It's probably not the elevation

6:37 p.m. on August 15, 2016 (EDT)
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Years ago I hiked to Camp Muir (10,000 Ft) on Mount Rainier and, during the last 1,000 feet of elevation gain, I couldn't catch my breath, I got light headed and when I finally got there I had a wicked headache. 

Later my friend made it to ~13,500 feet and he just couldn't continue. He was light headed and couldn't catch his breath. He wasn't able to summit. 

In each case we both blamed altitude. Also afterward we each went home, lost fifty pounds, got born again hard, came back and sent the 14,000+ ft. peak in style, joking and laughing the entire way.  

I'm not saying that altitude sickness (AMS) isn't real.  It kills people all the time. It is nothing to mess with and has nothing to do with fitness or gender.  Some people can die going from sea level to as little as 8,000 feet.  Their brains swell, their lungs fill with fluid, and now they don't pay taxes. 

I'm just suggesting that, if you felt like you were going to die on that 6,000 or 10,000 foot climb you might not want to sell your ice axe and take up croquet just yet.  Hit the road, put the fork down and try it again in your new and improved body.  You can do it!  Probably.   


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Before fitness.  This guy is really winded!


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Stronger, faster, lighter.  "What elevation?"

8:19 p.m. on August 15, 2016 (EDT)
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Re: Its probably not the elevation

Congrats on the fitness accomplishment. But it was still the elevation =P. Altitude sickness severity is definitely directly proportional to fitness level in my personal experience. The more in tune your body is, the easier it is for it to cope with altitude related issues.

9:03 p.m. on August 15, 2016 (EDT)
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Re: Its probably not the elevation

In my experience body stress is a big factor. Wether it be fitness level or excess alcohol intake the night before or lack of sleep  Can all help contribute to the effects of altitude sickness. 

3:25 a.m. on August 16, 2016 (EDT)
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Re: Its probably not the elevation

I have to say you are brave ! You can do it after the fitness accomplishment.

9:42 a.m. on August 16, 2016 (EDT)
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Re: Its probably not the elevation

Rambler, being out of shape makes it hard to work at altitude but true altitude sickness or AMS is not fitness related.

Having low cardio fitness just makes life harder in general.

12:10 p.m. on August 16, 2016 (EDT)
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Re: Its probably not the elevation

The two best books on altitude illness are Charles Houston's "Going Higher" and Peter Hackett's "Mountain Sickness".

A few years back, I was a guinea pig, errrh, a "participant" in a study (one of the privileges of living close to Stanford University where a lot of studies of humans in the outdoors are carried out). Here is an over-simplified summary of what is known about altitude -

About 10% of the population (including Sherpas and Andean natives) adapt readily to altitudes over 9000 ft, thanks to having 6 particular genes (or genetic anomalies, depending on who in the medical world you talk to). According to the study I participated in, I am one of the lucky ones. This just means I acclimatize more rapidly than 90% of the population, but you can't just drop me on the summit of Everest straight from sea level. This rapid adjustment shows up for me, for example, in my expeditions to Peru (I returned from this year's expedition to Peru July 25). I leave home at 8 ft above sea level in the plane to Lima, then take a bus (8 hours) to Huaraz (15,000 ft), then head up to our research area, which may take me to a summit at 18,000 ft. My blood oxygen saturation (98% at home) drops to 90% in Huaraz (many of our team drop to 85% or less) and climbs back to 96-97% at the 15,000-20,000 ft level within 3 to 5 days. Most people on the expeditions take 1-2 weeks to get back into the 90-95% range. And yes, I do carry a pulse-ox meter with me when going to altitude. Again, note - this does not make me "superman" - I still have to acclimatize, albeit faster than most of the population - that's just genetics.

About 10% of the population cannot adapt to altitudes over 10,000 ft. A friend of mine was in that group. Notably, he suffered a serious loss of judgment, along with the headaches and other symptoms (the "umbles" which are a signature of altitude sickness - mumbling, stumbling, fumbling). When climbing Sierra peaks, his technique was to camp for a few days at 8000 ft or so, then push fast to the summit of a 13,000 to 14,000 ft peak and head down immediately. Unfortunately, the loss of judgment resulted in his (and a companion) pushing to the summit of Shasta (14,200 ft or so) trying to beat a full white-out storm. Instead, they reached a point in the whiteout where they could no longer find their way and had to stop. Both perished, one from hypothermia, the other from a fall and resulting broken neck.

