Jun 30, 2009 at 5:12 pm #1237452
Companion forum thread to:Jun 30, 2009 at 6:55 pm #1511423
I've had AMS twice now in the Andes and have helped friends through bouts of their own in the Himalayas. I can sympathize with Jeff. The fatigue and desire to sleep is very overwhelming and going down is the only way to get better. A few thousand feet of descent can make a significant difference and is a very fast way to address the problem assuming you are still mobile.
A competent leader must be able to make the decision to turn around or change plans for the victim/group because AMS will rob you of the judgment to make that decision for yourself.
Depending on the size of the group having a plan in place in case the trip leader gets sick. With small groups of competent people decision making takes place differently than with less or inexperienced groups led by one individual.
Health conditions before going into a trip have played a significant factor on both of my incidents. Any lingering colds, coughs or respiratory illnesses can quickly lead to problems at altitude. One's health does not get better above 10k…it only deteriorates. Best not to head up unless you are 100% healthy.
Good write up. I'm always interested in reading what others keep in their first aid kit and learning from their experience. More articles of this nature are welcomed.Jul 1, 2009 at 5:52 am #1511475
@kamperdaveLocale: VA, DC, MD
This article comes at an interesting time for me. Myself and two friends are heading to Absoraka-Beartooth in MT for a 5 day backpacking trip in early September. We are all admittedly fairly new to backpacking but young and in good shape. Unfortunately since we live on the east coast the highest elevation immediately available is generally around 4000 feet max.
We'd planned to camp out the first night in a regular car camping site and begin hiking the next day. The highest elevation on our route is just around 10,500 feet, which is inconsequential compared to the Andes or Himalayas, but I wonder if there are any precautions we should take based on elevation, particularly because we all live pretty much at sea level?
I'd very much appreciate your insights.
-DaveJul 1, 2009 at 6:09 am #1511477
Taking advise based on other people's experiences is risky because each person handles altitude change differently. If you stick with standard protocol until you know how your body reacts with altitude change, you will be better off.
Here is a website with some good basic information. altitudehttp://www.princeton.edu/~oa/safety/altitude.htmlJul 1, 2009 at 6:20 am #1511478
@kamperdaveLocale: VA, DC, MD
Bill – Thank you! That link is very informative.
Seems silly asking about altitude precautions in an area that is some of you guy's back yard but I'd rather over-prepare in the knowledge department rather than be surprised.Jul 1, 2009 at 7:13 am #1511483
@dgpostonLocale: Texas / Colorado
I'm heading to Colorado in 10 days for a 11-day excursion along the Colorado Trail. I live in Houston, Texas (elevation 60'). Every year I have gone (this will be my 3rd summer bpacking there), I have gotten sick and vomited, then got better once I acclimated. In 2007, I flew to Denver and then woke up the next day at 6:00 to climb Mt. Bierstadt (a 14er). I made it to the top, but on the way down got really ill. When I got back to Denver (5280'), I was much better and slept. Two days later I went backpacking in RMNP and was fine. In 2008, I dayhiked a couple days at around 10000' before going on an overnighter where I camped at 12000'. During the night, I felt really sick. We hiked out the next morning and I vomited on the way down. The next day, we headed out for a 4-day trip in the Weminuche and I was fine (albeit tired).
Should I take Diamox ahead of time to prevent this cycle this year? Are there any side-effects?Jul 1, 2009 at 8:13 am #1511491
@hikinggrannyLocale: Gateway to Columbia River Gorge
I did a lot of reading about acclimatization last summer after having problems in Wyoming's Wind Rivers. While I had studied about altitude illness in a WFA class, I'd never experienced it because I grew up in Wyoming and Colorado and never had any problems. However, I've lived at or near sea level most of the time since and done most of my backpacking in the Cascades at altitudes of 5,000 to 6,000 feet. I didn't develop any severe symptoms, but it sure slowed me down!
It appears that you didn't adhere to the two rules of acclimatization: Climb high, sleep low for several days, or don't raise the altitude of your sleeping place more than 1,000 feet per day.
For your first trip, you basically went straight from sea level to 14,000 feet.
For your most recent trip, you did the right thing the first few days (climb high, sleep low), but then you raised the altitude of your sleeping place by 7,000 feet. Altitude sickness is more apt to show up while you're sleeping.
