8/15/11 Trip Report & HAPE

Posted by: Diane

8/15/11 Trip Report & HAPE - 08/29/11 02:37 PM

This report is about an amazing hike to the summit of Mt Whitney and a subsequent case of HAPE. For all of us who spend countless hours researching every possible thing that can go wrong on the mountain and preparing for it all, most do not even think about the possibility of HAPE as it is considerably rare.

Little history on myself. I'm in my early 40's and in excellent physical shape. I'm very active in pretty much every type of sport and have been an avid hiker for many years. Our decision to hike Whitney was made in January of this year, so I increased the intensity and frequency of my gym visits and put together a consistent regimen of weekly hikes and runs. I was already in physical shape for the one-day hike of Whitney, but mentally I wanted to ensure the trip was easy so I could truly enjoy the vas beauty of the mountain during the ascent.

Although I lived most of my life in the Pacific NW, I currently live close to sea level in Southern Cal (OC), so I included the typical training regimen of high altitude hikes. The only time I had any sign of any mountain sickness was Baldy, where I experienced very mild nausea on the summit, which went away after 10 minutes of rest. Although it seemed like we hiked very slowly as I'm not use to frequent rests during hikes, we reached the summit in just over 2 hours, which included a 20 minute rest at the ski hut.

I'm somewhat of a health/nutrition buff, so my preparation included a strict regimen of pre-hydration (4-6 liters water every day the two weeks prior to trip, more on work-out days), additional electrolytes to balance water intake (love NUUN tablets - also use in our hydration packs while hiking), liquid chlorophyll (although I slacked off the last week prior to hike), ginkgo biloba (don't know if it works for AMS, I take for other reasons), heavy diet of fish and green food, very limited alcohol, Glucosamine/Condroitin, Chia Seeds (they are part of my regular diet - I either soak them in water and then add to my juice, or I sprinkle them in my smoothies or other food items), and a high antioxidant beverage to help with recovery (athletes need much more antioxidants than non-active persons). Outside of the increase in water intake, I pretty much always follow a healthy diet (I need every edge I can get to make sure I can still out-hike my husband who is younger ).

I also had a prescription for Diamox, which I have never used before.

We arrived in Lone Pine early Saturday morning (13th) and headed for Horseshoe Meadows (10,000') for a short hike to Cottonwood Pass (~11,200 according to my GPS). I had taken just under 100mg of extended release Diamox the night before. I suffered the normal side effects of Diamox - frequent urination and taste sensitivity). Our hike was very easy, mostly shaded and just under 8 miles RT. I completely emptied my 3l Camelback during the hike, but didn't realize until later that my liquid intake did not off-set the side-effect of frequent urination. My ER doctor was negative toward the use of Diamox, as it can cause dehydration and you don't know it until it's too late.

On Sunday, we hung out at Whitney Portal, hiked the trail as far as you could without a permit, and spent the latter part of the day prepping our stuff for the next day's hike and very early morning. We stayed at a one of the Motel's in Lone Pine.

The next day we began our hike at 3am. Scouting the trail the day before made the trek in the dark much more enjoyable. We also had the help of headlamps and a beautiful moon.

We made pretty good time, even with our frequent stops to take pictures or take in the sights. We had planned to enjoy ourselves during the hike and not make it a race to the top - which was initially tough for me as I'm more of a power hiker.

We reached the summit just before noon, which included a 30 minute stop in the meadows and 30 minutes at Trail Camp. It was such a beautiful day, it was challenging to not stop and enjoy it.

The switchbacks were easier than I expected, conquering them in an hour and 30 minutes. We also hung out at Trail Creast for a while - so many amazing views from this location.

We probably spent too much time on the summit - an hour and 30 minutes, but we weren't in a hurry. I felt no symptoms of AMS outside of tightness in my head every once in a while. I also developed a slight cough, which I contributed to the increase of my breathing rate. My appetite was questionable, but not totally off. Some things - like my Twix candy bar, were awesome, and other things, like my tuna salad pita, I couldn't bring within a foot of my mouth.

My water intake on my ascent wasn't to par with my regular hiking. I only went through 3L on my ascent and another 1L from the summit to the first water source on our decent down the switchbacks. I used another 3L from the switchbacks to the Portal.

I felt great from the summit to Trail Camp, which we covered very quickly. At that point, my coughing was a little worse - but again, I didn't suspect anything but dry throat due to rapid breathing. My pace also started to slow and I started to feel very fatigued, which was completely out of norm for me. When I hike or run trails, I typically get a second wind and run a significant portion of my miles.

