High Sierra Topix

I'm on my 5th couch-bound day after picking up a nasty bug, presumably on the sierras trip I just returned from, that my ER doctor described as 'causing my innards to exfoliate'. I'm not shy so I'll provide more details if people want them, but we'll suffice it to say that I've visited the restroom more times per day than I ever thought possible and dispensed of more liquid than I thought my body could contain. Joyously, I have had no other concerning symptoms (no fever, cramping, blood, etc.), however that also means that I have to wait for 7 days of symptoms to occur before they will consider prescribing anti-microbials. Apparently research shows them not to significantly increase recovery time for infections that don't have any of the above concerning symptoms.

Now, my scientific career often dips into the realm of environmental microbiology, so I know what critters are out there and I know what they can do. But, when my trusty ~8 year old Steripen Adventurer broke my first day on the trail, I made a conscious decision to push on and drink untreated water, because I also knew I could fill up at pretty pristine and infrequently visited high alpine sources, where the bacterial load is low.

Anyway, for whatever reason, it came around to bite me this time. So I'm curious- anyone else gotten a recent case of the Sierra's Revenge?

Here's an interesting article on the topic that describes the relatively pristine quality (at least at that time) of high Sierra water and the greater likelihood of getting sick from poor personal hygiene. I swear I washed my hands.
http://www.latimes.com/travel/la-os-gia ... story.html

I led Sierra Club backpack trips for 20 years, so I always took the lead in setting up a water treatment system of some sort (iodine, filter, or boiling). As a result, nobody ever got sick from the treated water. OTOH, some people went swimming with their head underwater and came up spitting out lake water. Among those, there were a couple of cases of giardiasis. I was informed that they were diagnosed and treated and responded normally to the medication.

I did a trek in Nepal, and it was theorized that a cook boy rinsed out some cook pots with raw water, so half of the trek members came down with giardiasis over some days. Flagyl was in short supply after a while.

What is difficult is sorting out the effects of parasites, bacteria, or viruses.

bobby49 wrote:I led Sierra Club backpack trips for 20 years, so I always took the lead in setting up a water treatment system of some sort (iodine, filter, or boiling). As a result, nobody ever got sick from the treated water. OTOH, some people went swimming with their head underwater and came up spitting out lake water. Among those, there were a couple of cases of giardiasis. I was informed that they were diagnosed and treated and responded normally to the medication.

I did a trek in Nepal, and it was theorized that a cook boy rinsed out some cook pots with raw water, so half of the trek members came down with giardiasis over some days. Flagyl was in short supply after a while.

What is difficult is sorting out the effects of parasites, bacteria, or viruses.

Interesting! I had a similar experience on a scientific trip to Africa. We were all fine... until we weren't... Not full blown giardiasis, thankfully, but still unpleasant!

When volunteering for SAR I got curious and started asking people, both other SAR and hiking group members, about confirmed cases of giardia. By the time I stopped asking I had racked up more than 35 doctor/lab confirmed cases attributable to the high country.

Since people can easily be carriers and never show symptoms, I tend not to take "I've been drinking untreated water all my life and never been sick" as an indicator of the safety of the water at any elevation. There is so much human usage of waterways that I just don't trust it.

Twice: Once from a low elevation stream through cow territory in Sequoia (I didn't realize the filter was missing from my water bottle) and once from a puddle full of bugs and goop (Descending from a rock climb in the middle of the night that wasn't supposed to take that long, at about 6000 ft).

They were both "diagnosed" as giardiasis without running the lab because the lab costs more than the medication, but the meds worked so maybe that's what it was. The only way to test for giardia is a stool sample so next time someone tells you they had it ask them if they gave the stool sample.

In grad school studying aquatic ecology I thought about doing a study on giardia in the Sierra, so I did a literature review and haven't filtered water since. If I'm above 7,000 ft and the water is moving I drink it. If it's still water I dip down past 1ft and drink it. The cysts float and cannot survive being frozen so at that elevation you'd need a LOT of poop in the water to get the concentration high enough to give you symptoms (9 cysts gives you a 25% chance of developing symptoms, 9/liter is a lot more than you'll find in the High Sierra). As many people have probably heard, and I also read, the likely culprit for sickness in the Sierra is poor hygiene. There are things in your colon that a good, but if they get into your stomach they are bad.

As a side note, you no longer need flagyl to fix it (that stuff is worse than giardia), there's a newer med that's single dose and has no side effects. I forgot what it's called but I tried it and now I don't even care if I get the bug again.

Long story short, I choose my sources thoughtfully but never filter above 7k. I'm more afraid of getting a staff infection or strep throat on an extended backpacking trip again.

