Mt. Whitney Portal Store & Hostel Forums General Mt. Whitney Portal Store Message Board Trying to understand what happened to me

Steve - I'm curious about the sleep aids, because I too suffer from insomnia particularly the night before a hike. I was under the impression that sleep aids tend to depress breathing while sleeping. It is for this reason that I have never taken them. Am I wrong in my assumption?

Depends what you take. Melatonin works for me, at least to help me fall asleep, and from what I have read, does not depress respiration. I have also read that Benadryl may be okay at altitude, though I am skeptical and have not tried it.

In case this is helpful, my newest and best routine now involves my iPhone and music. My insomnia on a backpacking trip is so bad that I stress about the insomnia, which only makes it worse. The iPhone helps me not stress about the insomnia, and I find I can actually go back to sleep.

Also, if altitude-related sleep apnea is causing your sleep issues, diamox may be the ticket.

Speaking of fluids (and as someone who is at risk for hypokalemia when I hike at altitude), the large amount you sweated could support an electrolyte imbalance, while the small amount you peed might undercut it as an explanation. Hypokalemia is a different form of imbalance that involves potassium rather than sodium, and something I have learned to monitor based on prior experience (though nothing as terrifying as what you describe).

Good luck with you MD appt.

Akichow - that ipod idea sounds brilliant to me....don't know why I never thought of it. I actually have some of those delta sleep system mp3's, that I use at home when I get insomnia. I need to give that a try.

Something that occurred to me in the night was the amount of ibuprofen you took. Did you take eight all at once on two occasions? I sometimes take three in a dire situation but I am 6'2" and weight around 200#. Even under doctors orders, when I was having an unbreakable high fever, I was never told to take more than three every four hours.

Morning Dharma...

Incredible story and an amazing amount of information from all of the other members. Glad you are alive and able to speak about it.
I am wondering if Hyponatremia coupled with AMS and the other issues you were experiencing could have contributed to your mental state. I have been experiencing cramps in my calves for the first time in nearly 30 years of backpacking and climbing and thought I was not hydrating enough. Turns out I was hydrating too much without any salt intake and creating the situation I found myself in. Maybe one of the docs could go comment more on this subject. In any case, glad you are well...

K...

Dharma, out of curiosity what did you eat that day and was it still in its original package?

Wow that is quite a story Dharma. To say you were having an "off" day is an understatement. I'm glad that you made it off the mountain and then made it home safely. I've been hiking with very little sleep these days, and I drink a LOT of water as well. My worst symptoms to date have been headaches that won't go away. After reading your story, I'm definately going to pay more attention to electrolytes. Thank you for sharing. I hope you don't have any more experiences like that.

Good morning Dharma,

Glad to hear you realized that you needed to descend and that you made it safely off of the mountain.

Realizing that you need to descend is not as easy as it may seem, as demonstrated by my experience Saturday (Sept 22).

(sorry for the novel below)
On the switchbacks, my hiking partner (Dave) and I ran into a lady hiking solo. We played leapfrog with her for a bit until we started talking. She seemed to be a bit odd to me, but not knowing her, I didn't know if that was just the way she was, or if it was something else. One thing that I noticed is that she'd go flying by us like she wasn't working hard at all, then five mins later I'd see her nearly passed out, sitting on a rock. I tried telling her that she was better off going slow and steady instead taking long breaks after sprinting up the trail. She said she needed to sprint b/c her group was waiting for her.
When I got to trailcrest, Dave was talking to her at the top. I noticed that she looked really cold - shivering a little. I told her that if she was that cold, she might want to consider heading down, as it probably wouldn't be warmer headed towards the summit. Dave and I regrouped, took a bunch of pictures and headed towards the summit. On the way to the summit, I asked Dave about the lady and told him I hoped she turned around and headed back down. When talking to her, Dave said that she repeatedly answered his questions with 'It's just the altitude.... I'm in great shape, not winded, it's just the altitude.' At that point, I started thinking that I should've spent more time talking to her and really encouraged her to head down.
Dave and I spent 30 mins on the summit and started the trip back to the Portal. About a mile from the summit, we ran into the lady. She was with a friend now, but was vomiting and was using an emergency blanket to stay warm. She had made it to the summit (yesterday I realized she's in one of my pics). I hiked with the two of them for the next hour or so. At some point, we were joined by 2 others that were in her group.
Talking to one of them, I learned that the lady started vomiting near Outpost Camp. Two of the people in the group had just met her the night before (not sure how she knew the other person in the group). One of the guys gave her the keys to his car at Outpost and told her to head down and meet them that night after the hike. Apparently the lady slept at outpost for 20 mins and headed up the mountain.
When the trail started heading uphill (near the JMT junction), the lady was stopping every 50-100 ft to rest. One of the group members tried to take her pack, but she refused b/c 'she needed her water.' I was able to get her to give up her pack by saying 'Your water isn't doing you any good. You're puking all of it up, and the weight is slowing you down. The most important this is getting off the mtn right now.'
Talking to the group, I learned that they had friends at Trail Camp and that their plan was to leave her there overnight so that she could hike out on her own in the morning. At that point, I may have gotten a little rude, but starting explaining that she could have AMS, which could 'turn into' HACE and/or HAPE and that is she goes to sleep at Trail Camp, she may not wake up in the morning. Soon after that, I was asked if I was actually a Dr (I'm not). Not sure if they were question the validity of my statements or what...

