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Trouble in Paradise: Altitude Illness in SEKI
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Addie Bedford
(addiebedford) - MLife

Locale: Montana
Trouble in Paradise: Altitude Illness in SEKI on 06/30/2009 18:12:56 MDT Print View

Companion forum thread to:

Trouble in Paradise: Altitude Illness in SEKI

(drown) - F - MLife

Locale: Shenandoah
"Trouble in Paradise: Altitude Illness in SEKI" on 06/30/2009 19:55:40 MDT Print View

I've had AMS twice now in the Andes and have helped friends through bouts of their own in the Himalayas. I can sympathize with Jeff. The fatigue and desire to sleep is very overwhelming and going down is the only way to get better. A few thousand feet of descent can make a significant difference and is a very fast way to address the problem assuming you are still mobile.

A competent leader must be able to make the decision to turn around or change plans for the victim/group because AMS will rob you of the judgment to make that decision for yourself.

Depending on the size of the group having a plan in place in case the trip leader gets sick. With small groups of competent people decision making takes place differently than with less or inexperienced groups led by one individual.

Health conditions before going into a trip have played a significant factor on both of my incidents. Any lingering colds, coughs or respiratory illnesses can quickly lead to problems at altitude. One's health does not get better above only deteriorates. Best not to head up unless you are 100% healthy.

Good write up. I'm always interested in reading what others keep in their first aid kit and learning from their experience. More articles of this nature are welcomed.

Edited by drown on 06/30/2009 19:59:37 MDT.

David Stapleton
(KamperDave) - F

Locale: VA, DC, MD
Re: "Trouble in Paradise: Altitude Illness in SEKI" on 07/01/2009 06:52:10 MDT Print View

This article comes at an interesting time for me. Myself and two friends are heading to Absoraka-Beartooth in MT for a 5 day backpacking trip in early September. We are all admittedly fairly new to backpacking but young and in good shape. Unfortunately since we live on the east coast the highest elevation immediately available is generally around 4000 feet max.

We'd planned to camp out the first night in a regular car camping site and begin hiking the next day. The highest elevation on our route is just around 10,500 feet, which is inconsequential compared to the Andes or Himalayas, but I wonder if there are any precautions we should take based on elevation, particularly because we all live pretty much at sea level?

I'd very much appreciate your insights.


Bill B
(bill123) - MLife
Altitude Sickness on 07/01/2009 07:09:41 MDT Print View

Taking advise based on other people's experiences is risky because each person handles altitude change differently. If you stick with standard protocol until you know how your body reacts with altitude change, you will be better off.

Here is a website with some good basic information. altitude

David Stapleton
(KamperDave) - F

Locale: VA, DC, MD
Re: Altitude Sickness on 07/01/2009 07:20:09 MDT Print View

Bill - Thank you! That link is very informative.

Seems silly asking about altitude precautions in an area that is some of you guy's back yard but I'd rather over-prepare in the knowledge department rather than be surprised.

David Poston
(dgposton) - F

Locale: Texas / Colorado
Diamox on 07/01/2009 08:13:58 MDT Print View

I'm heading to Colorado in 10 days for a 11-day excursion along the Colorado Trail. I live in Houston, Texas (elevation 60'). Every year I have gone (this will be my 3rd summer bpacking there), I have gotten sick and vomited, then got better once I acclimated. In 2007, I flew to Denver and then woke up the next day at 6:00 to climb Mt. Bierstadt (a 14er). I made it to the top, but on the way down got really ill. When I got back to Denver (5280'), I was much better and slept. Two days later I went backpacking in RMNP and was fine. In 2008, I dayhiked a couple days at around 10000' before going on an overnighter where I camped at 12000'. During the night, I felt really sick. We hiked out the next morning and I vomited on the way down. The next day, we headed out for a 4-day trip in the Weminuche and I was fine (albeit tired).

Should I take Diamox ahead of time to prevent this cycle this year? Are there any side-effects?

Mary D
(hikinggranny) - MLife
Altitude Illness on 07/01/2009 09:13:01 MDT Print View

I did a lot of reading about acclimatization last summer after having problems in Wyoming's Wind Rivers. While I had studied about altitude illness in a WFA class, I'd never experienced it because I grew up in Wyoming and Colorado and never had any problems. However, I've lived at or near sea level most of the time since and done most of my backpacking in the Cascades at altitudes of 5,000 to 6,000 feet. I didn't develop any severe symptoms, but it sure slowed me down!

It appears that you didn't adhere to the two rules of acclimatization: Climb high, sleep low for several days, or don't raise the altitude of your sleeping place more than 1,000 feet per day.

For your first trip, you basically went straight from sea level to 14,000 feet.

For your most recent trip, you did the right thing the first few days (climb high, sleep low), but then you raised the altitude of your sleeping place by 7,000 feet. Altitude sickness is more apt to show up while you're sleeping.

In your shoes, I would plan the trip around the acclimatization criteria: two-three days of climb high (10,000-11,000 ft.), sleep low (maybe sleeping higher than Denver the second night, at 7,000-8,000 feet). After that I'd start camping at an altitude a bit lower than the one to which I was climbing (maybe 8,500-9,000 feet) and try not to raise the altitude of my sleeping place more than about 1,000-1,500 feet per night. That's what I'm planning when I go back to the Winds this summer.