When we reached the meadows, I stopped to double up my socks. The fatigue was also causing pains in areas of my body that I had never had before, which was both confusing and frustrating. I had already taken 600mg of IB on the summit, so I knew some pain was already being masked.

By the time we reached Outpost Camp, I wasn't sure how I was going to make it down, at least in a decent time. I could hike very slowly, but covering 3.8 miles at a slow pace didn't seem like a good option. Outside of pain, fatigue, and coughing, I didn't have any other symptoms that you would associate with mountain sicknesses. I took another 600mg of IB to help with the last leg of the descent and I gave my backpack to my husband, which was only 12 pounds, but it helped.

Not knowing what I was doing was wrong, I covered the last 3.8 miles without stopping and at the fastest pace my body could handle, and mostly in the dark. All I could think of was getting off the mountain. We reached the Portal at 7:30pm. Our descent took us 6 hours, which was pretty good considering my struggles.

Made it back to our Motel in Lone Pine, picked up dinner along the way, which I couldn't bring myself to eat. A hot shower never sounded so good, yet felt so bad. The hot water was actually cold when it hit my back. For the first time I noticed I still had a shortness of breath. My resting heart rate was at 113, a far cry from my normal rate of 55, and I was running a fever. It was 90 degrees outside and all I wanted to do was cover up with 10 blankets while my husband was shedding clothes. I did a little research and decided I should go to the hospital since my symptoms were getting worse.

To my surprise, Lone Pine has an ER and hospital. Actually they have 4 acute patient rooms and 33 rooms for elderly nursing care. I was thankful for this as the next hospital of choice is in Mammoth, and we didn't have a positive experience with their ER a couple years ago (my husband broke his back snowboarding).

The ER/hospital doctor and nurses were great. Along with every other person I came in contact with. I was diagnosed with moderate HAPE and AMS. Although I didn't have the usual outward symptoms of AMS, my labs showed different. I can't begin to describe how off my blood work was - they couldn't believe I had made it off the mountain on my own. The first 24 hours my conditions worsened to severe HAPE. I gained 20 pounds of fluids during the same time. At first I questioned the accuracy of their scales, but one look in the mirror and truth be told. One positive thing - my face was filled out and I had lost most of my wrinkles - at least temporarily.

I spent three days in the Lone Pine hospital. My x-rays didn't show improvement, but my labs did. I was also diagnosed with Pleural Effusions, which were a complication of the HAPE, and significantly slowing my recovery. It took almost 10 days to get my breathing and constant coughing under control.

In regards to myself, I learned a lot from this trip:
- Excellent physical fitness and acclimatization training does not make you exempt from getting sick on the mountain.
- Diamox is good for mountain sickness, but also bad. The side effect of increased urine output can cause dehydration. Water intake must be increased significantly to offset fluid loss.
- Focus on deeper breathing while at high altitude. Short breaths help contribute to fluid build-up in the lower portion of your lungs.
- If your pace slows up more than normal, stop and monitor your recovery - not just in time, but more importantly, count your heart rate. If after a short rest, your heart rate does not go down, there can be reason for concern.
- Coughing is not a good sign, especially if there are crackles.
- Make sure your hiking partner is well versed on all mountain sicknesses - not just headache/nausea. They are your eyes and ears when your brain and body is not functioning normally.
- You should be hungry after 22 miles and 17 hours on a mountain. When the thought of those yummy Whitney Portal french fries I had eyed they day before (and promised myself after my day on the mountain) didn't even sound appetizing, then I should have known something was wrong.
- I'm not sure hiking Whitney in one day is the right thing for everybody, even with proper acclimatization at 9-10,000' feet. Climbing over 6,000 feet in one day to a high altitude is stressful on the body - and I don't mean in the physical way. Us "sea-level sissies" need to take even more precautions.
- Limit time on the summit, where you're most exposed to lower oxygen levels. Eat, drink, take pictures, and short rest. If needed, I would spend more time resting at lower altitudes such as Trail Camp.
- If you are experiencing signs of HAPE (coughing with crackles, shortness of breath at rest and not recovering easily, fatigue out of normal), do not push yourself hard on descent, it could place even further stress on your body and worsen your conditions. My rapid descent caused my conditions to worsen.
- During busy months, the Lone Pine hospital might have a couple HAPE cases a week. They have also had a few deaths over this summer.
- It is very important to monitor your conditions and your hiking partner's conditions at all times - if something is wrong, don't let it get worse.
- This message board is the best - I have consistently read for almost a year. Really helped me prepare.

I'm recovering nicely, although still coughing when my heart rate increases or I take a deep breath. Much better than not being able to sit up on my own or lay flat while enduring really bad chest pains (couldn't take good pain meds as it slows your breathing and worsens HAPE).

