Dealing with / avoiding altitude sickness (Utah)

Hey guys,

I'm a northeast hiker (NY, NJ, NH, etc.) but I'm flying into northern Utah for a 2 day hiking excursion in mid Sept. I'm slightly concerned about how my body will handle hiking at these elevations. I've been over 5k in the Whites and ADK's but I'll be hiking to the summit of Mount Timpanogos (a little under 12k ft) on my first day and Lake Blanche/Sundial Peak my second day (a little over 10k). This will be my first time hiking at these elevations and I won't have much time to acclimate (I arrive in Salt Lake City on Friday at 4:20 pm and the avg. elevation in SLC is under 4,500 ft) and I hit the Mount Timp trailhead first thing Sat morning. Is there anything I can do to prepare other than listen closely to my body and continually rest at the first sign of feeling "off". I've heard there is an over-the-counter drug called Accli-Mate that helps with AMS, does anyone have any experience with it? Or know whether it actually helps? Any other pointers to avoid AMS?

Thanks

Personally, I wouldn't take altitude drugs (like Diamox) until I know I need them. That might not work for a 2 day trip when you have no experience at altitude so think of this trip as a test run. If you don't react well this trip you'll know whether you want to try them next time.

Stay hydrated, no alcohol or caffeine, try to get as much sleep as you can. You'll probably have a bit of a headache the first day, so you may get relief by taking aspirin/ibuprofen, but hydrate. After that, listen to your body. Don't be afraid to turn around if you're feeling miserable. The mountains will be there next time.

Take it slow, drink a lot of fluids, use sunscreen. Most people can go briefly from sea level to 12K feet without major issues, but for anything above 10,000 feet the other piece of advice is not to go alone. A partner can help check on your condition and can help get you down in a hurry if needed.

Accli-Mate is one of those "energy drinks" that has never been tested in any meaningful way. It wouldn't be too hard to run a study, but somehow the folks selling this kind of stuff never seem interested.

10 and 12K are not very high for hiking (as opposed to sleeping). In 2002, when I was a 65 year old kid, I left Boston on a Saturday, slept in Silverthorne, CO at about 9K, and next day (Sunday) hiked Ptarmigan Mountain (12,498 feet). I took Monday off, and on Tuesday I hiked Quandry Peak (14,272 feet).

Sure, I huffed and I puffed, but I got the job done

[Added]Important note: Your mileage will (not may ) vary. Adaptation to altitude is a very individual process, largely unrelated to fitness or general health.[/Added]

This is a very ambitious (and potentially dangerous) program and many people would be unable to complete it. That said, some people have more tolerance of altitude than others (it is highly variable) and might be able to do it. Your chances would be much improved if you took some time to acclimatize beforehand.

Reversing the order of the peaks might also improve your chances--hiking the 10K peak before the 12K peak might improve your acclimatization for the higher peak.

Pressure breathing and intentional hyperventilation may help. (However, since both are conscious actions they cannot be done while sleeping.)

You do not mention your sleeping altitudes: sleeping somewhere around 7K or 8K ft the first night might be helpful and similar to ~1K ft higher might be good for the second night. (Don't sleep too much higher--AMS often appears during the night when breathing is normally depressed.)

There is some delay in the development of AMS--thus one can often start from a safe altitude, go well above the safe altitude for 6-12 hrs, and get down quickly to the safe altitude without consequences. However, if one stays at the unsafe altitude one can develop AMS...

Do not hesitate to retreat if you have problems--there are 3 treatments for AMS: 1) get down, 2) get down, and 3) get down. Delays (such as waiting for morning) can be fatal.

There is more info in "Medicine for Mountaineering" and "Freedom of the Hills".

Doug

You don't know until you know so to speak. Everyone has a different reaction to altitude and a different rate of acclimation.

Personally, I have been taking Diamox/Acetazolamide above 12K since 2007 and find that it not only helps improve my rate of acclimation but helps me feel stronger once above that level. The key is finding the right mix for yourself, which takes a little trial and error. Too much has a dehydrating effect since it WILL make you pee a lot and can lead to sluggishness for a different reason. Another side effect is that it causes tingling in the hands and feet which is very annoying for some.

