Acute Mountain Sickness strikes

AMS victim hiking toward Fish Creek Saddle

On a backpack this weekend up the Fish Creek Trail to San Gorgonio (11,503′), my backpacking partner was struck with Acute Mountain Sickness (AMS) on Aug 20.  As with all of the cases I have run into including the times I have had trouble, the vectors for the problem are consistent:

• Hydration
• Sleep
• Training
• Fitness
• Psychology

When any of these items is problematic, bad things are likely to  happen on the mountain.  I’ve suffered from this myself.  The two items that get me are lack of sleep and hydration.  Several years ago, I and another climbing partner took the Palm Springs Tram up to 8,000′ and headed toward San Jacinto at 10,500′.  We made it about 2/3 of the way and both developed pounding head aches.

We had been up late the night previous and had not properly hydrated, as evidenced by our lack of relieving.  The exercise load was serious, as most people who try and hike that mountain when coming straight from sea level can attest.   We also made the attempt in late spring when there was still snow above 9,000′.  The dry air and harsh sunlight dehydrated us even more.  By the time we were more than half way up, we did an evaluation.  She simply asked me and I asked her, “How are you feeling?”  We both replied pretty bad.  Having you head throb when climbing up a mountain isn’t a good experience.

However, this trip on San Gorgonio struck my backpacking partner much worse than my experience on San Jacinto.  Prior to the trip, he was talking about being worried about suffering from altitude sickness.  This is one thing I’ve found that is similar to motion or sea sickness.  You can actually make yourself feel bad miles from any water.  The same can happen when you talk and obsess with mountain sickness.  If you think yourself into feeling ill, there is a good chance that your mind will work over your matter.

To allay the problem of headaches, we started an aspirin regime at breakfast, taking 2 pills ever 4 hours.   This worked amazingly well for him.  I’ve always used this technique and very rarely have that irritating light ringing in my head.  There are several other popular remedies for AMS (Vi agra included!).  But, aspirin is over the counter and is incredibly cheap.  One thing – make sure the bottle hasn’t expired – aspirin really does lose its effectiveness over time.

Hitting the trail, we both did quite well.  We got on the trail at 930am.  Not an alpine start but the distance to the peak on Fish Creek Trail (9.3 miles) wasn’t a worry.  After an hour of hiking, my partner began slowing down.  A little slowdown was expected, as this was his first foray into high altitude in 15 years.

By the time we hit lunch at noon, things weren’t looking as good.  He was only able to eat about 1/3 of a peanut butter and jelly sandwich, so he tried eating some of the food bars he had.  They went down but he wasn’t happy with them.  He had been drinking plenty of fluids but had only gone once at the very beginning.  For drinking a liter of water by this point and not going, I was becoming concerned.  Just after stopping, his pulse rate was 158, just near max for a man of 58 years old.  After resting for 15 minutes, his pulse dropped to 100.  Rather high and something to note.

We rested for a while to see how he felt.  After a while, he said he was okay and we geared up to carry on.  He had already begun suffering from the effects of AMS.  As I have suffered from lack of appetite higher up, I noted it and began watching him.  We kept the pace pretty slow, so it wasn’t a race up the hill.  However, a queezy stomach and lack of appetite is a first sign things have gone wrong.  See the Lake Louise AMS Worksheet to learn to evaluate the problem.

The link to the description of AMS sickness can be found at the Lake Louise Consensus.

After we started walking, he noted that he started feeling tired.  When someone has been sedentary for years and has just begin training in June, it’s difficult to determine if this is just fatigue from being in amazing shape or there is a more systemic problem developing.  To lighten his load to see if it was just a matter of not being in great shape, I took his food bag & bad weather clothing, lightening his load by 5 pounds.  This dropped his total pack weight to 10 pounds.

After going on for another 2 hours, we took a rest.  At this point, he started complaining that his stomach wasn’t feeling good.  At this point I knew the hike was over.  Overexertion in the sun will get you like this, but after a good half hour rest, things usually improve.  He rested for a good hour while I hiked up the trail, checking out the sites and noting how difficult the above trail was.  It didn’t get easier for another mile.

After returning and checking on him, we determined it was time to head down.  He was feeling queezy and exhausted.  Fortunately he didn’t have a headache or dizziness – that would have been far, far worse.

After walking down the trail a bit, I could see that his coordination was starting to slip, as his footing wasn’t very sure going down the trail.   The beginnings of ataxia were starting to creep in.  He continued to deteriorate on the Lake Louise Scale, now racking up 4 points.  At this point I became quite concerned about a trail injury, so I took his entire pack and shouldered it.  This way, he only had his water bottle and clothes on him to carry.  Since I made sure he packed ultra-light (I always do in 3-season packing), the load wasn’t too bad, maybe 30 pounds for both packs.  This made it easier on him and his load stumbling decreased.  He wasn’t dizzy but things weren’t improving until we got to 8,300′.  He did get sick a few times.  A score of 5 on the Lake Louise Scale.

Once we got off the mountain, he started feeling much better after a few hours.  Just like that.

Now I have a much better feel for evaluation and where things start going really wrong.  I learned that when I go with people, I might need to carry their gear and be ready to evacuate.  Or I might need to bail myself out.  Plan accordingly.