Re: My experience with HAPE and some questions

I almost didn't want to write this trip report, since it turned out such a disaster when I had big plans of doing 3 weeks in Yosemite and the Ansel Adams Wilderness.

Early last month I got what seemed like a mild respiratory infection, but decided against seeing a doctor since I didn't have a fever, chills, or anything like that. A couple of weeks before my scheduled trip to the park I was feeling normal again and figured the trip was A-ok. The first night I stayed in the TM backpackers camp and slept like a log (really nice low 30s temperature felt great when I'm used to sleeping in high 70s, low 80s with mid 70s dewpoints in South Texas). Second day I hiked out to Mono Pass with a full pack and a week's of food; about 40 lbs, so not especially light, but not a backbreaking load either. Progress was a little slow, but I didn't think much of it since my first day out on a trail is usually kind of tough coming from 800 feet elevation in San Antonio. Had no headache, my appetite was great (e.g., was eating 3200 calories or so per day in days 1 & 2), etc. Made sure to drink lots of water to keep hydrated, since I know that's critical at altitude. By the time I got to Mono Pass the winds were really howling and filled my sinuses pretty good with mucus (I guess from the pine pollen).

Sleep that night was really lousy, and I got up at 4am and decided to go hike up the south face of Gibbs (I have always heard 'climb high, sleep low' for acclimation). My sinuses cleared right up and I felt great again, but right as I came to the highpoint of the south shoulder (~12,150 feet or so) I looked down and noticed my fingers were really swollen. Since I have never had that happen and I had never read about it, I became concerned and headed back down to camp about 10,700 or so near Mono Pass, and the swelling was gone within an hour of getting back. However, my appetite was really lousy this third day, which is another strike on my checklist for AMS. I figured if I couldn't get a good night's sleep again, it would be time to go back in the morning. Did a short dayhike out to the Sardine Lakes from there, but mostly it was a rest day to hope I could start acclimating.

Winds and full sinuses returned, and by night I started feeling like I had crap in my lungs, got really tired just digging and using a cathole, had trouble breathing at rest with a really fast heartbeat at rest, had a kind of a drunken walk, and a dry cough. Those symptoms just screamed HAPE, and I knew it was time to leave right then. I know HAPE never improves and waiting it out could have proved deadly. I carefully packed everything up (but still left a pair of gloves! ARGGGHH!) and left about midnight. Thankfully I had pumped a gallon of water right after forcing down a small dinner, anticipating that I might have to leave in the morning.

The hike back to the road was very very slow. My stride was probably 1/3rd of my normal hiking stride, and I was needing to stop every 100 feet or so to take minute or two breaks to catch my breath. I eventually got back to the trailhead and waited a couple of hours for sunrise in the bathroom (didn't want to dig out my sleeping bag when there was another alternative to stay warm), then hitched a ridge to TM. The 900 feet or so difference between the Tioga Pass area at the trailhead and Mono Pass seemed to make a pretty good difference in my breathing, and the difference was night and day by the time I was at 8600 feet at TM. My appetite had finally returned so I had breakfast, but figured it best to take the YARTS down to the valley that morning and head back to Texas.

A few questions: has anyone had similar experiences? E.g., I wonder if the clogged sinuses (and thus, much lower level of oxygen being delivered to my body because of them) contributed to the HAPE symptoms, or if that is something strictly related to the air pressure? Or is it even known? I realize that minor infection that I thought I completely kicked probably strongly predisposed me to getting it also. I have never had so much as a headache camping at 9000ft+ nor dayhiking up to 11,000, but I got hit pretty hard this time (first time camping at 10,700 feet). Funniest thing was the best I felt on the entire trip was at 12,000 when going up Gibbs.



Edited 2 time(s). Last edit at 08/17/2012 12:01PM by mbear.

I guess I'm wondering if this is something I'm likely to be stuck with at this kind of elevation in the future, or if that two strikes I had against me (sick earlier in the month, bad allergic reaction camping in an area with high winds) contributed strongly to it happening. I know I'm asking way too much here, but I'd like to hear if anyone else has dealt with this. I was talking with a guy who has done climbing in the Himalayas who said he'd get HAPE and HACE on occasion, but that it wasn't just something that happened when he went to X height. For anyone who has experienced it, is this your situation also, or does it usually happen once you hit a certain altitude for a certain number of days? Thanks.



Edited 2 time(s). Last edit at 08/17/2012 12:01PM by mbear.

Didn't get a lot of good pics, but here are a few I liked


Mount Lewis. This looked incredible at sunset, but my camera isn't so good in low-light conditions so you gotta look at the midday pic instead!


Is this part of Kuna Crest?


Kuna Peak


Rodgers, Lyell, and Maclure with Helen Lake and Spillway Lake in the foreground


Looking down Bloody Canyon at Upper Sardine and Mono Lakes



Edited 1 time(s). Last edit at 08/17/2012 12:08PM by mbear.