In your shoes, I would plan the trip around the acclimatization criteria: two-three days of climb high (10,000-11,000 ft.), sleep low (maybe sleeping higher than Denver the second night, at 7,000-8,000 feet). After that I'd start camping at an altitude a bit lower than the one to which I was climbing (maybe 8,500-9,000 feet) and try not to raise the altitude of my sleeping place more than about 1,000-1,500 feet per night. That's what I'm planning when I go back to the Winds this summer.
You might want to hold off on climbing 14ers until near the end of your trip.
If you still get AMS symptoms with such a regimen, then it may be time to try a preventive diamox program. However, you might want to talk to your physician now and take some with you in case you do develop AMS (but take it at the very first symptoms–Jeff's story demonstrates that you shouldn't wait until you're really miserable).
I personally would not try to substitute drugs for a proper acclimatization program. Your mileage may vary, though, especially if your vacation time is very limited.Jul 1, 2009 at 9:56 am #1511506
@swimjayLocale: Northern California
A few years ago I tried taking Ginkgo Biloba for several days before and while on a trip which took me from sea level to 9500 feet the first day, and then to 13,000 on the second. I had no symptoms of high altitude sickness (though I have at other times–principally an intense desire to sleep and sometimes a feeling of nausea akin to motion sickness, plus, sometimes, a general desire just to die and get it over with–not unlike the way I've sometimes felt being on a small boat in choppy water).
A quick google search turns up the following links:
There doesn't seem to be any hard science yet, though I first heard about the effects of Ginkgo more than 5 years ago. Admittedly, if this was a bullet-proof solution you'd think it would be gospel by now, so…Jul 1, 2009 at 1:06 pm #1511561
@verberLocale: San Francisco Bay Area
Nice write up. Thanks! My understand is that there was some initially promising data on the effectively of ginkgo such as was briefly mentioned in High_Altitude Illness by Hackett and Roach published in NEJM
BUT I am pretty sure there was some very extensive study completely in 2007 which found no evidence of ginkgo biloba was effective. I can't find the study right now :-( I have several friends that take ginkgo on the theory that it won't hurt, and it might help.
There has been a bunch of discussion about acclimatization. Taking the time to acclimate is certainly the safest and most reliable approach.
It's worth noting that people react differently, and that people's reactions can very over time. I had a friend who always gets sick if he sleeps above 8k ft… and consistently gets sick if he goes up more than 2k/day after that. If he doesn't want to get sick he always starts the first night at 7k… and plans his route to stay under 2k gain each day. I have another friend who had been on tens of trips where he went from sealevel to sleeping at 12k ft in the same day. Then last summer we went from from sea level to 9k and he got sick enough that we headed back down the next day. As they say in the stock market past performance is no guarantee of future performance.
–markJul 1, 2009 at 5:12 pm #1511601
One factor that effect one's acclimatization over time is that the real factor behind Altitude sickness is the drop air pressure. This varies with elevation of course but also varies spatially and temporally based on climate, weather, temperature, latitude. It's not a homogeneous effect where all over the globe at an elevation of xxxx ft/m is equal to xxx Air pressure.
You can go to the same peak/mountain range and get sick one year and not the other. Your body can react differently everytime because of the variety of factors effecting it, with elevation being only one of several factors (albeit the main one).
Rather than being focused on elevation alone, which is a guide. It's best to monitor your bodies' reaction to the altitude every time you head up and not take any previous experience at said altitude as a given that you will be alright.Jul 1, 2009 at 5:54 pm #1511606
@swimjayLocale: Northern California
I'm not sure about this, but I think that one of the physiological changes accompanying altitude sickness is a drop in the pH of the blood–the blood becomes more basic, as carbonic acid is removed from the blood. This is a complicated response to change in atmospheric pressure, but may be exacerbated by excessive panting, blowing off CO2 more quickly than it is being formed, which can be a reflexive reaction to a general sense of not having enough air. I've found that the fitter I am going into a trip, and the lower my breathing rate, the higher I'm able to go before I start to feel a bit, or more than a bit, off.
