I get sick at altitude, cam I ever trek Nepal?

[Palmore Hoyt]

Howdy friends. I’m an ultralight backpacker with a history of what I think is Acute Mountain Sickness (AMS).  I feel it at 3-5k feet, bad headache and exhausted at 7k and delirious at 9k. I have spent a week acclimating to the Sierras (4k then 6k then 8-9k) and then at the first pass at 12k I was a mess. Maybe I should have taken longer and not made the jump from 8500 to 12k.  I drink a ton, eat well, and am fit, female in my 40’s.  Over the next 9 days I acclimated more and found that when I hike really slow, I feel better  (maybe that should have been obvious–less headache, less nausea, not as faint, my brain works better)

Anyway, given all this, should I just erase Nepal, Machu Picchu and Mt. Killamanjaro off my list?  After all, it’s not just about me, it’s everyone else on the trip whose trek could be compromised. Plus there is the health risk.

What do you suggest?

Don’t go?

Or are their ways to make it safe and enjoyable?

Thank you for your feedback!

[Pedestrian]

Get a copy of this book and read it; also carry it with you on any trip (it is small).

ALTITUDE ILLNESS
Prevention & Treatment, 2nd Edition

By author: Stephen Bezruchka, M.D.
160 Pages, 978-0-89886-685-8
Mountaineers Books 08/23/2005

Also find a doctor who has experience diagnosing and dealing with AMS and related conditions.

You might get some interesting anecdotal responses here but you’d be best off getting informed and experienced medical advice. Altitude issues are not to be trifled with.

[Art …]

how old are you ? … ok you said in your 40’s.

have you ever had a treadmill stress test ?

what altitude do you live at? how intensely can you train at your home altitude?

altitude sickness below 6,000 ft is pretty uncommon.

I live at 500 ft above sea level and can get mild altitude sickness at 7,000 ft but I can always acclimate with time and Diamox to levels up to 14,000 ft. but don’t recommend you use Diamox until you are sure it isn’t something else.

[David Thomas]

Among my hiking companions over the decades, I’ve noticed a huge range in response to altitude.  And it can be independent of other measures of physical fitness (although smoking ALWAYS seem to hurt).  I tend to handle it pretty well and it takes a quick trip to 12,000 (like not a single night at a intermediate elevation) for me to get some AMS symptoms.  One hiking buddy, whose track times, percent muscle mass,  and aerobic fitness were all better than mine would experience AMS much sooner and at much lower elevations.

When I was leading week-long backpacking trips in the central Sierra, a few clients knew it was an issue for them, and they’d start a few days early, camp near the 5,000-6,000 trailhead for a few days before the group arrived and that helped a lot.

The onset of your symptoms, despite your excellent preparation sound like an extreme case.  If some people are at 99% percentile for adaptability to altitude (Reinhold Messner?), someone else is at the 1.0 percentile.  It sounds like you might be that person.

One thing I noticed on moving to Alaska 20 years ago was that I could hiking to above treeline, stomping over alpine ridge lines without the least bit of huffing and puffing or any symptoms of altitude sickness, despite having not acclimated at all.  Because what looked to my native-Californian eyes as 8,000-10,000 in the Sierra was actually only 1,500-2,000 feet above sea level.

So I’d suggest you reframe your “high-elevation” quests as “high-latitude” or “high-climatic zone” trips.  If you like the scenery around tree line, then mainland Alaska, the Aleutians, Yukon Territory, Iceland, northern Scandinavia, South Island NZ, Patagonia and anything in Antarctica meets that criteria without the thin air.

[jscott]

+1 to what David wrote. There’s no way to enjoy altitude if you’re physically miserable.

I would add the Pacific Northwest to David’s list. And for that matter, wild coastlines. There’s no lack of beauty and scenery, even wild alpine scenery, at lower elevations.

[Ross L]

Have you had a blood test for iron levels? My wife had similar issues on a Lares Valley trek in Peru, turned out she was quite low in iron and does better now that she is on supplements.

[Palmore Hoyt]

Thank you David and the +1 from Jeffrey. What you write rings so true for me. Accept the limitation mother nature gave me, don’t risk my enjoyment let alone my life hiking high. Instead, enjoy the world at lower elevations, there is surely enough of it!

[David Thomas]

Not sure of your gender, but especially if you’re female, get your iron levels checked.  You could be walking and talking just fine down at sea level, but the added oxygen-carrying demands of even moderate elevation really tax you if your hematocrit levels are low. Adult males normally range from 42%-54%, I’m in the high 50s unless I’ve been donating blood recently.  Women are normally from 38%-46% but can be a lot lower.  Heavy periods and a low-red-meat diet can result in levels half of normal unless you’re taking supplements.  Supplements can be a pain, because they’re constipating, so two iron pills with four prunes might be needed.  And, if you’re on birth-control pills, there’s no particular reason to go off it every 4 weeks to have a period.  You can go 2 or 3 months between periods (ask your doctor, blah, blah, blah).  Or if you don’t do red meat, then eat more salmon (the “other red meat” in our household).  Dark green and orange vegetables have iron too, but nowhere near what a 1/4-pound burger or small piece of steak has.  Cooking acidic foods (spaghetti sauce) in cast-iron cookware adds some, but it isn’t hem-iron so your body doesn’t absorb it nearly as well.