At least you got to see a few good views up there. Pretty cool view from part way up Gibbs. I was around there on 8/2. Wildflowers were great near the trail head and between Spillway Lake and Parker Pass. Here is a video near Parker Pass.

Thank you for posting this. My dad and I are climbing Mt. Whitney in two weeks and this reminds us to pay close attention to how we are feeling before we even start the hike.

Hi Bear,

I am surely glad that you're feeling better! You are a wise man to follow your instincts and return to lower elevations when you did. I hopes this serves as a lesson to others.

I have had issues with acclimatization my whole adult life. Mostly my issues are the same as most. When I was younger I would drive from sea level in the Bay Area and start hiking by 10am. By 2:30 or so I would be at 9 or 10,000 ft or so and felling miserable with headaches and nausea.. I could always fight through it. Until one time...

Much like you, I had been sick a few weeks prior and was still recovering, but felt great. We drove through the night, didn't sleep much, got delayed by a road closure on Tioga Pass, and arrived at the Whitney Portal at 8am. We had planned to relax and sleep a bit before heading up to the mid-camp above the treeline. Needless to say, I was much slower than usual but didn't think much of it at first. And then the symptoms hit me hard around 10,500 ft. Dizziness, shortness of breath, nausea, and a brutal cough. My partners recognized my situation and forced me to return to a lower elevation while they continued on (assholes...lol). Once I had dropped 2,000 feet or so, the difference was obvious and I recovered quickly and was able to sleep and eat. I drove down from the portal, slept in my van, and picked them up the next afternoon. I do not care to EVER repeat that experience!

The good news is...This was a one time event for me, and for you too, I think (I'm no Dr.). Although you exercised much more care in acclimatizing than I did, I'll bet our preexisting condition was the root of our issues. You never know when a simple ailment is going to become a big concern at elevation. I certainly wasn't going to miss Whitney because of a cold two weeks ago! All we can do is be aware of our bodies and make good decisions.

Age is also a factor, for me at least. It has been tougher to acclimatize now that I'm older, but i do it with much greater care these days and I have never had a repeat. Knock on wood!

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"It is all very beautiful and magical here - a quality which cannot be described. You have to live it and breath it., let the sun bake it into you" - Ansel Adams



Edited 1 time(s). Last edit at 08/17/2012 02:14PM by Jayabrams.

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Jayabrams
My partners recognized my situation and forced me to return to a lower elevation while they continued on (assholes...lol).

Nobody went down with you?

Nope...bastards left me to die...jk...

They were very concerned but I was kindly accepted by a group heading down to the trailhead, so I encouraged my friends to continue. They kept me moving and kept an eye on me. Really nice people.

I've returned the favor many times over since....

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"It is all very beautiful and magical here - a quality which cannot be described. You have to live it and breath it., let the sun bake it into you" - Ansel Adams

mbear,

I'm convinced everybody is different in respect to altitude effects. No doubt your sinus problems contributed greatly to this recent experience. I would not allow it to discourage you for future ventures to altitude; just make sure you're not suffering sinus problems before you go. I began Yosemite high altitude backpacking in 2009, using Lee Vining as my base camp between hikes. In 2009 I did a day hike first to Sunrise Lakes at 9,450' for acclimation purposes. In 2011 I did a day hike to the crest above Upper Granite Lake at 11,200' for acclimation. In both cases subsequent overnight hiking yielded no problems regardless what altitude I slept at. In 2010 I shortchanged myself on time and ommitted the initial day hike, attacking the pass at Echo Peaks immediately at 10,800'. That one yielded a monstrous headache that forced me off the ridges (had to skip the saddle on Matthes Crest) and I got down to below Echo Lake for the night as soon as possible. The lower altitude solved the problem immediately. Later on that trip I spent a night at Bernice Lake at 10,217' with no ill effects.

Essentially, the only backpacking I do now is in Yosemite once a year. I live near the east coast at 500' altitude. By 2011 it seemed that altitude no longer had any effect on me whatsoever, regardless where I camped, despite only exposing myself to such altitudes but once a year. Like I said, everybody is different. An alternative which I've never cared to look into is to spend a night at the TM campgrounds the day before doing overnights on the trails. This gives you an entire night's acclimation at 8,600'. In any event, no two people are alike and any one person's experience may vary substantially from one trip to the next. Unfortunately, finances and other considerations have forced me to forego Yosemite this year but I'll be back next August. Who knows what this one-year layoff will cause in the way of altitude sensitivity? Time will tell.

Jim

mbear,

Another thing you mentioned was swelling hands. Have you ever experienced that before while backpacking or day hiking? I used to have that happen all the time simply due to my hands swinging back and forth for a long period of time. As soon as I got into the use of trekking poles the problem went away because the hangs were now closer to heart level.