A doctor friend of mine once pointed out that true acclimation would take quite a while (increase in blood hemoglobin , etc.), but the body has some kind of interim process that can make a difference in days, not weeks.Jul 1, 2009 at 6:00 pm #1511609
There is a delayed reaction in your bodies' reaction to a sudden change in altitude. You may feel better in the first 12-24 hours vs. the next 2-3 days. This can mislead you into going higher than you should or give a false sense that all is OK. Hence the need to be conservative and stick with a moderate climbing rate.
The Feb issue of Trail Runner Magazine had an article about this specific issue with strategies for low elevation runners having to compete at elevation.Jul 1, 2009 at 6:48 pm #1511619
@alfrescoLocale: San Francisco Bay Area
I find that to combat altitude sickness, I have to stay VERY hydrated – I drink way more than I think I need to. I've experienced problems a couple times in the past. Since I started drinking lots more water when I know I'll be gaining elevation, I've had no further problems…including hiking to the top of Whitney in a day.Jul 1, 2009 at 10:25 pm #1511647
@cbertLocale: N. California
blood ph tends to go up at altitude due to less co2 caused by increased respiration
kidneys respond by expelling bicarbonate
drinking fluids helps w/ expelling bicarbonate
increased max vo2 fitness level would help with ph balancing responses
increased fitness also can be detrimental, paradoxically, as it allows faster altitude gain – physiological response gains from improved fitness might lag behind the faster ascent rate
i was having AMS symptoms once about 300' below Shepherd Pass (12K) – 2nd day from sea level & stopped to rest, drinking down an "emergen-c" drink mix. my doctor friend/hiking buddy suggested it was a combination of the b vitamins, acidity of the vitamin c, and the fluids that resulted in my feeling much better rather rapidly & being able to continue on over the pass and on for an 8 day trip, all above 10kJul 2, 2009 at 6:59 pm #1511799
@dreichelLocale: Lake Tahoe
Thanks for sharing your experience and nice work dealing with the situation.
I liked the part of the write up where a partially restored Jeff yelled the rest of you out of bed at 6am.
Altitude issues are weird and unpredictable, and it's good to be reminded that they can pop up even in fit people and a strong group.Jul 5, 2009 at 8:56 pm #1512208
@ksawchukLocale: Northern California
There are several adaptations that happen in response to elevation. You breathe harder/faster and blow off CO2–this alkalinizes your blood (higher pH) and your kidneys have to get rid of HCO3 (bicarbonate) to compensate. Your body produces a chemical called 2,3 DPG which makes your hemoglobin release oxygen despite the lower concentration of oxygen at elevation.
Increases in hemoglobin and increased capillary (blood vessel) density take weeks to months.
Diamox alkalinizes your urine–you basically pee out bicarbonate so when you breathe harder you are more easily able to achieve "acid base balance". It works and I'll leave the decision about whether to use it or not to the individual. It's probably safer and better to ascend slowly (and slowly can vary with the individual–I've never had a problem camping at 10,000'the first night but I sure feel the effects on my hiking performance)
Since writing this article I've dumped the benzoin–leukotape has such a superior adhesive I don't need it. With leukotape I think I could have hiked the JMT several hours faster–the blisters were that bad.Jul 6, 2009 at 12:43 am #1512233
@gealaLocale: Hannover, Germany
I've a question concerning the First Aid Kit. You don't list bandages or compression bandages (or I have overlooked it) but you mention it in the text. Do you take some with you? How do you attend bigger wounds to stop bleeding? I use mainly sterile wound pads (don't know the term in English) without a cloth bandage attached, that you can fix with tape. But sometimes a bandage is nice just to protect the clothing from the blood.Jul 6, 2009 at 8:46 am #1512271
@ksawchukLocale: Northern California
I do list some small bandages and Steri-Strips for convenience but should the need for any larger ones arise I would use a bandana, wadded TP (unused of course) or ripped clothing (though I'd have to be pretty desperate to resort to this! I'd start ripping from the bottom of a shirt to preserve most of its function). The Leukotape works well to hold these into place.
