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Altitude Sickness: John Muir Trail Case Study

Imagine hiking over Mono Pass then south bound on the John Muir Trail.  Another beautiful week in the Sierra’s with some of your buddies, one who is on his first backpack trip and is blown away by the beauty.  You never had any issues in the Sierra’s except an occasional headache that you could not figure out if due to lack/low amounts of caffeine or to elevation.

Now in 2013 you are hiking the second day and especially the third day and your hiking partner is commenting that this year he can keep up with you and even get in front of you which never happened before.  You are struggling and working hard for hikes that you have never had problems with.

Like a lot of adult males your blaming the extra pounds you put on each year, now up to 215lbs for 5’10” and maybe your age 57 y/o is causing issues.  I swear I’m going to lose this weight when I get back from this hike.  One of the three of us has asthma and he has a dry cough each morning then you also have the dry cough that sounds exactly like his.

Mono Pass

While approaching Muir Pass we camped at Wanda Lake at 11,413 ft. elevation.  You were really tired and beat. We had a hail storm for about an hour then you ate a little dinner and lay down to go to bed.  You could not breathe thru your nose because you were huffing and puffing so hard it took 1-2 hours before your breathing to slow down enough that you could fall asleep.

Learn more? Check out the next page.

16 Responses to Altitude Sickness: John Muir Trail Case Study

  1. Daryn August 13, 2014 at 10:41 pm #

    Nice reminder. Thank you. HACE and HAPE are real hazards and don’t only happen in the “death zone.”

  2. Joe C August 15, 2014 at 7:56 am #

    Interesting read. I got AMS for the first time in my life a few years ago; went from 3,000′ to 11,000′ in a day. Doctor had just lowered my BP medicine. Up all night trying to throw up, felt like a super hangover the next morning. Went back down the next day, slept 12 hours. Got up to eat, food sounded horrible, slept 8 more. Felt OK and went back up the next. Scary though; glad I turned around.

  3. C Moore August 15, 2014 at 8:14 am #

    Great job publicizing this issue. I have a collection of news clips of Search and Rescue (SAR) incidents for a couple of years. AMS can contribute to disorientation and getting lost, falling and getting injured, etc. And as a member of American Alpine Club you will get rescue insurance to cover $5K or SAR costs. Best not to become a statistic!

  4. Peter August 15, 2014 at 8:39 am #

    The first mountain I ever climbed was a 14er in Colorado. No acclimatization, no experience, and no concept of how to pace myself. Definitely had a lot of that going on, and was very glad to get back down to a more reasonable altitude (which, surprisingly was still over 10,000 feet) to recuperate. i missed the peak of the mountain by about 30 feet, because I was too dizzy to do a 10 foot vertical climb.

  5. Liz August 15, 2014 at 10:38 pm #

    This same discussion came up recently on a Philmont list. One of our members is an MD/Ph.D.; he stated that recent research is implicating genetics in predisposition to HACE/HAPE/AMS.

  6. renegadepilgrim August 16, 2014 at 7:58 am #

    This is so helpful! I’m heading to Nepal soon and AMS/HAPE/HACE has been at the front of my mind.

    • Doug Prosser August 17, 2014 at 10:11 pm #

      Read through the articles & presentation slides before going. You may want to discuss what meds to bring with Mountain Physician.

      • renegadepilgrim August 18, 2014 at 10:17 am #

        I have read through the articles and links and presentation slides. I used to work with an MD who is a Medical Advisor for Portland Mountain Rescue (who has advised me to take Diamox as well), and also have 14 years experience in Emergency Medicine as an ED Tech. Trust me, I’m doing my research, and in my case, too much knowledge can be a bad thing. :)

  7. Randall Dee August 16, 2014 at 8:56 am #

    Thanks so much for posting this. I’ve done 2 trips into the Wind River Range recently above 10K ft where I kept waking up at night with the feeling that I was suffocating and my breathing had stopped. I live at below 500 ft elevation. If it appears that I have a predisposition to HAPE/HACE, then should I not do these high elevation trips?

    • Rich Jackson August 17, 2014 at 7:47 pm #

      Taking Diamox 250 mg twice a day beginning the day before ascent can help to prevent altitude sickness in susceptible individuals. It is a carbonic anhydrase inhibitor and a diuretic which will also help you sleep at night.

    • Doug Prosser August 17, 2014 at 10:19 pm #

      You may not be experiencing HAPE but Periodic Breathing. Peter Hackett MD said just a little acetazolamide (Diamox) 62.5mg (1/4 of 250mg tablet) prior to bedtime really works to improve sleeping at altitude. I was just at a Wilderness Medicine conference and they called the Diamox a “High Altitude Sleeper Agent” and recommended the same dosage.

  8. kennym101Kenny Meyer October 21, 2014 at 9:45 am #

    Excellent write up. Very helpful. Wish I stumbled into it earlier. Ends up I collaborated with a couple Docs on a similar write up but for JMT hikers.
    Thanks again for writing this up. Regards, Kenny

  9. Karen Najarian November 3, 2014 at 12:03 pm #

    Good read. I have sleep apnea which makes it all worse. As for attributing problems to altitude unless known otherwise, I had one client who’s scalp started itching. Knowing I was supposed to attribute it to altitude but also knowing that didn’t sound right, I missed an allergic reaction he was having to another client’s granola which increased a few days later to anaphylaxis. I did have the good sense to give him a Benedryl the first time around and luckily we were down in Yosemite Valley when the anaphylaxis hit. THEN, I had another gal who was exhibiting altitude symptoms but after an evac it was discovered she was having a heart attack. Doh! Needless to say, REI and I had safety and pre-qualifying disagreements.

  10. deserthiker June 11, 2015 at 11:25 am #

    What the article forgot to mention is the HAPE is rare at elevations found in the Continental US and typically only hits those with a predisposition for it. While the article states that it accounts for 50% of the deaths in the mountains, it doesn’t mean OUR mountains.

    • Doug Prosser June 14, 2015 at 7:58 pm #

      The conference I went to in Boulder had as number of phycians from the telluride ski area that talked about seeing numerous HAPE patients both adult and pediatric. If I recall what they said Telluride has a part of their resort high on the mountain and that is where the patients are coming from.

    • kennym101 June 15, 2015 at 3:46 pm #

      HIgh desert hiker. Just wondering if there what research or reference you found that says HAPE is rare in the Continental US. I’ve been reading that HAPE can occur as low 8K (Gallagher & Hackett, “High-altitude illness.” Emerg Med Clin N Am 22 (2004) 329–355). The average elevation of the JMT south of Donahue pass is 10K. So it would seem that HAPE is a real possibility in the Sierras. Since rescue opportunities in the Sierras is probably much better than they are on South Pole, perhaps you just mean HAPE fatalities? Also, is there a reason you excluded HACE?

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