You might want to hold off on climbing 14ers until near the end of your trip.

If you still get AMS symptoms with such a regimen, then it may be time to try a preventive diamox program. However, you might want to talk to your physician now and take some with you in case you do develop AMS (but take it at the very first symptoms--Jeff's story demonstrates that you shouldn't wait until you're really miserable).

I personally would not try to substitute drugs for a proper acclimatization program. Your mileage may vary, though, especially if your vacation time is very limited.

Jim Sweeney
(swimjay) - MLife

Locale: Northern California
Ginkgo Biloba on 07/01/2009 10:56:27 MDT Print View

A few years ago I tried taking Ginkgo Biloba for several days before and while on a trip which took me from sea level to 9500 feet the first day, and then to 13,000 on the second. I had no symptoms of high altitude sickness (though I have at other times--principally an intense desire to sleep and sometimes a feeling of nausea akin to motion sickness, plus, sometimes, a general desire just to die and get it over with--not unlike the way I've sometimes felt being on a small boat in choppy water).

A quick google search turns up the following links:

There doesn't seem to be any hard science yet, though I first heard about the effects of Ginkgo more than 5 years ago. Admittedly, if this was a bullet-proof solution you'd think it would be gospel by now, so...

Edited by swimjay on 07/01/2009 10:57:21 MDT.

Mark Verber
(verber) - MLife

Locale: San Francisco Bay Area
Re: Ginkgo Biloba on 07/01/2009 14:06:40 MDT Print View

Nice write up. Thanks! My understand is that there was some initially promising data on the effectively of ginkgo such as was briefly mentioned in High_Altitude Illness by Hackett and Roach published in NEJM

BUT I am pretty sure there was some very extensive study completely in 2007 which found no evidence of ginkgo biloba was effective. I can't find the study right now :-( I have several friends that take ginkgo on the theory that it won't hurt, and it might help.

There has been a bunch of discussion about acclimatization. Taking the time to acclimate is certainly the safest and most reliable approach.

It's worth noting that people react differently, and that people's reactions can very over time. I had a friend who always gets sick if he sleeps above 8k ft... and consistently gets sick if he goes up more than 2k/day after that. If he doesn't want to get sick he always starts the first night at 7k... and plans his route to stay under 2k gain each day. I have another friend who had been on tens of trips where he went from sealevel to sleeping at 12k ft in the same day. Then last summer we went from from sea level to 9k and he got sick enough that we headed back down the next day. As they say in the stock market past performance is no guarantee of future performance.


Edited by verber on 07/01/2009 14:15:51 MDT.

(drown) - F - MLife

Locale: Shenandoah
"Trouble in Paradise: Altitude Illness in SEKI" on 07/01/2009 18:12:01 MDT Print View

One factor that effect one's acclimatization over time is that the real factor behind Altitude sickness is the drop air pressure. This varies with elevation of course but also varies spatially and temporally based on climate, weather, temperature, latitude. It's not a homogeneous effect where all over the globe at an elevation of xxxx ft/m is equal to xxx Air pressure.

You can go to the same peak/mountain range and get sick one year and not the other. Your body can react differently everytime because of the variety of factors effecting it, with elevation being only one of several factors (albeit the main one).

Rather than being focused on elevation alone, which is a guide. It's best to monitor your bodies' reaction to the altitude every time you head up and not take any previous experience at said altitude as a given that you will be alright.

Jim Sweeney
(swimjay) - MLife

Locale: Northern California
Fitness and altitude sickness on 07/01/2009 18:54:14 MDT Print View

I'm not sure about this, but I think that one of the physiological changes accompanying altitude sickness is a drop in the pH of the blood--the blood becomes more basic, as carbonic acid is removed from the blood. This is a complicated response to change in atmospheric pressure, but may be exacerbated by excessive panting, blowing off CO2 more quickly than it is being formed, which can be a reflexive reaction to a general sense of not having enough air. I've found that the fitter I am going into a trip, and the lower my breathing rate, the higher I'm able to go before I start to feel a bit, or more than a bit, off.

A doctor friend of mine once pointed out that true acclimation would take quite a while (increase in blood hemoglobin , etc.), but the body has some kind of interim process that can make a difference in days, not weeks.

(drown) - F - MLife

Locale: Shenandoah
"Trouble in Paradise: Altitude Illness in SEKI" on 07/01/2009 19:00:33 MDT Print View

There is a delayed reaction in your bodies' reaction to a sudden change in altitude. You may feel better in the first 12-24 hours vs. the next 2-3 days. This can mislead you into going higher than you should or give a false sense that all is OK. Hence the need to be conservative and stick with a moderate climbing rate.

The Feb issue of Trail Runner Magazine had an article about this specific issue with strategies for low elevation runners having to compete at elevation.

Edited by drown on 07/01/2009 19:54:12 MDT.

