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#22509 - 03/31/12 09:06 PM Swelling due to Altitude
CMC2 Offline


Registered: 11/04/09
Posts: 160
Loc: CO
I read an interesting topic on the WPSMB about how Altitude may cause Swelling with some people. I was slightly aware that heat could do this and Harvey Langford has responded to two submissions on the subject. I think this topic would be of interest to many on the WZ and I am sure several of our Drs would have info about this subject.

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#22511 - 03/31/12 09:29 PM Re: Swelling due to Altitude [Re: CMC2]
Steve C Offline


Registered: 09/22/09
Posts: 7583
Loc: Fresno, CA
I saw that post, too, by Rosabella. She talks about swelling in her hands and face AFTER being at altitude for several days, and then it continues for more than a few days. She implies it continue for an entire trip, and Rosie does full JMT hikes.

Harvey Lankford made a good reply. Maybe he'll discuss it here as well.

I have always had my hands swell when hiking at altitude. I sort of thought it was due to the backpack straps cutting off some circulation, but that may not be it. At least with my hands, since I have started using hiking poles, so I am gripping the handles all the time, the swelling in the hands is not nearly as bad.

Last summer, after spending three days at 10,000' at Thousand Island Lake, my wife had swollen feet and hands at the end of the trip. It took several days at home for the swelling to dissipate. I thought maybe it was due to her chronic kidney issues, but now Rosie's post makes it sound different.

My wife's experience is different from others, in that she rode in and out on horseback, and didn't do any serious hiking either. So it wasn't such a different environment from home -- except for the altitude.

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#22516 - 03/31/12 10:22 PM Re: Swelling due to Altitude [Re: Steve C]
Ken Offline


Registered: 10/29/09
Posts: 742
Loc: Los Angeles
I've also had swelling of my hands, which I don't have with hiking poles.

I don't think it is altitude related, so much as hiking related. I have the problem at low altitudes.

I think, Steve, that your first impressions about kidneys might be very likely. Sitting on a horse is QUITE provocative, which I rediscover every time I ride one 10 miles...and can't walk for a half hour afterwards. One's hands are also somewhat compressed into the sides, which would retard return circulation, also.

I don't get swelling post-riding, though.

so....got me!

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#22517 - 03/31/12 10:38 PM Re: Swelling due to Altitude [Re: Steve C]
RenoFrank Offline


Registered: 08/06/11
Posts: 428
Loc: Reno, NV
I too suffered from swollen hands when I hiked before I started using poles. I'm not sure if it's because of the altitude; most of my hikes near Reno are from 8,000 to 10,000 ft. I had read online that it's helpful to put your hands over your head to decrease the swelling. So I think my hands don't swell because they are kept at or above waist level now .

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#22518 - 04/01/12 06:18 AM Re: Swelling due to Altitude [Re: RenoFrank]
Harvey Lankford Offline


Registered: 11/10/09
Posts: 1015
Loc: Richmond, Virginia
If anyone is not looking at both forums, here is a copy of what I posted on the other one. Gives me something to do in between exercises for my 4.5 months post-total knee and too-slow recovery. Still plan to be in Sierras again this summer. Harvey


Post 1
I received an email from Ernie to answer this one. Tough to explain. Incompletely understood. Here is one brief description I found.

Edema of Altitude

Peripheral edema and facial edema are relatively common. If seen as an isolated finding without other symptoms of AMS it is not considered AMS, and is not a contraindication to ascent. It is likely to worsen with ascent, and is more common in women than men. It resolves rapidly with descent. Treatment, if necessary, is symptomatic with either acetazolamide or low doses of oral furosemide


This quote was from the NORMAL physiology section of:
http://www.high-altitude-medicine.com/AMS-medical.html#edema

I can tell you one story. A friend brought back pictures from his trip to the Himalayas. He was up on the Lhotse Face and turned around at 24,000 ft. His face was incredibly bloated. He did not need to tell me what altitude he was at-it was obvious. Lots of folks look like that up there.

Now why lesser degrees of facial or peripheral edema occurs at moderate altitudes like the Sierras is presumably an individual susceptibility to that particular altitude effect. Other effects, like pulmonary hypertension and risk of HAPE, are likewise highly variable as to what altitude they occur at. Some people get it, some don't.

You can get this edema independent of your salt intake. A healthy body (young, no hypertension, good kidneys) at high workload can handle a lot of salt just fine, extra calories, too. Enjoy it.

As far as dependent edema is concerned (gravity pulling and trapping fluid in lower areas of the body) yes, there may be some of that. But much of it (especially in the face which is near the top of the body, whereas the legs are much lower) is presumably a poorly understood change in membrane permeability. One of the main reasons steroids (like dexamethasone) help altitude and other illnesses is because they are potent membrane stabilizers.

Hope this helps.



Post 2
It would be interesting to know how many of us get hand swelling just walking around. Feet we might easily understand just from gravity effect and not-so good veins to return fluids back "uphill" in our bodies. Arms and hands also have different anatomy but the same gravity gradient.

Now for some veterinary medicine. The reason cattle with high altitude illness called Brisket Disease get swelling in the brisket (chest) rather than the legs is that the various connective tissues in their legs are different and tighter than humans and they cannot swell there.

