can be a painful condition that makes some simple chores (such as priming a pump-pressure stove) difficult.
High-altitude edema or peripheral edema is a temporary swelling of the face, eyes, fingers, and ankles. Using hiking poles can help reduce the possibility of peripheral edema in the hands.
How Long Does It Take to Acclimate? How Long Do the Effects Last?
Full acclimatization takes about one month for most people, though most feel strong at high altitude (more than 5,000 feet) after three to four days. The rate of ascent is an important factor: acclimating from sea level to 8,000 feet is easier than adapting from 8,000 feet to 16,000 feet. If properly ascending, hikers in Colorado generally feel “normal” after two to three days above 10,000 feet. After approximately 6–10 days, your body will have completed most major high-altitude-related adjustments; it takes roughly 7–14 days to lose the major benefits of acclimatization.
Illnesses and Symptoms of Altitude Sickness
Just about everyone who ventures up to altitude gets a sampling of AMS at one time or another. In mild cases (which are most common), the condition is bearable, though a little uncomfortable. Slight headaches, nausea, loss of appetite, malaise (a vague lack of energy or ability to think clearly), and sleeplessness are common and can often be dealt with by using over-the-counter pain relievers. For fast relief (that has worked for me), Advil Liqui-Gels are tops—and I’m not just saying that because they gave me a free car! (I’m just kidding of course. My car, a mountain-beaten 1989 Honda Accord, looks like it was donated by Sanford and Son.) Aspirin, acetaminophen, or ibuprofen may work better for you. Mild AMS can occur anywhere between one and three days after arriving at altitude and usually lasts a few hours to two days, as symptoms gradually diminish. These conditions are generally harmless, but they do raise a yellow flag. If they do not subside, they could lead to more serious conditions.
Moderate cases of AMS are quite a bit worse. This is the worst condition I’ve experienced (read sidebar “The Bierstadt Incident,” for details), and even though it truly was a moderate case, I felt like I’d just gone 10 rounds with Mike Tyson in a room lit by 80,000-watt lightbulbs after eating a gallon of moldy mayonnaise. If you couldn’t guess, moderate AMS is like a powerful hangover and is generally unaffected by most pain relievers (though antacids or Pepto-Bismol–type medicines may soothe your stomach). Moderate AMS is an amplified version of mild AMS: the headache is more intense, the nausea often results in vomiting, and even simple exertion can leave you out of breath. The only way to feel better is to descend. Going higher may be possible for stubborn souls, but it could cause the condition to worsen. Descending 1,000–3,000 feet will make a big difference and is recommended. (It may even rebalance the body enough for you to give the hike another go in a few hours.)
Severe AMS is no joke. This life-threatening condition cannot be ignored, as it may be a precursor to cerebral edema. All the conditions of moderate AMS are present, along with the following symptoms: lack of balance and muscle coordination, confusion, or severe mood changes. At this stage, people may become unaware of their surroundings and may become angry, hostile, or unintelligible. A good test is having them walk a straight line, similar to the sobriety test issued by the police. Rapid descent is your only choice; get the afflicted person down any way you can. Wait until the person is back to normal (which may take days, or not happen at all until you descend farther) to resume ascending, doing so with an eye on potential recurrence.
When diagnosing AMS, it is important to note that the symptoms may instead be signs of hypothermia (covered), fatigue, stress, dehydration, or nerves. A good rule of thumb: If the person isn’t having fun (or can’t tell you if they are or not), descend immediately.
HAPE and HACE are acronyms for altitude sickness in its most dangerous and deadly form. While both conditions are relatively rare in Colorado, both can happen as low as 8,000 feet above sea level. High-altitude pulmonary edema (HAPE) occurs when fluid from the blood leaks into the lungs. As blood struggles to adapt to altitude, pressure in the arteries (which is aggravated by exertion, dehydration, and cold) causes water and fluids to escape into the lungs. HAPE is a progressive condition. After several hours or days of undiminished AMS, the victim’s condition may enter into HAPE. He or she will breathe rapidly, even when at rest. The smallest tasks will be exhausting and will leave the victim moody and tired. Often, even speaking becomes a laborious chore. If the condition is allowed to get worse, breathing becomes visibly frothy and audibly bubbly and is often accompanied by a dry cough that expels sputum from the lungs. The victim’s lips turn permanently blue, due to the lack of oxygen traveling through the body. (Lips should be the same color as one’s fingernail beds.)
HAPE is not a moderate condition; without immediate treatment at a medical facility, a victim can rapidly phase into unconsciousness and death. Descending will help, but professional medical treatment is paramount. Even with the best medicines, the decline is sometimes irreversible. It’s serious business; luckily, it is fairly rare between 8,000 and 14,000 feet. In Colorado, most HAPE victims come from sea level and ascend to over 9,000 feet in a matter of hours (by plane or car), and stay there—or worse, go higher. Recovery from HAPE is normally a total return to the old self, though any occurrence may denote a propensity for HAPE.
High-altitude cerebral edema (HACE) is as scary and deadly as HAPE. HACE is a progression of severe AMS and is caused by excessive water swelling the brain. As cells dilate in a desperate effort to absorb more oxygen, the brain gets waterlogged. By the time your body is taking these extreme measures, it may be too late. HACE is characterized by severe confusion, inability to speak or function, inability to move, numbness or weakness on one side of the body, severe nausea, and severe headache. HACE shuts down a body at a terrifying rate: unconsciousness, coma, and death are the inevitable outcomes of untreated cases. Descent is imperative, and medical attention must be found for the victim. Even with treatment, permanent neurological damage may result. This is a rare condition for Colorado’s modest heights, but people have died from HACE at as low as 10,000 feet. Don’t be scared of it, but be aware of it.
The X-Factor at Altitude: Psychological Strength
Performing well at altitude is not all in the legs and lungs. One’s mental state can enhance or impede the experience of being at high elevations. Hikers who are relaxed, strong, confident, happy, and positive experience few problems at altitude—and when trouble does occur, they calmly deal with it. Part of this comes from knowing one’s body and how it reacts: experience in the mountains is a big plus. Fear, anger, and apprehension increase the body’s overall stress level and can actually accelerate and magnify the symptoms of AMS (or even induce “phantom” symptoms such as migraines, nausea, or weakness). Because emotions are extremely personal and affect us in very individual ways, there’s no way to universally prescribe how one should balance the competing needs of the body, the mind, and the psyche when making decisions. A few things to consider:
Highly emotional people are likely to have difficulty finding the balance between smart hiking and overthinking things. Hiking partners can make or break a day in the mountains. My advice: When you find a good hiking partner, hold onto ’em for life!
Whenever an unexpected stressor (bad weather, irritable companions, exposure, and so on) happens, I take five slow, deep breaths. It sounds corny, but it helps me center my mind and focus on what needs to be done.
Though we often escape to the mountains to clear our heads, burdening and troublesome thoughts may make it difficult to perform well at altitude. High-altitude hiking, scrambling, and climbing require an elevated state of concentration,
