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#36642 - 05/20/14 07:56 PM AMS? on Cirque Peak hike
63ChevyII.com Offline


Registered: 08/07/12
Posts: 670
Loc: Colton, California
I took a group of 4 up to Horseshoe Meadows this past weekend for an over-nighter at Chicken Spring Lake. All of us had some (somewhat) surprising issues with the elevation. I have a few ideas about why this happened and am interested in what you guys think.

Background Info
Hiker A - no previous issues with AMS. Successfully hiked Whitney a year ago on an overnight trip, spending one night at the portal campground and a second night at Outpost Camp.
Hiker B - no previous issues with AMS. Successfully day-hiked Whitney a couple years ago with no acclimation period
Hiker C - history of 'AMS headaches*' whenever hiking above 11k
Hiker D (me) - history of 'AMS headaches*', suffered as low as 9,000 ft when carrying a heavy pack (overexertion?) or when taking the Palm Springs Aerial Tram (fast ascent). 2 summits of Mt. Whitney as dayhikes, once with no acclimation period.

* I'm not sure what the headache that comes with AMS feels like for others, but for me it feels like I've been hit in the back of the head at the base of my skull.

What happened (IIRC)
Hiker A - started struggling early on, first showing problems (headache, generally not feeling well) as we started the climb up to Cottonwood Pass. Since Hiker A had not been able to exercise recently and hadn't suffered from AMS previously, we figured that it was due to overexertion and not being in shape. By the time we reached Chicken Spring Lake, Hiker A was exhausted and had a horrible headache, took a nap and later vomited. We let Hiker A sleep for about an hour and made plans to get Hiker A off of the mountain. When awakened, Hiker A was doing much better, was able to eat and drink and was sharp mentally (the headache was gone), so as a group (group included a physician's assistant) we decided it was ok to stay on the mountain. Hiker A decided to not attempt Cirque the next day, but to sleep in. Hiker A had trouble sleeping through the night and the headache was back the next morning. On the hike out was exhausted.

Hiker B - hiked to Chicken Spring Lake without issue, but did not sleep well. Did not attempt Cirque Peak due to the cold temperatures. Suffered from headache on day 2 during the hike out.

Hiker C - hiked to Chicken Spring Lake without issue. Had trouble sleeping and had a headache most of day 2. Reached Cirque Peak, but had a hard time doing so. Descent was also very exhausting, suffered from nausea after trying to eat on Day 2.

Hiker D (me) - I started getting a headache and stiff neck around 10k feet. Headache went away after taking some ibuprofen at Chicken Spring Lake. Slept from 9pm - 12am, but between 12 am and 3:15 am woke up in a panic at least three times, feeling as though I could not breath. Reached Cirque Peak the morning of day 2, but was extremely exhausted and thought about turning around as I neared 12k feet. I was exhausted even on the ascent, when I realized I had not eaten since 7 pm the night before. Felt nauseous as soon as I started eating.

Possible Causes?
Hiker A - ate with my family and stayed at my house Friday night. On the drive to Lone Pine, we learned that my son had thrown up during the night and again Saturday morning. Since Hiker A had never suffered from AMS, we thought that the cause might be the same 'bug' that caused my son to be sick. Since he was mentally sharp after his nap and no history of AMS, we decided to stay on the mountain.
If AMS was the cause of the nausea, I wonder if part of the problem was overexertion. We all had heavy packs and Hiker A was reluctant to go on the trip because he felt he was 'out of shape.' My house is also at 1000 ft. I wonder is going from 1000 ft to 11000 in just a few hours was a factor. On Hiker A's Whitney hike, he had nights at the portal and Outpost camp before going above 11k feet.

Hiker B - I wonder if the symptoms were due to spending the night at such a high elevation. Hiker B wondered if the headache may have been due to a lack of caffeine.

