My (failed) attempt at a SHR section.

First off, Justin, those great photos, the berries, the trout, and the country you hiked thru would seem to indicate you got your money's worth, even if you didn't complete the SHR section you intended. Many trips don't work out as planned for a variety of reasons. The key is to remain flexible and take what the situation allows. You did just that, and I commend you for your flexibility. It will serve you well on future trips. As for the problem with altitude, I am a little puzzled. You don't mention having any problem with Kearsarge Pass, which higher than Grouse Lake, which makes me wonder if maybe the problem wasn't with altitude per se but one or more of the following: dehydration, the heat going up from Roads end to Grouse lake, hiking too fast. Also, if you determine that none of the above were involved, you might consider talking with your doc about a prescription for Diamox. It is pretty effective for preventing altitude sickness. Somehow, though, given that you are young, strong, and presumably at least reasonably fit, I suspect one or more of the 3 things I mentioned have a lot to do with the problem. If I were you, I would use carefully selected shorter hikes that involve ascending to 11-12K feet to experiment with hydration, pace, and building tolerance to heat, possibly Diamox, or any other variable you think might be involved, to sort out the cause of the problem before committing to a longer, more demanding route like an SHR section hike.

My 2 cents.

+1 on the Diamox. The stuff seems to work for those prone to altitude sickness.

"Only having one water bottle (1L) and frequently running out of water didn't help. I'm starting to wonder if I will ever be able to do a successful high alpine hike. I seem to have a very abnormal problem with elevation."

You seem to have a very normal problem with elevation and dehydration.

For the last time that I backpacked over Kearsarge Pass, I left home and slept one night at 8000 feet, then drove to Onion Valley at 9200 feet. That day, just for training, I hiked up to the pass and back to Onion Valley. After sleeping a night at Onion Valley, I was ready to go with a loaded backpack and had no problems throughout the trip to Forester Pass.

For the next time that you try this, I suggest you carry two water bottles, and you can fill one or both, just depending on how much running water is available. Maybe mix some electrolyte beverage powder into one. That will cause you to retain water better which will help out your muscles.

–B.G.–

I do have a prescrip for Diamox and I took a generous dosage throughout the trip. I can't function without it. I've spent a few trips at 7-9k and the standard thing when waking up is to pop a couple and wait 15 minutes before getting up, otherwise I feel terrible and everything is exhausting. Even packing my bag gets me winded. The Diamox helps a lot but on this trip it wasn't enough.
I'm wondering if the elevation change did something. I went from 9k to 5k and then up to 9k all in one day. The day before I was at 12k and the day after we went up 11k. Lots of up and down.
I had no problems going over Kearsage Pass, other than being a little more winded. It hit me later in the trip. I also didn't have much of a problem getting up into kearsage basin and over the pass on our last day (which was about 20 miles).

There are many things that could have contributed to my problems. I wasn't drinking enough. My partner didn't bring any water treatment and I had one bottle of iodine tablets which we shared. He used almost all of them on remote high alpine lake water did not need to be treated (he was carrying them and I didn't see him doing it, otherwise I would have stopped him) and at times we were walking through areas that had stock travel and I avoided drinking these sources because we had so few tablets left – it was a problem that I'm not going to let happen again. I'm going to try electrolytes and see how they help.

I think it's worth going into more detail about my symptoms. I have never felt sick – as in I never felt like I was going vomit or had a headache. These are common symptoms that I've never, ever gotten at altitude. I mostly get extreme exhaustion. I will be walking at a decent pace and suddenly I have to stop every 30 seconds to rest. This trip I was getting very fast heart rates and had to frequently stop to let it calm down. My mind becomes very cloudy and it's hard to focus. It's like I start to forget where I am and what I'm doing. A few times I started to slip and fall over as if I was going faint but I caught myself (this had me very concerned). I had poor judgment and on the cross country sections and I often found myself scrambling over boulders instead of walking through grass.
My symptoms were constantly changing and random, sometimes subsiding, sometimes so extreme that I was forced to stop moving, but mostly making me feel miserable. It was hard to predict when it would hit me.
It's also worth noting that my partner had no issues. I felt bad about slowing him down like that.