But start with getting your hematocrit levels checked.  If a medical appointment is a big bother or expense, then go to donate blood.  You’ll get an answer about your hematocrit (they do a finger stick and spin down a sample before collecting any blood) and if you’re low, they won’t let you donate a unit.  And, instead of charging you, they’ll give you cookies and juice.

[David Thomas]

Oh, and like vitamin-D levels, iron levels in your blood take weeks and months to go up or down.  So if you get lab results that your iron levels are low, accept that you’ll need dietary changes or supplements for several months to affect a significant change.  Make an appointment for 3 months out, do everything they tell you, and then get retested.

[d k]

If you do need to take iron, check out Slow-Fe, which as I recall has the highest dose you can get non-prescription, and in a form more easily absorbed without side effects.  I took it years ago when I had exceedingly heavy periods and found I’d gotten quite anemic.

[Paul Wagner]

And you can add Patagonia to the list as well!

[Ben H.]

…Accept the limitation mother nature gave me, don’t risk my enjoyment let alone my life hiking high. Instead, enjoy the world at lower elevations, there is surely enough of it!

You shouldn’t throw in the towel yet!  You should talk to a doctor and see what you can do.  Have a doctor verify there isn’t an alternative explanation for your symptoms.  Even if it is AMS, you can discuss treatments/acclimatization techniques with your doctor.

 

[Paul McLaughlin]

You also might consider the possibilty that you acclimatize more slowly but can do it given enough time. easy enough to test this in the sierras or rockies if you have the time, by starting low like 3k and gaining no more than  1k per day. But i would certainly get medical advice as well.

[Catherine Harley]

Add Scotland to that list of destinations.  Lots of mountains – the highest is only 4411′ and you have the freedom to roam with almost no restrictions. Despite the low altitude there are plenty of challenges aka the terrain and  the weather.

Munro (- a mountain over 3000′),  “bagging” is a well known obsession ;-)

[Ken Larson]

I would highly recommend a book (70pgs) Published by The American Alpine Club, 1980 entitled Mountain Sickness – Prevention, Recognition and Treatment by Peter H Hackett M.D.

http://www.mountaineersbooks.org/cw_contributorinfo.aspx?ContribID=329

Peter Hackett is a world renowned high altitude expert and altitude research pioneer. He is a leading authority on altitude illness, high altitude climbing, wilderness medicine, and the effects of altitude on people living and working in the mountains. Dr. Hackett is also a board certified Emergency Physician. Dr. Hackett has been at the frontier on altitude research, with years of experience in the Himalayas, Denali, South America and in Colorado. Dr. Hackett has authored more than one hundred articles on altitude issues, has edited six books and is respected internationally for his expertise.

In addition to his extensive clinical and research experience, Dr. Hackett’s recreational activities of high altitude mountaineering, skiing, and living at altitude have lent him a personal understanding of altitude physiology. This includes the 111th summit on Mt. Everest. Dr. Hackett directs all executive, clinical, research, and educational activities of the Institute for Altitude Medicine.

To date a lot of the information has been covered in Peter’s book in this thread,  BUT a lot more that you will find very helpful in his book!

e.g…. Preexisting Medical Conditions at Altitude

http://www.altitudemedicine.org/altitude-and-pre-existing-conditions/

[Jerry Adams]

I agree about going to an authority, although anecdotal advice like this thread has good ideas to pursue

http://www.webmd.com/a-to-z-guides/tc/altitude-sickness-topic-overview#1

I get severe headaches above 10,000 feet.  Mostly, I just avoid that.

https://en.wikipedia.org/wiki/High-altitude_pulmonary_edema

There are life threatening conditions like Pulmonary Edema.  You may or may not be more susceptible.  Maybe read up about it so you know if it’s happening.  Like crackling breathing noise and blue skin color.   Normally, the solution is just to go to lower elevations.

[Palmore Hoyt]

Thank you all for your informative and caring posts. I will talk to my doc,  I just had some blood work done couple months ago and I can ask him to look at the iron levels if they are there. Rest of sure, I won’t give up until I learn more. And in the meantime or if needed long term I will take to the lower elevations as there are clearly many amazing places I can go.

[Palmore Hoyt]

Thank you Catherine for the tip on Scotland.  When you say that you can roam free there, does that include backpacking overnight  without a permit?

[Jerry Adams]

When people acclimatize on Everest, they go to higher elevation during the day, then back down a couple thousand feet of elevation to sleep.  Then go up to higher elevation and sleep. Repeat

[Author]

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