Managing AMS on Whitney

Posted by: Whitney Zone

Managing AMS on Whitney - 07/05/04 01:10 AM

Posted by ellenclary, 07-05-04

Greetings all,

My question is probably best answered on another forum (suggestions welcome), but I just got back from a Whitney trip so I can be very specific.

It's becoming clear that I am quite sensitive to changes in altitude above 10,000'. In light of this, we took 4 days to do what normally for many folks is a 2 or 3 day trip. Even so, I was ill for several hours after each change in elevation, though the next morning I was fine.

Our camps were
- Portal (8400')
- Outpost Camp (10,360')
- Trail Camp (12,000')
(summit attempt - couldn't get over 13,800' near the Keeler needle)
- Trail Camp

Standard advice is to only ascend 1000' each day, but that's not easily possible on Whitney, and campsites above 13,000 are very few and not fun places to camp.

I'm trying to figure out what to try next (besides just climbing shorter mountains.) I take asprin to thin my blood. Do you think I should carry oxygen? I'd feel a bit silly, but given that I'm to the point of giving up on climbing (a hobby that I love), it may be worth a try (especially as being sick makes me love it less and less).

I'll be going back in August, but it will only be to Lower Boy Scout Lake and the highest thing I may climb is Thor Peak and maybe not even that. wink

Ellen

PS. AMS = Acute Mountain Sickness
not to be confused with the more serious
HACE (High Altitude Cerebral Edema)
or HAPE (High Altitude Pulminary Edema)


Posted by Tony B, 07-05-04
Here are some highlights which I got from someone else who posted these highlights from a good article from THE NEW ENGLAND JOURNAL OF MEDICINE on AMS.


Acute Mountain Sickness
As seen in the New England Journal of Medicine, July 12, 2001; By Peter Hackett, MD and Robert C. Roach, PhD --- Here are the Highlights: 1991 Colorado survey study: Acute Mountain Sickness (AMS) in 22% at 7,000-9,000'; 42% at 10,000'. Risk factors include previous bouts of AMS, residence below 2,800', exertion and preexisting cardiopulmonary conditions. Persons over 50 years of age are somewhat less susceptible to AMS whereas children are about as susceptible as adults. Women are less susceptible than men to HAPE (High Altitude Pulmonary Edema) but equally prone to AMS. Physical fitness is not protective against high-altitude sickness. Genetic factors and environment probably explain varying individual susceptibilities. Descent of 1,500 to 3,000' usually leads to resolution of AMS; HACE (High Altitude Cerebral Edema) may require greater descent. New evidence suggests that ALL people have swelling of the brain at high altitudes. One hypothesis is that those with high cerebrospinal fluid volume to brain volume experience AMS less often, since they have more skull space with which to accommodate brain swelling. 400 to 600 mg. of ibuprofen decreased or resolved high-altitude headaches. Gradual ascent is still the best strategy for AMS avoidance. Prophylactic aspirin (325mg. every four hours totaling three doses) reduced the incidence of headache from 50 to 7%. The notion that over hydration prevents AMS has no scientific basis. PETER HACKETT, MD: Associate Professor, University of Washington School of Medicine; Director, Denali Altitude Research Project, Medical Control, Denali National Park Mountaineering Rangers; Emergency Medicine, Grand Junction, Colorado


Posted by HikerMom, 07-05-04
I am also sensitive to altitude. I have tried Ginko with little luck as well as aspirin on of 3 previous attempts. All(except #3)were overnights allowing for several days of acclimation at Portal and camps on the mountain. I came to the conclusion, after my second try last summer, but before my 3rd try 3 weeks later last summer, that I have a problem.

Another issue is that we spend a great deal of time and energy preparing and planning for these hikes, and can't afford for something to go wrong on the mountain in respect to AMS. For many, it's a one shot deal on that permit date.

Last summer, before my last hike, which was a dayhike with 3 days of acclimation at Mammoth prior, I went to see a physician and finally broke down and tried Diamox. The difference was asounding. It's not without it's own side effects (tingling hands/feet, distorted carbonated beverage taste, frequent urination) but I found those effects to be nothing compared to that aweful feeling of my head wanting to explode, or constant nausea. We leave next Saturday for another day hike on Monday, July 12 and I've got my meds ready.

I don't think anyone should have to deny themselves the pleasure of high altitude hiking. If this is a serious problem for you, speak to a doctor who can discuss all the pros and cons with you and together you can make a good decision. Good luck!