When we got to the Portal around 930 pm, a sheriff told us that the lady had made it off the mountain and was doing ok.



Based on my experience above, I wonder if this is necessarily true. I feel like I should've noticed she was having AMS symptoms, but not knowing her made this more difficult I think.

Anyway, this entire experience has reinforced my feelings about only taking people you've hiked with on trips like this and the importance of taking responsibility for those in your group. Someone should have stayed with her at Outpost and ensured that she headed down the mountain and not up.

dharma, I have no clue what hit you on the mountain, but your description reminded me of a trip report I read a couple of years ago by wazzu. The guy she ran across on the trail seems to exhibit very similar symptoms to what you experienced. Wazzu's September, 2010 TR is copied below (couldn't get the link to work). It's long but interesting. Glad you made it down safely and hope you get this figured out.

"The short TR -- After leaving the portal at 9:45pm on Wed 9/22 for a day hike (my permit was for Thurs 9/23), got as far as the Whitney Zone sign at 11:30pm, when a severe gastro-intestinal event made me decide to return to the portal. The complete story is below. The overall theme might be "Life is what happens while you are making other plans." Be warned, it's fairly legthy and I tried to not use too much graphic detail regarding my gastro-intestinal disorder.

I had been staying at Horseshoe Meadow Sun-Wed to acclimate. Had a great time and will write up a separate TR. Moved over to the portal on Wed 9/22. Arrived at the store at exactly 11am, and it was too late for breakfast, thus no Mt Pancake. (11 is the change to the lunch/dinner menu) Had the BLT with fries, and had water from my water bottle. Set up my tent in the backpacker area. Scored a great parking spot close to the bear lockers and camp area, not too far from the TH. Even found an almost empty bear locker next to the car. Things were looking good, as far as logistics.

Walked around the portal, chatted with a few folks, decided to go lay down and take a nap around 3pm as I was still planning on getting a 10pm start up the trail. My water bottle was empty and I attempted to use the water faucet in the backpacker camp to re-fill. The water was brown. Ugh!! Went up and used the faucet near the toilets. (This may have contributed to the GI event later in the evening)

Manged to get some shut eye, although had to get up a few times to use the restroom, but I attributed to nerves and keeping myself well hydrated. Hind sight being 20-20, this was a indication something was not right. I had my alarm set for 9pm to get up and get moving. Well, no need for the alarm, as the camp area got really busy a little after 8pm. Some coming in and setting up, others returning from hiking and breaking camp. I decided to join the neighbors and got up, dressed, ate, and packed up my gear. I was debating weather to pack up everything and put it in the car or leave up in case I needed to use at the end of my day hike. Again, looking back, should have left the gear up. But at the time, I decided I would not want to be packing gear after a 16-17 hr day, and I had a reservation at the hostel for Thurs. At the end of my long day, all I would need to do after my burger and beer, would put my pack in the car and head down to Lone Pine.

