Comitato per l’Educazione Terapeutica organizzazione non lucrativa di utilità sociale

4th DAM Meeting, “-2015” by Aldo Maldonato

Here we go again! The group of mountaineers with type 1 diabetes that has already climbed in 2012 Gran Paradiso (4061 m) and Tresenta (3609 m), in 2013 Castore (4228 m), Liskamm Nose (4272 m) and top of Mt Blanc (4810 m), and last year the Mischabel (4545 m), this year spent a week around 4000 m, again in the , , making base in the village of , Val d'. The mountaineering moments were alternated with meetings of Therapeutic Education, both with AM who took charge of organizing this new adventure, and with Jean Philippe Assal – the European father of therapeutic education – and with his wife Tiziana who for some years has collaborated with him enthusiastically. The suggestion has come as usual from Marco Peruffo, who for many years now keeps sharing his exceptional experience of diabetic mountaineer “in altitude” with common humans – affected or not by type 1 diabetes. His proposal arrived in January and found me in a delicate moment, because had just made a “coupon” that had put me back into shape, but had a little cracked my securities. Marco's stimulus served to remove doubts... and I started with the organization. The first answers were even too enthusiastic... so much to make me wonder if it was not the case to close the enrollments. Then, after reaching numbers that threatened to blow up the meager budget of the Comet, there were several waivers: most of them were timely due to family or work reasons, and two at the last minute due to slight indispositions. I wish to clarify here that the ComET sponsored the safety of the initiative by recruiting 7 professional guides, and it gave a small contribution to the few who asked for it, but for the rest the participants paid from their own pockets and there were no other sponsorships. In short, we finally returned to the usual number of participants: 8 people with type-1 diabetes, 1 with multiple sclerosis, a very involved spouse and two "older" diabetologists (besides me, the indomitable Gianfranco Poccia from l’Aquila), both not yet affected by diabetes but already endowed with a rich heritage of various ailments, more or less related to age. To represent with a logo the spirit that guides us and binds us, Marco has commissioned and produced, thanks to ADiQ, the symbol of our meetings: “Diabete & Alta Montagna”, where the conjunction consists of a mountain rope wrapped in a figure-of-eight knot, also called true-love knot . Originally the mountaineering project was to reach the Cabane de Mountet (2886 m) on the first day, starting from Zinal (1675 m). From there, make two excursions just below 4000, then go down in the valley and rest one day. Then reach the Cabane de Tracuit (3256 m) and the next day try the summit of the Weisshorn (4505) from its long and challenging North ridge. Unfortunately, the conditions of the mountain since mid-August had become too dangerous and even before leaving, we knew that the Weisshorn ridge was now impassable due to too much snow. The educational project included 2 afternoon meetings of 1.5 hours each in the refuges, a 3-hour afternoon meeting in the hostel in Zinal, and two final meetings with the Assals: 3.5 hours on Saturday afternoon and 2.5 hours on Sunday morning before leaving, and so we did.

At long last, after so many preparations, here we are converging on August 23rd from Abruzzo, from Lazio, from Veneto, from Piedmont and from Lombardy to Zinal, where we arrive around noon and we find the Assals to welcome us for a brief greeting. The weather forecast indicates rain for today and tomorrow, but good weather starting from after- tomorrow and for the rest of the week: it will turn out to be exact, and in the end we can consider ourselves really lucky. The first ascent to the refuge takes place in the rain for almost half the 4 hours necessary to climb the moraine of the , crushed under our of 12-15 Kg backpacks. The glacial amphitheater that surrounds the Cabane de Mountet can just be guessed through the clouds, and at the refuge we find the Swiss guide Armand Salamin, who greets among us also our "historical" guide, Piero Bosetti from Cortina d’Ampezzo, whom he already knows from last year at the Dom; the other two Swiss guides, Romain and Christian, join us shortly thereafter. The refuge is ancient, but refurbished and very well maintained by a family of really kind managers. The fact that it is practically empty and that we are almost the only guests does not hurt ... On the 24th, as expected, drizzle or snow and the guides offer us a “walk” on the glacier. Since the weather will adjust to open in a beautiful rainbow, the walk will turn into a 900m climb to reach the sharp ridge that connects the with the , at an altitude of 3750 m. The overcoming of the terminal crevasse on a precarious snowy bridge (that we have baptized Pont Gruyère) will give us some shiver, but Romain will assure us beyond the crevasse with a "dead body" buried in the high snow. In the afternoon, taking advantage of the calm offered by the refuge, we make our first educational meeting, sharing everyone's expectations for this week at high altitude, and addressing the first problems encountered by some in adapting the therapy to the new exercise regime. On the 25th weather is good, but when we leave for the Trifthorn (3728 m) at 5 in the morning we do not know yet because it is dark and the refuge is wrapped in a thick fog that will last until the afternoon. Finally, after an hour's march, at dawn the sky appears quite clear and the profiles of Zinalrothorn, Obergabelhorn, and Grand Cornier stand out clearly. Among these giants our goal (shown in the picture by the wash) appears not without its sharp dignity. Only one participant, not accustomed to snow and ice, and who had come with the

