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Bob Gross
(--B.G.--) - F

Locale: Silicon Valley
Re: altitude preparation on 08/12/2013 20:10:10 MDT Print View

Jim, one thing that you might do is to purchase one of these tiny pulse-oximeter gadgets. They just squeeze onto your finger. You push a button, it takes a few seconds, and then it starts displaying results, pulse rate and blood oxygen saturation.

You say that you don't think that you have breathing problems. OK. It is also possible that the blood oxygen saturation has been dropping and you are not aware of it. If your body is functioning perfectly, your respiration rate will increase if saturation drops. However, it works faster or slower in different people, so it wouldn't be stupid to monitor it.

The old standard diagnostic for resting pulse rate is pretty clear. When you arrive at any one elevation, perhaps a camp prior to your first ascent day, put up a tent and relax for at least one hour. Then record your pulse rate. If it is over 110, and for sure if it is over 120, then that is the sign of early stage altitude illness. If it is well under 110, then that isn't it. It helps to know what your normal sea level pulse rate is.

I've plotted my own resting pulse rate versus altitude. First is sea level, and then the pulse rate increases slowly over ascent. As long as it stays out of the 110 range trouble, then sleep overnight and continue. If the pulse breaks out of that normal curve, it is a bad sign. Some climbers use this as a trigger for when they start taking the Diamox pills, although it is best to start them before you get into trouble.

It would not be completely stupid to have a blood pressure cuff in your car, while you are still car camping prior to starting out. You could have blood pressure problems that you didn't know about. As an example, some people have started monitoring their vital signs this way and then discovered that they had a diabetic condition. But, if you don't have any numbers, then it is all guesswork. Your physician may not want to write a Diamox prescription based on guesswork, so often they will order up a battery of tests.

--B.G.--

Jim Sweeney
(swimjay) - MLife

Locale: Northern California
Great and considered advice on 08/12/2013 22:21:11 MDT Print View

Thanks very much, Bob, for this thorough advice. I have a prescription for Diamox coming, and will begin taking it a day before my next trip.

In my case, symptoms are almost always the same: seemingly sudden onset of a rapid and thready pulse, quick fatigue, and the desire to take a nap, as though someone had just pulled the plug on me-- not the kind of ordinary, slowly developing fatigue one might experience just from effort. If I stay at altitude, the pulse stays elevated, easily over 120, then overnight diminishes, leaving me somewhat spent.

This last weekend, starting at Road's End and heading toward Avalanche Pass, with 29 pounds, (19 of it food),I was doing great through the switchbacks to Sphinx Creek Junction, and well on the switchbacks and stairs just past the junction, but a mile or so into the forest, just as I reached the small creek which crosses the trail, (at about the same altitude as where Sphinx Creek crosses the trail, probably about ~8400'), I was suddenly wiped out, pulse thready and over 120, though breathing normal, and had to flog myself to get to a campsite near Sphinx Creek.

Had I done day hikes to altitude beforehand, like Alta Peak or Jenny Lake out of Stony Creek, I'm sure I would have been fine, as, just three weeks earlier, having done Alta, two days before, (with similar symptoms at 11,000' --not carrying weight) I comfortably got to Sphinx Lake at 10,500', in a day, with only mild distress at 8400', which I dealt with by taking a nap.

Will also order a pulse-oximeter. Notice that Amazon carries them.

Sorry if this is too much detail for the general reader here, but Bob doesn't have a PM set up yet, and perhaps this is useful to others.

Edited by swimjay on 08/12/2013 22:23:43 MDT.

Glenn Price
(gbprice) - MLife
altitude symptoms on 08/12/2013 22:50:19 MDT Print View

You might want to consider this in your selection of treatments
http://med.stanford.edu/ism/2012/march/altitude.html

Ken Thompson
(kthompson) - MLife

Locale: Behind the Redwood Curtain
Re: altitude symptoms on 08/12/2013 22:56:12 MDT Print View

Another use for vitamin I. interesting.

Jim Sweeney
(swimjay) - MLife

Locale: Northern California
+1 Glenn on 08/12/2013 23:03:38 MDT Print View

Whoa, that looks great. If Ibuprofen works (and I know this doesn't make a lot of sense), it would seem like less of a chemical intervention than Diamox.

From Glenn's article: "Some researchers think the condition occurs because a lack of oxygen to the brain causes it to swell with fluids. Ibuprofen may help to reduce that swelling."

Have been doing Lumosity, a "brain-tainment" site for several months now, scores gradually increasing. Clearly my brain has been getting bigger, with a corresponding drop in spare skull volume, making me more vulnerable to pressure caused by fluid build-up. Time to choose -- go dumb and go high, or go smart and stay low? Tough call.