Hiker C - performed well (IMO) based on previous hikes. Did great on the hike to Chicken Spring Lake, but I wonder if the lack of sleep and elevation finally took it's toll on day 2. Cirque Peak is a PR for elevation.

Hiker D (me) - I was surprised at how early and how much I struggled on the hike. In the end, it ended up being one of my toughest hikes ever, ranking up there with Cactus 2 Clouds and Mt. Whitney. The cross country route really took it out of me. To put this in perspective, I carried two packs for a portion my last training hike (March 29, total pack weight ~50 lbs for 3300 ft elevation change over 5.7 miles) and had a much easier time. This of course was at a much lower elevation (<6000). I was if my problems started early due to my (overly) heavy pack weight and not being able to exercise for the last 6 weeks (overexertion). I've noticed that when my pack is heavy (40+ lbs) I always get a headache that feels like I am suffering from AMS. On day 2, I feel that my physical exhaustion was partially due to not eating well and lack of sleep. From 11 am Saturday until 2 pm Sunday, I ate <3000 calories. My BMR is around 1900. I am wondering if trying to sleep at 11k was a bad idea, especially since I have been suffering from bad allergies (apparently) for the last 6 weeks. Maybe an intermediate step is needed before I sleep at this elevation.

Some Questions
1. If I am carrying a heavy pack (40+ lbs), it seems that I always suffer from a headache that feels like AMS. I've had this happen to be at elevations <10000 ft when carrying my son in a child carrier. Is it possible that the pack is resting on something and is causing this? Is it more likely that the headache is due to overexertion?

2. If someone vomits while hiking at elevation, do you automatically assume that it is AMS? Would you immediately descend? My gut feeling is that it should be assumed to be AMS until proven otherwise. As a side not, Hiker A is still dealing with stomach issues today (Tues). Sunday night, my wife (who was not on the trip) starting having stomach problems and still has them now.

3. I would like to hear any thoughts you have on our situation or similar experiences. I am open to constructive criticism.
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#36647 - 05/20/14 09:29 PM Re: AMS? on Cirque Peak hike [Re: 63ChevyII.com]
SierraNevada Offline


Registered: 09/05/11
Posts: 1097
Loc: NorCal
Originally Posted By: 63ChevyII.com
Hiker B wondered if the headache may have been due to a lack of caffeine.

No coffee? That explains everything. smile Just kidding, not to make light of this. I'm not a doctor, and I don't play one on TV, but I bet one will weigh in on this (Harvey).

Seems to me there's a high percentage of people getting similar food poisoning symptoms at a wide range of elevations, but what do I know.

-- Hiker E

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#36649 - 05/20/14 10:07 PM Re: AMS? on Cirque Peak hike [Re: 63ChevyII.com]
2600fromatari Offline


Registered: 10/18/10
Posts: 452
Loc: San Diego
This is all from personal experience and not scientific in any ways.

1) Yes, overexertion and lack of sleep will play a big role in whether I develop AMS or not.
2) A headache alone may be caffeine related. I have a friend who has never developed AMS in over 30 years hanging around the Sierra. He got a headache at Finger Lake so bad he could hardly move. Brewed some strong tea and 30 minutes later he was hopping around like a rabbit. He was an avid coffee and tea drinker and went cold turkey before the trip.
3) I do not think the location of the headache means anything. I've developed it from the temple to the back of the skull.
4) Acclimating at the Horseshoe Meadows is only a good idea if you can sleep, otherwise, head over to the Portal. I have from time to time and have done better. Higher is not always better.
5) As I stated in the other thread, weather may be a factor. My own personal belief.

