Yes, altitude struck. Kat knew what she might be in for, because she had had a similar experience in Ecuador on her 4-day Cotopaxi trip. I knew what we might be in for, too, because Kat had told me of the Cotopaxi incident; and yet, after listening to her story and understanding the parameters of her Ecuador experience I still encouraged her to attempt Mera: because slow and gradual acclimatization can make all the difference.
And it did: after ten days of gradual ascent Kat, 60 years old but in absolutely killer cardio shape, breezed through her Ecuadorian highpoint to upwards of 20,000ft. Yet just a couple hundred feet shy of the summit - literally some 10 minutes below the top - things changed. Within a matter of minutes Kat went from climbing strong to temporarily not being able to walk. Here are a few thoughts I want to share for all of us who spend time at altitude (or are planning to do so) to mull over:
- Fitness and training have very little, if any, impact on your susceptibility to altitude sickness. If they did, Kat would not have had to turn around at 21,000ft
- Proper acclimatization does make a big difference: acclimatize slowly and thoroughly, and you may be able to climb safely to altitudes that may have seemed out of reach previously. That said… this is very important:
- Acclimatization cannot be rushed. To acclimatize fully to extreme altitude (commonly thought of above 5,500m or 18,000ft) requires more than three weeks! Which is a much longer period of time than most climbers budget. Expeditions with 10-14 days of trail time to 20,000ft are quite typical for Himalayan and Andean mountaineering. Seven-day trips up Kilimanjaro (19,341ft) are considered standard. As such, even on trips with “relaxed” acclimatization schedules many of us will pursue high summits on suboptimal acclimatization. Don’t short-change yourself by trying to save time and move up faster
- Recognize that, unless you are spending months in the high mountains, you will not be fully acclimatized during most high altitude adventures. Adjust your pace accordingly; don’t be tempted to push too hard
- Kat’s condition changed rapidly. Leading up to 21,000ft she had - by her own account - no headache, no nausea, and only the occasional mild bout of dizziness. Then, from one minute to the next, she was slurring her speech and had to sit down. She was lucid enough, and the whole team knew enough of her history with altitude, that we were all clear she had to descend immediately. Thanks to Kat’s tremendous physical and mental strength she managed to descend on her own to feet with assistance from her daughter Tara, Mingma Sherpa, and myself. While fitness and training may not impact your susceptibility to altitude, they sure do help in extricating yourself from bad situations!
- As on all my high-altitude expeditions, I carried Diamox and Dexamethasone on Mera Peak
- I typically advise against the prophylactic use of Diamox - as I did this time, counseling Kat to not take Diamox ahead of summit day. My argument is that slow climbing and gradual acclimatization should enable your summit, rather than drug-altered chemistry. In retrospect, and in a case like Kat’s (i.e. for someone with a history of issues at altitude) this may have been the wrong call; prophylactic Diamox for the final day or two to the summit might have helped prevent Kat’s symptoms at 21,000ft
- Dexamethasone is a corticosteroid which can be used to reverse the symptoms of acute mountain sickness, though it does not improve acclimatization. While in the mountains, I consider Dex a rescue drug: take in case of emergency, and descend immediately - which is how it was used on this climb
- Be aware that everyone's symptoms of altitude sickness are different. HAPE and HACE manifest themselves differently, and not everyone who develops HAPE or HACE may show all of the common symptoms. Both conditions are extremely serious with fatal consequences if left untreated
- HACE symptoms: severe headache, vomiting, slurred speech, confusion, unsteadiness, drowsiness and loss of consciousness
- HAPE symptoms: shortness of breath, headache, heart palpitations, difficulty walking uphill, cough potentially with frothy sputum tinged with blood, chest discomfort
Prior experiences with acute mountain sickness are the biggest predictor for future episodes; everyone’s ability to acclimatize and function at altitude is different, and seems to be largely driven by your DNA (Example: I have a super fit ultra-running friend who can run a hundred miler no problem, but develops acute mountain sickness as soon as he ascends above 10,000ft). There is only so much you can do in terms of acclimatization schedule, climbing strategy and emergency preparedness.
Even if you haven’t yet found your limits at altitude, be aware that they do exist - be it at 14,000ft or at 20,000ft or maybe even at the summit of Everest, who knows. But we all have a limit on how high we can go; if you find yours, make sure you and your team know how to respond - and get back down safely, quickly.