Mentally, I'm ready to head back up the mountain to conquer it versus it conquering me. Next time I'm taking the Mountaineer's route and spending a few nights on the mountain and enjoying my french fries at the Whitney store.
Posted by: Steve C

Re: 8/15/11 Trip Report & HAPE - 08/29/11 03:36 PM

Wow, Diane! Thanks for posting. Sure glad you are ok now. It is amazing how long it takes to recover from the swelling and misplaced fluid in your body.

After three nights at 10,000', my wife came home and experienced swollen hands and feet. Now I am wondering if the altitude might have caused that.

The one thing you might add to your plans: instead of sleeping at a motel in Lone Pine before the hike, spend several nights at Whitney Portal, or better, Horseshoe Meadows. Sleeping higher is better for acclimatization for a Sierra hike.

Edit 9/9/11: Here is yet another report of a similar experience by a hiker:  A case of HAPE
Posted by: quillansculpture

Re: 8/15/11 Trip Report & HAPE - 08/29/11 04:26 PM

This Trail Report is an ABSOLUTELY MUST READ for anyone who hikes Mt Whitney and/or other elevations. Everything you did was perfect prior to your hike. Excellent physical shape, nutrients, hydration. I would only question the length of time on the summit, but lots of people stay up there for an hour or more. I've even seen some people drink beer up there.

That was not just a complete report, but a great report, one I will always remember. Thank you so much for sharing.

Steve, this one should go under the "What Can Go Wrong on Whitney" section for everyone to read in the future.
Posted by: Bee

Re: 8/15/11 Trip Report & HAPE - 08/29/11 06:37 PM

Hi Diane,

Do I read correctly that while you made a few hikes at altitude before your dayhike, there was no sleeping at altitude before the trip?

This sleeping at altitude before summiting seems to make a world of difference. Steve C & I were part of a group that slept over on the Whitney summit after two nights prior at 10K. Other than being cold, I felt no different than at sea level when I woke up the next morn at 14k.
Posted by: Akichow

Re: 8/15/11 Trip Report & HAPE - 08/29/11 07:54 PM

Thank you for sharing your story. How frightening! I am glad you are on the mend.

I have a question: could you or your partner hear the crackles while you were doing your descent? When did you start to hear the crackles?
Posted by: Julie

Re: 8/15/11 Trip Report & HAPE - 08/29/11 08:07 PM

Hi Bee -- your post said you slept 2 nights at 10K. I was wondering, where did you sleep? Was it at Outpost Camp? If so, was there a reason you didn't try going from Outpost Camp to Trail? I'm trying to decide where to camp for our trip over Labor Day. Thanks!
Posted by: Bee

Re: 8/15/11 Trip Report & HAPE - 08/29/11 08:15 PM

Hi Julie,

Apon arrival at 10:00pm, we drove up to HorseShoe and camped overnight. The next day, I got a walk-in overnight pass (for that day), so we started at about 6:00pm and hiked until sundown and camped at around 10k. The next morn, we summited and slept on Whitney that night. The next day, we returned to Lone Pine (to drive to Death Valley)

I never felt a single twinge of AMS. I have experimented a bit with Diamox, but I found that sleeping at altitude worked pretty much by itself (and I could easily do without the inconvenient pit stops)
Posted by: quillansculpture

Re: 8/15/11 Trip Report & HAPE - 08/30/11 06:59 AM

I think it's really important to note the everyone is different in how they will or will not feel the effects of AMS. That's the importance of pre Whitney hikes above 10,000 feet. I had several hikes above 10,000 before my first Whitney summit. After my first hike I had congestion in my lungs and kept spitting out yellow junk for days. And that was only to 10,200 feet. I kept doing my hikes above 10,000 and never had that happen again. I've had slight headaches every time I go above 12,000 and also nausea, but never bad.

My friend goes to La Paz Bolivia to see his wife's family and he always gets headaches at the hotel in La Paz (12,000 feet.) His son has never had headaches and neither has his 80 year old mother. At the hotel in La Paz, they deliver oxygen canisters to your room. Again, different for everybody.
Posted by: Bob R

Re: 8/15/11 Trip Report & HAPE - 08/30/11 07:02 AM

Originally Posted By: Diane
For all of us who spend countless hours researching every possible thing that can go wrong on the mountain and preparing for it all, most do not even think about the possibility of HAPE as it is considerably rare.

A year ago, I wrote about HAPE on Mt. Whitney, but the focus was different: Dexamethasone and HAPE

The entire link is worth reading, but I'll extract a little of it here: Estimates for the likelihood of contracting HAPE seem to vary all over the map, according to the many different studies. Assuming 160 people a day climb Mt. Whitney, the estimates translate from a low of one person every two months to a high of seven per day. (One study suggests up to 24 per day.)