Started up the trail at 9:45pm. Couldn't ask for a more perfect evening. Huge harvest moon out and bright as could be. Almost no breeze, temps had to be in the low 40's. Just cool enough to be glad I had the long underware, but did not need the fleece hat or gloves. Saw a few of the last day hikers coming down. One couple were in pretty good shape, they just left too late in the day. Took them 16 hrs, 9hrs up and 7hrs down. Meet a few others close to the TH, but the most notable encounter was a guy named Mike.

Mike was coming down after starting at 4:30am with his brother Dave. (Mike looked like mid to late 20 something healthy looking guy) We met about a mile or so before Lone Pine Lake. He made it up some of the switchbacks, but got wiped out and turned around. He was hanging out at Trail Camp waiting for his brother, Dave. Dave apperantly continued up to the summit. Mike waited at trail camp for hours, but the cold got too him, as there was a little bit of snow on Wed afternoon. Mike said he had not seen any other up-hill hikers for hours. He asked that if I see his brother Dave, to let Dave know that he went back to camp. He did not seem too worried about Dave. I didn't think too much of it. But if I saw any other downhill hikers, would ask if he had a brother name Mike, and pass on the message.

Continued on up and was really enjoying the hike. I had a good pace going, for me, the weather was perfect, everything I hoped for back in Feb when I dropped the lottery application in the mail. Looked out at the lights of Lone Pine, saw campfires down in the portal and campgrounds, had the trail to myself, the moon lighting up the granite walls, what could be more perfect?

Made it to the Whitney Zone sign, just past LPL at 11:30pm. Since technically I shouldn't be in the Whitney Zone until midnight, this was a good time/place to take a break and have a bite to eat. I had a bagel with some peanut butter, and was nibbling and looking around and tuning into all the sights and sounds. Just trying to be aware of any bears or other varmits that might want me to share my midnight munchie. I noticed a headlight comming down. I wondered if this could be Dave. The hiker was a above me, but I could see the headlight slowly moving downhill. That's about when I suddenly felt the need to use the wag bag. In fact it was a very urgent need. I was trying to get the damn wag bag out and opened when I realized it was either leave a mess in my pants or leave a mess on the rocks. I really do apologize for the mess on the rocks I left, but it was a very sudden 'event'. After that was over, I was doubled over with cramps.

I was sitting on another rock near the sign, wondering if this will pass, should I wait it out, get up and get moving uphill to work it out, or head down? I really didn't want to head down. The weather was great, I had trained, planned, was prepared, and most of all, I really, really, wanted to get to the summit. I was sitting weighing my options when the headlight I had noticed coming downhill was very close. He was stopping and looking very close at some of the large boulders and putting his face about an inch from the boulders. I was thinking he might be having trouble seeing and was trying to gauge the shape of the boulders so he could walk around them. I asked if he was ok or needed help. He didn't respond. He was getting closer to me. I asked if his name was Dave. Still no response, but he was getting closer and about 15 feet away when I asked if he had a brother named Mike. He finally responded, 'yeah, Mike's my brother.' I mentioned I had passed Mike and he was going back to camp.

That was the start of a very interesting conversation, to say the least. It was getting close to midnight and he had been on the trail since 4:30am. That's 19.5 hrs of hiking, plus the time he was up before the hike. Anyway he made the summit, but admitted he was more determined to make the summit than his physical condition should have allowed. Anyway, after chatting a while, I asked if he was having trouble seeing as it looked like he couldn't see the rocks and was using his hands to feel his way around. Dave's response was, 'I think I'm halucinating. I thought I saw people in the rocks. I wanted to see if I could touch them and get a closer look.' I asked him if the people were moving or talking to him. No, they were not talking to him, but sometimes they were moving in the rocks. In fact he wasn't sure if I was real or another delusion.

I asked about the last time he ate or had some water. He had water and powerade, and was drinking, but really wasn't interested in food. I rattled off my food supply in case something might be of interest to him. He said he just really wanted to get down. This is the moment when my next wave of intestinal cramps started and I almost vomited. The guy that is exhausted and halucinating is now asking me if I'm ok. All I could think of 'what kind of scene is this? Full moon, midnight, a little under 10k in elevation, 2 people not in the best physical condition and 2.5 miles from any type of help'.
That's when I decided to head back to the portal. I asked Dave if he would mind if I hiked with him. He seemed to welcome the offer and so off we went.

