altitude sickness, what's your call?

[Woody]

I'm with the consensus here. Go Down as quickly and as directly as possible.

 

[jessbee]

Yep. I'd agree with all responses here. Go down now.

SB, I'd expect a more difficult scenario from you!

 

[hikingfish]

Yep. I'd agree with all responses here. Go down now.

SB, I'd expect a more difficult scenario from you!

Sure it sounds easy as we write this from our offices...what about if you just forked a couple of thousands of dollars to get to your destination, used up all your precious vacation time and you know full well you'll probably never be coming back on this particular mountain and this is your once in a life-time shot at it...I know, it's the journey that counts, not the summit, erm, I meant destination But then again, that saying was probably thought of by someone in his office...(and not a peakbagger!).

Fish

 

[David Metsky]

But then again, that saying was probably thought of by someone in his office...(and not a peakbagger!).

There is another saying: There are old climbers, and there are bold climbers, but there are no old, bold climbers.

The guideline was created by people who know how altitude sickness works. When you are feeling that bad, there is little chance it is going to fix itself. People die from this, so going down really is the only option.

When I was in Nepal the Himalayan Rescue Association (doctors who work at altitude in the trekking regions) said the highest correlating factor for getting AMS was being in a large paid group. The social pressures of not holding up the group are large; people are prone to ignoring the signs for fear of spoiling the trip for everyone. Sadly, they occasionally die as a result, as happened just before my small group went over the pass. That's why it is doubly important to stick to the guidelines and impress upon the entire group that this is non-negotiable. It's a tough sell at first, but it can be done.

 

[DougPaul]

what about if you just forked a couple of thousands of dollars to get to your destination, used up all your precious vacation time and you know full well you'll probably never be coming back on this particular mountain and this is your once in a life-time shot at it...

The alternative is possible death. Take your choice.

And even if you make it, you may be too miserable to enjoy it.

Doug

 

[skiguy]

When I was in Nepal the Himalayan Rescue Association (doctors who work at altitude in the trekking regions) said the highest correlating factor for getting AMS was being in a large paid group. The social pressures of not holding up the group are large; people are prone to ignoring the signs for fear of spoiling the trip for everyone. Sadly, they occasionally die as a result, as happened just before my small group went over the pass. That's why it is doubly important to stick to the guidelines and impress upon the entire group that this is non-negotiable. It's a tough sell at first, but it can be done.

This is an excellent and interesting point about social pressures. I have seen many dynamics occur in groups big and small but also have seen first hand the power of money and far away places from home create some not so nice situations. On one of my first big mountain trips I used a guide service.The same people who were very cooperative and really wanted to get along with others on the way up turned into ogers on the way down when they had not made the Summit. Social dynamics with people you have not met before can certainly be interesting especially when Altitude is thrown in. At the same time I have met and enjoyed some life time friends in some of the same places.

 

[DougPaul]

This is an excellent and interesting point about social pressures. I have seen many dynamics occur in groups big and small but also have seen first hand the power of money and far away places from home create some not so nice situations. On one of my first big mountain trips I used a guide service.The same people who were very cooperative and really wanted to get along with others on the way up turned into ogers on the way down when they had not made the Summit. Social dynamics with people you have not met before can certainly be interesting especially when Altitude is thrown in. At the same time I have met and enjoyed some life time friends in some of the same places.

Social dynamics can also be a big factor in groups going out into avalanche terrain in iffy conditions.

Doug

 

[Kevin Rooney]

Sure it sounds easy as we write this from our offices...what about if you just forked a couple of thousands of dollars to get to your destination, used up all your precious vacation time and you know full well you'll probably never be coming back on this particular mountain and this is your once in a life-time shot at it...I know, it's the journey that counts, not the summit, erm, I meant destination But then again, that saying was probably thought of by someone in his office...(and not a peakbagger!).

Fish

I've got no problem with the point of view IF you're on a solo expedition and will endanger no one else by errors in judgement (except perhaps your immediate family back home who get to remember you as that a..hole husband/dad whose head exploded on Peak X because he was too stupid to turn around).

If you're with a group then everything changes.

 

[RoySwkr]

SB, I'd expect a more difficult scenario from you!

I reread the initial post carefully and on second reading got more of a feeling that the person actually had AMS and not just "symptoms of AMS". Surely there is no disagreement that someone with AMS should head down.

On the other hand anyone sitting at a computer who can definitively diagnose what someone had a few months ago a continent away should be working for the Mayo Clinic The issue here is that someone showing symptoms of AMS might actually have a number of less serious conditions instead (including dehydration) for which going down may not be effective treatment.