A few examples.

a) I was in the Sierra leisurely summiting several high peaks for approximately 5 days. I felt so good, I took a quick-for-me pace up Agassiz on the 6th day and developed a bad headache that didn't go away until I was back in Bishop.
b) I had acclimated at the HSM for a night, hiked Langley the next day, slept at Third Lake the day after, climbed Temple Crag on the 4th, lounged at Third Lake the 5th day, and developed a monstrous headache a quarter of the way up the Swiss Arete on the 6th day after spending the last 5 days above 13k and 14k with ZERO issues. Problem? Heavy cold winds came in on the 5th evening. I couldn't sleep and had to wake up at 3 AM.
c) Same as above for the first two days. Third day went to Thunderbolt Basin. Climbed Thunderbolt and Starlight the 4th day with ZERO issues. A storm was coming in the distance. It rained lightly throughout the 5th day and I developed a bad case of AMS from noon until I woke up the next morning when the storm passed.

I've had many examples all similar to the above. I believe sleep and exertion plays a critical role. I also personally believe people who are sensitive to the altitude like me may be affected by low pressure systems.


Edited by 2600fromatari (05/20/14 10:09 PM)

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#36652 - 05/21/14 01:38 AM Re: AMS? on Cirque Peak hike [Re: 63ChevyII.com]
Steve C Offline


Registered: 09/22/09
Posts: 7191
Loc: Fresno, CA
Anyone who drinks several cups of coffee daily and quits cold turkey can get headaches. Starbucks brand has a great tasting single-cup instant -- I get it in the grocery. First time I tasted it was about 5 AM one morning on top of Mt Whitney. A JMT finisher found me sleeping in the hut, and offered me a cup. It was great! (I now keep it around the house.)

You guys need to try Diamox. I, myself, would not go to Horseshoe Meadows without it, let alone hike out of there! (The PA in your group should read up on it.)

A person vomiting is on the verge of serious trouble. It appears you were ok staying, since the he/she improved. However, it could have gone the other way. Leaving someone alone after that could lead to serious trouble. If someone could check up on them each hour, and if the situation worsens, get them the h**l out of there!!!

Two things seem to make AMS worse: Exertion (that 40 lb pack weight), and ALSO hydration. You did not mention it... Was everyone consciously drinking enough? When the appetite goes, so can thirst. I always make sure I drink more than enough to satisfy my thirst when I am at altitude. Peeing clear is the indicator that you're ok. Using a pee-bottle at night makes it easier for me -- otherwise I would limit my liquid intake before bed, which is not good for the AMS.

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#36653 - 05/21/14 04:20 AM Re: AMS? on Cirque Peak hike [Re: 63ChevyII.com]
Bob West Offline


Registered: 11/13/09
Posts: 768
Loc: Bishop, CA, USA
From you description, it appears that you and the rest of your group were carrying way too heavy packs for your physical conditions. Start working on reducing the amount of stuff you carry, and start doing some daily walking.

As we age, it is important to maintain a regular exercise program, throughout the off-season, if we expect to cope with mountain hiking in the Summer.

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#36661 - 05/21/14 09:06 AM Re: AMS? on Cirque Peak hike [Re: Bob West]
63ChevyII.com Offline


Registered: 08/07/12
Posts: 670
Loc: Colton, California
Not wanting to look irresponsible or foolish, I was reluctant to post all the details of what happened, but my desire to learn from this experience is greater. I appreciate all of the responses.

Originally Posted By: 2600fromatari
This is all from personal experience and not scientific in any ways.I believe sleep and exertion plays a critical role. I also personally believe people who are sensitive to the altitude like me may be affected by low pressure systems.


While not scientific, your observations and ideas regarding AMS make sense to me and seem logical. I agree with them.


Originally Posted By: Steve C

You guys need to try Diamox. I, myself, would not go to Horseshoe Meadows without it, let alone hike out of there! (The PA in your group should read up on it.)

I've used it in the past (Whitney '11, '12, '13), but not on this trip. I mistakenly thought that the night at Chicken Spring Lake would help.
I experimented with it a bit on my Whitney trip last year. I took it for the 3 days prior to leaving home. Day 1, I took it the morning before we left and we spent that night at Rock Creek. Day 2 I did not take it, hoping that the ummm... 'crappy' side effects would dissipate before we started our Whitney overnight hike on Day 3. On Day 4 we started our hike very early (hoping for a sunrise summit), but I only made it to Trail Camp. Hiker C from this weekends hike was not feeling well (headache, dizziness) and I volunteered to descend.

