Had to bail early on a Yellowstone backpacking trip!

[DWR D]

I would suggest you ask your doc to refer you to a cardiologist. You can have a good calcium scan and still have beginning blockages. Or, as suggested above, electrical issues. I have a friend that his primary care doc gave him a stress ekg test… everything looked good… doc said your heart is good… 3 months later he had a heart attack… I just read that calcium scans don’t detect the beginning soft plaque build up that does not have much calcium in it yet… none of these tests are 100% accurate. Stay on it until you find some answers… Good Luck…

[Joey G]

That’s no good and what I’m wanting to avoid. I had some blood work done today. If it doesn’t show anything than cardiologist is next.

[bradmacmt]

What’s your age, height and weight?

[Joey G]

47

5 10

235

[David B]

I am replying to this a little late, so you may have already seen your PCP again or been in contact, but…

I think the earlier responses about hyponatremia are correct.  I am a physician, primary care, but also do travel medicine and hyperbaric medicine.  I prescribe diamox frequently for prevention of altitude sickness and I can, with relatively strong certainty, say that this was NOT  altitude sickness.  Altitude sickness happens over 3500m of altitude and you were nowhere near that.  People feel crummy when they go from sea level (Austin) to higher altitude because your blood cells have not adapted to a higher altitude, so you are getting relatively less oxygen to everything important; you feel tired, short of breath easier, more fatigue but it is not dangerous to your body.  Altitude sickness is a more specific scenario which causes pulmonary edema and cerebral swelling due to acid/base shifts in your blood stream; diamox prevents this but does not prevent you from feeling awful at altitude.

I am not sure where you saw the recommendation for 1 gallon of water daily or where the Academy of Science calculated that number, but that is not a generally accepted recommendation unless it was based of a very narrow set of circumstances.  60 ounces a day is roughly what an inactive person should take in, more for activity based on your personal amount of sweating (you could weigh yourself before and after exercise and figure out your water loss). Your body is MUCH smarter than we are and generally will tell you if you need water. Drink when you are thirsty, don’t when you aren’t.  Maybe drink more if your pee is really yellow. Forcing so much water on your body dilutes the sodium levels in your body, causes changes in the brain and gives your kidney problems dealing with the fluid (why you pee’d so much overnight).  It could certainly cause heart rhythm problems, but your symptoms are more consistent with hyponatremia than with atrial fibrillation or any other arrhythmia. It would also take a long time for your brain to fully recover from that kind of stress.  Getting bloodwork is absolutely good to do but quite possibly was back to normal by the time you saw your PCP.  Making sure your heart is healthy is also a good idea, but it doesn’t really fit this particular scenario.

Anyway, that’s a lot of words.  Just wanted to explain things. Hope you get a chance to go again.

David

[maxjerz]

Also late to reply, but wanted to throw out an idea I hadn’t seen mention mentioned here. I’m not a doctor, but I do have experience with odd medical problems and I have a *lot* of trouble with high altitude.

Some of your symptoms sounds like what I experience due to postural orthostatic tachycardia syndrome (POTS), which is a type of dysautonomia (dysfunction of the autonomic nervous system, which regulates things like your heart rate and blood pressure). Specifically, your description of feeling worse with exercise/exertion, dizziness during exercise, brain fog/difficulty concentrating, even your very high resting heart rate. POTS can also make you much more sensitive to electrolyte imbalances and make it very hard to stay hydrated with plain water (so you pee it all out and can get more dehydrated the more water you drink). My POTS gets much worse once I go over about 5500′ (I also live at sea level). And it can take a long time for my body to calm down after a flare, so symptoms can persist for more than a week after returning to sea level. POTS can be triggered for the first time from viral illnesses and has become much more common in people who have had covid. POTS is not something most doctors are familiar with so your doctor may not have even thought to screen you for it.

If any of this sounds familiar, here is a good place to read more about POTS, including a test you can try at home if you have a way to measure pulse and blood pressure: https://www.dysautonomiainternational.org/page.php?ID=30

I hope you’re able to find some answers to what’s going on with your body. If it is POTS, it’s treatable and manageable, and you can still backpack and enjoy the backcountry with some extra consideration to your body’s needs.

