the muscles, the stretches and that's gonna help you with your rib muscles. Okay. I have another question about not related to altitude but just general travel safety in Peru when it comes to avoiding water or food contamination and things like that. You've been, so you can let me know but my general thing is if I'm not used to the area and my GI tract is not used to the normal bacteria, the area I use filtered water or bottled water wherever I go. That's just me in general unless, in the hotels they'll tell you we have filtered water. We have our hotels filtered and that makes a difference of whether you brush your teeth with the faucet water versus your bottled water. If I'm insured at any point I'm gonna use bottled water to even brush my teeth, put on my toothbrush, things like that. That's just general water anywhere. And on the trail actually because this question came up the other day because the porters and the guide will be providing the hikers with water every day. So the way it works on the mountain the chef would boil a large quantity of water to make sure that the water is good to be consumed. They let it sit there for a little bit to cool down and then they would give it to the travelers. Oh, that's wonderful, boiled water. Yes, boiled, I mean like so if you're going somewhere and like in India people drink a lot of tea, I'm okay because we know that's steaming hot. So boiled water is good. Some people also take some tablets, I forgot what they're called, but they have acclimatization tablets or purification tablets. You could take those and always add to your water if you're insured or they now also make a neck on call the company because I'm not endorsed by anybody, but they make bottles that where it actually has a filter to it that you can actually put it in the bottle and it filters through like carbon filter, whatever to make it filter water. Awesome. There's another comment about having adequate supply of thermal blankets on hand like thermal blankets of the emergency blankets. I would assume that's what a thermal blanket means in this case, but anything to keep you warm, I'm assuming would help you as you make it colder if you were dehydrated or running thin up top. Am I going too far in what I'm guessing there? No, I mean, I think they're probably thinking that a mountain's getting too cold. That's like hypothermia. Okay. There's usually, I think in the small emergency kits like every emergency kits would have a thermal blanket. So it looks like an aluminum. Exactly, yeah. And I remember one time we were hiking to the Grand Canyon and one of the hikers was just not a hiker at all, never trained and then just showed up and just started shivering so he couldn't keep the temperature of his body inside. So they ended up wrapping him in thermal blanket like that. Okay. Awesome. Do we have anything else? I don't think I have any other pertinent questions pertaining to altitude, no. Okay, this was awesome. Do you have any other tips traveling to Peru that would be helpful to people and I think we're still getting some questions about really anything that can help somebody who's hesitant about going to Peru because I know it's not the easiest destination to travel to, but at the same time, it's not the craziest destination to go to. Yeah, it's not crazy. It's not crazy. Someone asked, would you be light? No, please. Purification or bullet, you'd be light, no. For water. I can say just once again, listen to your body. Once again, listen to your body because your body is gonna be honest and true to you about the hike and whether you can complete it and let someone know always. I will always have, of course, I'm sure you tell people have a buddy system, let somebody know, particularly if you're on this hike and you do have a medical problems, I know a lot of people like being secretive and know it's my body, know it should know. Have a buddy system that somebody knows that, hey, I do have a little asthma and if something happens to me, here's my inhaler. Because if you pass out, someone's gonna be like, what's wrong with them, where do I go? So someone should know in your system what to do. Good shoes are gonna be very important. I'm sure you go over that about type of hiking shoes because if your legs and your feet and your legs get fatigued, it's gonna actually draw more of your hydration. You get what we call lactic acidosis because the muscle breaks down into this molecule called a lactate and it builds up your body. It's a big molecule and usually the kidney can filter it but if you get too much, it's like trying to push a lot of stuff through a filter that won't go and hydration is okay, hydration is okay. So if you started to feel your muscles are fatigued and sore, drink more water, more water, more water. Get laid, cramping, drink more water, water, water, water, water. Awesome, I think sometimes when you're hiking, it's just like when you're feeling good, you keep hiking, you forget about the water until it's probably too late. That's why I like the water bladders that you can have on your camel back and then you just have the tube close to you. This way you can hydrate all the time and just cough and take a bottle from your back. The point too is to go hydrated already. So a lot of us are normally dehydrated and I say when I see people in the hospital, I just assume they're a leader down. I do, everybody needs a leader. So just like you're training for the hike, train your body to receive the water because if you flood yourself, your body with water it's just gonna pee out a lot but if you used to intaking that amount of your normal body water, then it's gonna use and stimulate your blood and cells. So the formula I like to use is the normal daily intake of