JMT and Altitude Sickness

Ultimately, altitude sickness is a matter of genetics; but you can exacerbate or diminish the effects with behaviour.

Hydration is HUGE. I don't normally get any effects from altitude, but on Day 2 of Kilimanjaro, I let myself become dehydrated, and I had a severe headache (plus fatigue). I realized my mistake, starting drinking as much as I could, and everything cleared up perfectly.

You can certainly plan your JMT so as to hit the valleys in time for camp; in fact, many people prefer to tackle the passes when they're fresh in the mornings.

You will also adjust over time as your body manufactures more red cells.

You seem to have a pretty good feel for what worked/didn't from your last hike, so I have every confidence that you'll be fine!

Edited to correct — I did mean red cells!

–Perhaps consider an itinerary in the Sierra that involves lower altitudes

–Consider bringing a heart rate monitor. Establish your normal sea level rate(s) at rest and while exercising. Then you'll have something meaningful to compare your at altitude rates with.

I have no experience with drugs for altitude sickness; I'm sure people will chime in. But expecting a different outcome from before seems, perhaps, unlikely. You just can't wish away the need to acclimate. (That said, I have had trips where altitude affected me more than usual for no discernible reason.) Your planned trip takes you to even higher elevations than when things went bad before. I guess ask yourself if it wouldn't be more enjoyable to stay at 10-11,00 feet feeling well, as opposed to going very high very quickly and perhaps feeling rotten or worse.

On the other hand, everybody feels sluggish without acclimation going over 11,000 feet. I guess it depends on whether 'sluggish' crosses over into 'nauseous with a headache and unable to continue'.

Those who know about altitude drugs may have a more optimistic assessment.

"Hydration is HUGE."

+1 to that. I suspect that a good deal of "altitude sickness" cases in the Sierra are more likely due to dehydration from the more strenuous nature of the first day. Heavy pack, heavy legs, a morning often spent in the car…It's very easy to forget how much you need to be drinking.

I've also wondered a lot about fitness base with this issue. Every time I've had what I thought were "altitude" symptoms in the Sierra it coincided with being relatively poorly conditioned for what I was asking of my body. I've never had symptoms when I went in with an excellent conditioning base, even on days on which I did two passes and over 20 miles straight out of the car.

Rarely have I heard people complain about altitude on the third day. While often attributed to "acclimatization" I think a lot of it is simply a matter of breaking your body in to the workload, adapting to a new food/hydration/sleep schedule, and getting your trail legs back.

I'm not saying altitude doesn't factor, but I suspect its role is often overstated compared to other issues. AT least that's been my personal experience.

"You will also adjust over time as your body manufactures more white cells."

Valerie, I'm sure that you didn't mean white cells. Did you mean red cells?

Well, your body isn't going to manufacture red cells very quickly, either. Basically, neither red nor white has much to do with this in the short term.

It sounds like the typical symptoms of AMS. He started the problem by rushing up from sea level. One night sleeping near the trailhead would have helped him some. That quick transition was coupled with some dehydration, and that got him going on a bad trend. Even his recovery sounded very typical.

–B.G.–

id allow a more gradual acclimatization if I had previous issues. Too much time and effort and $ expended to risk it.

"…I hope to plan a trip starting at Onion Valley through Whitney portal (5 days including flights on first morning…) which will have me crossing 13,300 ft Forester Pass on day 2…"

Very foolish, considering your history with altitude sickness… did you learn nothing from the last time??????

The most foolish part is flying in the same day you will be going over Kearsarge Pass.
How about flying in, car camping that night at,say, 7 or 8,000. then start hiking the next day?

I've had this theory about mountain accidents (some leading to death), that the main cause is often being in a rush to fit a trip in, regardless or weather, or other circumstances that should set the yellow lights a flashing.

It could be your altitude sickness will not be as bad this time.
But it could be worse. Altitude sickness is unpredictable.
And, though unlikely, could lead to HAPE… High Altitude Pulmonary Edema… and possible death. It is nothing to fool around with… and sometimes you can't walk out if it is bad.

billy

I got alt sickness on my first Sierra peak, Olancha at the southern end of the Sierra. With the group I was with we backpacked in order to climb a peak. So Olancha was my first Sierra backpack, first Sierra peak, and first altitude sickness. I stupidly continued on to the peak with a raging headache.

Never had it again, on scores of peaks and high passes. So I conclude it's spotty and unpredictable, and can go away entirely. It can't hurt to hydrate lke crazy.