I was hoping that I could start the acclimation process by taking the diamox, let the fact that I was above 10,000 ft take over, then hopefully not have GI issues on a trail where I had to carry everything out.


Originally Posted By: Steve C

A person vomiting is on the verge of serious trouble. It appears you were ok staying, since the he/she improved. However, it could have gone the other way. Leaving someone alone after that could lead to serious trouble. If someone could check up on them each hour, and if the situation worsens, get them the h**l out of there!!!

In most situations, I would have descended immediately. Looking back, my judgement was clouded by a few things:
1. Hiker A's prior hiking experience with with no AMS issues. I realize now that this shouldn't have been a consideration.
2. Having a PA in the group. The same person has also worked as a leader/supervisor for large groups of students on outdoor/adventure trips. Being a leader requires specialized training.
3. Knowing that my son had vomited twice earlier in the day. I thought Hiker A likely had food poisoning. This thought was reinforced when Hiker A starting cracking jokes and was sharp mentally after his nap.
4. I tend to be overly cautious and I have become self-conscious of this. At times I overcompensate and don't speak up when I should. I need to get over this.

Three of us shared a tent, so Hiker A was checked on throughout the night. I was not going to leave Hiker A alone on Day 2. If Hiker B had not decided to stay at camp, I would have stayed.


Originally Posted By: Steve C

You did not mention it... Was everyone consciously drinking enough?

I am usually really good about hydration, but I know that I did not drink enough on this trip.


Originally Posted By: Bob West
From you description, it appears that you and the rest of your group were carrying way too heavy packs for your physical conditions. Start working on reducing the amount of stuff you carry, and start doing some daily walking.

As we age, it is important to maintain a regular exercise program, throughout the off-season, if we expect to cope with mountain hiking in the Summer.



I agree Bob. Since I live in SoCal, I am able to hike year round. The frequency of my hikes drop off during the winter, but I still get out there once or twice per month. One of my favorites hikes is Skyline Trail in Palm Springs (11 miles, 8000 ft elevation gain). During the off-season I also ramp up my weight training, cardio (high intensity interval training on a stationary bike) and I walk 6-10 miles per week due to my job. I have been 'under the weather' for the last 6 weeks (sick, possible allergries) and my training had dropped off as a result.

I really need to reduce my pack weight. On my first Whitney hike in 2011, my daypack was 28 lbs. One most dayhikes now, my pack is down to around 22 lbs (still too heavy). When I start adding overnight gear, the weight gets ridiculous. This was only was 2nd overnight hike.

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#36663 - 05/21/14 09:21 AM Re: AMS? on Cirque Peak hike [Re: 63ChevyII.com]
Steve C Offline


Registered: 09/22/09
Posts: 7191
Loc: Fresno, CA
> Day 2 I did not take it, hoping that the ummm... 'crappy' side effects would dissipate before we started our Whitney overnight hike on Day 3.

Not sure what your "crappy" side effects are. "Buzzing" or tingling fingers is the most common one. I've only felt that once.

Normal dosage for AMS is 125 mg twice a day as the maximum, and some people take half that. Were you taking more?

- - - - -

When I am not feeling well, but not bad enough to be in bed and no fever, I'll still do a workout, but I just go lightly -- maybe half the usual. I think the warmup and increased circulation helps me get over whatever is bugging me.

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#36664 - 05/21/14 09:46 AM Re: AMS? on Cirque Peak hike [Re: Steve C]
63ChevyII.com Offline


Registered: 08/07/12
Posts: 670
Loc: Colton, California
Originally Posted By: Steve C

Not sure what your "crappy" side effects are.

Diarrhea. sick

The first time I took it I also got the tingling, metallic taste and nausea. After reducing the dosage these three side effects mostly went away.