water should be half your body weight and ounces, okay? So you can translate that to liter kilograms but say if you are a 150 pound person, you should be drinking 75 ounces of water per day. We're like, that's a lot of water! But that's just the normal, that's just the normal. That's not even adding the extra that you need. So yes, when you started doing that and people were like, well, then I'm gonna have to pee and then I'm gonna have to get off the trail. But if you've done that over the month ahead of time before you start hiking, your body knows how to handle that and you're not gonna be running to the bathroom all the time. I was afraid you were gonna say 75 pounds of water, I was gonna say, I should lose some more weight. Ounces, so it's pounds to ounces, yeah. Half of your body weight and ounces. Oh, one more thing about, so dehydration, we talked about, what about nutrition on the trail while we're hiking? I know you mentioned that we need to load up on carbs maybe the days before and they do a great job of feeding us all great food on the trail. But then just in between, let's say we start, we have breakfast and then we hike for five hours until it's time for lunch. Yes, we still need to make sure that we are having some snacks or eating food on the trail. Yeah, you make sure, because once again, I say hi altitude will make you feel like you don't wanna eat or suppress your appetite. I know a lot of you are like, oh, I'm gonna do a protein bar. I think your snacks should be high energy one. You can do nuts and things like that but high energy ones because the protein, once again, it's a big molecule. Yes, the protein helps with the muscles, but it's gonna be a big molecule trying to be filtered through your kidney and it's gonna be competing with everything else. So that's why they say stick with, but snacks are good. What about things like the high density, nutrient dense sort of goos that you would see other on the go athletes? I know they're already very easy to digest in terms of they're not food that you have to chew up and then are they worth it or are they not helpful in this situation? You mean the commercial ones? I think I like Gittering goo or other ones like that. I don't know what else they would call them or goos. I don't know. You know, yeah, just eat regular food. I will say one of the, to stick, keep up with your electrolytes. I have found one of the good things is who do I have in here? It's called the high IV hydration packages. Yes. Liquid IV. Liquid IV. Liquid IV, that's a liquid IV. So yes, so you put it in, it keeps up your electrolytes and it's not as high as in sugar as some of the other ones. And I did see recently they now make it sugar-free. Oh, that's perfect. I was actually just the other day talking to a friend. The liquid IVs are great. You just throw them there for us, but I don't like the high sugar in there. Just, it's nice to hear that they are coming up with the sugary ones. They are, yeah. Awesome. I think that's it for us really. Yeah. If you want, we can give you the floor for a moment. You just tell us what you have going on or anything you want to say about your adventure, your story here. Sure, so once again, you know, like I say, I'm a travel medicine doctor. I do travel the world, but I also recently, I don't know if you know I'm actually have become a travel advisor. So I'm a certified advisor. I know another thing about pocket. So I do plan group trips myself with my professionals and I cater to physicians, mostly to physicians, groups that want to travel because I give them continued medical education where they can actually get lectures and use their education money to take these trips. Then they're culturally emergent or basically some of them are pampering. So my site, if you want to check me out is MedQueen, that's M-E-D, Queen Tours, T-O-U-R-S.com. You can go to that site. I talked about my book, Travel 911. It's good for everybody. It's written for the non-medical person. And you know, we talked about high altitude sickness, but it also talks about jet lag, blood clot, traveler's diarrhea, give a little first day kit. So if you're hiking and you need to make a makeshift splint for your ankle or your arm, it's in here, okay? And you can get this on Amazon if you want it electronically, Books of Novo, or you can go to Travel 911 book. I keep things simple, Travel911book.com and I will see you in your copy. Awesome. And by the way, about the book, I do have an extra copy. So if anyone watching us right now is interested in grabbing the copy, just send me a direct message and I will be happy to send you one. So first message I receive, I will send the copy of the Travel911. And it's a really, really nice, easy read. I remember the first time I had it, we just read it on the way to Kilimanjaro when we were going to Tanzania, very easy read. Great, thank you for the endorsement. Yeah. And for about the group trip, this is happening from November 6th to November 16th. This is a hiking group trip. So we will be hiking the Inca Trail alongside with other trails in Peru, like Rainbow Mountain, Lake Muay Thai. So if you guys need any questions about the detail day by day itinerary, just send me a message and I will be happy to share that with you. I think we can probably wrap up. Thank you so much, Dr. Yvette McQueen. I just love that you give us all your time, all the time whenever it comes to learning about healthy things to do while traveling. So we really appreciate your time. Well, I hope you have a great trip. You know, if you're hiking there and you got wifi and you wanna text me, you know you can't. Awesome, awesome. Thank you, thank you so much for your time. Thank you, Dr. Yvette. Yeah. All right, have a good day. Bye. Bye.