Interesting article on HAPE risk factor

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Baffman
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Post by Baffman » Sun Apr 29, 2007 12:11 am

This conversation is amazing to me. Two years ago I went up to Whitney on a dayhike with some friends. This was my second trip. I went more as a favor than actually wanting to tackle the crowds again. Shortly below trailcrest, at about 13,000 ft, I suddenly felt extremely tired. I told the others to go ahead and I'd meet them at trailcrest. We all met up, took a break and continued on. I made it to the top again. The first time, I marched up and it was no big deal. This last time, it took all I had. I'd go maybe 100 feet and have to either sit or at least put my head to my knees for a time. I was so exhausted I couldn't hardly believe it. I needed to throw up, but it wouldn't come. The others didn't wait for me. Great. I almost turned back and probably should have. Anyway, on the way down, at about the same elevation where I aged 100 years, I came back to life. I was honestly a bit scared for myself on this trip. Until reading this post, I didn't realize how stupid I was by going to the top. I've spent a lot of time in the Sierras and intend to do the same until the day I die. I know I'll never put myself in that situation again. I work some really oddball hours and in order to get to sleep, I had 3, maybe 4 beers before bed at Whitney Portal. It sounds like maybe this was a factor.

Hey George, I'm really happy to have met you last fall. I felt sort of like I was intruding by stopping by, but you and your wife were so nice and obviously used to visitors. Please excuse me. Hopefully I can bug you again!








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HACE

Post by gdurkee » Sun Apr 29, 2007 1:12 pm

Hmmm. Even more interesting.

I'm not as familiar with HACE. Only seen a few cases in the last 5 years. But, as I think it over, they were rapid onset < 1 day. One guy started feeling symptoms on a day hike to Whitney but kept going. This turned out to be the 2nd time it had happened. By the time he got to the top, he was having hallucinations his wife was having a garage sale up there. I got called on a sketchy cell phone call for assistance. When I got to Trailcrest, there was a bad lightning storm. A guy coming down said he'd talked to the guy and he seemed fine (he was able to carry on short and fairly normal conversation). I bailed and started up again the next morning to be sure. I found him on the trail. He'd spent the night out with no gear and stumbled down one of the gullies on the west side. Was heading back up to his wife's garage sale. Very difficult to talk him down to a place I could fly him out from. Finally had dispatch call his wife who told him to come down with me. He seemed to listen to that... . He was absolutely fine when the helicopter got down to Lone Pine. An hour of oxygen on the scene didn't seem to do him any good at all.

So anyway, thanks for those stories. We don't hear about the people who get out on their own. This may be much more common that I thought.

Baffman: great to have met you last year. I'm slowly running into some of you guys. Just met Strider the other day.


g.

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Post by mountaineer » Sun Apr 29, 2007 3:30 pm

By the way, a scientist at Barcroft saw me stumbling down the trail. He came out and gave me a ride the last two miles down to my truck where my brother was waiting for me. He drove down that road like crazy and every 1000' drop I started feeling better and by the time we were back in Big Pine I was feeling fine.

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Post by BSquared » Sun Apr 29, 2007 7:03 pm

Hey, let's hear it for the scientists ;)

Gee, I've been feeling sorry for myself because I get AMS like clockwork: anything over about 10,500 without acclimation, and I can expect to wake up around 2:00 AM with a splitting headache and dry heaves. Codeine works wonders (but brother, the dreams!), as does a day or two at intermediate altitude (Tuolumne Meadows traditionally). But this is obviously small potatoes to what you guys are talking about. I had no idea this stuff was so dangerous; I'll be keeping my eye out -- on both myself and my companions -- in the future!

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Re: HAPE / HACE

Post by Snow Nymph » Sun Apr 29, 2007 11:18 pm

gdurkee wrote:Whoa!! These are all classic.


Night 2: they're having trouble sleeping. They may (?!?!) find it more comfortable to sleep sitting or propped up. Very bad sign. Fluid is significantly accumulating in the lungs. But don't depend on this as a sign.

The big sign is day 3. The person is very slow. They walk maybe 200 feet, stop, bend over and breathe; another 200 feet (or less). Stop and breathe. They are hurting. All of you are in trouble at this point. .
Yes, he couldn't breathe laying down, and sat up a lot. At the time this was new to me. If it happens again, I'll know it by day 2, its the way his head hangs down, how he moves, etc. On the 3rd morning, tieing his shoe or coming his hair was a big ordeal. He was totally helpless. One foot in front of the other was hard for him to do. He had to be talked to constantly.