*disclaimer: this is how I made my decision not to filter, if you try the sweet pleasure of drinking straight from a stream and die it's not my fault!

Some of the folks who are in water rescue have been hospitalized with it, treated multiple times. Our SAR team fairly routinely does water rescue above 7k... you don't get a chance to filter water when it's running into every orifice, and there's really no chance of blaming kitchen practices in cases where you drive up and jump in the water, then go to the pub in Shaver for dinner.

In one case, a career dog handler contracted it and has had symptoms on and off for years, treated many times with different antibiotics, and still has issues with it.

Sorry, don't buy that giardia is not worth avoiding.

limpingcrab wrote:Twice: Once from a low elevation stream through cow territory in Sequoia (I didn't realize the filter was missing from my water bottle) and once from a puddle full of bugs and goop (Descending from a rock climb in the middle of the night that wasn't supposed to take that long, at about 6000 ft).

They were both "diagnosed" as giardiasis without running the lab because the lab costs more than the medication, but the meds worked so maybe that's what it was. The only way to test for giardia is a stool sample so next time someone tells you they had it ask them if they gave the stool sample.

In grad school studying aquatic ecology I thought about doing a study on giardia in the Sierra, so I did a literature review and haven't filtered water since. If I'm above 7,000 ft and the water is moving I drink it. If it's still water I dip down past 1ft and drink it. The cysts float and cannot survive being frozen so at that elevation you'd need a LOT of poop in the water to get the concentration high enough to give you symptoms (9 cysts gives you a 25% chance of developing symptoms, 9/liter is a lot more than you'll find in the High Sierra). As many people have probably heard, and I also read, the likely culprit for sickness in the Sierra is poor hygiene. There are things in your colon that a good, but if they get into your stomach they are bad.

As a side note, you no longer need flagyl to fix it (that stuff is worse than giardia), there's a newer med that's single dose and has no side effects. I forgot what it's called but I tried it and now I don't even care if I get the bug again.

Long story short, I choose my sources thoughtfully but never filter above 7k. I'm more afraid of getting a staff infection or strep throat on an extended backpacking trip again.

*disclaimer: this is how I made my decision not to filter, if you try the sweet pleasure of drinking straight from a stream and die it's not my fault!

Probably important to note that giardia is not the only offender of concern. Cryptosporidium (and others) are just as common in alpine environments, sometimes more common.

AlmostThere wrote:Some of the folks who are in water rescue have been hospitalized with it, treated multiple times. Our SAR team fairly routinely does water rescue above 7k... you don't get a chance to filter water when it's running into every orifice, and there's really no chance of blaming kitchen practices in cases where you drive up and jump in the water, then go to the pub in Shaver for dinner.

In one case, a career dog handler contracted it and has had symptoms on and off for years, treated many times with different antibiotics, and still has issues with it.

Sorry, don't buy that giardia is not worth avoiding.

I will certainly be treating water at all costs after this experience! Even if it's another critter causing the issues.

20 consecutive years no filtering (except thru bandanna). No issues, but I'm very picky about my sources.

In one case, a career dog handler contracted it and has had symptoms on and off for years, treated many times with different antibiotics, and still has issues with it.

If the dog handler had symptoms for years it would most likely be Cryptosporidium, Giardiasis almost always goes away on it's own unless he had some sort of immune disorder.

Some of the folks who are in water rescue have been hospitalized with it, treated multiple times. Our SAR team fairly routinely does water rescue above 7k

I'll admit I've only been on one SAR in the high Sierra but everyone in my group said they never filtered water (seasonal trail crew and backcountry rangers) so we have different experiences to draw from, hence the difference in opinion.

Probably important to note that giardia is not the only offender of concern. Cryptosporidium (and others) are just as common in alpine environments, sometimes more common.

Very good point, there could be Campylobacter, Cryptosporidium, Salmonella, Shigella, Yersinia, Aeromonas, Clostridium, and Escherichia coli, and I should point out the last one is by far the most common culprit.

I'll finish with a quote from one meta-analysis that is freely available online, and while not a published source, it cites all of its claims:

Recall that San Francisco water can contain a concentration of 0.12 cysts per liter [24], a figure now seen to be higher than that measured anywhere in the Sierra. San Francisco city officials go to great lengths to assure their citizens that the water is safe to drink, and if true—as it most assuredly must be—this comparison alone is quite revealing.
Even Los Angeles Aqueduct water, with only 0.03 cysts per liter [25], has a higher concentration of Giardia than all but two of the 69 Sierra sites examined.