Read this from Altitude Research Center:
http://www.altituderesearch.org/hypoxia/altitude-hypoxia-explained

"Never had it again, on scores of peaks and high passes. So I conclude it's spotty and unpredictable, and can go away entirely"

And I have known people who have 20 years experience climbing peaks at high altitude… 20,000 and above, never had altitude sickness…then one day got it on an easy backpack at 10,000 feet.

It can go away. It can come back. and you can get it after never having had it for many years. Totally unpredictable.

billy

"Totally unpredictable."

That might be overstating the case. I would say that it is rather unpredictable.

I know one man who works for a government agency, and his job involves travel to many mountain locations. He started getting altitude illness thirty years ago, but for him it is totally predictable. He gets a splitting headache each and every time he goes above 11,000 feet. It is not 9000 feet or 13,000 feet. And it gets him every time. He had to take Diamox, and that makes it better for him. It does not completely eliminate the symptoms, but at least he can get through it.

There are a few of us for whom symptoms are predictable in that they never occur. I've been above 14,000 feet maybe a hundred times, and it has never hit me. I've been well above 20,000 feet and it didn't hit. It's not genetic, because I come from a family of flatlanders.

Experts will tell you that if the symptoms never hit, then there is an increased chance that it will never hit you in the future. But, these are all statistical chances.

–B.G.–

All I know for sure is what works for me, I always sleep at at least 6000 feet the night before I start, generally that means I either stop during the drive at a handy spot, spend the night in the car or by the roadside, get up early and drive the rest of the way to the trailhead, or I arrive at the trailhead at night, sleep there and start hiking in the morning. This takes me comfortably to 11,000 foot campsites on the first night, I may have a very minor headache that night but that's it and I feel fine the next day.
So your schedule would be just plain too fast for me, I need that night before. You don't need a whole extra day – if you fly into REno and drive the the trailhead or close to it, sleep at about 8k, and start the next morning that ought to help. But if you can't get time for that I would do a different trip, either shorter so you can do a night at the trailhead, or lower. Lots of beautiful places in the Sierra that are lower.

Diamox.

Don't suffer.

8 hours of sleep and an extra gallon of hydration wont help if you have altitude issues.

AMS can ruin your fun. Unless your fun is exiting the mountain with a headache, while vomiting, lightheaded, and fatigued.

the o.p said "a couple of years ago I learned the hard way. I flew in from Florida (sea level)" etc.

It's almost as if he wanted to remind himself of what he learned, because he wants to repeat the same itinerary except this time he wants to climb even higher. I agree that flying across the continent, which will affect his sleeping pattern/bio clock and is itself somewhat stressful, then driving to the trailhead, and then starting to climb, is at least going to be very taxing. Choosing to follow this up with a difficult several days of hiking at high altitude is, according to the o.p. himself, asking for trouble according to his own previous history. "I learned the hard way". Once you learn, you change your behavior. I learned the hard way that drinking half a fifth of whiskey will give me a hangover. Darned if it didn't continue to give me a hangover every time after that too. The only way to avoid the hangover was to drink less whiskey, which translates in this analogy to hiking at lower altitudes if you don't have time to acclimate.

Yes, who knows, maybe his altitude issues were a one off the first time. It may not hit again. But something about the way this thread opened suggests that the o.p. knows better. The call of altitude is just too beautiful; he wants to climb the highest mountain in the lower forty-eight states from sea level bang just like that, but..

In any case, it's not as if there aren't great places to hike at 10-11,000 feet in the Sierra. Given more time to acclimate, even a day or two at the start, the Whitney trip would probably be doable. A lot of people just need a few days to acclimate; nothing wrong with that.

Spending a night at the trailhead makes a huge difference in my experience.

What was said about hydration has proved to be true in my case as well. The air is extremely dry in the Sierra, and sometimes you don't realize how much you are sweating because it dries so quickly. One must offset this, so I drink way more water than I feel thirsty for, especially on the first couple of days. I also add some electrolyte powder to my water each day.

I also realized that altering my daily caffeine intake would result in a bad headache, so I usually add some caffeinated crystal light to my water, or pop a caffeine pill in the afternoon.

Some of these things may not be to prevent altitude sickness, but could alleviate the symptoms that are similar to it.

AMS is very individual – I suffer less than many others, but once got hit at 5,000 when, after being inactive at sea level, I was suddenly moving steel around all day at 5,000 feet.

Doing a 14-teener is so much harder cold turkey than with even just the prior night at 7,000-8,000 feet.

