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Lowlanders and Acute Mountain Sickness - a word of caution

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Lowlanders and Acute Mountain Sickness - a word of caution

Postby joshmcd » Mon Jul 18, 2011 8:34 am

First post here - I've really enjoyed this site over the last year as I have researched and studied the 14ers. Thanks to Bill and all who collaborate on this site. It really is an exceptional community.

A little bit about me: I'm a lowlander from the Houston, Texas area. I started going to Colorado at least once a summer as a family tradition when I was young and it has continued for years. I now have about 35 trips under my belt and am familiar with remote hiking, camping, and class 1-2+ climbing to 12,000 and 13,000 ft peaks. I haven't ever done technical climbing, and the highest rock face I've climbed was only about 15 feet. I wasn't very familiar with the 14ers in the state until last year when I found this site. I became somewhat obsessed with it and decided to start hiking one 14er each trip to Colorado.

We just returned from our trip this year and I wanted to post a warning to other flat/low-landers who make 14er attempts. My wife and I had decided to start out with Holy Cross as our first 14er, but with the Tigiwon road closure, we decided on La Plata instead. Looking back on it, we should have picked something less steep, but we are both in decent shape and capable hikers so we went for it. We have both been actively working out since January with the intent to be ready for the climb and like I already mentioned, it became somewhat of an obsession.

We started out around 5:45 AM on July 11. Everything went well until we hit 11,500, at which point my wife began to become very emotional about the climb. It seemed kind of odd to me and she kept making statements about how steep the climb was and that she was becoming frightened. She insisted on continuing, but kept making comments of being scared.

I kept asking her how she was doing and she began to state that her head hurt and that she was beginning to feel nauseated. I began to recognize the symptoms of AMS (acute mountain sickness, AKA altitude sickness), but we decided to give it a little longer as she's had some health problems in the last year and we thought this might be related. We slowed down to try to give her some time before getting too high too fast.

Things didn't get better, and after we reached the NW ridge at 12,700, we sat down to take pictures and evaluate everything. As we sat there she developed almost the full list of AMS symptoms. She became somewhat incoherent at times and complained of severe head pain, stomach nausea, and dizziness. Her hands began to swell and she had trouble focusing on standing up, steadying herself, and taking her next step.

I tend to be a mind-over-matter guy, and we were both so excited about hiking our first 14er. However, I know what AMS is and I recognized that my wife had developed a fairly severe case. I decided (against my wife's will) to abort the climb and get her back off the mountain.

When we got back down to the trees around 11,500, she said her headache had begun to subside, and by the time we finished the steps down through the trees, she was almost normal. For over 1500 feet, however, I was holding her hand and helping her walk down the rock steps high on the ridge slope and then down the switchbacks which were quite dizzying for her. She doesn't have a fear of heights, but she could hardly take a step down without me holding on to her because she was so disoriented.

My point in this whole writeup is hopefully to make other lowlanders aware of the severity of altitude sickness and that it is a serious situation that anyone in your group is susceptible to. Please don't ever let peer pressure or the desire to summit overcome your sensitivity to others in the group because it could be a very dangerous situation for them and ultimately yourself. Additionally, you need to know the symptoms and when you begin noticing AMS either in yourself or someone else in your group, quiz them repeatedly to see if they are worsening. If they are, get them off the mountain. One of the worse symptoms is stroke, which is something you can avoid most of the time and you don't want to happen miles from the trailhead and even further from the hospital.

One of the other things she kept saying is that she didn't understand what was wrong with her. She kept saying she was fine but just didn't feel like herself. She didn't recognize that what she was experiencing was altitude sickness..which seems to be another common symptom for those who suffer from it.

So we didn't make it to the summit, but we made a solid attempt and we will try to do a better job of acclimating before making future climbs! Everyone stay safe out there.

