Interesting article on HAPE risk factor

[mountaineer]

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.

[BSquared]

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!

[Snow Nymph]

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.

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.

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.

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.

[mountaineer]

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.

[Skibum]

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.

[Baffman]

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?

[Rosabella]

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!

[mountaineer]

Hey Mountaineer,

Didn't I see you at Woodstock?

No, why do you ask?

[gdurkee]

Duuuuude:

By the time we got to woodstock We were half a million strong And everywhere there was song and celebration And I dreamed I saw the bombers Riding shotgun in the sky And they were turning into butterflies Above our nation We are stardust Billion year old carbon We are golden Caught in the devils bargain And we've got to get ourselves Back to the garden.

Butterflies though, no white rabbits. That's a different song.

Great Gamow-bag-in-action photos. That's rangers Erika and Rob and your tax dollars at work. Do you have any others from that night? I don't think we have any of an actual SAR using one (rangers too busy pumping...).

As far as age as a risk factor, I haven't seen anything lately. I used to read that young males were more susceptible, but I think that was skewed because more young males hiked. The only risk factor I'm aware of now is a previous occurrence of HAPE.... . Not too useful sometimes.

The youngest I've seen is 15 or so and the oldest in his 60s. Few women, but that might be the demographics of backcountry users. The person in the Gamow photos is a woman. I can think of two other women, one of whom died (age 20 or so).

Several of you have mentioned being adequately hydrated. That affects AMS, but I don't think it's a factor in HAPE or HACE -- though I don't understand it well enough to say for sure.

And, if you want to be totally paranoid, you can get in deep weeds from drinking too much water. The symptoms are very similar to HACE -- altered mental status, vomiting, eventually convulsions and death. Comes from drinking too much water and no food or electrolytes: hyponatremia

http://en.wikipedia.org/wiki/Hyponatremia

Extremely rare, but I've seen two cases in the last 5 years. Both almost died and I thought one was HACE.

A good book to have to familiarize yourselves with this stuff is Wilkerson's "Medicine For Mountaineering."

Happy and healthy trails!!

g.

[Rosabella]

George - sorry, these were the only pictures I took. You're right, the female Ranger was Erika, but the male Ranger was Paul Larson, he was located at the Tyndall Creek Station. I just remember he had beautiful long hair . (...and no, I'd not been to Woodstock either, I could have/should have... I just graduated that year 1969... what a year!!!)

ANYWAY... That trip we spend the night on top of Mt. Whitney, and on the way down we ran into Paul and Erika - they were doing a day hike together. They said that the woman was evacuated safely and was doing fine.