Posted by Cakie, 07-05-04
Ellenclary: If you have the time, have you tried doing things such as: sleeping at Mammoth Lakes for 2-3 days (altitude 8,600 feet). Or sleeping in a tent at Horseshoe meadows, which is almost 10,000 feet?

I had a girlfriend years back who had the same problem you did. She never got above Trail Camp when we did Whitney because she would feel increasingly dizzy, then vomit, then tell me her head felt like exploding.

She did two things: we slept at altitude for 4 days long before our next attempt and she drank copious (and I mean COPIOUS) amounts of water.

Ellen: are you drinking enough water? That means 5 liters the day before you hike, 2 liters prior to the hike and then 24 ounces per hour? Lots of people won't do this, but when my then-girlfriend did this, she has no AMS symptoms and summited in 6 and a half hours.


Posted by IGOHIKN, 07-05-04
I've always thought that drinking LOTS of gookinaid (2 gallons) helped me make it up without any AMS symptoms. I drove up from San Diego, spent one night at portal campground and dayhiked with no symptoms. Check out gookinaid.com for more info.
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Posted by GoingBackSoon, 07-05-04
Having hiked with people very sensitive to the altitude sickness issue, it is always a concern. I have found that just a few extra days really helps. Even one more night could get you to the top. It may never be easy, but possible.

I of course carry Diamox also, just for a little edge.


Posted by Candace, 07-05-04
Ellen,

I would also be interested to know how much water you're drinking. I think this is a key component in people developing AMS and I base this on experience of watching people get AMS over the years at high altitude. If you're not drinking a liter per hour, why not try doing this during your next Whitney attempt and see if it doesn't make a huge difference.

It make be that you are simply a person who is genetically predisposed to having problems with altitude in which case water probably wouldn't help. But if you don't mind, how much water were you drinking when you attempted Whitney and got AMS? Also, how much fluid did you drink in the 24 hours preceding your climb?


Posted by ellenclary, 07-05-04
Since folks have been asking, I drank quite a bit of water, gookinade and diluted gatorade until I got nauseated then drinking was a lot harder to comtemplate, because I had that feeling that anything was going to make me heave, but I could still stomache the gatorade so I made myself drink that.

My urine was fairly clear most of the time, though when I was ill I was sure it wasn't.

Maybe Diamox is in my future. I've tried Ginko for other reasons and it makes me a touch wired, but I may try it again.

I wish there was a place to camp at 13,000'. It's the ascending over 1500' in a day that seems to get me. Maybe I should just hang out at Trail Camp for a few days, but even though it's entertaining, it's not the most appealing of campsites ya know? wink

Though I could make a career out of being a docent there as I know the view pretty well. The switchbacks begin over there, trail crest is over there, no that's not Whitney, that's Muir, Whitney is way over there, yes it's a long traverse from Trail Crest to Whitney - it's 2.5 miles and quite rocky, you will have to descend some after Trail Crest to hit the John Muir Trail, take a jacket as it's really cold up there. There is a snow patch near the summit that you'll have to cross up there.

After 2pm I could turn into a parent of a teenager . If someone approaches the switchbacks I could ask "Where are you going?" "Do you see those clouds?" "If it starts to thunder you know to come down right away?" "Do you have a jacket?" "Do you have water and food?"

This could be fun.

Or maybe I should stop with the lofty goals. Once of the best times I had was a trip from Horsecamp (wait that's Shasta) um, Horseshow Meadows and through the Mitre Basin. I was somewhat ill at Horseshoe since it's 10,000' but that cleared up in a day. Nice gradual ascent and wound up camping at 12,500 and was ok. Even dayhiked over Crabtree Pass.

In August I'm taking my partner up the Mtner's Route just because I want to show her the area (and the ledges) I think we'll just drop anchor at Lower BS Lake or Clyde Meadow and then do day hikes from there.

Ellen


Posted by Cakie, 07-05-04
Ellenclary: Not to be a pest (honest), but you write, "I drank quite a bit of water, gookinade and diluted gatorade." I don't want to nag, I'm trying to help you, but this is not a specific answer. What "quite a bit" is to you might not be anywhere near adequate, especially for a person who has a tendency to develop AMS. Were you drinking 24 ounces of fluid per hour while ascending? Did you drink at least 6 24-ounce bottles of fluid the day prior to the ascent?