Looking at Dave's condition, it made me realize what it really meant to be hiking by myself and really needing some help, how long it could be before someone came by, and how much I could be crushing someone's dream if they needed to walk me down the trail or go get help for me. If I was feeling 100% I'm not sure I would have taken the time to talk to Dave or notice his condition. I probably would have passed on the message from Mike and continued on up the trail.

It was a very slow trip down to the portal (took me 1:45 to hike up and 2:00 to for us to hike down). Many stops, quite a few times Dave asking me if I saw the people in the rocks. Had to let him know they were halucinations. We had to go very slow over the log crossing as he was having trouble with the width of the logs. He had to use his hiking poles to 'feel' the width. I did get concerened at the water crossings. He couldn't perceive the water. He thought the ground was dry and was going to walk right through the water. It took a minute or two to convince him there was water on the trail and to walk on the rocks. I checked his boots after he crossed to make sure his feet weren't soaked. When we got back to the portal he didn't realize we were at the end. He didn't recognize the 'wood thingy' (stolen from another thread) structure.

I asked him where his camp was. He and his brothers were staying at one of the family campgrounds. I offered to drive him down. He was coherent enough to realize that he would need his car in the morning and either he or one of his brothers would have to hike up if he left it up near the TH. I suggested letting if go for the night and figure it out when he got up. He was going to drive himself down, if he could remember where he parked the car. Buy now I'm actually starting to feel better and starting to think if I could get this guy to a safe place, I might try to get to trail camp, because at this point I'm pretty sure the summit is out to the question. After a brief discussion, we came to an agreement, I'll drive him down to his camp in his car and he'll get one of his brothers to drive me back up. (I met Mike on the trail; he has another brother Adam, who did not go up the trail)

It took a few attempts to find the right camp, and if anyone was woken up around 2:30am as we drove around trying to find the right camp site, I'm sorry. Anyway, the campsite was in the 3rd campground from the portal in sight #43. So, if any of you were neighbors to Dave, Mike and Adam from San Diego and we woke you up, sorry for the disturbance. I will say it was another weird experience listening to how these 3 guys interacted with each other. The 2 brothers were asleep when we drove up. Neither wanted to get out of the tent to check on Dave, and neither seemed all that concerened that he was hallucinating. Maybe I was too concerned over a person that I did not know, but I would always be wondering if he did get in an accident and hurt himself or hurt someone else, should I have done more.

Mike eventually came out of the tent and drove me back to the portal. I was thinking I might be able to find a group or someone else to hike with for a little while as more people were starting their dayhiking adventure. As I started to walk up to the 'wood thingy' I felt the sudden need to use the toilet. I ran back across the road and made it just in time. This was the worst 'gastro-intestinal' episode of the night. After this episode, I realize that I had completed my hiking for the day. Physically, I was done. I'm not sure what is going on with my gut, but it's not something I wanted to deal with while trying to even hike up to Outpost camp."

Just got back from the doctor, and I must say, I am amazed. I had a CT scan, which was completely normal. Initial neurological exam was normal. Blood work showed completely normal except for sodium which was only very, very slightly low, (134). The doctor said he is fairly certain I didn't have hyponatremia, but it is possible that I might have had a mild case, but a mild case would not cause the severity of symptoms that I had. He felt that the amount of water was ok (he knows my background) but thinks in the future, that I should pay more attention to sodium, as the amount that I sweat will cause me to lose more than the average person. He also said that Cytomax, (by the way, I diluted it too much) had lower sodium levels than some other drinks. He doesn't think I had HACE, although he feels altitude was a definite contributing factor.

So...here is what happened, (Ken I hope you read this)
The initial diagnosis is basilar type migraine (sometimes called basilar artery migraine) complicated by other factors. He asked everything I ate, (see below) and noted that there were several migraine triggers in my diet. He also said this particular type of migraine is made worse by exercise, and that he has read cases where altitude, although not the culprit, can make a migraine have symptoms that are much more severe than typical. What is really scary is that he said that this particular type of migraine commonly causes people to lose consciousness, so I guess I was lucky. He also noted, interestingly enough, the fact that I felt really, really good before it happened. He said that it is not uncommon to have a "euphoric" feeling before a severe basilar migraine, although they don't know why. He said that it's highly unusual to feel that good without a wink of sleep, so he thinks I went through a euphoric stage. He also said that my symptoms followed certain other stages, which is why I stopped hallucinating rather quickly, yet still had the horrific headache, (which actually got worse as I descended). He said this is typical.