A number of years ago someone drowned on a Boston AMC whitewater canoe trip, he took a spill into heavy water and what might have been annoying to most people proved fatal to someone with a lung condition. Much was made about "he should have told the leader about this condition" but if he had he probably wouldn't have been allowed on the trip. Thus there may be a tendency for people to lie both about preexisting conditions and about how they feel right now. Note that the guy in the base note has already held the group up a day, if they turn around now and lose another day this guy will never be invited on a high altitude trip again. He may also miss out on what may be a long-awaited vacation.

On the other hand, I have hiked with a number of hypochondriacs who exaggerate their condition, unfortunately the best plan is often to assume the worst but as in the above try to avoid ever hiking with them again

AMS is not really a problem in the NE but heart attacks are, and chest pains can arise from a number of things. As a leader, if somebody who is carrying a large backpack for the first time recently has chest pains, do you call a helicopter or give them Ibuprofen? If somebody dies on your watch you'll never forgive yourself, but if you treat every symptom as oncoming death nobody will want to hike with you.

 

[DougPaul]

On the other hand, I have hiked with a number of hypochondriacs who exaggerate their condition, unfortunately the best plan is often to assume the worst but as in the above try to avoid ever hiking with them again

AMS is not really a problem in the NE but heart attacks are, and chest pains can arise from a number of things. As a leader, if somebody who is carrying a large backpack for the first time recently has chest pains, do you call a helicopter or give them Ibuprofen? If somebody dies on your watch you'll never forgive yourself, but if you treat every symptom as oncoming death nobody will want to hike with you.

Agreed.

In a real situation, what to do about such things is often a judgment call. Mild AMS may resolve if you stay put. Or you can endure it for a few hours to reach a peak or get over a pass. Severe AMS can progressively get worse until you die. And enduring mild AMS is part of the normal acclimatization process for many.

It is easy to know what to do in severe cases of many problems, the mild ones can be more problematical.

Doug

 

[Tim Seaver]

If this person really has AMS, they need to go down

I think it's a matter of degrees - benign vs. severe. Lots of people get AMS on Denali (I did) and are still able to safely climb. Acetazolamide and/or dexamethasone are pretty effective for reducing the symptoms, but when to make the call to descend is a tough one.

Acute Mountain Sickness

Acute Mountain Sickness Acute mountain sickness (AMS) is a symptom complex seen a few hours to a few days after ascent to altitudes above 2500 meters. Most individuals with AMS present with a mild form of the condition, characterized by headache in association with one or more of the following: lassitude, insomnia, anorexia, nausea, dizziness, or peripheral edema. More severe AMS is characterized by an altered level of consciousness, ataxia, or cough with shortness of breath at rest. Such symptoms suggest that AMS has progressed to high altitude cerebral edema (HACE) or high altitude pulmonary edema (HAPE). HACE and HAPE are generally associated with more rapid ascent to higher altitudes. AMS is usually benign and self- limited. HAPE or HACE are potentially life-threatening conditions, especially if further ascent is undertaken. The incidence of AMS on Denali is about 30 to 50% and is most often mild to mod- erate in severity. Most climbers treat their AMS by halting ascent, resting, and using analgesics for headache. Descent is always effective therapy, and is recommended in more severe cases. Drug therapy with acetazolamide or dexamethasone may be used to speed resolution of symptoms.

 

[skiguy]

I think it's a matter of degrees - benign vs. severe. Lots of people get AMS on Denali (I did) and are still able to safely climb. Acetazolamide and/or dexamethasone are pretty effective for reducing the symptoms, but when to make the call to descend is a tough one.

Acute Mountain Sickness

Tim thanks for posting this. Colin Grissom IMO knows his stuff in this area and I can speak first hand here. My first trip to Denali I had the pleasure of meeting and speaking with him at the 14000 foot Medical Camp. He even took some of my blood because I agreed to and also had mild AMS and he needed subjects for the research he was doing at the time on AMS, HACE, and HAPE. After a long discussion about acclimitization and the use of Diamox with him the big point he made that really hit home was that everyone acclimitizes differently. Also he mentioned that World Class Mountaineers can and do acclimitize differently and sometimes SLOWLY. He also implied that acclimitization can be different in the same individual on different occasions. He also said that one's own acclimitization process is only truely learned after time in the mountains understanding one's own individualities to altitude. For these reasons this is why I alluded to earlier in the thread about the subject's experience at Altitude and if they had just gone quickly or not to 11000 feet.

