high altitude pulmonary edema at 9000 feet elevation

Shortness of breath (dyspnea) at rest always stuck in my mind as a red flag. This graphic from 2010. Not sure if updated.

Airplanes are typically pressurized to 8,000. People with heart issues can experience issues at that height: fluid build up.

• Scary… but it does happen

Commercial airplanes pressurized to 5,000… but, yes, some can have problems with that…

Commercial airlines vary vary considerably in terms of cabin pressure.  My altimeter watch has detected pressure down to 8,000 feet often.  Obviously, when flying to Cusco, Peru, cabin pressure ended up at about 11,000 feet–the elevation of Cusco!

Mountain Sickness Recognition in Brief
Peter Hackett, M.D.

Commercial airlines flying modern jets pressurize around 7500 to 8000-foot density altitudes.  Unless you’re the flight attendant pushing the beverage cart around, you’re not exerting yourself so at very little risk, but a smoker might see the O2 saturation drop with a pulse oximeter*.

There’s an increasingly awareness in general aviation (non-pressurized, prop planes) that while FARs are very specific (oxygen required for pilots spending more than half an hour between 12,500 and 14,000 feet, for flight crew anytime above 14,000, and for passengers above 15,000 feet), best practices would be supplemental oxygen by 10,000 feet because of the effects on cognition and night vision.   Pilots are sometimes surprised I’ve repeatedly hiked to 14,500 feet but 1) I was somewhat acclimatized and 2) definitely stupider than at sea level.

* pulse oximeters were once $400 at REI, but are now $7 to $12 on eBay.  Small and compact, I’d consider them a helpful diagnostic tool for large groups at altitude, especially when tourists get very high very fast like on Kilimanjaro.

I’ve witnessed several people get severe AMS and one possible case of HAPE.

In 2011, our club did a self-guided climbing trip to Rainier and out of 12 people, two got AMS above 12,000 feet and their rope teams had to turn back.  They didn’t feel better until we were descending close to Cathedral gap around 10,680 feet.

Then about 10 years ago, my wife got AMS and mild HAPE when we hiked into Marms Lake at 9882′ and we had to hike back out the following morning.  Halfway back to the Big Sandy TH she felt 100% better.

On a later trip to section hike part of the JMT, she didn’t get AMS, but as we climbed from Lake Thomas Edison over Goodale Pass heading north, her fingers were like swollen purple sausages.  She felt much better by the time we reached Nüümü Hu Hupi, (formerly known as Squaw Lake).

Any time she goes above 9,000 feet now, my wife gets an Rx for Diamox and starts taking it a day before we arrive at elevation.  It’s just the way it is with her physiology.

Below is a good article to discuss with your doctor if you’re prone to pulmonary edema. I am a physician, and I always carry a little nifedipine. Alternatives for treating pulmonary edema include viagra and cialis.

https://www.aafp.org/pubs/afp/issues/2020/0415/p505.html

Mae West: “are ya happy to seem me, sailor, or do you just have a bad case of pulmonary edema?”

I ran into someone who was carrying way too much weight, a newbie really, at Vogelsang, which is what, 10,000? He was clearly suffering from altitude and maybe over exertion. I made sure he was hydrated and his heart was fine. He had no interest in descending and still had a sense of humor and was moving well in his tent. He just wanted to lie down. A bit of nausea. We talked about his options and I was more or less convinced he would be ok. Sadly I’d forgotten to take along Viagra and anyway, that would have been creepy suggesting it this guy, who was hiking solo. Viagra increases heart rate, doesn’t it? are folks sure this is indicated? Or maybe increasing blood flow is the point. It sounds horrible in those circumstances, frankly. I’ve been told that it leaves men feeling like crap all on its own, afterwards.

you’ve been told???

Viagra increases blood flow by reducing resistance in the lungs and is actually used in newborns with a disorder called pulmonary hypertension. That said, I would not be handing it out on the trail without communicating with medical expertise. Plenty of potential significant side effects.

Hi, a couple of years ago near altitude 3000 m while going up in the trail I felt I was fatigued, checked my watch and noticed around 165 bpm,  quite high for the amount of the steepiness of that trail. It went up rapidly after just a few steps. After nearly 30 min rest I managed to arrive to my objective of the day, at 3300 m but struggling (I started hiking roughly at 1650 m)…and pretty much immediately turned around going back rapidly down although I felt a little dizziness and sort of nausea… at the time (still today) I associated high bpm with (out of) physical shape and the rest of the symptoms to light panicking / worrying given that I was solo and no one to be seen in a high mountain environment. I had my inreach mini with me but I remember was quite stressed by the thought of not being able to push the button (I was in condition to push it of course but the dizziness and the relatively intimidating environment influenced my thoughts). I managed though to remain in control (having also enabled tracing every 30 min).