Note to Ken - I handed the doctor a printout of everything everyone had written, and when he got to your comments, he said "yes!" out loud. He was impressed that you reached this conclusion without really knowing my medical history or where the pain was in my head, and asked what type of doctor you are. He said the fact that I had pain in the back of my head and neck was significant.

A couple of important things to note (just in case anyone here experiences migraines) is the lack of sleep. He said he felt that was the singular biggest contributing factor to the severity, and is a major trigger, and I got quite a talking to for embarking on a hike at altitude with no sleep. Evidently, while this type of migraine can produce severe symptoms (including hallucinations) and be frightening, he doesn't feel I was in any danger, and in fact, he said I should have gone to sleep, which would have probably caused it to subside within a matter of hours. The fact that I descended, actually made it worse, as physical activity always aggravates it. With that said, he stated that without knowing what it was, it made sense to descend (always having to assume altitude first).

He also said typical migraine medications are never given for this type of migraine, (although I failed to ask why), and that it's entirely possible this was a one-time thing. He did say that when hiking in the future, I should never go alone, should make sure I get enough sleep and stay away from trigger foods, and should pay special attention to the sequence of events, (particularly the euphoria feeling) to help me recognize the difference between altitude symptoms, (which generally come on slowly and get worse) and this type of migraine, which occurs suddenly. He also suggested extra acclimatization days, as altitude without adequate acclimatization is a stressor on your body, and therefore, a trigger and an aggravating factor. I have a follow up appointment with a neurologist for further follow up.

To answer some of the questions that have been asked:

Ibuprofen - I took 2 at 9am, (to be proactive about knee swelling), 2 half way up (around noon), (when I had twinges of knee pain). I then took 4 when I awoke with the severe headache (around 5pm). Upon descending, I took another 4, when the headache was at it's worse (around 8pm), which I promptly threw up, so then took another 4 to replace what I had thrown up. The doctor said while I took a lot of Ibuprofen, he didn't think it was a factor.

Food -
Breakfast:
2 eggs (migraine trigger)
hashbrowns
2 full pieces of toast
1 slice of bacon (migraine trigger)
1/2 cup coffee at 4am, and 1 cup at 10am (migraine trigger)
Snacks:
Honey stinger vanilla waffle
Fritos
Dehydrated fruit (pineapple and mangoes)
Dinner:
1/2 Mountain House Pasta Primavera, (I always only eat 1/2 of a 2 person portion)
6 Wheat crackers
Cup of Hot Cocoa (migraine trigger)

In all honesty, the migraines I experienced in the past had diminished so much over the last couple of years, that I thought I was done with them. I had also never experienced this type of migraine before. It almost feels kinda silly thinking that all this drama was caused by a migraine, but the doctor explained that this is not the typical migraine, and I was just lucky I didn't lose consciousness, (as some people do).

I want to thank everyone for all of their input. Although the doctor doesn't think I had hyponatremia, the information you provided sparked a conversation with the doctor who did make suggestions for better salt balance. I have learned a lot through this process, and feel much less frightened about what happened. I have a much better understanding of what I need to do in the future, and hopefully, will have a better time next time I go.

Bulldog34 - wow...that certainly is scary, and while I would never wish it on anyone else, in a weird sort of way, it makes me feel better that I am not the only one. Hallucinations are the scariest things I have ever experienced.

How admirable of wazzu to look after that gentleman. I hope he ended up ok.

Glad all is well

Ken gets the big gold star, diagnosis from afar.

Old saying in medicine:

It is more common for a common disease (migraine) to present in an uncommon way than for an uncommon disease (HACE on Whitney) to present in its common fashion

So true....and big kudos to Ken, as well as thanks to everyone.

One thing the doctor mentioned, (and he prefaced it by saying he was not a high altitude specialist, but he had been to high altitudes before) was that the first thing that made him think it was not HACE, was the fact that I remembered everything in such vivid detail. He said typically, if your brain is swollen to the point of those symptoms, you remember nothing afterwards. Whereas, in the case of neurological symptoms from a migraine, you can remember everything.