[Joey G]

Thanks maxjerz and David!

I finally saw a cardiologist and got an ekg. It was good. We are now scheduling a stress test. I have researched POTS and many of the symptoms I had make me think it could be that. I think I’ll ask to be tested for it.

It could have been the too much water. I calculated myself not thinking it would be too much. I drink about 90 ounces a day. I am always constipated when I start a backpacking trip and thought that I would try to hydrate before the trip to try and prevent that.

So, if I drank the last gallon of water on Sunday, but had the issue with peeing a lot Tuesday night ( about 9 times during the night), would those two things be correlated? I mean if it’s been over 48 hours? The hike started Monday morning and I think I drank way less Monday and Tuesday. I thought I was actually dehydrated until I started peeing so much.

 

[Dan]

There are some gaps in the story, and hopefully you can reconstruct it, although if you were woozy with brain fog, it may be a lost cause. You seem pretty certain that you drank a gallon on day zero, but you’re not sure how much you drank on day 1, so that’s a pretty big open question. You think you urinated approximately 9 times that evening, which sounds very extreme, so that’s also an open question in my mind. It would seem to be an obvious symptom of overhydration, but maybe it only seemed like 9 times. It’s hard to know.

The facts are foggy, which isn’t helping the diagnosis, but at least this conversation has uncovered some possible answers. Hopefully you can take something away from this discussion and make some changes next time that will allow you to enjoy the amazing trip that you planned.

[Joey G]

To make it easier to consume:

Friday, Saturday, Sunday: Day -2 through 0, 1 gallon of water. Little physical activity.

Monday: Day 1, unsure of water consumption. Guessing 2-3 liters. Hiked 6 miles. No symptoms. Didn’t get much sleep.

TUESDAY: Day 2, unsure of water consumption. Guessing 2-3 liters. Hiked 14 miles.  ( pee’d 9 times at night ). All the symptoms. Very sucky day. Gives me PTSD thinking about backpacking again.

48 hours from drinking a lot to peeing a lot.

I’ve continued to have symptoms since being back home. Only when I do some physical activity and my body warms up. Have a new symptom of sometimes when I get up to quickly, I get lightheaded.

Also, just found out a person we were with got Giardia while on the trip. We were using aquamira tablets.

[Moab Randy]

Joey, I hope you’re feeling better and have figured this out. But since this has turned into a bit of a thread about water intake, I’ll add my thoughts.

When backpacking or any other time, I never follow any guidelines about water intake except one. I think the very very very frequent discussions in the media and advertising about “needing to keep hydrated!” and being sure to drink at least such and such every day and to just keep sucking on those Camelback bladders all day are mostly oriented around selling products. The media has gotten Americans to believe they are all dehydrated and therefore not functioning optimally.

Here’s my guideline: drink when I am thirsty, not before. (Makes life simple.)

The only adjustment I might make is if I were to find my pee very very dark, then drink more. But that doesn’t happen to me, even with all the desert hiking I mostly do. If it were to, it might mean I was rationing water because of short supply, which is a different matter. But I’ll grant that perhaps some people for whatever reason don’t have an appropriately working “thirst sensor.”

You quoted this: “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.” That one-size-fits all figure is useless because it doesn’t account for temperature or wind or humidity or exertion levels or food intake or body mass.

The guidelines I care about are how much water I need to carry or have access to for my trips. Interestingly, on a recent 9-day sea kayaking trip off the British Columbia coast, I used only two liters per day (all no-cook meals). Another time, on a long summer dayhike in Canyonlands I drank three gallons, and that didn’t include meals or getting rehydrated at dinner.

Hyponatremia is a real deal. Once, soon after starting down the Bright Angel Trail in the Grand Canyon I stopped a young man who looked ill. He said he was coughing up blood. He had hiked down from the North Rim that morning and was almost to the South Rim. He had made sure to drink plenty along the way, but had eaten little. Rangers carried him out on a horse.

[Joey G]

Thanks for sharing that Moab. I’m definitely going to be more conscience about my water intake.

[Author]

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