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“We have to get down” by Linda Pohle Coping with altitude sickness My friend Mary, 49, lives in Minnesota. An avid runner, she has completed two marathons. She arrived in Denver on Thursday morning; we spent that night in a cabin on the Poudre River (elevation 7,400´). Friday morning we left the West Branch trailhead (8,400´) and six hours later camped below Grassy Pass (10,400´) in the Rawah Wilderness area. Mary drank four quarts of water and Gatorade on the pack in and only began to suffer a bad headache after climbing 100´–200´ above camp. She ate dinner but was in the tent by 7:30 p.m. She took one Diamox tablet, which has proven helpful to some hikers/climbers at altitude, because she had suffered symptoms of altitude sickness on previous trips. The sound of my friend’s hurried unzipping of her sleeping bag awoke me from a sound sleep. Clouds covered the nearly full moon, and it took a long time to locate my headlamp in the darkness. When I switched on the light, I found Mary half out of the tent, vomiting. I looked at my watch: 10 p.m. Daybreak was eight hours away and we were six miles from the trailhead. “We’ve got to go down,” I said, although the thought of leaving my warm sleeping bag and venturing into the pitch black wilderness was chilling on several levels. So I did not argue when Mary said it would be too dangerous to hike out in the dark. I fell asleep, only to be awakened as Mary struggled out of the tent again. This time I had the light on in seconds. It was not quite midnight. As Mary continued to be sick, an acronym leapt into my mind: HACE, or high altitude cerebral edema. I realized that, if we didn’t go down and Mary’s condition worsened, I would not be able to get her down on my own. Galvanized by the horrible vision of calling Mary’s children to tell them their mother had died, I told Mary we were leaving, and hurriedly began to pack. Mary did not protest. She was clearly still sick, though no longer vomiting. We set off at 1:30 a.m. Still no moon. I was very nervous at first about following the trail in the narrow beam of a headlamp. The fear soon subsided, however, and I found it fairly easy to manage. When in doubt about the direction of the trail, I simply swept the headlamp left and right. We went slowly and cautiously, walking through streams we had crossed on logs in the daylight. Wet feet were not a concern this night. Mary’s flashlight gave out after twenty minutes and, even though I turned off my headlamp when I could see the trail without it, I began to fret about the age of the spare batteries in my pack. We were going to need more light than the existing batteries could give us. After sipping water, Mary began to vomit again. After an hour and a half, we had descended about 1,000 feet. We walked silently; Mary was too sick to talk and there really wasn’t much we felt like saying anyway. My headlamp was dimming noticeably. We stopped to rest; with fear and hope I put in the spare batteries. The light was strong and steady. At 3:30 a.m., two hours after leaving our campsite and three miles down the trail, we came to a trail junction. Although Mary felt better, she was almost entirely done in physically, so we threw our sleeping bags on a tarp and went to sleep. Thankfully, there was no rain. Mary woke me at 7:30 a.m. saying she needed to keep going down. We were back on the trail in minutes. By 10 a.m., we were at the trailhead—exhausted, but safe and sound. We had packed twelve miles in twenty-four hours. On the drive back to Denver, Mary was able to drink water for the first time in more than twelve hours and even managed a fruit juice bar later on. But, over the next two days in Denver, she never felt completely well. Back in Minnesota, Mary called to tell me that her symptoms finally disappeared when the airline cabin was pressurized before take-off. Right and wrong Because this story has a happy ending, we clearly did a few things right on the trip. Most importantly, we beat a retreat to lower altitude. Altitude guru Dr. Peter Hackett said, “There are three rules for treating altitude illness: descent, descent, descent! This remains the gold standard of care. It is never a poor decision” (quoted in Stephen Bezruchka, Altitude Illness: Prevention & Treat ment, The Mountaineers, 1994, p. 39). What interests us most, however, is what we could have done to avoid or minimize Mary’s altitude illness. These are our primary conclusions: Instead of taking Mary from sea level to 10,400´ in under thirty-six hours, we should have planned another day of acclimation, perhaps staying in Denver the first night and Poudre Canyon the second. We should have cut the first day’s six-mile pack into two days, or picked a less strenuous trip. Research suggests minimizing exertion early in a trip, but we were lulled into a false sense of security by Mary’s high level of physical fitness, which was a double-edged sword. Because she was in good shape, she easily managed the long pack in. Taking Diamox, which was not prescribed specifically for her, may have contributed to Mary’s symptoms. Acetazolamide is distantly related to sulfa drugs and Mary has had an allergic reaction to sulfa in the past. (Her own physician dismissed this as a factor, however, and most references I consulted don’t mention the sulfa connection.) Al Ossinger noted that some forms of altitude sickness are common to all hikers/climbers, but especially to those who go to a much higher elevation than where they live, such as Mary. He correctly pointed out that Mary and I should have been more alert for altitude effects, but that we were probably distracted by being together and off for an adventure in the beauty of our Colorado mountains. Good advice. Mary has promised that she is not giving up backpacking in Colorado because of this misadventure. But we’re going to do things differently next time—and certainly at lower altitude. |
Signs and symptoms of Acute Mountain Sickness*
*Schimelpfenig and Linda Lindsey, NOLS Wilderness First Aid, National Outdoor Leadership School, 1991, p. 245. |