Very big thanks to everyone, (and especially Ken) for helping me understand this. My biggest fear was that I would never be able to go to altitude again, which is clearly not the case.

I also have to give thanks to my doctor, who spent an extraordinary amount of time with me, explaining everything. He really went above and beyond.

dharma, as I read your story it brought back memories of my adventure with Dave. Based on the comments from your Dr. I think Dave's hallucinations were from exhaustion. When I got him back to his camp, one of his brothers mentioned Dave had been up for 23 hours. I have no idea whatever became of Dave. I left him in the care of his 2 brothers, and he had crawled into a tent to sleep.

I very glad to hear you are ok and will venture back on the trail someday. And thank you for sharing your story as others may learn form it.

Dharma, Wow - what an experience. Glad you are still with us and that everything checked out ok at the docs.

I always wanted to post this link to a Dr. Hackett interview, but thought his comment about dehydration and brain swelling might be taken out of context. I find it an intresting notion and would like to find out more about it. Maybe Harvey can bring it up when they meet. It's about half way down in the text.

http://www.pbs.org/wgbh/nova/everest/exposure/hackett.html


John

Although dharma apparently did not have HACE, the mystery of her case (and pattywatty case) seems to have struck a cord of interest by many of us here. I'll followup on this comment:


John, he did not have time to elaborate in that interview that the corpus callosum and white matter instead of gray matter of the brain are more susceptible to fluid swelling. We know this now because of his pioneering work and the miracle of modern imaging techniques. He also mentioned spinal fluid. It just so happens to be true that Diamox acts on electrolytes, is a diuretic, and reduces spinal fluid production!

I leave on the 600am train to DC tomorrow and really look forward to hearing Dr Hackett speak. On the other hand, the old Brits of the 1920s had it figured out. Here is none other than George Mallory about the brain at high altitude:

Mountaineers have often observed a lack of clarity in their mental state at high altitudes; it is difficult for the stupid mind to observe how stupid it is.
George Mallory, Chapters IV-VI, X-XI in
Bruce, CG, The Assault on Mount Everest 1922, page 129

Dharma, I'm so glad to hear that the news is good, and the future looks bright.

I'm impressed by the thoroughness of the visit with your doc...that is not often the case. Hang onto that one.

Ken - I was impressed with his thoroughness also. He seemed fascinated in what had happened, and was impressed with your diagnostic abilities. And believe it or not, this is a Kaiser Permanente doctor. I know Kaiser gets a bad rap, but my husband and I have had nothing but positive experiences. Thanks again for your assistance and expert advice.

Harvey - Am I to understand that a certain amount of dehydration is a good thing? I have struggled with dehydration in the past. For instance, although I drank 2 1/2 liters of water and 1 liter of a Gatorade-type drink when doing the ski hut route on Mt. Baldy, I failed to urinate all day until several hours after arriving back home. My doctor seemed very concerned with this, although he does admit, he's not a high altitude specialist. I'm confused about how much I should be drinking when hiking at altitude.

Hey Harvey, you are so modest. I was interested that, right from the start, you suspected this was not HACE. I had assumed, from my own, nonmedical first read through, that it might be, partly because, in addition to the headache, disorientation, and other mental effects, it sounded like she might have been wobbly and ataxic. At least that is the image I got in mind as I read.

I was wondering about the location of the headache, which I don't think was mentioned in the original post (although it is addressed in this last one). Is it correct that HACE often is localized and frontal lobe? I am not sure where I picked that up. My single bout with AMS on Kili was both those things...intense pain in frontal lobe...the type that makes you hold you forehead in your hands...something i often see among day hikers at Trail Camp. The larger question is, is headache location significant in attempting to winnow down possibilities and make a diagnosis?

Yes, I am impressed with both Ken and Harvey, and how willing they are to help and try to make sense of things.

I don't know if the location of the headache indicates something other than HACE, but I know it was significant from the perspective of what type of migraine it was. My doctor said most migraines are one side of the head, and it is unusual to have one at the base of the skull, (with weird sensory changes in the neck as well). I don't think I mentioned that in the original post, but with so much going on, I was trying to keep myself from writing a novel.