"I mostly get extreme exhaustion."

It would not be a stupid idea to get your physician to run some lab tests. The heart rate and cloudy mind could come from several things, and you need to get those ruled out. Things like diabetes, which also relates to an issue of water balance.

I've hiked with people before who did not know that they were diabetic. One minute they were doing fine. The next minute they felt shakey. The next minute they were laying on the ground.

–B.G.–

Nice pictures.

Sorry about the sickness, happened to me once too.

I find a lot of factors come into play with altitude sickness. Sometimes I think I'm missing some nutrient, other times water is the key, once I just went up too high, nothing helped and I had to go back down.

Its a bummer but you're still here and the mountains will be there next time. After I bailed from one trip a Forest Ranger told me I did the right thing. Apparently a young man with similar symptoms to mine had tried to tough it out and ended up dying.

Edit – Your symptoms are a bit different then mine but I wouldn't give up on high elevetion till you try a similar hike with really good hydration and good nutrition. Water is key for me, I feel it pretty fast if I don't have enough. For big high altitude days I'm usually carrying two liters just to be on the safe side.

Edit 2 – I don't know but changing elevation fast seems to make me feel weird. Once in Colorado at less then 10,000 ft. I felt funny coming down Elk Park. I had been out for 3 weeks so I was plenty acclimatized and I was going DOWN. My theory is that I was either feeling weird because of a fast decent or lack of nutrition (I'd lost weight on that trip felt a bit dizzy when I got really hungry).

"The key is to remain flexible and take what the situation allows. You did just that, and I commend you for your flexibility. It will serve you well on future trips."

This wasn't the first time I've had to change plans during a trip. It's depressing when you spend months planning and finally have the time for a long trip and everything falls apart. I was walking through an unbelievably beautiful place but I felt miserable and it was impossible to enjoy it. I was really angry and depressed at one point but I walked out of there satisfied. There were enough good experiences to outweigh the bad.

I'll get the route done eventually, even if I have to plan for a very slow pace. There is always next summer (and the one after that). I had no trouble with the cross country travel. The only thing holding me back is the altitude.

Symptoms: some form of heart arythmia might be in play? altitude and dehydration could easily bring this on.

"some form of heart arythmia might be in play? altitude and dehydration could easily bring this on."

I'm thinking along the same lines. Maybe time to have a chat with a cardiologist?

It does sound like dehydration played a really big part, though. And, as Luke mentioned, possibly nutrition.

Question for Justin: Were you taking in a lot of carbs, at least 30% of your calories?

My knowledge of nutrition is very limited, but I always end up eating a lot of carbs. So probably a lot more than 30%.

The problem is that your physician cannot easily diagnose anything like a high altitude illness without putting you in a low pressure chamber or something else equally complex. That's impractical.

About all the physician can do is to rule out all of the ordinary things that can be tested. Once those are out of the way, then you might close in on a high altitude susceptibility.

Also, I hope that you were consuming your Diamox pills correctly. Normally you would start them 24 hours before you arrive at Onion Valley. Plus, normally Diamox will tinker around with your body's water balance, so you typically need to drink a lot more water for the first 24-48 hours. If you were already into your dehydrated period, then this is not good. In contrast, I have seen others who attempted to take Diamox pills like they were vitamin tablets, the more the merrier.

I've seen others who had a terrible time at high elevation. It turned out that they had been taking some strong herbal remedies because a friend had suggested that stuff.

–B.G.–

"About all the physician can do is to rule out all of the ordinary things that can be tested. Once those are out of the way, then you might close in on a high altitude susceptibility."

Precisely the point. Eliminating the more common possibilites is probably the best place to start.

Plus, normally Diamox will tinker around with your body's water balance, so you typically need to drink a lot more water for the first 24-48 hours.

Critical. Diamox is, among other things, a diuretic. Given that you were not drinking much water, it is possible the Diamox actually contributed to your problem.