Diamox is proven and widely accepted as an aid for acclimation but opinions vary on when and how it should be used. The basic principle is that it flushes bicarbonates from your system which in turns speeds up breathing and helps your body process the thinner air more efficiently. That is my layperson's summary. Good stuff. I don't leave home without it. Doctor-prescribed only.

Thanks guys. Sounds like I should stay away from the Accli-Mate and that my best strategy will be to use good judgement. To answer some of your questions Doug. I'll be sleeping in Provo Utah on both Fri and Sat nights which is at an elevation of around 4,500 ft in the northern Utah valley. I thought about reversing the hikes but there are logistical and hiker-related reasons I've ordered them this way. From a hiking standpoint, my first day will be more of a wild card day where I'll have less of an idea how my body will react. Since I'll be hiking alone, by doing Mt Timp first, I'll be on the more popular (more crowded) trail on the busier day (Sat) my first day. Other reasons for this order: hitting the harder summit first when my legs are fresh, leaving the hike with a shorter bailout option for the 2nd day, and lastly, driving logistics back to the airport Sun night. Just out of curiosity Doug, as long as I use good judgement and come prepared with basics like hydration, sunscreen, etc, why do you use the word "dangerous"? I'm all about caution, but didn't really see this as a dangerous endeavor as long as good judgement and common sense is employed.

Mohamed, I see you are from Thornton NH. I'll be staying at a cottage at the Shamrock Motel in Thornton next month while my wife and I hike the Whites!!!

And thanks for the advice David, I definitely am thinking of this as trial run. It's only a glorified weekend trip. If I handle the elevation just fine I'll feel much more comfortable to begin planning one of the longer, more serious hikes I have my sights set on (Wonderland and the JMT).

Edit: Thanks Puma. I think need to find out my reaction without Diamox before I can begin to consider using it. I need to know my body's baseline reaction so to speak.

VeganHiker said:

Just out of curiosity Doug, as long as I use good judgement and come prepared with basics like hydration, sunscreen, etc, why do you use the word "dangerous"? I'm all about caution, but didn't really see this as a dangerous endeavor as long as good judgement and common sense is employed.

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Read up on Acute Mountain Sickness. HAPE and HACE are non-trivial and can occur in people as low as 8,000 feet. Especially if you've never gone to altitude before it pays to be aware and cautions. Know the warning signs. It's helpful to have a hiking partner because one of problems is that you lose the ability to observe the symptoms in yourself. I don't think it's likely that you'll have a severe case of AMS but it would be foolish to ignore the possibility.

Even skiing out west you can feel the altitude at 10k'-12k', but I suspect skiing is a lot easier since you keep going up and down fairly quickly (and going down is generally the cure for acute altitude sickness).

I am headed to Colorado on Tuesday and here is how I get myself quickly acclimated for 14k: I drink lots of water on the plane, around 80 ounces. I do a quick hike the same day I get into town that will take me close to 10k feet. I am usually winded so I hike at a slower pace. The next day I do an early morning hike that tops me out at 12-13k feet. I am usually winded again but I hike at my normal pace. I take the next day off and do some little hikes with the family. That works great for me and I have never felt the affects of altitude. I also think it affects people differently as well so like others have said you never know until you get there.

David Metsky said:

Read up on Acute Mountain Sickness. HAPE and HACE are non-trivial and can occur in people as low as 8,000 feet. Especially if you've never gone to altitude before it pays to be aware and cautions. Know the warning signs. It's helpful to have a hiking partner because one of problems is that you lose the ability to observe the symptoms in yourself. I don't think it's likely that you'll have a severe case of AMS but it would be foolish to ignore the possibility.

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Thanks for that resource David. Very informative. HAPE and HACE sound downright scary. Some of the HACE symptoms of disorientation and bizarre behavior sound a lot like hypothermia symptoms. I'm definitely going to do my due diligence and go into this trip so I'm informed of what to look for. The link you gave mentioned a self-assessment score card. I'm going to see if I can find a copy of that somewhere online. Unfortunately, my wife can't make this trip so I have no choice but to hike this one alone. This might be the first time I'm actually glad I'm a somewhat slow hiker.

