Had to bail early on a Yellowstone backpacking trip!

[Joey G]

I’m posting this to see if others might have experienced these issues before. I’ve seen a doctor and they are chalking it up to altitude sickness. I’m not totally convinced.

Also, I know nobody here is a doctor.

1. I left for Bozeman from Austin, Tx Friday Sept 13. Bozeman is around 5k elevation. I landed around 3pm, bought 3 gallons of water and started drinking the first one. I downed it before sleep.
2. In the morning Saturday Sept 14, I left for West Yellowstone ( 6700 elevation ). Beautiful drive. Checked in and went and did Yellowstone NP things. Downed another gallon this day.
3. On Sunday, drove around Yellowstone NP doing cool stuff. Downed another gallon of water.
4. Monday, the trip began. We started north Yellowstone. Our trip was in the northwest region. We were a group of 7. I was middle of the group in terms of hiking. I didn’t have any symptoms. I did have trouble sleeping. I think I might have gotten 2 hours of sleep.
5. Tuesday, packed up and before we left camp we were in full rain gear. It even hailed a little before left camp. About 3-4 miles in, I was at the back of the group. My coordination was off. Like I would perceive things but it was slow for me to respond to them. On an uphill, I felt like I was going to blackout. When I had this feeling I would stop and sit for a few minutes. I attributed the uphill to me having the blackout feeling. So from then on, I slowed down a lot to make sure I wasn’t exerting myself too much. I had the blackout feeling 3 more times Tuesday. This was a long day. Rained all day and temps were between 35-45. When I got to camp and into dry clothes, I did not leave my tent. It rained all night. During the night I pee’d like 9 times. Because it was raining, I went in a bottle. I had to empty the bottle once and filled it up again. I don’t think I dozed off at all this night. I would doze off and have the leg jerks that would wake me up. Plus the rain was loud.
6. Wednesday, I bailed. I found an exit point and hiked about 6 miles. I still had the disoriented feeling. It was a flat day so no blackout feelings. Went at a normal pace. Left trail this day found a hotel in West Yellowstone and slept like a log.
7. Thursday, Woke up and I was out of it at the breakfast buffet. I remember getting eggs and like not knowing where to put the spoon. It was very confusing for me. Left back to Austin this day.
8. Friday – Today ( Tuesday ). Friday I went to see my doctor who did my vitals and chalked it up to altitude sickness. Said if I didn’t feel better by Monday to let them know and they would give me a steroid. Well, I still felt off Monday morning and I started the steroid this morning.

 

I know that nobody here is a doctor, BUT I do think there is more backcountry experience here than my Austin, Tx located doctor would ever have. So, if anyone has had issues like I explained or known someone who has let me know what it ended up being.

I had never hiked in the cold and rain before. I wan’t really keeping up with my water in take. When we took breaks I would down water. I did eat less snacks than I planned on eating. About half.

[Joey G]

I didn’t mention my physical fitness.

Prior to the trip, I was doing Saturday and Sunday hikes ( back to back ) of about 4 miles 1.5k elevation each day with a 25 lb pack. I was doing this for about 5 weekends straight before the trip.

Before that, I was doing it once a weekend for about 2-3 weeks.

The elevation grade shouldn’t have been the issue. It wasn’t that much difference than what I was doing here.

[Dan]

I’m sorry you had that experience at what sounded like a great trip. Must have been very disappointing.

Have you considered hyponatremia? Peeing 9 times overnight sounds excessive. Or nutrition, are you familiar with what bonking feels like?

Altitude sickness is possible, but I wouldn’t think it is very common in Yellowstone. And people usually feel better very quickly when they descend, while you still had symptoms at breakfast the next day.

[Stephen Seeber]

I am not a doctor but I am aware that drinking large volumes of water  can have adverse effects.  So, here they are.

[Joey G]

If it was hyponatremia, would the peeing have been delayed about 36 hours ( Sunday to Tuesday night )? Like, the night after finishing the last gallon I would think would have been the lots of pee night. I don’t know much about hyponatremia.

I thought I had bonked before. Before when I thought I bonked, I barely could walk 2 minutes without stopping. It was like I was forcing my mind to make my legs move. This wasn’t that bad. Also, I didn’t have the blackout feeling before when I thought I bonked. Maybe this was bonking and before was something else.