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Re: Lowlanders and Acute Mountain Sickness - a word of caution

Postby a94buff » Mon Jul 18, 2011 8:45 am

Great reminder, thanks for the post. It happens to us CO residents too; I had it happen on Longs (Keyhole route) last September and Quandary this May. Both occasions I had very poor/restless sleep (and only a few hours of it at that) the night before so I chalk it up to that. I didn't get quite as far down the road as your wife; but had terrible nausea/headache - on Longs I was dry heaving every 2 minutes for about 3.5 straight hours. I did keep going (and summited) because my balance and coordination wasn't suffering - I was well aware I was experiencing AMS so I was paying close attention to whether or not I was still able to make my hands and feet do what my brain wanted them to do - but in hindsight, I probably should have turned around. Ledges/Narrows/Homestretch is no place to discover that you've lost your basic motor skills.

Same thing as you guys, by about 11,500 I felt much better and by the time we got to the car it was as if nothing had ever happend. AMS is no joke but easily fixed simply by descending.

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Re: Lowlanders and Acute Mountain Sickness - a word of caution

Postby reinselc » Mon Jul 18, 2011 8:57 am

As another flatlander, I think its really important to be careful about this, and to use common sense when planning your trip.

Driving or flying to denver on Saturday? Don't try to climb a 14er on Sunday. There are many 12k peaks that are fun to do on your first day.

Also, being in good cardio shape really helps. If you're running 5 miles a day before you get there, it really helps. Also, be smart about eating/drinking. Lots of water and easy to digest foods. No big steak and 3 glasses of wine the first night your above 2000'.

My routine that I have gotten used to and it seems to work is to try to climb to 8-9k on my day of arrival (if possible), 11-12k on my second day, and then an easy-ish 14er on day 3. But I don't do anything above class 2 until I have been sleeping above 8000' for 3 nights. Just enough to worry about on the Crestone Needles of the world without worrying about getting dizzy and nauseous at the top.

Be Safe!

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Re: Lowlanders and Acute Mountain Sickness - a word of caution

Postby Jim Davies » Mon Jul 18, 2011 9:10 am

reinselc wrote:Also, being in good cardio shape really helps.

I've read that the opposite is true; well-conditioned athletes are more likely to get AMS, probably because they're used to pushing themselves harder.
Some people are afraid of heights. Not me, I'm afraid of white blood cells.

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Re: Lowlanders and Acute Mountain Sickness - a word of caution

Postby edhaman » Mon Jul 18, 2011 9:25 am

I am not a medical professional, but it sounds like Joshmcd's wife may have been showing signs of HACE, which is much more serious than your garden variety AMS. She may want to talk with an altitude-aware physician before her next 14er adventure.

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Re: Lowlanders and Acute Mountain Sickness - a word of caution

Postby crossfitter » Mon Jul 18, 2011 9:44 am

I've noticed that if I push myself at a pace where I'm sucking wind/feeling bad, it is very difficult to start feeling better even if with a complete stop for a while. Being in good shape helps a ton because you can move at an overall faster pace, but it doesn't make you immune to feeling the altitude. I treat high altitude exercise with an attitude analogous to sweating. I.e. conventional layering advice says to never allow yourself to sweat, and I think you should never allow yourself to get worn out. If you can't maintain your pace for hours without feeling the need for a rest, you're probably moving too fast for your abilities and/or the conditions.
- A mountain is not a checkbox to be ticked
- Alpinism and mountaineering are not restricted to 14,000 foot mountains
- Judgment and experience are the two most important pieces of gear you own
- Being honest to yourself and others about your abilities is a characteristic of experienced climbers
- Courage cannot be bought at REI or carried with you in your rucksack


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Re: Lowlanders and Acute Mountain Sickness - a word of caution

Postby steelfrog » Mon Jul 18, 2011 10:00 am

This was a good experience and should be learned from. I also am a Dallas lowlander. I regularly take "newbies" on what I call "drive by" attempts of 14ers and 13ers. Doing it this coming weekend, matter of fact.

In my opinion, you can't rely on chance to keep you safe, and on a drive by, you will not have a chance to properly acclimatize. Diamox is a regular part of my routine. You can either take it a couple days in advance of the trip (and during) or take it as you feel needed. Signs I have noticed of incipient AMS:

Peripheral edema (in hands, feet, lips); elevated heart rate that won't go down upon rest; mild headache; mild nausea

When you start to get these, take the Diamox and wait 20 minutes for symptoms to abate.