The people who suffer most from AMS and its variants are males in the 18-30yo range, according to both Houston and Hackett. This is attributed to such strong, super-fit young to middle aged men charging up the mountain, rather than pacing themselves. Jeff's comment that:

true altitude sickness or AMS is not fitness related.

is sort-of right. More accurately, it is the opposite - the strong, fit males tend to push hard, while the old geezers take it easy. Note the comments from Jeff about how hard it was on his earlier hike to Camp Muir and how much easier it was years later.

Now that I am past the 3/4 Century mark (in addition to have the lucky genes), I find that my leisurely pace often gets me up the hills faster than the young bucks. As the guides on Kilimanjaro say "pole, pole", which translates to "slowly, slowly."

This is an over-simplified summary. For a more complete explanation and comments on the effectiveness of Diamox and ibuprofen, I suggest you read Houston's and Hackett's books. In addition, pace yourself - "pole, pole".

7:21 a.m. on August 18, 2016 (EDT)
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I'm surprised no one has mentioned hydration. Extreme effort without proper water intake can cause dizziness & headaches. 

When I went to climb Rainier, I had a prescription of Diamox. During our gear shakedown, our guide insisted we get rid of it and said if he found anyone taking it on the trip he wouldn't allow us to summit. (Our lead guide was a jerk on multiple levels). 

10:02 a.m. on August 18, 2016 (EDT)
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Thanks to Bill.  Many factors contribute to one's ability to handle altitude starting with genetics.  Age is a factor, but can be overcome with high levels of fitness.

I have always struggled with high elevations, and gave up the thought of climbing at a young age. It was an amazing experience though to spend 3 1/2 weeks in the Andes and hike with the local people at 13,000 feet.

10:14 a.m. on August 18, 2016 (EDT)
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I really like Bill S's comment and believe that is the case in most circumstances. Some people for sure have more difficulty performing at altitude than others. We have a house out in Colorado that sits at 8,450 feet above sea level. We spend 8-15 weeks out there a year. Usually everyone does great when hiking above 10,000 feet. This summer like most summers we took 2 extra kids (16) besides our daughter with us and one of them had a harder time then the other kids running and hiking over 10,000 feet.  All of these kids are athletes (cross country ski racers and runners) so fitness isn't an issue nor was hydration as I made sure they drank and ate enough.  I think as Bill indicated genetics plays a role in how we function at altitude.  We all had about 7-8 days of sleeping/functioning at the lower altitude before we went up higher so we slowly worked the kids up to higher elevations so I was mindful to have them adjust. This altitude sickness and the issues it presents typically happens to at least 1 person in our group that hasn't spent any time at higher elevations. I wonder if the more time (like my daughter who has been going out to CO since she was born) you spend at altitude makes a difference? Bill if you can comment on this that would be grand. Thanks!

2:43 p.m. on August 18, 2016 (EDT)
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As I noted, my comments were oversimplified. There are a number of factors at play - genetics, conditioning, hydration, nutrition, speed of ascent, level of activity, time and nature of acclimatizing, and more.

Hackett and Houston found that "climb high/sleep low", with the sleeping altitude climbing at about 1000 ft/day, is a fairly good way to acclimatize.

Diamox works well for many people IF you follow the directions religiously, especially combined with "climb high/sleep low" and ascend "pole, pole"

For Tammy - There has been a lot of debate on this. I would have to dig through Houston's and Hackett's books, plus maybe dig through Auerbach's huge tome. But I will note that there have been some notable situations among Denali volunteer rangers where they would go back to Talkeetna for a few days to resupply and a brief break, then head straight back to the 17k camp, only to get hit with a monstrous headache or even HAPE or HACE. It is fairly clear in the mountain medicine books that for most people, it takes a week typically for most people to acclimatize (using the climb high/sleep low approach), then just 2 or 3 days back at low altitudes to loose the acclimatization.

Couple of other things - the legend is that Sherpas (I mean the Sherpa people, not the porters referred to as "Sherpa") are able to head up Everest with no acclimatization needed. The truth is that Sherpas do acclimatize fairly rapidly, but are susceptible to HAPE and HACE if they ascend too rapidly.

A study about 2 years ago (again out of Stanford) took a group of people to the White Mountains (the ones along the California eastern border) up to altitude rapidly. They were given pills to take - placebos for some, ibuprofen for others. The ibuprofen provided a fair amount of relief for roughly half of the people receiving the real ibuprofen and little for the other half. The placebo people almost all suffered significant AMS symptoms - headaches, nausea, loss of appetite, etc. So, ibuprofen MIGHT help you with AMS.

I do find that If I carry 60-70 pounds of climbing and camping gear more than 15 miles or so and an altitude gain of a couple thousand feet of ascent, I tend to get sore shoulder muscles. Plus, at my age, I tend to get sore knees. My appetite stays up, though, and, as mentioned before, my pulse/OX stays above 90-95%.