I started them several days before the trip. I took 2-4 tablets each day while hiking depending on how I was feeling.

I've always had problems with judging my hydration. The air up there felt really dry as if it was sucking the moisture out of me. I tried chugging a bunch of water when we stopped at a source, but I have a hard time doing that without feeling sick. I can only drink a 1/2 liter at a time. It's like being dehydrated but not thirsty… if that makes any sense.
Only bringing a 1 liter bottle during a dry year was a huge mistake.

"I took 2-4 tablets each day while hiking depending on how I was feeling."

That's not what is printed on the Diamox bottle, is it?

I've had a prescription three times, and I have only actually consumed the drug once. However, the hikers that I see taking it most successfully started on a half-dose, and they only increased it to full dose when they were going particularly high, like above 15,000 feet or so.

Further, some people are allergic to sulfa drugs, and Diamox is in that category. Instead of feeling allergic to it, some people just feel like crap.

The people I saw with the worst problems with Diamox were on the top of Kilimanjaro, and it was because they were terribly dehydrated.

–B.G.–

"So probably a lot more than 30%."

Which eliminates one possibility for feeling lightheaded and lethargic. One down,
"n" to go.

"I've always had problems with judging my hydration."

Yes, some hikers are that way.

If your body won't automatically get thirsty enough, then make yourself a system. Put marks down the side of your water bottles, and make a point of stopping to drink it down one mark every so often, a half-hour or something.

Also, I found that a lot of hikers and backpackers don't feel like drinking plain water. So, put some flavor into it that you like. Some of us use an electrolyte beverage powder, but it doesn't have to be full strength. It could be Kool-Aid, iced tea powder, or anything else that will encourage you to drink.

You probably need to be urinating a few times per day, and if the urine is getting too yellow, that is a sign to drink more water. Similarly, if you get too dehydrated, then you may get constipated. Then you feel bad again and again.

–B.G.–

"I tried chugging a bunch of water when we stopped at a source, but I have a hard time doing that without feeling sick. I can only drink a 1/2 liter at a time. It's like being dehydrated but not thirsty… if that makes any sense."

Have you considered evening your water intake out a bit, for instance 1/4 liter every 20 minutes or so, and slowing your pace down to maybe 2 mph for starters? You can always try going faster after you get this problem under control and drinking more or less, depending on the results you get. Drinking a lot of water at one time can bloat you and interfere with efficient absorption of the water.

"Only bringing a 1 liter bottle during a dry year was a huge mistake."

+1 I think this whole hydration area is a good place for you to start looking for solutions.

Chugging doesn't work well for me. Well I do camel up at times but I can only take so much, especially at altitude. I do tend to chug more in the evening, maybe resting has something to do with it?

+1 on a system of constant hydration. I never really thought about it but at some point I decided I needed to average 4 liters a day. So one by mid morning, one by lunch and so on. Whether I chugged or sipped was less important then spreading 4 or more liters out over the course of the day. This was a minimum, I've gone over it plenty of times, if I've drunk a two liters by mid morning I plan on spring 6 or 7 out over the course of the day.

Keep trying, my theory is learning to read your body is a skill you develop with practice (and I'm not perfect either). On a 31 mile day I took a break when I felt myself getting overheated and thirsty. After a bit I was fine. My brother nearly bonked soon after. He's in better shape then I am when it comes to running. But he just didn't know how to pace himself on a slower but longer hike. I don't tell that story to brag on my athletic abilities because there are lots of people her much more athletic then me. The point is that practice helps. You'll figure it out eventually.

Edit – Now that I think about it I remember feelings similary crummy once at "only" 12,000 in Colorado. I'd forgotten my water bottles so I was using two 16 or 20 oz bottles I'd bought in a store. Streams were dry (fall) and I got thirsty, then had a head ache, then dizzy and irritable. We camped pretty high that night (11,000 or so. But once I had a good drink at a creek I started feeling better.