gdurkee wrote: If at any point someone is slow to respond to answering questions, making decisions, hallucinating, stumbling -- ANY mental impairment, YOU NEED TO DESCEND IMMEDIATELY! Whatever time it is, you need to get down about 2,000 feet if possible. Even 1,000 feet is helpful. Someone's also got to go for help; whatever time it is. It's a difficult decision to make, but if you can't move the person down, you may have to leave them alone to get help. There's nothing else you can do for them if you can't get them down. Oxygen will help, but the only thing that will cure them is low altitude.
I got him to Rock Creek, then ran to the ranger station. I had to run to keep up with the ranger on the way back to Rock Creek, he moved FAST. SnowDude drinks a lot so he wasn't dehydrated. The morning we descended to Rock Creek, he drank 100 oz just that morning. On the trip where he was helo'd out, he said he had to pee, but when he crawled out of his tent, he couldn't. He crawled a lot the night before someone got help.

gdurkee wrote:By the time you can hear fluid in the lungs (and in the 70+ cases I've seen, I've only heard rales with a stethoscope maybe 5 times) they could be less than a day from dying. When they're actually gurgling, you don't have much time. Hours, maybe.

"Rales" (and there's some disagreement about the term) describes the crackling you hear, like hair being rubbed together when you listen to the lungs closely. On the off-chance you have a stethoscope, try the right upper lung close to the armpit. But don't get hung up on this as a symptom.
The first two times (3rd morning), he breathed out so I could hear the gurgling. The last time (3rd morning again) it woke me up. It was dead quiet in the morning, and I'm a light sleeper. The gurgling woke me up! We didn't need a stethescope to hear it.



gdurkee wrote:The main symptoms of HACE are a severe headache, unrelieved by aspirin etc., sleepiness/groggyness or altered mental state (hallucinations, slow to answer, can't make decisions etc.). This is obviously another medical emergency. Only descent will help them and you've got to do it while they're competent enough to walk.
The first time (I didn't know him then) he said his symptoms were more like HACE. He couldn't pee, sleep, eat, or talk. He was out of it. Symptoms started on the 3rd day. He was helo'd out from Guitar Lake on the 5th day.

Hopefully, with all the precautions we won't see it again.
Expose yourself to your deepest fear; after that, fear has no power, and the fear of freedom shrinks and vanishes. You are free . . . . Jim Morrison


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Post by mountaineer » Mon Apr 30, 2007 10:29 am

My mistake was that when it hit me at 13k I said to myself I could make it to the summit...it was sooooooo close. I literally crawled the last 100' or so. I wrote a short story with all the details but a computer crash ate it. Maybe I will do so again. Some of the halluciantions were really strange. I walked up to a naked guy sunbathing(60mph winds and 20-30F) and kicked him telling him he was going to freeze to death, he didn't move so I thought he was already dead when it finally dawned on me it was a white rock. Little white rabbits were darting all about and I couldn't figure out what they were doing up there...when I got closer to them, they stood still, as if paralyzed by my presence. Once again, I realized later that they were little rocks.

About 6 mos later on the east face of Shasta...I climbed up the glacier for 8 hrs to reach 13k...feeling great the whole time. Suddenly, I became very tired...not sick yet, but tired. It took me 30 seconds to decide to go down, based on my experience on White Mtn. I butt-glissaded down the glacier about 3,000' vertical feet in 30 minutes. 30 minutes to descend what it took 8 hrs to ascend! I only had to self arrest twice when I got going too fast towards a couple of rock bands.

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Post by Skibum » Mon Apr 30, 2007 1:44 pm

Hey Mountaineer,

Didn't I see you at Woodstock? ;)

This has been a great thread. I have yet to experience any form of altitude sickness with the exception of skiing on Mauna Kea on the Big Island. Worst headache I've EVER had.

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Post by Baffman » Tue May 01, 2007 9:53 pm

Forgive me if I missed it, but how does age come into play with altitude sickness? Who's more prone to it, older or younger?

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Post by Rosabella » Wed May 02, 2007 6:27 am

About five years ago we had just set up camp at Wallace Creek and a young couple came into camp... the woman was in pretty bad shape. He partner went to get the Ranger at Tyndall Creek while we stayed with her, but by the time the Ranger got back and determined that she was suffering from HAPE it was too late to evacuate her out.

The first Ranger contacted the Ranger at Crabtree Meadow to bring the "Gamow Bag" to get her thru the night. She was evacuated out in the morning. My sister and I stayed up all night keeping a fire going and making tea for the two Rangers. It was fascinating.... and the Two Rangers were amazing! They worked all night pumping this bag, they were so patient with the woman, and so appreciative of the smallest things like a cup of tea. I've never ran into a Park Ranger who hasn't been totally helpful and courteous, but these two were pretty darn amazing!

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Post by mountaineer » Wed May 02, 2007 3:30 pm

Skibum wrote:Hey Mountaineer,

Didn't I see you at Woodstock? ;)
No, why do you ask?

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