live in Colorado or the Gulf Coast, is a potential victim of altitude illness. A study several years ago found one in four visitors to a mountain resort had some altitude related symptoms.
Physical problems with altitude vary but can be grouped into three separate but related forms: Acute mountain sickness (AMS), high altitude pulmonary edema (HAPE), or fluid in the lungs, and high altitude cerebral edema (HACE), or fluid on the brain.
AMS is rarely seen below 6,500 feet. It becomes increasingly common above 8,000 feet, an elevation easily encountered on the Flat Tops. Symptoms are usually minor though they can be disabling. Severity is greater among those who haven’t taken time for acclimatization. A person making a rapid ascent may experience a headache— mild to severe—nausea, vomiting, shortness of breath, weakness, sleep disturbance, or experience periods of intermittent breathing.
Left untreated, AMS can advance to a serious, life-threatening illness, HAPE. It most often affects those who have had the problem previously, or have been acclimatized to high altitude, spent two or more weeks at low elevations, and then returned to high altitude. The symptoms can develop rather rapidly, in a matter of hours, or slowly over a period of one to three days. HAPE can occur with no symptoms of AMS.
A person suffering from HAPE will experience shortness of breath, irritating cough, weakness, rapid heart rate, and headache. The problem frequently gets worse at night. A pulse rate higher than 110 and respiration over sixteen breaths per minute is an early sign of HAPE. A medical emergency exists should the rates exceed a pulse of 120 and twenty breaths per minute. If the illness is untreated, the victim can go into a coma. Death may follow within a very short time.
A person with symptoms of HAPE must be immediately evacuated to lower altitude, preferably below 6,500 feet. Oxygen may help mild cases but descent is still necessary.
HACE is less common than the other forms of altitude illness but is the most serious. Symptoms include severe headache, confusion, hallucinations, unstable gait, loss of vision, loss of dexterity, and facial muscle paralysis. A sufferer may fall into a restless sleep, followed by deep coma and death. Immediate descent is required if the victim is to have any hope of recovery. Oxygen, if available, should be given by facemask at the rate of two to four liters per minute.
Symptoms of all three forms of altitude illness are progressive. Some are overlapping. It doesn’t follow, however, that one form will always progress to another, more serious condition. A person can have HAPE or HACE without first showing symptoms of AMS.
Anyone showing signs of HAPE or HACE should be taken to lower altitude immediately. On the north side of the Flat Tops, the nearest medical facility is at Meeker. If you exit the wilderness by I-70, treatment is available at Glenwood Springs.
A person might think that a physical conditioning program would prevent altitude illness. It ain’t so. Fitness will give you more endurance and aid in the efficient use of oxygen. But it won’t prevent altitude problems. Even if your fitness level is excellent, don’t let it lull you into overextending yourself before acclimatization.
A conditioning program should begin at least twelve weeks prior to traveling to high altitude. The body requires this length of time to respond to physical training. And remember that acclimatization is lost once a person has returned to low altitude (below 6,500 feet) after as little as ten days.
Even after completing a conditioning program, a person who lives near sea level is going to require time to acclimate to high altitude. When possible, you should allow two or three days to adjust to the altitude before engaging in any rigorous activity after arrival. Even then, you’ll likely feel more tired than usual from normal activities. Smoking will decrease your performance at altitude and should be avoided.
Those who suffer from respiratory ailments such as asthma should be aware that the conditions could be aggravated by high altitude if not treated. Other ailments such as pulmonary hypertension may also be made worse. Anyone who uses medications for these conditions must also use them at altitude. One caution, though. The use of sedating antihistamines (the kind that make you drowsy) can decrease respiration while sleeping, worsening some symptoms of altitude illness.
Dehydration contributes to altitude sickness. Under ordinary conditions, the body needs about two to four quarts of water per day to stay hydrated. At altitudes above 8,000 feet, fluid requirements increase. Three or four quarts per day should be considered a minimum. Thirst is a poor indicator of need. Get lots of fluids and drink frequently. Avoid, or at least minimize, the use of beverages containing caffeine or alcohol as these contribute to dehydration.
Electrolyte replacement drinks are assimilated quickly. Those in powder form can be carried easily and mixed with water, ready for use as needed. Just make certain you get adequate fluids, whichever type you use. As long as your urine is colorless or very light yellow, you are sufficiently hydrated.
Some people are more susceptible to altitude illness than others. Medical help is available for this situation. Paul S. Auerbach, MD, MS, FACEP, FAWM, is the Redlich Family Professor of Surgery in the Division of Emergency Medicine at Stanford University School of Medicine. He is the world’s leading medical expert on wilderness medicine and a prolific author. He is the editor of Wilderness Medicine, and author of Medicine for the Outdoors and Field Guide to Wilderness Medicine. The doctor’s books are recommended for anyone who ventures into the backcountry.
Dr. Auerbach recommends the use of Diamox (acetazolomide) to aid acclimatization. A dose of 125 to 250 mg, taken twice daily, is advised beginning six to twelve hours before ascent and continued for twenty-four to forty-eight hours after reaching the maximum altitude. A prescription is required.
The drug does have some side effects. It will cause increased urination so get more fluids to stay hydrated. It can also cause tingling in your fingers and toes shortly after taking each dose. Taking the smaller dosage will reduce the frequency of urination. The tingling sensation shouldn’t last very long. The symptoms, while annoying, are less so than altitude illness. One word of caution, though: Don’t take this medication if you are allergic to sulfa drugs.
Minor headaches associated with AMS can be relieved with ordinary over-the-counter pain medications such as aspirin, acetaminophen, or ibuprofen. If you’re having headaches, however, you may not be getting enough water. To prevent further difficulty, do not ascend to higher altitude until you are free of headache for twelve hours.
The best way a person can prepare for a high altitude adventure is to spend a lot of time at altitude. For the majority of us, this isn’t practical. The next best thing is to prepare physically and mentally. Understanding acclimatization and getting yourself in top physical condition will improve your ability to meet the challenge of the Flat Tops and other high elevation travels.
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MAPS FOR THE FLAT TOPS
Although the US Geological Survey publishes topographic maps (quads) that cover the Flat Tops Wilderness they are not the preferred quads to use. USGS quads covering the wilderness are more than thirty years old. The topography doesn’t change significantly in that time but other features do. Roads, trails, and campgrounds that are built or abandoned may not appear on their quads.
The latest USFS map of the White River National Forest was completed in 1991 and is out of print. It shows surface ownership or control using color. This allows the wilderness traveler to know which land is public or private to avoid unintentional trespass.
The National Geographic Society (NGS) acquired Trails Illustrated (TI) of Evergreen, Colorado. They publish maps of the more popular recreational areas of the state. The USGS quads are used as a base. Data from many sources are