If you want to summit Whitney, you're going to have to drink a ton of water. It sounds to me like you weren't drinking enough.


Posted by Ken, 07-05-04
We had a thread a while back about OVER-drinking of water, producing a life-threatening problem.

One doesn't need to do quantum mechanics to figure this out. Clear urine means a person is not dehydrated. Really pushing fluids at this point can produce serious effects.
_________________________
Good judgment comes from experience,
and experience, of course, comes from poor judgment.



Posted by ellenclary, 07-05-04
Hi Cakie,

No you're not being a pest, but when one is ill it's really tough to keep drinking even when one is aware how important it is. So fluid quite likely was an issue. I had with me a 70 oz (2+ liter) Camelbak, a 1 liter Nalgene, and a 1 liter Platapus collapsable (not always filled).

Since reading Bob R.'s paper I decided that there wasn't enough evidence to support continuing to filter water and instead focused on maintaining keeping clean in particular my hands. As a result I was refilling each vessel on a regular basis. (Though I still don't drink out of the specious Trail Camp pond, but instead hike up to that spring that crosses the switchbacks.

So to attempt to answer your question I think it was about 4 liters the day before and the day of. Though I'm sure when I was nauseated my rate of drinking went way down.

Ellen


Posted by Alpine Swine, 07-05-04
If you want to summit Whitney, you're going to have to drink a ton of water. It sounds to me like you weren't drinking enough.

This is incorrect. Nowadays people carry too much water. Most people on big moutains carry only 2 liters on any climbing day. History has proven that if you start and end the day hydrated you can get by with less weight and climb faster (safer).

By all indications Ellen has classic maladaptation to altitude. THIS DOES NOT MEAN SHE CAN'T GO HIGH! She will either need to invest the time to properly acclimatize (including time, nutrition, hydration and proper breathing) or try something like Diamox, which works by increasing nightime respiration and may be obviated by breathing correctly in the first place.

Ellen: When you breathe in on a climb make sure to fill your lungs fully and from the diaphram like a singer. Exhale forcefully through pursed lips like you are blowing out candles on a birthday cake. This has the effect of raising the oxygen partial pressure presented to your lungs (much like a SCUBA system at depth). If people make fun of you laugh with them...On the summit.

Take Diamox also if you really need it but chances are you probably don't. Better to spend more time on the mountain enjoying the reasons we climb for in the first place.

Best wishes...Climb On!


Posted by Memory Lapse, 07-05-04
Ellen,

First I am not a doctor but please read this. Just another bit of information to consider.

"The symptoms of hyponatraemic encephalopathy are similar to those of dehydration, including nausea, vomiting, and confusion. Therefore, people with symptoms may think that they need to drink still more, but further water consumption can lead to seizures, delirium, coma and death."

Could you be drinking too much water? I suggest you consult a physician if you are going to continue hiking at elevation.


Posted by Cakie, 07-05-04
Hyponatremia can be ruled out, you have to drown yourself in liquid to get this condition, which generally seen in hot, dry environments like the Grand Canyon. You also don't eat anything in order to get this disorder which is uncommon.

Alpine Swine, I beg to differ with you. AMS symptoms are proven to be alleviated with drinking fluids. The body needs and will utilize 24 ounces per hour. Assuming a Whitney hike lasts 12 hours, that's 12 liters, to many "a ton of water." My feeling is that Ellen would not have AMS symptoms if she drank 24 ounces per hour. I hope she tries this and reports back to us the results and good luck, Ellen.

Anyone carrying only 48 ounces of water on a hike generally lasting 10-13 hours is a fool and will not perform to the best of their ability and will be grossly dehydrated at the conclusion. I exclude a trail runner who can do the mountain in 3 hours, but those super-fit people are few and far between. I hope no newbie here is listening to this "advice!"


Posted by ellenclary, 07-05-04
By the way thank you all for your time and attention. I half expected to be pointed to another forum. I should have known better.

Alpine Swine, you're the first one to bring up forced/pressure breathing - a really important topic. Fortunately I had the good sense to take a basic mountaineering class from Shasta Mountain Guides and they covered it and I was definitely doing it and I probably would have been worse if I wasn't. My partner Terri said that she got a little ill a couple of times and realized that she wasn't breathing properly. When she did, the illness went away.