There is no need for drugs at 14,000ft or lower period. I sleep high to aclimate. I lived in San Fransisco and could drive to Touolome meadows 10k, sleep the nigh then go to 13k or better the next day. Ive also seen guys fly into denver 5k, then try to go 13k or so the next day and get wacked sick. You need to hydrate and watch for headaches,if you feel sick go down. Personally 12k is not that high imo, just listen to your body.

VeganHiker said:

Some of the HACE symptoms of disorientation and bizarre behavior sound a lot like hypothermia symptoms.

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Yes, it's "your brain doesn't work." And the first bit of your judgement that goes is your ability to figure out if your judgement is impaired.

HAPE shouldn't be a problem in the short time you have. It's very likely you'll feel fine on the first day; many people have a window of ~24 hours where they're fine. You're likely to feel terrible on day 2. As others have said, drink lots of water, avoid caffeine and alcohol, try to sleep (you may want to crack a window to ensure you're getting all the oxygen that's available), go really slow, eat lots of carbs. True life-threatening HACE (AMS is a mild/early form) is pretty darn unlikely too; I'd be more concerned about impaired judgement. If anybody passing you on the trail expresses concern or suggests you go down, take it seriously. Also be mentally prepared for the possibility of an asthma attack, even if you don't think you have asthma (dry air + high respiration rate); my first was on Mt. Bross and I had no clue what was going on, which was REALLY SCARY. No need to carry anything you don't normally, but relax and breathe very slow and deep if you feel your throat closing. It will be uncomfortable.

You're highly unlikely to get into serious danger with your proposed itinerary. Your chances of actually pulling off everything you have planned, fair to middling.

David Metsky said:

Personally, I wouldn't take altitude drugs (like Diamox) until I know I need them. That might not work for a 2 day trip when you have no experience at altitude so think of this trip as a test run. If you don't react well this trip you'll know whether you want to try them next time.

Stay hydrated, no alcohol or caffeine, try to get as much sleep as you can. You'll probably have a bit of a headache the first day, so you may get relief by taking aspirin/ibuprofen, but hydrate. After that, listen to your body. Don't be afraid to turn around if you're feeling miserable. The mountains will be there next time.

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Actually, if your body is used to morning caffeine or a nightly drink you want to keep that routine. Your body will adjust better if its also not fighting lack of caffeine. If I was going to spend a month over 14k (i.e something like Denali) I probably would kick the caffeine habit long before, but for a quick trip to Utah, don't not not drink coffee if your body is used to it. Altitude sickness doesnt bother me, but I have many climbing partners whom it does, and the effects feel worse if morning caffeine is skipped. Def skip the altitude drugs and take aspirin/ibuprofen at the first sign of sickness. Hydrate hydrate hydrate. Chances are it will be a pretty consistent elevation that it will hit you, but you will be amazed at how quickly you feel better once you get back under said elevation.

In discussions such as this, there are always people who state absolutes based on their own experiences. Not at all surprised to see some painting with a broad brush. It's pretty typical.

The best thing you can do, IMO, is learn as much as you can about the issues, learn your own body - which means first going to altitude without meds to see how you naturally react - and then make future decisions based on what you know.

Here is a link from the CDC that lays out the facts about altitude, genetic predispositions, time required to acclimatize and the advantages of Diamox in speeding up the process at middle elevations such as 12K - 14K if that is your choice.

http://wwwnc.cdc.gov/travel/yellowbook/2014/chapter-2-the-pre-travel-consultation/altitude-illness

I would also add - again based on my experiences - that as someone who will be attempting Denali next year that I am very glad to have the history I do with Diamox. I know what works for me and would not want to be using it for the first time trying to figure it out at 17K - 20K feet.