And the stresses are cumulative – dehydration, lack of sleep, lack of conditioning, alcohol, high workload, and quick ascents all combine to bring you down. So be packed and organized days in advance. Get good sleep. Shift your sleep cycle to your destination time zone in advance (by shifting your sleep and, more importantly, your light exposure). Hydrate. Eat food you know agrees with you. Do hill work with a pack for weeks in advance. Do stairs if you can't do hills. If you hike high (11,000-14,000) at least sleep low (7,000-9,000).

Any of us would be fine, tomorrow, sitting in a lawn chair at 10,000 feet, reading a book. Few of us could handle Forrester Pass at 3 mph with a 50-pound pack unless we worked up to it. The more in-shape you are and the lighter your load, the less likely you'll get into an unpleasant case of AMS.

"It's not genetic, because I come from a family of flatlanders."

Unless you believe in Lamarckian inheritance, this sentence is nonsensical.

"No" ?

Many scientists believe that natural adaptability to high altitude is carried by genetics to some degree. They hypothesize that natives of the high Andes inherit their adaptability. If I were from the high Andes, I might try to claim the same thing.

However, my entire family had existed below 700 feet elevation, and I was the only family member to have ever successfully gone to very high elevations and still I didn't get any symptoms.

–B.G.–

Bob, it's either nature (genetic, inherited) or nurture (acquired by conditioning or due to environmental factors). What else is there? Unless you think that your tolerance for altitude is attributable to some of kind special training that you do, or to your diet, or some such thing (implausible, but not impossible), then it's your genetics. It doesn't matter that your ancestors didn't live at altitude – not all genetic differences are attributable to adaptive natural selection. In fact, for natural selection to ever work at all, there has to underlying variation – different phenotypes for natural selection to select among. You just happened to inherit a particular combination of genes that work well at altitude. Even though all of your genes were inherited from your ancestors, none of your ancestors had the same exact combination of genes as you.

The only slight distinction one might make is that it's conceivable you might have a new mutation, although statistically that's highly unlikely. In that case, you might say that the trait is not inherited, although it's still genetic.

someone else said it above.

Diamox.

250mg twice daily starting 2 days before you hit altitude and continue at least 3 days into your trip. possibly reduce the dosage to 125 mg twice daily if you are concerned about the mild side effects.

Pilots in non pressurized cabins are required to wear oxygen above 8000 ft. The mental impairment for 8 hours at 8000 ft is the same as 1/2 hour at 11,000.

Mountaineers adage is climb high sleep low. You can get away with short stints to altitude, but must return to avoid increased effects. It can take 30 days to develop all the red blood cells, but shorter times to increase other adaptions.

Caffeine or lack of, for regular users adds to headaches.

Gradual increase in altitude is the way to go. Find a sports doctor who knows about this stuff to help.

be sure the medications you take, if you take any, do not include ingredients that you would be allergic to. I'm very lucky not to have any altitude issues, because I am deathly allergic to sulfa-based drugs.

Personally, I would not take Diamox or any other drug to deal with altitude sickness.
When you take drugs you are introducing yet another potential problem. If you have a reaction to the drugs, then you are sick from the drug as well as altitude.

I know many here on BPL will defend Diamox, but I think people should think twice before taking a drug just to be able to recreate at high altitudes. Better to take you time to acclimate going up. Or just don't go so high. Lots of beautiful places at lower altitudes.

But then, we do live in the 'pill culture' so I am probably just talking to myself.

Billy

Ralph, I will go with special training, both physical and mental.

–B.G.–

One time I was on a trek climbing Kilimanjaro. There were twelve of us plus all of the leaders, guides, and porters. I believe that all twelve of us had brought Diamox because of the high altitude. However, I monitored my physiological reaction to the altitude, and I did not intend to actually consume the pills unless I saw the first indication of altitude stress. I went all the way up and down without the pills and without any symptoms. The porters were not so lucky, partly because none of them were carrying water bottles, and there was almost zero running water high on the mountain. So, I would expect that they were dehydrated. We got to our high camp 500 feet below the summit, and there was a water shortage for everybody. The trip leader came to me and asked if I had any Diamox left. Since I hadn't consumed a single pill, I had my entire bottle full. The leader asked if I would be willing to give up some of my Diamox, since he wanted to provide it to his porters that were feeling very bad from the altitude. I warned him of several things. First, it is not good form to wait until you have big symptoms and then begin taking the pills. Second, it is not good form to take the pills when you are already dehydrated and there is a water shortage. His porters might have an allergic reaction with medicine like this. However, his attitude was that his porters had seen most of the trekkers taking these pills for altitude, and they thought that there must be something good and important about Diamox. So, I gave the leader half of all of the pills that I had, and he gave the magic pills to his porters that wanted them. I have a suspicion that they felt worse afterward.

–B.G.–