intention of just reaching the shelters, limits herself in both days to a nice walk on the glacier, and does not face the steepest slopes. Back to the shelter, after a quick snack, we walk down the long descent to Zinal, where we will arrive all quite exhausted after more than 10 hours since awakening. Thank goodness that the Auberge Alpina is very relaxing and that tomorrow is resting! At dinner we have the pleasure of having as guests Tiziana and Jean-Philippe Assal who, observing us, are rightly more concerned with the fatigue of diabetologists than for the conditions of diabetics! The morning of the 26th is so beautiful that some are tempted by a nearby rock gym, while others go to visit the dam and the Moiry glacier, upstream of Grimentz. In the afternoon, during the long education session, the critical issues encountered by some in the management of diabetes during more or less intense efforts are discussed, and the role of stress in the control of blood sugar is underlined, both under normal conditions and in the case of type-1 diabetes. The “fondue” dinner tests immediately the ability of the participants to prolong – in some way – the action of the insulin “bolus” to prevent the late rising of glycemia due to the proteins and fat of so much cheese . On the 27th the good weather continues and, starting at 10 full load for the Cabane de Tracuit, we are very pleased that the first half of the climb is still in the shade. We reach the refuge in the 4 h 10’ foreseen by the signals on the path, but the fast ones of the group employ a lot less. Marco, who has been waiting for the arrival of Italian guides from Vicenza (Ferruccio, Andrea and Carlo), impresses everyone by climbing in 2 h 15’. Even his management of diabetes arouses the admiration of the participants: thanks to his attentions and the help from Sara, who is very careful and competent in particular on the calculation of ingested carbohydrates, his blood sugar fluctuates almost always between 100 and 140 mg/dl, very rarely exceeding these limits and never very much. The Cabane de Tracuit, super modern and technological, stands at the antipodes of the previous refuge, not only because jam- packed with 120 people, but above all for the lack of kindness of the managers. The beautiful weather, however, and the full moon rising after dinner just behind the summit of Weisshorn make us soon forget the inconveniences. The 28th is scheduled as the most challenging, in which the group will split: the less experienced or less fit mountaineers will point to the summit of the (4153 m), while the others, having had to give up the inaccessible Weisshorn, will point to the Tête de Milon (3693 m) along a rocky ridge, the Crête de Milon, of almost 700 m in altitude, with steps of 4th and 5th degree, which starts at 2980 but can be reached going down much further along the path of access to the shelter. Given the difficulty of climbing at high altitudes, each guide will have only one client, while Marco will always make an independent roped party assuring his wife Sara and his nephew. Once had a quick breakfast at 5, observing the incredible rules imposed by the sour “guardienne”, we immediately divide into two groups, greeting in the light of the front lamps: the smaller goes up and the larger... goes down. The roped party aiming at the Bishorn, led by Armand, proves to be tight-knit and trained, surpassing dozens of other teams which left before them, reaching the summit early, and returning to the refuge before everyone else, already at 10:30 am. The group headed to the Crête de Milon strenuously reaches the start of the route in two hours, and divides into six roped parties: five of two and one of three. Also these parties rise quite quickly appreciating the beauty of the route, which is sometimes very exposed and generally not "very clean", perhaps because it is not frequented. Some also face some more difficult passages, while others, perhaps a little uncomfortable with their heavy boots for high mountains, prefer to get around one or two technical steps. After six and a half hours we reach the end of the route, almost all of us quite tired, and more than one, looking at the jagged north ridge of the Weisshorn in front of us, wonders if it would have been within our reach, considering difficulties and length of the route. But we are all happy for the result achieved in this spectacular environment and, after a reasonable stop and a quick descent on the glacier, we return to the refuge. For the 29th we plan the descent to Zinal in the morning and a risotto for lunch, before the afternoon meeting with the Assals. But the appetite comes with eating, they say, and in this case it is about hunger for peaks more than risotto: the bright exploits of ours on Bishorn convinces the "fast" of the group that if they leave early and pull straight, they too can reach the top of this "easy 4000", to quickly descend to the refuge and then down... to the midday risotto. So, while 4 of us descend quietly downstream (including me, who have already been on the Bishorn on August 19, 1990, even if I have a bit “dark” memory of it), two roped parties of ours, led by Piero and Marco accomplish this beautiful extemporaneous project, taking advantage of a wonderful time, and getting to have a close look at last year's Dom, and at the Weisshorn... of a future year. The quality of the risotto not really excellent (despite the great commitment of the sympathetic chef) may not have been an adequate reward, but having reached it on time for 12:30 was certainly a reason for satisfaction of the heroes and admiration by all those present. In the afternoon the Assals surprised and impressed us, first with a nice visit to the old village of Grimentz and with the presentation of the ancient site, still in use, of the village "Bourgeoisie", with annexed ancient wine cellar and aperitif with the wines it preserved. The main course, however, was the presentation that both made then for us. Jean-Philippe showed us his movie set in Venice, where Therapeutic Education is seen in the care of gondola manufacturers, in the delicacy and teamwork of Murano glass blowers, and in the endless rhythms that characterize the lagoon city; then he showed us an excerpt of the educational activity that has fascinated him for the last several years: the theater of experience, provoking many questions. Tiziana then conquered everyone with the illustration of her painting workshops, through which she manages to let patients express feelings buried deep in the conscience, often helping to solve situations that sometimes constitute real diseases. The conclusion was up to this wonderful day, with an excellent raclette, which for many of the participants was a discovery, pleasant and challenging at the same time. On the day of departure, at 8 am I asked the participants to write in the most detailed way possible “What I bring home after this meeting”. After half an hour, at the arrival of the Assal, we anonymously ‘returned’ the newly completed scripts, and then, after a brief interview with Prof. Assal on the reasons that led him to deal with Patient Education, we said goodbye with a big “Arrivederci!”