Originally Posted By: Steve C

Normal dosage for AMS is 125 mg twice a day as the maximum, and some people take half that. Were you taking more?


I take a total of 125 per day.

Originally Posted By: Steve C

When I am not feeling well, but not bad enough to be in bed and no fever, I'll still do a workout, but I just go lightly


That's what I usually do, but when I just couldn't kick it, I thought I was doing more harm than good. It seems now that I've developed allergies. Sunday night, after being away from home for 24+ hours, I felt great. The weekend prior I was in San Diego and felt great there too. Within 12 hours of being home, I was miserable again in both cases.

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#36688 - 05/22/14 08:08 AM Re: AMS? on Cirque Peak hike [Re: 63ChevyII.com]
63ChevyII.com Offline


Registered: 08/07/12
Posts: 670
Loc: Colton, California
I just woke up after sleeping for 14 hours. Prior to that, I spent 2 hours laying on the floor of my office too nauseous to walk to my car or drive home safely.

My wife (a nurse) was told there's a nasty GI bug going around right now. It doesn't change the fact that it would have been wise for us to descend Saturday afternoon, but it seems some of the symptoms were likely caused by something other than AMS.
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#36691 - 05/22/14 08:41 AM Re: AMS? on Cirque Peak hike [Re: 63ChevyII.com]
Steve C Offline


Registered: 09/22/09
Posts: 7191
Loc: Fresno, CA
Ooof! No fun to be sick like that. Hope it "passes" wink quickly.

It probably played a role in your hiking issues. You'll have to do a repeat to really see. smirk

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#36694 - 05/22/14 10:34 AM Re: AMS? on Cirque Peak hike [Re: Steve C]
63ChevyII.com Offline


Registered: 08/07/12
Posts: 670
Loc: Colton, California
Originally Posted By: Steve C
Ooof! No fun to be sick like that. Hope it "passes" wink quickly.

I'm feeling better today. Stomach is still weird (I haven't eaten yet), but the thing that is bugging me the most is my back from laying in bed so long.

Originally Posted By: Steve C

It probably played a role in your hiking issues. You'll have to do a repeat to really see. smirk

I'll be back up there. grin
I am hoping to try Langley at some point this summer.





Edited by 63ChevyII.com (05/22/14 10:37 AM)

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#36696 - 05/22/14 10:45 AM Re: AMS? on Cirque Peak hike [Re: 63ChevyII.com]
Harvey Lankford Offline


Registered: 11/10/09
Posts: 979
Loc: Richmond, Virginia
late looking at his thread

One man acclimatises quickly, another slowly…The whole process appears to be analogous to sea-sickness about which predictions are impossible.
Eric Shipton, Upon That Mountain page 376

yes, exertion worsens risk of AMS.

will not rehash all the details, but it sounds like some had AMS,
some other, some both

Diamox does not fix everything. Far, far from it.

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#36697 - 05/22/14 10:49 AM Re: AMS? on Cirque Peak hike [Re: 63ChevyII.com]
saltydog Offline


Registered: 02/03/11
Posts: 1535
Loc: Valley Ford CA!!!!
Aside from the complex diagnostic situation, there is an important strategic consideration that I am not sure has been touched on here. When you get these symptoms at altitude, it is best to assume it is AMS until demonstrated otherwise. It looks like for at least one of you it may have been GI, but you don't guess about things like that on the mountain. So having had your experience, I would review it in light of the question: did I respond based on the assumption that it was AMS or in the hope it was something else?