I know one runner who carries a baton with him. I asked him if it was to fend off dogs. He laughed, said yes, that too, but mainly to flip it back and forth from one hand to the other every now and then, first squeezing one hand and then the other. Makes me wonder if the two-walking pole people who get hand swelling get it because they clench both hands in isometric tension, rather than rhymthmic activity. I use a single walking staff and alternate hands. I only do this from long-time habit, but wonder if I accidentally get the same result of avoiding swelling as the baton guy?

Otherwise my earlier post emphasizes the facial edema problem of high altitude. I'm glad the quote I listed gave rosabella some reassurance.

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#22624 - 04/03/12 07:24 PM Re: Swelling due to Altitude [Re: Harvey Lankford]
George Offline
Woodsy Guy

Registered: 10/22/09
Posts: 202
Loc: California
Yes, this seems very common as low as 9,000 feet. I often see edema. People note it and ask about it. Seems benign -- that is, no obvious relationship to that and HAPE or HACE (though, at some level, it must be a similar mechanism...). For people acclimating normally, it goes away by day 3 at altitude.

Perhaps some MD could explain it better, but there's something going on with fluid in tissues. I notice (even in myself) that it builds up slightly in hands and feet, then after a couple of days, you piss a lot and everything's back to normal.

I rarely have symptoms of AMS (headache, nausea etc.). But a day or two of increased urinary frequency does happen (OK. Perhaps too much detail, but there you go...).

George
_________________________
None of the views expressed here in any way represent those of the unidentified agency that I work for or, often, reality. It's just me, fired up by coffee and powerful prose.

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#22630 - 04/03/12 11:00 PM Re: Swelling due to Altitude [Re: George]
CMC2 Offline


Registered: 11/04/09
Posts: 160
Loc: CO
Don't be surprised George if Laura asks you if you checked your pee color as she mentioned to Rosie on the WPSMB. Since you know both ladies from festive beverage celebrations with your wife at Charlotte Lake I am sure you can deal with her inquiry OK. I didn't realize that Physical Therapists did rotations in urology or at least some cross training in that specialty.


Edited by CMC2 (04/03/12 11:01 PM)

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#22638 - 04/04/12 07:01 AM Re: Swelling due to Altitude [Re: CMC2]
MooseTracks Offline


Registered: 11/02/09
Posts: 582
Loc: Bishop, CA, United States
Wiping your ass is a functional task, my dear Ernie. wink
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#52506 - 12/10/17 03:28 AM Re: Swelling due to Altitude [Re: CMC2]
Lcagee Offline


Registered: 12/10/17
Posts: 1
Loc: Ca usa
Originally Posted By: CMC2
I read an interesting topic on the WPSMB about how Altitude may cause Swelling with some people. I was slightly aware that heat could do this and Harvey Langford has responded to two submissions on the subject. I think this topic would be of interest to many on the WZ and I am sure several of our Drs would have info about this subject.
-------------------------

I'm trying to figure out how to post on this forum. I have this swelling problem. It usually occurs above 8000 feet. It primarily affects my knees while descending from a hike. Episode 1. Hiked up half dome. 9000 feet. On the way down noted my knees getting stiff. By the time I got to the bottom I was limping badly. I'm sure there was fluid in my joints. Also had swelling of the hands. Episode 2. Hiking in grand Teton. I think at about 8000 feet. Just a day hike uphill from the parking lot. Went up for a few hours hike my sline. On the way down my knees got so uncomfortable I could barely bend them. Had I been affected sooner I would have had trouble getting off the mountain. My hands were also swollen. Episode 3. Hiking in the high uintahs Utah. 5 day hike between 8000 and 10500 feet. Had fairly severe headaches starting as soon as I got above 9000 feet. Did not have the kneee swelling that time because that hike is when I hurt my knees. 17 miles downhill in the rain the last day with a heavy wet pack. I was younger then. Episode 4. Skiing at Breckinridge. Base is 9600. The day I arrived I got a headache and it lasted 5 days til I descended. I'm sure the mechanism is the same. Leaky membranes. A form of altitude sickness. Cerebral edema. Joint effusions. High venous pressure. I have no history of heart trouble. As an aside 4 years ago I developed headache that never went away that feels like altitude headache.

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#52507 - 12/10/17 05:16 AM Re: Swelling due to Altitude [Re: Lcagee]
Harvey Lankford Offline


Registered: 11/10/09
Posts: 1015
Loc: Richmond, Virginia

your achy knees (mentioned multiple times) are simply orthopedic, or musculoskeletal, not AMS, and not necessarily even local fluid retention related either.

You mentioned joint effusions so that wording suggests you might be in the medical field, but joint effusions are not part of the AMS solar system.

you have a lot of varying and unrelated scenarios in there, and as a first time poster it makes me think about an internet troll.

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#52509 - 12/10/17 09:06 PM Re: Swelling due to Altitude [Re: Lcagee]
Steve C Offline


Registered: 09/22/09
Posts: 7583
Loc: Fresno, CA
It sounds like multiple issues to me: The knees swelling could be a reaction to hiking if you don't normally do any sort of hiking or walking otherwise. I'm wondering what you do in the weeks and days leading up to these hiking situations.

As for the headache at 9000 elevation: That's quite likely AMS. Your symptoms make it seem that you are more susceptible than most people.

But I am really curious: You wrote:
> As an aside 4 years ago I developed headache that never went away that feels like altitude headache.
You developed a headache 4 years ago and it sounds like it never ended. Have you been living with it since then?

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