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tomdisco
mbear,

Another thing you mentioned was swelling hands. Have you ever experienced that before while backpacking or day hiking? I used to have that happen all the time simply due to my hands swinging back and forth for a long period of time. As soon as I got into the use of trekking poles the problem went away because the hangs were now closer to heart level.

The swelling hands were a first. I had asked the question on backpacker.com's forum and it seemed to be pretty harmless (wish I had known that while doing that hike, haha). Funny thing was I was using my hands a bit for balance since the face was somewhat steep and since a lot of the steps I would have to test before placing my foot down (pretty loose lock on the south shoulder of Gibbs where it happened). I guess that could qualify as having them swinging.

Your one year lay off will probably have not bearing on your altitude sensitivity unless you develope some sort of health issue during that time that effects your circulatory or pulmonary system. Also any acclimation that people get when being at high altitude for a bit will be gone in a few weeks as the body reasorbs the extra red blood cells and capilaries that the body forms after spending time at a high altitude so it does not matter if you return in a month or several years if your general health is the same.

We have been going to high altitude alot this year and if it is more than two weeks between trips, I will still need one day or so to get used to it. My son, on the other hand, seems to have very little issues of altitude changes and I have seen him go from 3000 ft to 12,000 in one day and he still can run around like he is at sea level.

For everyone who reads this...altitude sickness can occur in anyone at any time, whether it is your first or 100th visit to the high country. Acclimation or not.

Take care to recognize the symptoms. Stay hydrated. (And sometimes an orange or a piece or candy can immediately help with low blood sugar...)

Been there, done that.

4 summers ago on a Tuolumne Meadows - Reds Meadow trip very first night on trail. Camped at footbridge below Donohue pass (like 9800 ft) and woke up w/ rattle in chest and coughing reddish gunk. It was still to dark to head down but did so at first light and hiked back to Tioga Road. X-rays a few days later confirmed HAPE.

Very strange because I purposefully came to Yosemite a few days ahead to acclimatize and had day-hiked North Dome, Half Dome and Cathedral Lakes before hitting the trail. Looking back at it, I was feeling unusually lethargic on the Cathedral Lakes hike, so maybe it started then.

I should also note that I had hiked at/above 10K feet in years past without problems. From what I've researched since then, it can strike randomly and if you've had it once, you're considered at higher risk for getting it again. So, the pulmonary Dr. I saw told me to stay below 9,000 ft., which wasn't a very satisfactory response. I take Diamox now (which speeds rate of acclimatization) and have not had any repeat symptoms in past 3 years (and just completed the JMT this summer).

In addition to Diamox, my own personal prescription is to drink plenty of water, "climb high sleep low" and stay active for awhile if I'm sleeping at a higher elevation than previously (i.e., don't just crash in tent).

I'm very fortunate that I have never needed Diamox - I am allergic to sulfa based drugs.

The NOLS Wilderness Medicine book on high elevation issues is quite illuminating - acclimation actually takes 10 days, and will go away when you leave for lower elevation. The problem has to do with how your body responds in general - staying hydrated helps. Mountaineering: The Freedom of the Hills will instruct you to counter the increased difficulty of digesting proteins by packing more carbs and things that are easier to eat will counter the decreased appetite.

I only know that a cup-a-soup that tastes not so great at home goes down really, really well at 12,000 feet. I have one before dinner every night when out.

cjoz, what kind of dosage do you take? 125 mg twice a day? I have heard the side effects start really kicking in when people take 250mg all at once. I'm definitely not ready to give up high altitude hiking after one bad trip, though next time I'll be cautious and stay maybe 3 nights at TM at 8600 feet and maybe a week in the backcountry sleeping 9500 feet and below before getting into the 10000+ range in addition to getting a prescription for acetazolamide. Glad to hear you're able to conquer 14ers after getting HAPE at such a low altitude.



Edited 1 time(s). Last edit at 08/22/2012 10:23PM by mbear.

mbear,

We just return from our HS loop (TM to Sunrise to Merced to Vogelsang to TM). My 23 YO son has known AMS at about 7800 feet. He was perscribed Diamox, began with 1 pill a day 3 days in advance of the trip and 2 pills per day on the trip. He did great with no symptoms whatsoever. He had no side effects.

Hand swelling is not uncommon when walking or hiking. Here in the south it happens when walking in hot humid conditions. We call it fat fingers cause you notice it when your rings get tight. It clears quickly when resting or in coll conditions.

Be smart, know your body, and listen to it.

Randy

Randy,
Everyone (ok, at least me) are wondering how the Late Arrival went.
O... and I hope you enjoy your newly installed solar panels. Did the work myself.

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BigR
He had no side effects.

The only side effect I've noticed with Diamox is carbonated beverages taste weird.