Lisa Frugoli
(alfresco) - MLife

Locale: San Francisco Bay Area
Altitude Sickness on 07/01/2009 19:48:32 MDT Print View

I find that to combat altitude sickness, I have to stay VERY hydrated - I drink way more than I think I need to. I've experienced problems a couple times in the past. Since I started drinking lots more water when I know I'll be gaining elevation, I've had no further problems...including hiking to the top of Whitney in a day.

cary bertoncini
(cbert) - F

Locale: N. California
blood ph/etc & altitude on 07/01/2009 23:25:44 MDT Print View

blood ph tends to go up at altitude due to less co2 caused by increased respiration

kidneys respond by expelling bicarbonate

drinking fluids helps w/ expelling bicarbonate

increased max vo2 fitness level would help with ph balancing responses

increased fitness also can be detrimental, paradoxically, as it allows faster altitude gain - physiological response gains from improved fitness might lag behind the faster ascent rate

i was having AMS symptoms once about 300' below Shepherd Pass (12K) - 2nd day from sea level & stopped to rest, drinking down an "emergen-c" drink mix. my doctor friend/hiking buddy suggested it was a combination of the b vitamins, acidity of the vitamin c, and the fluids that resulted in my feeling much better rather rapidly & being able to continue on over the pass and on for an 8 day trip, all above 10k

David Reichel
(dreichel) - F

Locale: Lake Tahoe
nice write up on 07/02/2009 19:59:44 MDT Print View

Thanks for sharing your experience and nice work dealing with the situation.

I liked the part of the write up where a partially restored Jeff yelled the rest of you out of bed at 6am.

Altitude issues are weird and unpredictable, and it's good to be reminded that they can pop up even in fit people and a strong group.

Kevin Sawchuk
(ksawchuk) - BPL Staff - MLife

Locale: Northern California
Re: Fitness and altitude sickness on 07/05/2009 21:56:55 MDT Print View

There are several adaptations that happen in response to elevation. You breathe harder/faster and blow off CO2--this alkalinizes your blood (higher pH) and your kidneys have to get rid of HCO3 (bicarbonate) to compensate. Your body produces a chemical called 2,3 DPG which makes your hemoglobin release oxygen despite the lower concentration of oxygen at elevation.

Increases in hemoglobin and increased capillary (blood vessel) density take weeks to months.

Diamox alkalinizes your urine--you basically pee out bicarbonate so when you breathe harder you are more easily able to achieve "acid base balance". It works and I'll leave the decision about whether to use it or not to the individual. It's probably safer and better to ascend slowly (and slowly can vary with the individual--I've never had a problem camping at 10,000'the first night but I sure feel the effects on my hiking performance)

Since writing this article I've dumped the benzoin--leukotape has such a superior adhesive I don't need it. With leukotape I think I could have hiked the JMT several hours faster--the blisters were that bad.

Edited by ksawchuk on 07/05/2009 21:59:20 MDT.

Wolfgang Zeiler
(geala) - F

Locale: Hannover, Germany
First Aid Kit on 07/06/2009 01:43:03 MDT Print View

I've a question concerning the First Aid Kit. You don't list bandages or compression bandages (or I have overlooked it) but you mention it in the text. Do you take some with you? How do you attend bigger wounds to stop bleeding? I use mainly sterile wound pads (don't know the term in English) without a cloth bandage attached, that you can fix with tape. But sometimes a bandage is nice just to protect the clothing from the blood.

Kevin Sawchuk
(ksawchuk) - BPL Staff - MLife

Locale: Northern California
Bandages on 07/06/2009 09:46:06 MDT Print View

I do list some small bandages and Steri-Strips for convenience but should the need for any larger ones arise I would use a bandana, wadded TP (unused of course) or ripped clothing (though I'd have to be pretty desperate to resort to this! I'd start ripping from the bottom of a shirt to preserve most of its function). The Leukotape works well to hold these into place.

Perhaps not ideal but in >1000 nights in the backcountry I've never had a major wound to dress. A couple of deep finger cuts has been the worst that I've seen.

Martin Wilde
( - F

Locale: Pacific Northwest
Sleeping at high altitudes on 07/06/2009 15:31:17 MDT Print View

Back in 2007 I did the JMT in 18 days. I had no altitude problems until the very end where I could not sleep about 11000' very well. I remember the last night at Guitar Lake I kept waking up every 30 minutes gasping for air. Strange as I had no headaches, excellent appetite and the next day rocketed up to the summit of Mt. Whitney. Two days earlier Forrester Pass gave me no problems. I slept fine at 10,500' a few days earlier.

Something wacky about sleeping above 11000'?

Ken Helwig
(kennyhel77) - MLife

Locale: Scotts Valley CA via San Jose, CA
Re: Sleeping at high altitudes on 07/06/2009 20:47:23 MDT Print View

Folks we are all different and have different problems. I was in Yosemite a few months ago at 4000 feet and suffered altitude sickness. I usually drive from the ocean (Santa Cruz) and drive to 8-9000 feet and start hiking right from the start. I have never had a problem until that day. It happens. Just drink, and eat food. Take it slow on the first day. You will get thre! Drink lots of water and eat.