The prescription from my doc says take 2x250mg tablets for 2 days before climbing; then one a day while climbing. I have heard that this is overkill, and found it to be true. I do a half tablet a day, for one day before climbing and half a tablet a day while climbing. Haven't had any AMS myself while doing this now for years. Side effects of this I have found to be non-existent.

Glad you didn't have any REAL problem on your trip. You really pushed the limits! Death can happen and does happen from HAPE/HACE--a guide buddy of mine lost a client in Cali at 10,500 from HAPE.

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Re: Lowlanders and Acute Mountain Sickness - a word of caution

Postby joshmcd » Mon Jul 18, 2011 10:54 am

Thanks for the info on HAPE/HACE. I had forgotten about this more severe variety of altitude sickness. I did a quick lookup and that definitely seems like what she may have been experiencing. I appreciate the response. That may really help us before we try again.

I know how easy it is to get into the mentality that you will just be fine and push forward, particularly for those of us who are only in the mountains for a few days out of the year. It is very frustrating to have to turn around, especially when you aren't the one suffering. We just need to be aware of the dangers and the necessity of stopping and descending at times.

Is there a specific physician we should look up to have her evaluated? If she suffers from HAPE/HACE, it would definitely be good to know before any further attempts. She is already talking about going with me on my next attempt, but I don't even know where to begin with doctors to get her checked out here in Houston at sea level.

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Re: Lowlanders and Acute Mountain Sickness - a word of caution

Postby Dukietown » Mon Jul 18, 2011 12:01 pm

I know it's sort of already been said but wanted to add my $.02. A couple things to consider for anyone looking to adjust to and perform at altitude. First, hydrate or die. One of the best ways to help prepare your body is to be properly, or even overly hydrated for the days leading up to and including the climb. Another is to take all opportunitutes to acclimate in any way possible. Most of the 14ers have somewhere nearby at a good elevation that you can camp at for a night or two. Spend a couple days at say 10,000' doing some shorter day-hikes just to get used to the feeling of exerting yourself at altitude. Last, and probably most important, listen to your body. As you saw you can't just push through altitude sickness. The peaks aren't going anywhere and there's no shame in having to turn away from any climb for whatever reason. Don't push it and risk serious health problems and a SAR effort to bring you down.

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Re: Lowlanders and Acute Mountain Sickness - a word of caution

Postby Theodore » Mon Jul 18, 2011 12:23 pm

Big +1 on hydration. I also think some people just have bad luck with altitude. I've been lucky enough to avoid any problems so far and I've done most of mine within 24 hours of leaving eastern kansas, at ~1000ft.

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Re: Lowlanders and Acute Mountain Sickness - a word of caution

Postby steelfrog » Mon Jul 18, 2011 12:54 pm

Yes, I didn't mean to suggest that Diamox is a be all end all. We hyperhydrate starting 2 days before the hike. Pounding down massive quantities of water and other fluids. No alcohol whatsoever. Also, during the hike of course hydration and calories are critical. Sometimes the symptoms of AMS can be the same as hypocaloria. Altitude dampens the appetitie and thirst, so it's important to hydrate and get calories even when you doin't feel like you need them. Yor ability to lose fluid and consume calories climbing way outstrips your ability to replenish, so you can really get behind the curve on these things.

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Re: Lowlanders and Acute Mountain Sickness - a word of caution

Postby tinman » Mon Jul 18, 2011 2:24 pm

From what I've heard and read, AMS is not particular to who it hits. I've read that you can hike in the mountains a hundred times with no problems and then on then next trip, pow! Anyway, I'm a native Austinite and have lived now in Houston for the past 15 years. We've been hitting the 14ers for the last 5 years and find like others have noted above that hydration is the key. I drink a gallon of water on the drive up and continue to drink while we're up there and have never had a problem. We'll be back in August with the intent to finish the last 8 14ers on my list. Josh, if you want, send me a pm and we can talk 14ers.

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