 

[Puma concolor]

My recent experience with Acetazolamide - AKA Diamox - was also very positive with western elevations between 12,000 and 14,400. Taken properly, Diamox can be used for preventative purposes although I've also heard of it being used after symptoms of AMS appearing. I'd gotten AMS out west in 2006 and turned around on a 13K mountain (as noted, the proper course of action) but had much better luck this year with twice daily 125 mg doses. There are side effects (some tingling in the extremities, frequent peeing and flat tasting beer) but these side effects are apparently directly proportional to dosage. In other words, the side effects with 500 mg on a bigger mountain will be more significant than the 125 mg I took.

 

[Tim Seaver]

My recent experience with Acetazolamide - AKA Diamox - was also very positive with western elevations between 12,000 and 14,400. Taken properly, Diamox can be used for preventative purposes although I've also heard of it being used after symptoms of AMS appearing.

I would agree, and your description of the side-effects is right on the money.
The tingling extremities ( yes, all of them) is the strangest one

We carried on our expedition hoping to get by without it. But at the 14,3 camp I started getting sleep apnea, so I began taking it from that point. The morning after we summited, my partner was showing signs of moderate AMS and was in no shape to descend the semi-technical section of ridge to 14,3 from the Crow's Nest (17,3). So we took a "rest day" at 17,3, an altitude not typically recommended for recovery. He took some Diamox that morning, and by the evening his appetite and spunk were on the mend. For us, it worked out to be a good thing to have along, but as skiguy says, it's really an individual thing.

 

[Dr. Dasypodidae]

Great thread. In February 2005, my partner and I began taking Diamox at the 14.4 k Horcones valley base camp (Plaza des Mulas) on Aconcagua, but the Argentine doctor there recommended that we drop it and begin drinking more water instead (he recommended 5 to 6 liters per day, which was difficult to accommodate, but we usually topped 4 to 5 liters most days from thereon, which would have required multiple pee bottles at night on a snowy mountain). The doc's argument was that Diamox and related meds are also diuretics, and that in his opinion dehydration is a major causal factor for altitude sickness. As our hike panned out, we summited on our 10th day on the mountain, without even a headache at nearly 23 k, although I was a little light-headed. My partner then summited Everest about three months later, but I am not sure whether he used Diamox on that trip, although he did use supplemental O2.

 

[Puma concolor]

Agreed, Dr. D. I was in a position where I was doing a series of dayhikes so I had no trouble keeping myself hydrated. When I wasn't hiking, I was drinking. Had one or two beers at the airport on the way out and a couple of sodas that tasted flat, but other than that I was very conscious of drinking tons of water, vitamin water and other types of drinks that didn't dehydrate me any more than the Diamox was trying to do. Overall, I found that the ... ahem ... dehydrating effects of Diamox were within the first few hours of each dosage. On a multi-day/week expedition (like Denali or Aconcagua) where water isn't so readily available, there are certainly more factors to weigh. Time at altitude is obviously the best "medicine," but in my situation, I was trying to get up high within about 40 hours of leaving sea level.

 

[Kevin Rooney]

One key bit of info re: sleeping bear's scenario is whether John had ever been to altitude before. If this was his first time, then it would behoove the trip leader to err on the side of caution. The inference in her scenario is that he's a first-timer.

I'll add my own personal experience with acclimatization. The first time I did Rainier I'd done only a couple of other 14'ers so my experience with altitude was limited. We were fortunate to have a cardiologist from CO in the group who was generous with his expertise and time, and had been up 14'ers many times. Among other things, he taught us how to recognize the early symptoms HAPE (raspy voice, dry cough). Since that time I've been to 14'+ scores of times, but never above 14.5'. Despite that experience, I am invariably affected to some degree with AMS/HAPE/HACE, and the degree to which I'm affected on any given climb is directly related to how long it's been since I've been to altitude. When I lived on the east coast and did a yearly western trip, I would experience it the worst. Symptoms would begin as low as 7K' if I was somewhat dehydrated; otherwise, around 8.5K'. They'd begin with a mild headache, gradually increasing in intensity. Around 11K' my voice got raspy, and around 13K' a light cough would develop. By 14K' my head would be pounding. I never vomited, or felt like it, but did have a loss of appetite. After about the 3rd climb my body would be mostly acclimated, but would still feel a slight headache twinge (almost "pre-headache") around 14K'. At first I was discouraged, thinking that in time my body would adjust, and then I learned that it's rarely the case. So now I've learned to accept it, and have devised better coping strategies.