The coffee thing is an interesting point of discussion. I also make sure to continue drinking coffee at elevation because I know I will get a whopper of a headache if I stop drinking coffee even at sea level. My thought is that I don't want to ever be in a position where I'm wondering if my headache is from altitude sickness or lack of coffee.

Hi guys, OP here,

I think I had a major brain fart here. I was reading through the info in the link that Puma posted and one of the tables describes you at "low" risk for AMS is "People with no prior history of altitude illness and ascending to <9,000 ft (2,750 m)" and then it hits me... Even though I have never hiked in elevation much beyond 6k ft, I totally failed to consider that back in 2001 I drove up the Swiss Alps. I recall it was the highest auto road in Switzerland so I just googled it and it's at 8k. I felt fine, so I'm hoping that's a positive sign for how well I'll handle 8-12k. But perhaps not.

Lot of good information. My own experience climbing in the sierras and rockies was the worst was day 2-3. It is unpredictable so the only way you will know is to know. Take B12 and load up on fish in your diet. Fish will provide iron combined with b12 will set your body up to increase red blood cell production. If you want to know what it feels like to get AMS. Pick a friday night and get hammered, then get up and run a 10k!

On my first trip to Utah, I made the mistake of going directly from SLC to Park City and basically spent three days sleeping and skiing at altitude, dealing with mild altitude sickness without knowing it (thought I had come down with a flu bug that was going around back home, as I was tired/thirsty/no appetite/occasional nausea/winded).

Last summer, I slept low (ie SLC-Provo elevations) and started wth a sub 10K hike on day one (only issue was being winded higher up) and then jumped over 10K after that. Mt. Timpanogos was fantastic. I was definitely feeling a bit winded by the time I reached the ridge, which was the most challenging part of the hike (and a no fall zone).

VeganHiker said:

Hi guys, OP here,

I think I had a major brain fart here. I was reading through the info in the link that Puma posted and one of the tables describes you at "low" risk for AMS is "People with no prior history of altitude illness and ascending to <9,000 ft (2,750 m)"

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People who have been to altitude and have had no problems are one thing, people who have never been to altitude are another...

and then it hits me... Even though I have never hiked in elevation much beyond 6k ft, I totally failed to consider that back in 2001 I drove up the Swiss Alps. I recall it was the highest auto road in Switzerland so I just googled it and it's at 8k. I felt fine, so I'm hoping that's a positive sign for how well I'll handle 8-12k. But perhaps not.

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8K is traditionally the line at which some people begin to have problems. IMO, having driven to 8K without difficulties doesn't tell you much about your ability to rush to 12K. If you had had problems, it would have been a bad sign. (Your unstated altitude profile in the days or weeks preceding this trip may also have been important.)

An anecdote: I once went to a 3-day conference held at Keystone Ski area (9K ft). (Many of the attendees, including myself, came directly from the lowlands.) Out of ~150 people, a few had problems and one had to be given oxygen. (The ski areas are accustomed to such events and have oxygen on hand...)

We should also note that an individual may respond differently to altitude on different trips so good past experience is no guarantee for the next trip...

Doug

Montana said:

Lot of good information. My own experience climbing in the sierras and rockies was the worst was day 2-3. It is unpredictable so the only way you will know is to know. Take B12 and load up on fish in your diet. Fish will provide iron combined with b12 will set your body up to increase red blood cell production.

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Full acclimatization takes ~6 weeks but some factors kick in immediately (eg heavy breathing). On the two day scale of interest to the OP, there will be some changes in blood chemistry but I there will not be much change in the number of RBCs.

Individuals can respond differently on different trips to altitude so past experience while indicative is no guarantee. For instance, Sir Edmund Hillary was unable to ascend above 15K ft in his later days. (He had a near-fatal bout of AMS as a result of ascending above 15K.)


If anyone wants to learn about the process in detail, I suggest that you read:
Going Higher: Oxygen, Man, and Mountains, 5th Ed, by Charles S Houston M.D., David E. Harris, Ph.D., and Ellen J. Zeman, Ph.D. http://www.amazon.com/Going-Higher-Oxygen-Man-Mountains/dp/0898866316

Doug