What do you think, might have been a form of AMS instead?

“you’ve been told???”

Of course I’ve never needed Viagra…ahem…but out of a spirit of experimentation I suppose I tried it once,  perhaps twice. What a year! but seriously, for me it left an awful hangover. That is: it stressed my body pretty bad. I’ll leave it to a doctor to give it to someone suffering from pulmonary edema.

edit: Indrit, in all seriousness, you might have been having an episode of heart arrhythmia or perhaps tachycardia. And yes, panic or anxiety can push up the heart beat numbers on their own, so that has to be factored in. doubtless you made all the right decisions in descending rather than tryin to push on.

sounds like some sort of high elevation condition to me indrit, especially if it got better when you went to lower elevation

make sure you drink lots of water

I climbed Rainier and when I got near the top I felt terrible and turned around a couple hundred feet short of the summit.  I kind of forget the details now but I probably had a high pulse rate with even minimal exertion

When I got back down some I felt great.  Ran down the rest of the way from Camp Muir.

Prevention of Altitude Illnesses

Below are a few basic guidelines I’ve been taught at National Outdoor Leadership School (NOLS)  and used for proper acclimatization above 8K:

.  If possible, don’t fly or drive to high altitude. Start below 10,000 feet (3,048 meters) and walk up.
.  If you do fly or drive, do not over-exert yourself or move higher for the first 24 hours.
.  If you go above 10,000 feet (3,048 meters), only increase your altitude by 1,000 feet (305 meters) per day and for every 3,000 feet (915 meters) of elevation gained, take a rest day.
.  “Climb High and sleep low.” This is the maxim used by climbers. You can climb more than 1,000 feet (305 meters) in a day as long as you come back down and sleep at a lower altitude.
.  If you begin to show symptoms of moderate altitude illness, don’t go higher until symptoms decrease (“Don’t go up until symptoms go down”).
.  If symptoms increase, go down, down, down!
.  Keep in mind that different people will acclimatize at different rates. Make sure all of your party is properly acclimatized before going higher.
.  Stay properly hydrated. Acclimatization is often accompanied by fluid loss, so you need to drink lots of fluids to remain properly hydrated (at least 3-4 quarts per day). Urine output should be copious and clear.
.  Take it easy; don’t over-exert yourself when you first get up to altitude. Light activity during the day is better than sleeping because respiration decreases during sleep, exacerbating the symptoms.
.  Avoid tobacco and alcohol and other depressant drugs including, barbiturates, tranquilizers, and sleeping pills. These depressants further decrease the respiratory drive during sleep resulting in a worsening of the symptoms.
.  Eat a high carbohydrate diet (more than 70% of your calories from carbohydrates) while at altitude.
.  The acclimatization process is inhibited by dehydration, over-exertion, and alcohol and other depressant drugs.

As a physician pathologist, now retired, the urine description goal has always been a bit flawed. The term “clear” is a description of clarity and not color. Darker colored urine can still be clear or translucent. A more appropriate description would be “pale yellow and copious”, but it is not catchy like “clear and copious”. Urine color charts would label clear urine as a sign of overhydration. Many medical websites still get it wrong, in my opinion.

https://www.ncbi.nlm.nih.gov/books/NBK557685/

Yeap, thanks for the answers, I fully recovered once reached 2600 – 2400 m altitude.

“I kind of forget the details now but I probably had a high pulse rate with even minimal exertion”

I recall something similar indeed,  before that I was enjoying my hike and remember being relaxed.

Who knows,  interesting topic though. Thanks for sharing.

“Urine color charts would label clear urine as a sign of overhydration.”

Instead of clear above, it really should have read colorless. My goof.

Alternatives for treating pulmonary edema include viagra and cialis.

I’ve thought about taking cialis along hiking the Eastern Sierria but I’m there to hike and I’m afraid I wouldn’t leave my tent  ;-)

I was climbing and suddenly felt bad
So I looked to see what I had
A viagra or two
Well, that ought to do
It made me a placid, but not flaccid, comrade

Oops, wrong thread…

Anyone interested in AMS I reccomend listening to this podcast with Dr. Peter Hackett. https://podcasts.apple.com/us/podcast/peter-hackett-the-himalayan-rescue-association/id1287930776?i=1000396898564

He has a tremendous knowledge on the subject.

Thanks, Brad. Yeah, Hackett is the man when it comes to this subject.