4:08 p.m. on August 18, 2016 (EDT)
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Since I seem in the business of opening cans of worms, Bill, are you a fan of pressure breathing?

8:28 p.m. on August 18, 2016 (EDT)
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I am NOT a "fan" of pressure breathing, although I sometimes use it when I am hiking with someone who insists on going full speed ahead up the hill for an hour, then stopping and wasting a half hour recovering. Since I have a very fast recovery time compared to most people, I find this irritating, and very slow overall. I prefer to hike at a rate of 115-130 bpm, so I don't have to stop and can carry on a bit of conversation (yes, I wear an HRM). Since my measured max heart rate is in the 145-150 range, I am hiking pretty much in my aerobic range, although my comfortable biking rate is 145 and feels perfectly aerobic. Yes, I know, this violates the magic rule of 220 minus your age being your maximum heart rate. But people differ in their real maximum.

If I have someone racing up the hill, I sometimes resort to the rest-step approach. Or just hike at my aerobic rate, then walk past them at their half-hour-long rest break. If I hike at 120bpm for a couple hours, then stop, it takes about 5-10 min for my heart rate to drop back below 85-90 bpm. But if I have to wait 15-20 min for the "rabbit" to decide to start moving again, it takes another 15-20 min to get back up to get back to cruising (aerobic) heart rate of 120-130 bpm.

Since I set my pace by heart rate, I naturally go slower when carrying a heavy load or on a hot day like yesterday, and obviously when going uphill.

2:05 a.m. on August 19, 2016 (EDT)
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Adding on what's been said:

Correct me if I am wrong, Bill, but I recall Huston stated Diamox can provide relief for someone already afflicted with AMS, but prophylactic use of Diamox may actually increase the risk for AMS.  (Perhaps, Goose, this thought was behind your guide's sentiments.)  Note: Even if one follows all recommended practices, and doesn't have a genetic predisposition for AMS, you can still get it.  To some degree there is no predicting who will get afflicted or when.  Sometimes it just seems to occur randomly.

I get a mild case of AMS on occasion.  Most of the time, it was due to hiking high immediately after traveling from sea level.  Sometimes the hike was preceded by long days with little sleep.  But a couple of times I suffered horrible headaches, even vomiting, regardless I was following protocol.  I have been over 20K" twice, but my two worse AMS episodes both occurred below 9K"!  As far as I could recall, there was nothing about these trips that differed from other trips that were free of AMS.  In any case, descending, rehydrating, and NSAIDs usually brought relief within an hour or two.  I recall other occasions nursing others in my group who had no previous AMS episodes; twice the symptoms were so debilitating it confined these persons to their tent for a day or two.

Ed

12:09 p.m. on August 19, 2016 (EDT)
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Ed,

I scanned "Going Higher" (5th edition) to see if I could find such a statement. I did not find anything to that effect.

Diamox (Acetazolamide) is a diuretic (Houston says that was its original purpose). So while it reduces Cheyne-Stokes breathing while sleeping (the irregular, interrupted breathing many people suffer at altitude), it also promotes frequent waking to urinate. It also has a side effect of tingling hands.

Houston states clearly that Diamox works as a prophylactic, as well as a treatment for AMS. In "Going Higher", he has a detailed discussion of how Diamox interacts with the CO2 and other parts of the metabolism. Not being an MD, much less having detailed personal training in AMS, HAPE, or HACE, I can't say anything about an increased risk, and whether such a risk does or does not exist. There are some other medicines for HAPE and HACE, which our doctor has administered to a few people who developed symptoms of those.

I have never taken Diamox myself, and have not had AMS (but then, the study where I was a "subject" put me in the "fast acclimatization" category). On our expeditions to Peru, our doctor (who is a specialist in wilderness medicine and particularly high altitude) requires us to carry Diamox and provides us with detailed instructions in its use. Even those of us who don't use it have to know how to spot symptoms and when to give it to others (I always end up giving my supply to people who are suffering symptoms, though the group always includes "macho men" who claim to only have a "slight headache" - always seems to reduce their headaches).

The best and most effective treatment is if you get symptoms of AMS or especially HAPE or HACE, DESCEND IMMEDIATELY!

Again, I am NOT an MD. I can and have read the books on altitude problems, and can recommend that others read the books and talk to their personal physicians.

4:18 p.m. on August 19, 2016 (EDT)
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Thank you for the book recommendations I just ordered them...When I came from Korea to FT Carson in Colorado I had no problems with the altitude...But we had classes to soldiers on the affects and symptoms of altitude sickness..I did have one soldier who had a hard time adapting at first...

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