:>)

Bob Gross
(--B.G.--) - F

Locale: Silicon Valley
Re: Great and considered advice on 08/13/2013 00:13:35 MDT Print View

Jim, I am no physician, nor do I have the results to study from all of your lab tests. However, from the way you describe the symptoms, it seems somewhere between standard altitude illness and a diabetic condition. Have you had a blood test for this? It is very easy to rule out.

I have not yet subscribed to the Ibuprofen theory and brain fluids and all that. You aren't getting any ataxia, are you, loss of coordination like a stumbling drunk? For most of the climbers that I've been around who were getting some type of altitude problem, nearly all of them fell into the poor respiratory category.

I know of only one person who takes Diamox below 9000 feet elevation. Still some people have side effects from it, so starting with a half-dose wouldn't be stupid, just to see if you tolerate it. Some people are allergic to sulfa drugs.

At the last time that I was up there, I spent one afternoon at a Cedar Grove campground to relax, then started up early the next morning. I blasted up to Lake Reflection and arrived by 3 p.m. the first day. I didn't feel a speck of altitude problem, so I must have been doing something right. Total load was a hair over 30 pounds.

--B.G.--

Andrew Wolff
(Andrew)

Locale: Chattanooga
Altidude and the SHR on 08/18/2013 01:08:03 MDT Print View

Jim, you do immediately shoot up 6000 feet on the high route. Obviously the best way to deal with this, if you can't come from another high place like the New Mexico hikers did, is to break up the gain. One could start hiking a little later in the day and stay the first night in say Upper Tent Meadow and then complete the climb in the morning. I live at about 800 ft so thats not going to be any help to me with altidude at all. I was indeed counting on my fitness level and based on past experince believed that I'd be able to handle the ascent ok. It was however the biggest one day gain I've ever done and I could definately feel it the first night.

I was trekking in Nepal in May with some others and we had a chance to talk at length with a couple of doctors who had just finished a staffing rotation at the clinic at Periche. They recommended Ibuprofen to us as well and one of the members of our party who was having some trouble with the altitude (17 000+ ft) used it successfully along with diamox for the rest of the trip. I happen to be one of those who is allergic to Sulfa drugs, ibuprofen seems to be hard on the body, particularly for long term use but does seem to be quite helpful for short term rugged travel.

M G
(drown) - F - MLife

Locale: Shenandoah
Acclimatization on 08/18/2013 07:48:21 MDT Print View

The key is to plan extra time to acclimatize. If for example you can spend two extra nights and one extra day before " starting" you will stand a much better chance of avoidig problems. Plan to sleep between 6-8000 feet night one. Next day do a mellow day hike to above 10k and sleep between 9-10k . Then start you trip.

Herbal supplement Ginko is also known to help. Recommend taking them in the AM since they can mess up your dreams something bad if you take if late in the day. Start about 5 days before heading up.

Mike M
(mtwarden) - MLife

Locale: Montana
SHR on 08/18/2013 10:59:08 MDT Print View

thanks for the wonderfully detailed commentary and stunning photos- the SHR is high on my bucket list, this report just cements it- thanks!

Mike

jeffrey armbruster
(book) - M

Locale: Northern California
"Ropers Sierra High Route" on 08/18/2013 14:00:01 MDT Print View

Jim: you report your primary symptom as being an elevated heart rate. The rest of your symptoms "may" follow from that? Do you have a history of atrial fibrillation? Probably not, or you would have mentioned it.

Anyway, beta blockers like Atenolol will bring down your heart rate. However, I have absolutely no idea if this sort of thing would be recommended or not for your situation. (For example, taking a dose or half dose for the first day/night at elevation.) I'm just throwing this out with no medical background at all so take it with a grain or box of salt, so to speak. This is clearly something you'd need to talk to a cardiologist about.

I too get an elevated heart rate going from sea level where I live to 9,000 feet, for example Tuolumne Meadows. I've been surprised how even one afternoon/night at this kind of elevation really helps. I've monitored my heart rate and found that by day 2 and certainly 3 my rate has fallen significantly. A resting heart rate of 120 would certainly tire you out. Kind of scary.

I'm not sure if Diamox would address an elevated heart rate; I mean, I really don't know. Bob Gross can probably answer this.

Edited by book on 08/18/2013 14:02:09 MDT.

Bob Gross
(--B.G.--) - F

Locale: Silicon Valley
Re: "Ropers Sierra High Route" on 08/18/2013 14:22:48 MDT Print View

"I'm not sure if Diamox would address an elevated heart rate; I mean, I really don't know. Bob Gross can probably answer this."

Diamox tends to correct your blood's biochemicals in advance so that you don't get the pulmonary edema started, so the elevated heart rate never gets started by much. So, Diamox doesn't do anything for elevated heart rate, but it just gives you more safety margin so that you don't get into that state.

I know hikers who did not know that they had a mild cardiac arrhythmias. They would get off onto some strenuous hike like this and it would surprise them.