Tom, that's what I should have done but remember, only 1 water bottle.
I probably could have gotten away with that early in the season. I passed by so many dried up streams.

Bob, my physician initially told me to take 2 per day at most as a low dosage to watch the side effects. She told me to double it if I handled the medication well and needed it.

I don't think she had heard of diamox before I asked.

"I don't think she had heard of diamox before I asked."

Yes, I've run into that before, in 1995. I was getting a pre-expedition check-up, and I asked my physician for a Diamox prescription. He looked at me funny, because I didn't look like a heart disease patient. I explained that it was for high altitude, and he started to realize that I knew what I was asking for. So, he went online to check my story. Then after he was doing it, he asked me if I agreed with the standard dosage. Lastly, he asked me for how many days I was going to be up high, so he added on about five days to that and then the prescription happened.

–B.G.–

Justin,
Thanks for posting this. Lots of important lessons for many of us here.

I think planning adequate acclimatization time is critical. Bob's got the right idea, climb high on an acclimatization day(s) and sleep low. Increase incrementally. For example I'm going in next Monday over Kearsage. On Friday and Saturday night we'll sleep at 6,000 ft and hike up higher during the days. Sunday night will be at 9,000 ft. Monday night between 9,000- 10,000 then we'll do Forester pass. Hopefully fully acclimatized.

I've only take Diamox once before on Chimborazo in Equator since it is difficult to acclimatize there. Since then I've been to over 19,000 ft successfully witout it and I've also gotten very sick on at least two occasions at just over 16,000 in the Andes, both time having to bail/self evacuate. Once on horseback I was so weak. First time I got sick was very similar to what you describe. I actually lied down on the trail and just went to sleep. We never got further an had to set up camp there. Saw the same thing happen to my ex-wife in the Himalayas.

Some important lessons I've learned the hard way:

1. Health leading up to a trip is critical. Any lingering upper respiratory issues can lead to problems when you go up high. This led to my problems both times. Now I take extra time to get healthy before going up high. Sucks when you have limited vacation time but so be it.

2. A high fitness level can lead to problem as you move up too fast to properly acclimatize.

3. Diamox. I remember peeing like crazy while taking
it. Definitely important to stay well hydrated and also supplement electrolytes in the days leading up to going high and during.

4.When I need to discipline myself about drinking regularly I use the timer function on my altimeter watch. I set it to beep every 20-30 min and drink regardless of if I'm thirsty or not. Every nth drink I take a gel or snack to keep energy level up unlss I'm drinking a carbohydrate energy drink. For more intense efforts and the like I usually have two bottles one with plain water and one with drink mix to ensure I don;t overload my stomach. This sounds basic but the watch can help reinforce some discipline and it also forces you to keep track of the elevation change and your pace and alert you to any issues. These ideas come from Mark Twight's excellent book.

5. I recommend reading this:
http://www.amazon.com/Going-Higher-Oxygen-Man-Mountains/dp/0898866316/ref=pd_sim_b_2

6. Don't write-off herbal remedies: Coca leaf can help with acclimatization as can Gingko extract. Both have scientific evidence behind them. They shouln't replace Diamox for individuals prone to AMS but can certainly help healthy individuals aclimatize more easily and help relieve mild symptoms. Also good luck getting coca leaf in the US. Gingko is easy. Just bought a bottle tonite to start prepping for my jaunt coming up.

Some stunning photos BTW.

Your pics are great.

Your symptoms describe exactly how I feel when I'm not eating enough. Slow, lethargic, walking up hill is suddenly much harder, poor judgement, more likely to make route-finding errors. And I get cranky. (Just ask my wife.) I eat something every 2 hours even if I'm not feeling hungry, or I bonk.

"5. I recommend reading this:
http://www.amazon.com/Going-Higher-Oxygen-Man-Mountains/dp/0898866316/ref=pd_sim_b_2
"

M G, I agree. I keep a copy of it right here next to my computer. I've read some of Houston's earlier work, so I've seen the high altitude medical science progress a bit over the last few decades.

–B.G.–