PS: On the pack weight headache: I posted on this before my JMT last year. I had exactly the same deal on my training hikes with heavy pack. Finally concluded that it is due to exertion of a set of muscles around the base and back of the neck that are brought into play by weight carried on the shoulders. Solved it by a combination of hiking with a heavy pack to condition them, better adjustment of the hip harness and pack weight distribution. Probably the exercise was the most important.
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#36699 - 05/22/14 10:56 AM Re: AMS? on Cirque Peak hike [Re: saltydog]
63ChevyII.com Offline


Registered: 08/07/12
Posts: 670
Loc: Colton, California
Originally Posted By: saltydog
When you get these symptoms at altitude, it is best to assume it is AMS until demonstrated otherwise...did I respond based on the assumption that it was AMS or in the hope it was something else?

That is an important observation and something I touched upon above
Originally Posted By: 63ChevyII
2. If someone vomits while hiking at elevation, do you automatically assume that it is AMS? Would you immediately descend? My gut feeling is that it should be assumed to be AMS until proven otherwise.

My gut feeling at the time was that we should descend, but I let the 'credentials' of the others in the group trump my assumption. If there had been only two of us on the hike, I have no doubt we would have descended.

Originally Posted By: saltydog

PS: I posted on this before my JMT last year.

Do you have a link to the thread? (nvm, found it: http://www.whitneyzone.com/wz/ubbthreads.php/topics/32173/Training_question_pain_in_the_#Post32173)

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#36701 - 05/22/14 01:46 PM Re: AMS? on Cirque Peak hike [Re: 63ChevyII.com]
Harvey Lankford Offline


Registered: 11/10/09
Posts: 979
Loc: Richmond, Virginia
here is more on exercise-level and risk of AMS ..AND.. not just mild AMS but also its complications, even at a modest altitude.

"In 1943 British physiologist and physician Griffith Pugh evaluated military ski trainees at ‘The Cedars’ Mountain Warfare Training Centre at a moderate altitude of 6,890ft (2,100 m) in Lebanon. The tallest peak climbed was Cornet es Saouda 10,095 ft (3,077m). Pugh found that after only a few days of hard ski-mountaineering two men had dilated hearts on physical examination, the total rising to 10 of 33 after two weeks."

The dilated hearts refers to the sequence of small oxygen pressure decrease, pulmonary hypertension, right ventricle overload, and high altitude pulmonary edema (HAPE)- the most common complication of AMS. Some of his recruits (and all populations) were HAPE- prone. In 1943, the understanding of altitude illness was limited, and Pugh was way ahead of the curve.

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#36745 - 05/24/14 09:37 AM Re: AMS? on Cirque Peak hike [Re: 63ChevyII.com]
wbtravis Offline


Registered: 09/22/09
Posts: 1239
Loc: Corner of Jack Benny and Roche...
Based on my experiences at Cirque Peak and elsewhere...

1. Headache and over exertion...If I am not careful and over exert, I have AMS problems, even when dosing Diamox. This has happened twice at Cirque Peak. Usually, it is lack of appetite which cause either light eating at dinner or bypassing dinner. Rarely do I end up with a headache.

2. Vomiting...I guess you could descend but I have not. Generally, I feel much better afterwards. I have vomited as low as Whitney Portal after drinking a few glasses of wine, I have since stopped drinking at my high elevation starting points, I do ok once I've been out a couple of days.

3. Constructive criticism, etc...See above.

A friend and I had mild cases of food poisoning a few years ago in the backcountry a few years ago...it was no stinking fun. It was much different feeling than AMS.

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#36752 - 05/24/14 08:54 PM Re: AMS? on Cirque Peak hike [Re: wbtravis]
63ChevyII.com Offline


Registered: 08/07/12
Posts: 670
Loc: Colton, California
Originally Posted By: wbtravis

A friend and I had mild cases of food poisoning a few years ago in the backcountry a few years ago...it was no stinking fun. It was much different feeling than AMS.




My friend had never had any AMS issues in the past and so didn't have anything to compare it to. I've felt a little nauseous possibly due to AMS, but in general I'm just not interested in food above 11k or so in most cases.

As a side note, I lost 8 lbs last week due to the GI bug. Our babysitter, who saw my family near the beginning of the week is dealing with it now.
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