I do think eating could have played a role. I’m definitely going to take care of myself water and snack wise better in the future.

[Joey G]

Also, I drink about 60-90 oz a day normally at home. I have a 30 oz Stanley cup that I fill at least twice a day.

[Jerry Adams]

Drinking 1 gallon of water from 3PM until sleep is a lot

And it’s not like you were exercising a lot in the heat

If it’s cool I’ll drink about 3/4 gallon per day including cooking

[Joey G]

I would love for that to be it ( too much water ). That’s an easy fix.

I’m going to have to experiment with parameters on trips to really figure it out probably.

[jscott]

Agreed you were drinking a lot of water. Still…

what about exercise induced atrial fibrillation? Sure, your doc will have listened to your heart in his office for twenty seconds. But afib comes and goes. It might not have shown up in those twenty seconds. Your symptoms are somewhat consistent with afib–but also with any number of issues, I’d guess. altitude and excsersize and cold and stress—not good for heart issues. also, you weren’t eating snacks. All that water and little salt and electrolyte intake can affect the heart and other things. Although you weren’t sweating, it sounds like. Still,  lots of water can flush out electrolytes.

I’m guessing. this is not by any means a diagnosis.

[Joey G]

Two things I forgot to mention. My resting heart rate was 100 from the morning I woke up in Bozeman until I got back in Austin. Here in Austin it’s 58.

Some of the times I was having this “blackout feeling” was right after I was stressing about something. Like, “is this rain ever going to end” or “hope I’m not holding everyone back too much”. Which makes me wonder about your atrial fibrillation, jscott. However, I did have some heart scan done like 3 weeks ago that was looking at the elasiticy of my heart. This test: https://www.hopkinsmedicine.org/imaging/exams-and-procedures/screenings/cardiac-ct#:~:text=A%20cardiac%20CT%20calcium%20score,arteries%20can%20cause%20heart%20attacks.

Test results were perfect, but maybe it doesn’t check everything.

[jscott]

“Test results were perfect, but maybe it doesn’t check everything.”

A resting heart rate of 100 bpm is pretty darn high. Granted, altitude increases resting heart rate. But that’s a lot! When I’d go to lake Tahoe from my home at sea level, at 6700 feet at lake level,  my resting heart rate would go into the low-mid eighties from a normal 71. and then start to come down after about 14 hours. Hmmm.

I’m a veteran of atrial fibrillation.  there’s a saying in our community: cardiologists are the plumbers; electrophysiologists are the electricians. In other words, cardiologists deal with blood blow, blocked arteries, valve performance, etc. Electrophysiologists deal with the electrical signals sent across cells that coordinate the rhythms of the heart. Many, many elite athletes with superb plumbing suffer from afib and other heart rhythm disorders. The two aspects of the heart, plumbing and electricity, are entirely unrelated. Just like in your house. Michael Phelps has afib. His heart plumbing is superb. You see my point.

Many cardiologists also dismiss rhythm issues. too long to explain.

[Bob Shuff]

I’ve had serious fatigue issues at moderate altitude levels one of the first times I went to San Jacinto. Full disclosure I live at sea level and we took the tram up to over 8k’ so it was sudden. It was a snow camp and we were snow shoeing with packs. Lots of stuff I had not trained adequately for. I made it through the trip but was exhausted and struggling every step. When we took the tram down I instantly felt better.

Since that trip I now take Diamox before heading over 10k, and have not had a problem. I believe it is a diuretic of sorts, which may be coincidental, but I thought I would mention it. I’m not aware of any downside/risks for occasional use.

[AK Granola]

Why were you drinking so much water before the hike? If your normal is 90 ounces, and you’re drinking 128 ounces, it sure seems like you could have messed up your electrolyte balance. Getting up once to pee annoys the bejeepers out of me now that I’m old. I never used to get up at all. 9 times?!

Maybe next hike stick with your normal water and food intake, until you feel more hungry or thirsty. And salty things are always tasty when hiking.