Perhaps not ideal but in >1000 nights in the backcountry I've never had a major wound to dress. A couple of deep finger cuts has been the worst that I've seen.Jul 6, 2009 at 2:31 pm #1512315
@marty-wildegmail-comLocale: Pacific Northwest
Back in 2007 I did the JMT in 18 days. I had no altitude problems until the very end where I could not sleep about 11000' very well. I remember the last night at Guitar Lake I kept waking up every 30 minutes gasping for air. Strange as I had no headaches, excellent appetite and the next day rocketed up to the summit of Mt. Whitney. Two days earlier Forrester Pass gave me no problems. I slept fine at 10,500' a few days earlier.
Something wacky about sleeping above 11000'?Jul 6, 2009 at 7:47 pm #1512375
@kennyhel77Locale: Scotts Valley CA via San Jose, CA
Folks we are all different and have different problems. I was in Yosemite a few months ago at 4000 feet and suffered altitude sickness. I usually drive from the ocean (Santa Cruz) and drive to 8-9000 feet and start hiking right from the start. I have never had a problem until that day. It happens. Just drink, and eat food. Take it slow on the first day. You will get thre! Drink lots of water and eat.Jul 7, 2009 at 5:18 pm #1512561
@ouzelLocale: Pacific Northwest/Sierra
"I remember the last night at Guitar Lake I kept waking up every 30 minutes gasping for air. Strange as I had no headaches, excellent appetite and the next day rocketed up to the summit of Mt. Whitney."
It sounds like you were experiencing Cheyne Stokes Syndrome. It is quite common at higher elevations and is not a symptom of AMS. I experienced it sleeping at 19000' on a climbing trip in Nepal. Panicky feeling, but nothing to really be concerned about from what I could tell. Once I made the psychological adjustment, I'd just go back to sleep after each episode and, like you, carry on the next day with no apparent ill effects.Jul 8, 2009 at 5:51 pm #1512783
@150mphLocale: Los Angeles
Thanks for the great article Kevin. You really have a way with words. I'm always trying to refine my first aid kit and your list is helpful. I'm sure you tailor yours for different trips, locations.
Looking at quantities, I'm wondering if your listed kit is for your entire group for this trip, just for yourself, or a basic kit you always take on multi-day outings?Jul 16, 2009 at 9:36 pm #1514459
@nonbeingLocale: Fjäll, Himalayas
this makes for a good read, thank you all. If you would indulge me, my two and a half cents.
I am currently in the Andes, acclimatizing in Quito (3300m = 10500 ft). I will give myself 60 hours at this altitude before starting the backpacking, and even then I will start with low mileage days and work my way up from about this altitude… I have looked at this carefully, and as I have a lot of high altitude trekking ahead of me (1.5 months) I have become a little religious about maintaining acclimatization over this period…
I have a lot of (new found) respect for AMS as I had to abort an attempt to cross the Indian Himalaya (from Lamayuru south, for those who care, 21 days with donkeys and all) due to the onset of AMS (severe headaches, nausea, extreme tiredness)… I am glad I did bail out… it wasn´t pretty. I understand know with every bone in my body that people die from AMS (a friend of my partner did), and it´s a really dumb way to go, IMHO.
So (at least that´s the plan) I have the following ahead of me.
– To warm up and further acclimatize a shortened version of the Cotopaxi circuit (5 days)…from about this altitude here to about 14000 ft max sleeping altitude (I will skip the refuge for the climbers at 15 800 ft…maybe I wave at them from where I am). After the Cotopaxi circuit I will take great care not to go lower than I really have to (to return to Quito/Riobamba to pick up prepacked food supplies) and then move on to do the
– Chimborazo circuit which is slightly higher than the Cotopaxi circuit (on average about 1000 ft higher, all around 14 000 ft)… for which I will give myself a week (rather than "4-6 days"). It´s rather important that things are well around the Chimborazo, as this trek is fairly remote and off people´s radar….
Now comes the tricky bit.
– 3 days later I have planned to do the santa cruz-alpamayo circuit (in 14 days), incidentally almost the exact route Rick recently wrote about on BPL (in Peru´s Cordillera Blanca). This route will be physically more strenous than the two above (more altitude gains and losses) and I would like to be as well acclimatized as I possible can to do it.
I don´t find setting out on a remote, solitary and rather serious trek like that with medication-supressed headaches very appealing… But the way to Huaraz is via Lima, which is basically at sea level. So what I have planned to do is fly in to Lima from Quito and from the airport take a cab to the bus terminal and embark on the 8 hour bus journey to Huaraz (at 3000ish metres) right away. That should give me a total time below 3000 m of less than 12 hours.