Since I moved to the west I've found that I can maintain my 'resistance' to the altitude symptoms if I can get to altitude a minimum of 2 or 3 times a month. By 'altitude' I mean at least 10K', and preferably 12K' or higher. The conventional wisdom among the hiking crowd here is that the benefits of acclimatization to 14K' lasts about 2 weeks. I don't know if there's medical research to corroborate this, but most of these guys have the academic credentials to make this observation credible. When I'm able to maintain this level of acclimatization I'm able to summit a 14'er with only minimal discomfort.

I've often carried Diamox but never used it. There's some evidence that aspirin has a similar beneficial effect - if anyone's interested in looking into this more I think there are some related threads on the Whitney Portal BB.

As stated above, everyone's body is different, and acclimatizes at different rates in different conditions. Having said that, I've developed a level of comfort with the various symptoms so I have a better sense of knowing when I can safely 'tough it out' or should be turning around.

One thing that hasn't been mentioned is shortness of breath at altitude. This, to the best of my knowledge, is not considered a symptom of AMS/HAPE/HACE. If I'm able to get to altitude regularly, then the degree of shortness of breath is reduced, but it never completely goes away.

If sierra reads this thread I hope he comments on his own adaptation to climbing at altitude, as I know at times he's lived in areas with lots of high peaks.

 

[skiguy]

One key bit of info re: sleeping bear's scenario is whether John had ever been to altitude before. If this was his first time, then it would behoove the trip leader to err on the side of caution. The inference in her scenario is that he's a first-timer.

I'll add my own personal experience with acclimatization. The first time I did Rainier I'd done only a couple of other 14'ers so my experience with altitude was limited. We were fortunate to have a cardiologist from CO in the group who was generous with his expertise and time, and had been up 14'ers many times. Among other things, he taught us how to recognize the early symptoms HAPE (raspy voice, dry cough). Since that time I've been to 14'+ scores of times, but never above 14.5'. Despite that experience, I am invariably affected to some degree with AMS/HAPE/HACE, and the degree to which I'm affected on any given climb is directly related to how long it's been since I've been to altitude. When I lived on the east coast and did a yearly western trip, I would experience it the worst. Symptoms would begin as low as 7K' if I was somewhat dehydrated; otherwise, around 8.5K'. They'd begin with a mild headache, gradually increasing in intensity. Around 11K' my voice got raspy, and around 13K' a light cough would develop. By 14K' my head would be pounding. I never vomited, or felt like it, but did have a loss of appetite. After about the 3rd climb my body would be mostly acclimated, but would still feel a slight headache twinge (almost "pre-headache") around 14K'. At first I was discouraged, thinking that in time my body would adjust, and then I learned that it's rarely the case. So now I've learned to accept it, and have devised better coping strategies.

Since I moved to the west I've found that I can maintain my 'resistance' to the altitude symptoms if I can get to altitude a minimum of 2 or 3 times a month. By 'altitude' I mean at least 10K', and preferably 12K' or higher. The conventional wisdom among the hiking crowd here is that the benefits of acclimatization to 14K' lasts about 2 weeks. I don't know if there's medical research to corroborate this, but most of these guys have the academic credentials to make this observation credible. When I'm able to maintain this level of acclimatization I'm able to summit a 14'er with only minimal discomfort.

I've often carried Diamox but never used it. There's some evidence that aspirin has a similar beneficial effect - if anyone's interested in looking into this more I think there are some related threads on the Whitney Portal BB.

As stated above, everyone's body is different, and acclimatizes at different rates in different conditions. Having said that, I've developed a level of comfort with the various symptoms so I have a better sense of knowing when I can safely 'tough it out' or should be turning around.

One thing that hasn't been mentioned is shortness of breath at altitude. This, to the best of my knowledge, is not considered a symptom of AMS/HAPE/HACE. If I'm able to get to altitude regularly, then the degree of shortness of breath is reduced, but it never completely goes away.

If sierra reads this thread I hope he comments on his own adaptation to climbing at altitude, as I know at times he's lived in areas with lots of high peaks.

Good post Kevin...everyone adapts differently in any given situation. Sounds as if you have found a great formula for your personal physiology and experience. Certainly takes time and experience to do so but IMO when it comes to Altitude anyone can be given an ace to their advantage or disadvantage. It's all an ongoing learning experience.

 

[sleeping bear]

I had no idea this thread was still going!

So let's say John has been to 12,000 feet once before with no problems. On this particular trip he came from less than 1,000 feet and has been above 8 for 2 days when he begins to get sick.

I've done a fair amount of research on this in the past 10 days. The American Alpine Club has their journal online for free. I spent a couple of days searching and sifting through their articles. Super interesting.

 

[DougPaul]

Rather than trying to learn by playing scenario games, you might try reading "Going Higher", by Charles S Houston (an authority on the topic).

Doug