Rome, September 10, 2015 Aldo Maldonato

I thank all the participants with affection: Alberto, Antonella, Edoardo, Federico, Luigi, Miriam, Pietro and Sara. I sincerely thank Gianfranco Poccia and Marco Peruffo from the heart. A heartfelt thanks also to the guides: Piero Bosetti, Armand Salamin, Romain Tavelli, Christian Hofmann, Ferruccio Svaluto, Andrea Basso and Carlo Cosi.

Zinal, Valais (CH). August 30th 2015.

What do I bring home ...

✍ “... the new companions, different from one another, but all with a great desire to learn.” ✍ ”I take home a baggage lighter than the one I started with... My backpack is now rid of the fear of being alone...” ✍ ”... I learned so many management possibilities from my fellow adventurers...” ✍ ”... so far I thought that the management of this disease was well conducted by me. I realized that it was not really the case. So many things I only partially knew... “ ✍ ”... I was very impressed by the Assals, the way they work and their words on therapeutic education...” ✍ ”... I immediately thought that our week was very similar to the experiences proposed by the Assals: going to the mountains makes you aware of yourself, puts you to the test and forces you to risk, highlighting all the limitations and problems. In this, however, as in the theater of experience, we were supported by professionals (especially guides but also diabetologists) who, like the director at the theater, have accompanied us in the experience by making available for us the techniques that we did not master...” ✍ ”... I could see with my own eyes that those who know better themselves and their illness, as well as their therapy, manage better their blood sugar in extreme conditions... I had the confirmation that sharing helps patients to bring out their doubts, then they come out of such an experience with more knowledge, more certainties, more skills...” ✍ ”... I bring home a climate of sharing during meals and the sense of connection during the climbs that have been lived in group, united despite differences in experience and degree of preparation... I bring home the desire to live the Mountain beyond the summit, finding balance and serenity with myself and with those around me. "