:: So here is my question: how much – if any – of my acclimatization would I lose on that journey? I would suspect not very much, as both sleeping altitudes will be above 3000m – but then again, I don´t really understand the deep end of this discussion as some of you do. So please enlighten me.::
After the Santa Cruz trek I will return to Lima (again trying to minimize low altitude exposure) and fly to Cuzco, from where I have planned to embark on a 14 day trek from Mollepata to Yupanca just west of Machu P. (again a delightfully solitary experience), just above 10 000 ft… this part of the journey should be straightforward compared to what came before, as it´s not a terribly difficult route …and my legs should walk mountains by themselves then and the altitude is a little more contained. Well, it better be, because it´s pretty cold down there at night to begin with and the cocoon 180 quilt is not that lofty…
Any thoughts on this internary are very much welcome, and so is an answer to the question how quickly acclimatization is lost. What if I were to go down to 8 300 ft sleeping altitude for 1-2 nights between the hikes… would I basically have to start over acclimatizationwise?
Thanks for reading, and good night from Quito. You guys rock.Jul 16, 2009 at 10:12 pm #1514461
@cbertLocale: N. California
I spent one night at about 7000 ft (live at roughly sea level) before beginning a Sierra trek. In the last month, I've been above 8000 ft a few times on 3 trips, including 2 nights sleeping (2 other times on day hikes).
Just got back from a 5 day 4 night backpack. First night we slept at 10700 ft after only about 3 miles or so hiking. I was feeling some symptoms while fishing and cooking (headache, tired/weakness, lack of coordination, cognitive disfunction, etc), then when I went to bed, nausea came on strong, along with severe lack of coordination, weakness, etc – i almost fell on my face trying to walk 10 feet, for example: it was bad. Dinner left me violently and we sat up for an hour or two, trying to determine if the trip was over (had a 12000 ft pass to cross next morning). I was able to hold down an emergen-c packet and a liter of water, but couldn't lie down (nausea too bad), so I slept at first sitting up, propped up against a rock and made it through the night.
next day i made the pass no problem and continued on for about an 11 mile day (longest for me in 2 years), descending to about 8800 feet. felt great. following night we only ascended to about 9500 feet or so – also felt great. this (3rd) day was also a very easy day (maybe 3 miles).
next day was a long day that included crossing approx 12000 ft pass – also around 10 or 11 miles and included a mile or two of snow crossing. we camped at 10700 again, and i was sick again – didn't lose any calories this time, but thought i would & had to begin the night sitting up once again. i was pretty weak & almost unable to do anything once again.
next day made it over almost 13000 ft col – this was hardest climb i've ever done. felt pretty good most of the way up, but on the decline, ams was again setting in – actually i did have the headache and some mild symptoms earlier on, during the ascent, also some irregular heartbeats that i kept to myself at the time, but again it was worse after the effort, not during it.
what would i say to you? i think there are a lot of variables – i've never had any ams issues on the 4th or 5th day of a trip before, so i don't think there is much we can generalize. However, the old credo of "climb high, sleep low" i think is a good one – i seem to be able to handle pretty high and hard efforts, but at least on this trip, the day's destination altitude seemed to be the more telling factor.
***edit: this occurred in SEKI :)Jul 16, 2009 at 10:46 pm #1514465
I read this article when it came out, and thought "I'm glad I don't have that trouble". Famous last words, as I encountered AMS last week when I went to Northern New Mexico (from Texas). Been working out for months in preparation for this trip, and felt like I flew up the 2.5 miles to 10,600'. I was really shocked to wake at 2am with a splitting headache, and extreme nausea. Couldn't go back to sleep. The nausea left me around 9am, and left me weak, stumbling, and with what felt like the worst hangover in my life. No one, including me, thought it could be AMS, but we suspected. I sure knew I couldn't make it that day, going on up 5 miles, and to 12,000'. So I told the group the prudent thing to do was go back down. Went down to my house, slept 6 hours, tried to eat, couldn't, slept 10 more hours. Felt better in the afternoon, finally ate, went up to 11,800', met the group, felt fine, slept great. Weird stuff.
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