Cakie, I think what some folks are pointing out is that if someone drinks a lot of water that they are diluting the electrolytes in their system and that can make one worse. This is why things like Gookinade and diluted Gatorade are a generally good idea for some of the fluid you consume. I do not have a url reference for this at my fingertips sorry.

Ellen


Posted by Alpine Swine, 07-05-04
Anyone carrying only 48 ounces of water on a hike generally lasting 10-13 hours is a fool and will not perform to the best of their ability and will be grossly dehydrated at the conclusion.

Cakie: You may wish to check your facts. Extra water is dead weight on a serious climb and can kill you MUCH faster than dehydration in an area prone to objective hazards. While I realize that this board is geared towards hiking and other 'low performance' mountain activities, Ellen asked a serious altitude related question from the standpoint of a CLIMBER. I answered as such.

Just so you know a liter is about 33.8 ounces which means roughly 68 ounces instead of the 48 according to your math. This is the amount I took two days ago on Rainier (Kautz Route) from high camp (11K) to the summit and back. I still had water in reserve 10.5 hours later back at high camp. You are saying I did something wrong??? If you know any real climbers ask them about this and see what they say.

Like it or not, Whitney is a MOUNTAIN. This means that people need to be self reliant and ready to make sacrifices in the interest of their own survival and/or success. Perhaps if more people saw it this way we'd have fewer problems and rescues up there.


Posted by ellenclary, 07-05-04
One small point is that Rainier and Shasta are considerably further north and cooler than Whitney and that seems to make a difference. I know that Shasta Mountain Guides recommends 2 liters for a summit attempt of Shasta. On cooler mountains that may be enough, but for me, it's not enough for Whitney during the summer. Though Whitney does have some run off from that snow patch on the summit where you can get a water refill if you get that far.

Ellen (the altitude wuss)


Posted by HikerMom, 07-06-04
I keep coming back to this post with interest. As mentioned earlier, I have the same issues as ellen. I also beg to differ with cakie. Hydration and breathing are not always the answer. Ellen - go speak to a doctor and make a uniform decision.

On all my previous attempts, including the one I took diamox on, I drank over a gallon of water for three days prior to going to altitude, continued while spending up to four days acclimating, also drank gatorade and cytomax, climbed slowely, overnighted on the mountain and still had issues. SOME PEOPLE JUST DO!

My hiking partner, my father, and my husband, all of whom I have hiked with, and plan to hike with again next week on Whitney, have NO issues with altitude. They can drive up to portal and start walking.

Go see a doctor before you go again. Unless you have an unlimited supply of permits for the season and can afford to test everyone theories each time you attempt. Everyone's body is different.


Posted by Cakie, 07-06-04
I'm not saying drinking 24 ounces an hours is "the answer" to AMS. Some people with a predisposition to it will suffer from it even if they take adequate fluids. I am saying it is a proven way to combat the effects of it. The vast majority of people I see hiking simply do not drink enough. Two 24-ounces bottles of water in hot weather in August for a 12 hour hike is inadequate in my judgment, in fact it's insanely inadequate. I know... I know... people will say they saw some 20 year old kid drinking nothing but a coke during Whitney and they were fine the next day. Well, I'm talking about the vast majority of other people.


Posted by HikerMom, 07-06-04
Yes! Yes! Yes! There are tons of people who do not drink enough and then wonder why they get sick. All I'm saying is that some bodies are not able to handle altitudes. Having been there, done that, tried everything, I'm suggesting she seek medical advice.

Not to open another can of worms - but...ellen, do you get motion sickness? I do very easily, very acutely. I have always thought there was some correlation between the two. I think the motion sickness and altitude sickness has something to do with an inner ear thing. The people I mentioned earlier who do not get altitude sick also do not get motion sick. Just a thought - don't attack me here.


Posted by AlanK, 07-06-04
It is simply wrong to post absolute statements such as: "The body needs and will utilize 24 ounces per hour. Assuming a Whitney hike lasts 12 hours, that's 12 liters..."

The amount of water the body needs and will utilize varies a great deal. It depends on level of effort, humidity, temperature, body mass, initial state of hydration, etc. Anyone who has hiked in a variety of places under a variety of conditions knows this from direct experience.


Posted by ellenclary, 07-06-04
Hi HikerMom (and everyone else),

Rest assured that I've already contacted my Dr. about this issue and I will no doubt be trying the Diamox, next altitude hike (with a test run before as well). (And maybe do another test with Ginko as I'm pretty familiar with it.)