So, if you ever feel symptoms like this, it is a good idea to get checked out by your physician. Besides, if you need to get a prescription for Diamox, the physician is the person to get that going. One problem is that your physician can get you to do a treadmill test, but that won't prove anything about high altitude.

I had some symptoms one time, and then he had me do a treadmill test to try to figure out the cause. The physician told me the result. "Your treadmill score was exceptionally good. We don't know what caused your symptoms. The only thing we know is that it probably won't kill you." I didn't know whether that was good or bad.

--B.G.--

Walt Bizzare
(wbizzare) - M
About altitude sickness on 09/07/2013 23:06:31 MDT Print View

My first backpacking trip was 5 years ago and I did a cross Sierra hike that took me from Mineral King to Horseshoe Meadows in the Sierra's. Going from my sea level home to 8000 feet and then hiking to 10000 feet the first day sent my body into a diabetic shock. Most of my food made me sick and I was miserable the whole trip with extreme weakness and all the symptoms of diabetes. A few days in Lone Pine and I started to recover. When I got home I did some research and found that a lack of potassium can cause your body to stop producing insulin. I had prepared for the trip by running but never took electrolytes.

What I've learned is that taking electrolyte supplements before a trip and during the trip makes a world of difference in the ability to adjust to high elevations. My energy level is much improved and I don't suffer the effects of high elevations as much. I still have symptoms like not wanting to eat but I force down the food and that seems to work.

By the way that was a great article!

Thanks,
Walt

Bob Gross
(--B.G.--) - F

Locale: Silicon Valley
Re: About altitude sickness on 09/07/2013 23:16:51 MDT Print View

"What I've learned is that taking electrolyte supplements before a trip and during the trip makes a world of difference in the ability to adjust to high elevations. "

Walt, taking the electrolytes will cause you to retain more water internally, and that will keep you farther away from a dehydrated condition.

My theory is that dehydration makes up about 80% of the cause of altitude problems on the first day or two.

If I go too low on potassium, I just get muscle cramps.

--B.G.--

jeffrey armbruster
(book) - M

Locale: Northern California
"Ropers Sierra High Route" on 09/08/2013 10:15:54 MDT Print View

Concerning beta blockers for lowering your heart rate from altitude adjustment: my cardiologist does not recommend this.

Bob Gross
(--B.G.--) - F

Locale: Silicon Valley
Re: "Ropers Sierra High Route" on 09/08/2013 14:29:30 MDT Print View

"Concerning beta blockers for lowering your heart rate from altitude adjustment: my cardiologist does not recommend this."

I can't imagine who would have recommended it.

When you are high in the mountains, you generally want or need all of the blood pressure going that you can muster. You want all or most of the normal heart rate as well. Trying to fudge that with a beta blocker might make you feel much slower.

Increased heart rate at altitude is more of a diagnostic measure rather than something to strive for or against. A little bit of increase is normal. A lot of increase is a sign of something wrong, and typically it is of something pulmonary.

--B.G.--

Roleigh Martin
(marti124) - MLife

Locale: Moderator-JohnMuirTrail Yahoo Group
"Sierra High Route" vs "Sierra Haute Route" on 03/24/2014 11:13:04 MDT Print View

I'm attempting to document the various named High Sierra Trails and am not 100% sure if "Sierra High Route" vs "Sierra Haute Route" means something different or not. Anyone have an opinion?

http://thecalifornication.tumblr.com/post/50291283129/sierra-haute-route

Billy Ray
(rosyfinch) - M

Locale: the mountains
Re: "Sierra High Route" vs "Sierra Haute Route" on 03/24/2014 12:12:14 MDT Print View

My understanding is as follows:

There are actually two Sierra High Routes.
One is the Roper Sierra High Route that goes from King's Canyon to Twin Lakes near Bridgeport. This is a hiking route, much of it off-trail.

The other is called the Sierra Haute Route. It is an east/west ski crossing of the Sierra from Shepard Pass to Sequoia National Park. The word 'Haute' is used to connote some similarity to the Haute Route in the Alps. Some people substitute the work 'High' for Haute.

Billy

Roleigh Martin
(marti124) - MLife

Locale: Moderator-JohnMuirTrail Yahoo Group
Re: "Sierra High Route" vs "Sierra Haute Route" on 03/24/2014 14:28:30 MDT Print View

Thanks Billy. I see the Sierra Haute Route is also called the California Haute Route -- such as here: https://www.youtube.com/watch?v=QfcurDjrFzs -- where the page creator attributes the route to have been defined in 1978 (or he did the photos in 1978) -- don't know what the 1978 refers to here.

He states though, like you said: "California High Route Trans-Sierra Ski Traverse
from Shepherds Pass (Owens Valley to Lodgepole, Sequoia National Park) - 1978" -- I think the 1978 is that he made the Youtube taken from an old 1978 slide show of photos they took then.

I think I'll use as the acronym CHR versus SHR.