High Altitude

My first high altitude experience was going to the top of Mount Shasta (14,179 feet) in California. My head was pounding like someone was knocking on a door, and this continued for hours. After I made it to the summit and began to descend, the pain went away. This is a clue to the primary treatment for any altitude related problems: go lower.

AMS or acute mountain sickness: Common when going above 10,000 feet (3000 meters) without proper acclimatization. Symptoms include headache, nausea, weakness, shortness of breath, vomiting, and problems sleeping.

HAPE or high altitude pulmonary edema: Rare below 8,500 feet (2,500 meters) More common with younger (under 18) hikers and persons who have had the problem before. Symptoms develop 24 to 60 hours after arrival at high altitude, and include coughing, shortness of breath, weakness, headache, rapid heart rate, and progress to constant coughing, bloody sputum, fever and chest congestion. Crackling sound in chest, resting pulse rate of 110 respirations per minute, and respirations over 16 per minute are early signs of HAPE. Death is usually within 12 hours after coma starts.

CE or cerebral edema: Less common than AMS or HAPE, but more dangerous. Rare below 11,500 feet (3,500 meters). Symptoms include increasingly severe headache, instability, mental confusion, hallucinations, loss of vision, facial muscle paralysis, loss of dexterity, restless sleep followed by coma and death.

Climbers who intend to travel at high altitude should ask a doctor about the latest recommendations for medicines to take. For backpackers and others who primarily pass through high altitude for short periods of time, aspirin will help most headaches. The primary treatment for all altitude problems is to go lower. Often a descent of just 2,000 feet will resolve any problems, but in general, just keep going lower until the problem is resolved.

Swelling of the fingers is common at high altitude as well. This requires no treatment, and will usually go away when you descend. Increased gas and flatulence is a problem at altitude as well. Eat fewer foods that cause gas to avoid this problem.

There is many anecdotal reports of people having an easier time at altitude if they take ginkgo biloba supplements, or eat ginkgo leaves. There is little danger in trying this. The supplements are cheap and without side effects for most persons.

Another thing to remember is that the higher you go, the worse your ability to digest food gets. Try to stick to easy-to-digest foods like simple carbohydrates while you are above 10,000 feet.

Dehydration can cause headaches and other symptoms similar to high altitude illnesses. Often water supplies are rare or inconvenient at altitude (setting up the stove to melt snow repeatedly). Add to that the fact that you won't feel as dehydrated in the cooler air, and it is easy to forget to drink enough. At least start fully hydrated before going high up, and have your water bottles full.

I just read a wilderness medicine guide that suggested an ascent rate of only 1000 feet per day above 7,000 feet (2,000 meters). This may work for some on long-term expeditions at altitude, but it is unrealistic for general backpacking. By this rule, I should have taken 12 days to go from Riobamba Ecuador, at about 8,000 feet (2,500 meters) to the top of Mount Chimborazo at 20,600 feet (6,000 meters), instead of the 12 hours I took.

How fast should you ascend? It partly depends on what elevation you are starting at. It is certainly easier for me to run up to 14,000 feet now that I am living here in Colorado at 5,000 feet, than it was when I lived near sea level in Michigan. In other words, I am already partly acclimatized.

As another example of acclimatization, or a lack of it, consider a trip I took years ago. I traveled from Michigan to Silverton, Colorado, and immediately went to the top of a 13,000-foot mountain. Then I camped at 11,500 feet, and woke up feeling nauseous, with a headache and almost hallucinating. In the morning I descended to about 10,000 feet and soon felt just fine.

I was backpacking above 10,000 for the next week and never had any other problems with the altitude. I even went to the tops of five 14, 000-foot mountains along the way. The point is that it isn't easy to say what it takes for an individual to acclimatize (a 1,000-foot-per-day rule would have meant canceling the trip). More important than a rule, is to pay attention and go lower if you have any symptoms of high altitude illness.

Back to the example of my fast ascent of Chimborazo. The key here was to get up fast and down again just as quickly. I also would have been okay if I took four or five days to gradually acclimatize. However, if I had taken two days to climb the mountain, I probably would have been sick to the point of dying.

Fast means getting back down before the symptoms of high altitude sickness can become serious. Slow means getting your body accustomed to the altitude so you don't get sick. Somewhere in between is the most dangerous way.

There are other dangers that come with high altitude travel. Hypothermia is common, because of the cold and lack of shelter from the wind up high. Injuries are both more common because of the terrain and more serious because of the isolation. Lightning strikes are more common as well. Each of these will be covered in other chapters.

Key Points

1. High altitude can make you sick in several serious ways.

2. There most important treatment for altitude sickness is to go lower.

3. Ascend and descend fast or slow, but be careful in between.

4. Other dangers of high altitude include hypothermia, lightning and injuries.

Every chapter has tips for lightweight backpacking and wilderness survival.