Why don't we observe more of it? Again, from the link: "I have long suspected that unrecognized cases of HAPE (incipient, perhaps) among Mt. Whitney visitors are more frequent than commonly thought. For any number of reasons the afflicted person may turn around and descend, thereby quickly and easily correcting the situation--without ever having been aware of what it was."

As far as AMS is concerned, it appears that 1/3 to 1/2 of unacclimatized Mt. Whitney hikers experience it. The key word is "unacclimatized." Many who try Whitney are acclimatized, either because they've prepared well with the hints mentioned on this forum, or simply because they go to and stay at altitude frequently.
Posted by: Diane

Re: 8/15/11 Trip Report & HAPE - 08/30/11 08:28 AM

Hi Bee,

I slept at high altitude all nights except the one prior to my hike up Whitney. I've wondered if sleeping in Lone Pine the night before helped contribute - even though I only slept 1.5 hours.

My doctors are puzzled as to why I got so sick. One doctor believes the side effects of Diamox contributed to my HAPE and it probably began on the first day I was at high altitude (Horsehoe Meadows). I drank significant amounts of liquids, but not enough to offset the increase in urine output.

On another note - my husband followed the exact same regime as me, except I'm in better physical shape and pre-hydrated at a much higher level. He experienced the same side effects from Diamox and drank less water than me during all our hikes. He had no symptoms of any mountain sicknesses during our entire trip.
Posted by: Diane

Re: 8/15/11 Trip Report & HAPE - 08/30/11 08:37 AM

Originally Posted By: Akichow
Thank you for sharing your story. How frightening! I am glad you are on the mend.

I have a question: could you or your partner hear the crackles while you were doing your descent? When did you start to hear the crackles?


We really didn't hear any crackles in my breathing until the last couple hours of our descent and it got progressively worse for the next 48 hours. The ER doctor said many HAPE cases get worse before they get better.
Posted by: Akichow

Re: 8/15/11 Trip Report & HAPE - 08/30/11 09:08 PM

Thanks! I haven't seen HAPE first hand, and I wondered how obvious the crackles would be to a lay person/non doctor.
Posted by: Harvey Lankford

Re: 8/15/11 Trip Report & HAPE - 08/31/11 09:09 AM

Thank you for posting this important story.

HAPE just happens. Not always predictable who or when or why.

The MD comment about Diamox causing HAPE? It is a very, very mild diuretic and any degree of mild dehydration (that could be a factor in AMS, HAPE, HACE) would be mild and easily corrected with intake. And.... you may have dehydration from other non-Diamox factors like workload, sweating, fever, distribution of tissue fluid into places like the pleural space of the lung that you mentioned, etc, etc.

The MD comment that HAPE can get worse before it gets better is spot on. He has seen it before.
Posted by: SierraNevada

Re: 8/15/11 Trip Report & HAPE - 09/11/11 07:55 PM

Very well written compelling experience. Unforgettable.

My ER doctor was negative toward the use of Diamox, as it can cause dehydration and you don't know it until it's too late.

Was that ER doctor the one who treated you in Lone Pine? If so, that says a lot. He seems to be very experienced at this being on the front line for Whitney hikers. Makes me wonder about trying Diamox or not. I've found benefit using a small canister of O2 (6oz 18L of compressed 90% oxygen). Probably not enough benefit if one is fighting HAPE, but it helps for us "sea-level sissys" with the usual mild AMS headache and short breath.

Diane, will you use Diamox again when you go back up?
Posted by: Diane

Re: 8/15/11 Trip Report & HAPE - 09/15/11 02:37 PM

Originally Posted By: SierraNevada
Very well written compelling experience. Unforgettable.

My ER doctor was negative toward the use of Diamox, as it can cause dehydration and you don't know it until it's too late.

Was that ER doctor the one who treated you in Lone Pine? If so, that says a lot. He seems to be very experienced at this being on the front line for Whitney hikers. Makes me wonder about trying Diamox or not. I've found benefit using a small canister of O2 (6oz 18L of compressed 90% oxygen). Probably not enough benefit if one is fighting HAPE, but it helps for us "sea-level sissys" with the usual mild AMS headache and short breath.

Diane, will you use Diamox again when you go back up?


The ER doctor was in Lone Pine. They claim to get a couple HAPE patients per week during busy season.

I plan to continue use of Diamox, mostly due to the benefits related to headache and nausea. To offset any possible dehydration, I will increase my water intake and focus on deeper breathing to help prevent fluid buildup in my lungs.

My regular doctor has recommended I use an asthma inhaler to help open up my airways.