It is fascinating to hear other people's experiences and opinions even if they are divergent. I'm pretty good about researching things so I will check into anything I read and not take it at face value (unless it is as well documented as Bob R's stuff )

That is an interesting observation about motion sickness. I used to get car sick, but I've gotten really good at managing it (on mountain roads I make sure I'm the one who's driving, and when on a boat I'm out in the wind watching the horizon.) However it doesn't appear that I have inner ear issues. My balance is quite good (and learning rock climbing helped me get comfortable with sheer drop-offs) and I've never had problems with my inner ear.

This is all just underscoring for me that everyone's body is different in responding to drops in available oxygen, and maintaining hydration.

Ellen


Posted by Cakie, 07-06-04
Is the information on this page (information repeated ad nauseum in many medical journals) incorrect? It sure has worked for me relating to hydration.

http://www.lakerunclub.org/Hydrate.htm


Posted by Cakie, 07-06-04
Another site with essentially the same information on how much to hydrate:

http://www.bpr.com/triathlon/hydrating.htm


Posted by AlanK, 07-06-04
cakie -- Yes, the information is incorrect. For example, look at the following two statements from the second link:

1. "Fluid requirements increase dramatically during exercise in the heat."

That statement is correct. Fluid requirements vary dramatically depending on conditions.

2. The very next sentence says: "To determine how much you need to take in per hour during running multiply your weight in pounds by the average speed in miles per hour and divide by 28.5. For example, a 150-pound man running at 8 mph would need about 42 ounces (150 x 8 + 28.5 = 42.1)."

The first statement contradicts the second, which gives a single answer for something that varies dramatically. I think we all know this from experience. I drank 2 liters on a 10 mile hike yesterday. It was in the 90s. During the winter, I would have used perhaps half a liter and ended up as well hydrated.


Posted by Alpine Swine, 07-07-04
Rainier and Shasta are considerably further north and cooler than Whitney and that seems to make a difference.

This is true but imagine the winds high on Rainier when a system is coming in low (as on our summit day). We all could have used more water but no one got AMS or even a headache.

I never said that I am against drinking as much as you can on any mountain. Cakie just made some assertions that fly in the face of what many climbers have proven to be true. Certainly there is always an academically correct (and scientifically plausible) way to do things. The problem is that all this tends to break down in the mountains and when this occurs it is the flexible mind and body that will summit and/or survive.

Of course do what you can to stack the odds in your favor...My guess is though that you just need a bit more time acclimatizing than most...Take Care!


Posted by joeski, 07-07-04
I am always bewildered why people feel comfortable taking Gingko (which has been shown to be somewhat effective for AMS prevention) but are hesitant to take Diamox (proven effective and used in the military by people needing to quickly go to altitude without time for acclimating). I guess it's a West coast thing. You are doing the right thing by getting a prescription for Diamox 125-250 mg twice a day starting the day before your hike and using it as well while at altitude (see the New England of Journal of Medicine review already cited). You may have to bring this article to your doctor, unless the doctor by chance is versed in AMS prevention. Test it for side effects as if on your Whitney hike in advance of your hike. Water intake has not been shown to affect AMS. On my hike up Whitney June 10 of this year I carried 1 quart and a filter. I hiked up from the portal and back on only the 1 liter of intake. Everyone has their own biologic needs. One key is to adjust your clothing and pace to minimize sweating. It's interesting how we try to overthink what our ancestors did perhaps on a daily basis, i.e. walking 10-20 miles at altitude. Even without Gatorade!!

Joeski


Posted by ellenclary, 07-08-04
I now have Diamox in hand and will try it out in August on the Mtneer's Route. (With a test run before that.)

Thanks to all for the insights!
Everyone's been so civil here unlike the troll/pretender-ridden mountain lion thread that I'm staying out of.


Posted by Sierra Sam, 07-08-04
ellenclary:

A comment:

you should never try anything for the first time while you are on the mountain. Try it first before you leave to be sure that you don't have any side effects that would spoil your trip.


Posted by ellenclary, 08-19-04
I went back and had success with Diamox!
Will post more in a new thread.

Glad the board is back.


Posted by norweejunwood, 08-19-04
congrats ellen. interestingly enough, on our recent summit of July 30th, the only one of our party of 6 that succumbed to AMS was the guy taking diamox. we think he went from portal to trail camp too fast.

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