Too bad about missing your hike though. Yellowstone is a dream for me! Some day…

[Jerry Adams]

drink normally

if your pee is clear or just slightly yellow you’re good

if your pee is yellower or worse, then drink more

if you’ve been sweating a lot and you feel thirsty drink more

[Zero Flight]

To me it sounds blood pressure related – I’m thinking high altitude hypertension.  It could be just a bunch of altitude related things combined, but the fluid intake levels or some underlying occasional afib could also contribute.  High altitude is known to raise your resting heart rate but that’s excessive for that low-altitude rate.  Cold related diuresis is also more common at altitude, so it may have been that you weren’t retaining the water you were drinking.  Which could certainly contribute to hypernatrmiea.  Or it could be a whole mix of normal things that conspired together.

Did you have any kind of body monitor/smartwatch like a Fitbit or Garmin that could give you any numbers beyond pulse rate – O2, heart beat pattern, etc?  When you were checking your pulse, besides fast, was it a really strong *boom boom boom* that you might have even felt/heard in your ears, or was it thinner, or regular?  At normal elevation, do you ever get moderate to severe hangry bouts?  Folks who get hangry get hit HARD in every way by altitude.  How was your gut feeling (GI issues)?

[Joey G]

“Why were you drinking so much water before the hike?” – To get a adequate daily fluid intake.

“The U.S. National Academies of Sciences, Engineering, and Medicine determined that an adequate daily fluid intake is: About 15.5 cups (3.7 liters) of fluids a day for men.”

3.78541 L = 1 gallon

Is it really that odd to drink that much water in a day?

[Joey G]

“When you were checking your pulse, besides fast, was it a really strong *boom boom boom* that you might have even felt/heard in your ears” – At night while trying to sleep I would hear the boom boom boom in my ears.

[Zero Flight]

What was your sugar intake like for the day or two prior and up to the day back in West Yellowstone?

edit: also, did you experience anything abnormal about your hands, feet?

[Joey G]

I don’t think my sugar intake was abnormal. I ate savory foods for each meal. No real sugary snacks. Nothing abnormal about hands or feet.

[Zero Flight]

I’m going with AMS but could also have been out of whack with both electrolyte and glucose levels.  They’re all tied together.  I don’t think there’s much you can check for now, but your iron levels might shed a clue on some of it.  It takes a couple of weeks for iron levels to start drastically changing, so if still low that could point to a couple of things you’ll have to watch for, and which can contribute to still feeling off.

A quick note, sugar is an incredibly important and underappreciated twinsie to electrolytes.  The absorption channel works best when the electrolytes are paired with glucose, and can work slowly when not.

Maybe you drank too much for the amount of salt intake, maybe there was a problem with absorbing the fluids properly because you were at altitude and they just passed through, both of which can cause that fun hyponatremia a few folks brought up.  Hypoglycemia can also cause those dizziness, coordination, and confusion issues until corrected with a nice big soda or such.  Maybe you had mild iron deficiency related anemia or have an underlying problem.  Either way, I’d keep up with the doc, note your sugar, sodium, and iron intake, and of course get better!  And next time you’re ready for something like this, buy/rent/borrow a smartwatch that can track of some of those things at the time.  Maybe even a Kardia if you have the funds.

[jscott]

“At night while trying to sleep I would hear the boom boom boom in my ears.’

6700 feet isn’t really all that high. did you climb as high as 8000 feet? That’s still not that high. Your symptoms were fairly extreme. You were out over several days. Your system should have adjusted to these altitudes fairly easily. It didn’t. Tahoe is at 6700 feet. My resting HR would go into the 80’s and start to come down over the next twelve hours, as I mentioned. At 9,000 feet, the same pattern would occur, but at higher rates.

If your resting heart rate was 100 bpm when you laid down to sleep, then yes:

–you wouldn’t get much sleep

–the ‘boom boom boom” in your ears was saying, something’s not right.

You didn’t seem to have a virus or cold.

 

[Joey G]

We slept at around 75oo ft but hiked up to some passes at 85oo ft.

[DWR D]

Lake Tahoe is 6,225 ft;  not 6,700 ft….

[DWR D]

You saw a doc… maybe see a cardiologist…

[Joey G]

It’s been a week since getting back from the trip and still feel a little off. I went for a walk today and felt good to start but then about 20 minutes into it felt a little off balance / dizzy. It’s not like full on dizzy but just you can tell somethings not right. Gonna follow up with doctor.

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