Vomiting at altitude

[ToolMann]

Diamox can make carbonated beverages taste gross.

So bring bourbon instead of beer. Check.

 

[Mighty Mouse]

My hunting partner has historically gotten pretty severe AMS (with vomiting) when we go from 1000' to 10,000' on our annual elk hunt. He tried Diamox last year and experienced no AMS symptoms. Diamox usually causes increased urination, so be intentional about staying hydrated and keeping electrolyte levels up while taking it.

 

[SonnyDay]

OP you asked about other side effects of Diamox.

@Mighty Mouse mentioned (above) the one I am most familiar with. As many have said, drink plenty of water, but your buddy should be prepared for more pissing!

I never experienced the tingly extremities, but other guys in my party did. It can also cause ringing of the ears or blurry vision. Both of those suck if you're trying to hunt! But as far as I know, are pretty rare. Your buddy should be able to get off Diamox within a day or two... so hopefully these side effects would also be short lived.

Diamox can also increase skin sensitivity to sunburn. So make sure he puts the sunscreen on.

It can also interact with other meds, like aspirin, diet pills, anti-depressants, heart meds and such. As far as I am aware, you can only get Diamox as a prescription... so just make sure he checks out any possible interactions with his doctor.

Hope the barfing is reduced and you have a great hunt!

 

[5MilesBack]

If I said we need to just hang out for 3 days while he acclimated, he would say no I will just puke and carry on.

Well there you go. Sounds like he's got it figured out.

 

[ChrisAU]

It may not be the altitude. Every now and then I end up launching as well during elk season. Don't know why, but it happens. Two years ago about a week into hunting we got up and I had my coffee while we were driving to a spot. I get out, throw my pack on, start launching for about a minute with some dry heaving.......wiped my mouth off and then off we went. Another year it happened some morning when I left the tent to pee. I'm standing there peeing and suddenly started launching. Drank my coffee and away we went. My take.......mornings suck.

Yeah thats gonna be from some poorly filtered water IMO

 

[ztc92]

I think some read a lot into this. That's the internet i guess. I understand that time is the way to prevent the problem. I was seeking things to recommend to my friend because he seems fine with puking every year and has never made an effort to stop it. The only hunt it ended was his. 3 of us were there, and only he had a tag. He popped smoke after having a very active day, puking, not being able to eat, and feeling that he could not continue to meet the demands of big stalks if he could not eat and felt sick. On other hunts, he has had a rough day in the first day or two, and then he recovers. We have done big trips together for years. If I said we need to just hang out for 3 days while he acclimated, he would say no I will just puke and carry on.

Thanks for the helpful advice.

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Lots of great advice in this thread so far regarding the main solutions (Planned acclimatization and/or Diamox) and it seems you have your answer regarding your friends attitude towards implementing them. That said, I’m hopeful a lesson in the dangers of being at high altitude for prolonged periods of time will benefit others following along. I’d also like to highlight the dangers associated with the attitude of “I’ll just puke and continue on” in hopes others will not follow in your partner’s footsteps.

For anyone who likes data/sources, what I write is based on my own medical education in family, sports and wilderness medicine, most specifically the Advanced Wilderness Life Support (AWLS) course put out by the Wilderness Medical Society (WMS). Another good source would be the National Outdoor Leadership School (NOLS), though I have not done any of their training yet. Both WMS and NOLS have a wealth of information on altitude medicine and I would encourage anyone curious to explore these resources and educate themselves.

Let’s start with what the major illnesses that can occur at altitude, which are:
- Acute Mountain Sickness (AMS)
- High Altitude Pulmonary Edema (HAPE)
- High Altitude Cerebral Edema (HACE)

AMS is generally characterized by headache, nausea and fatigue that occurs when someone gains too much altitude too quickly. In simple terms, their brain is making them feel unwell because it is not tolerating the abrupt increase in altitude and associated drop in oxygen. We can compensate to some degree for this decrease in oxygen by breathing faster (Hyperventilation) which occurs subconsciously. However, when we sleep, we naturally breathe slower and the compensation is less effective, which is why sleeping at altitude is worse than being at altitude while awake.

When someone develops symptoms of AMS, the ONLY cure is to descend or modify their environment to simulate descending using things like oxygen tanks and pressurized chambers, which are usually not available. Taking Diamox once symptoms develop will not help as it takes time (24-48 hours) for the medication to affect your physiology and help your body compensate.

If someone has AMS and ignores their symptoms, choosing to either remain at that altitude (especially if sleeping), or worse, continue ascending despite their symptoms, they run the risk of developing HACE or HAPE. In simple terms, their body is no longer able to compensate for the lack of oxygen and the strategies their body attempts to use as compensation can lead to large shifts in fluid from inside to outside their cells. This fluid shift is what causes the edema referenced in the names HACE/HAPE.

HAPE could be thought of as drowning in your bodies own fluid. If you’ve ever seen someone with heart failure and “fluid on their lungs”, HAPE would be a very similar experience. Lungs filled with fluid cannot absorb oxygen or transmit it to your blood and this leads to hypoxia (low oxygen) in your tissues, which will be fatal if it continues too long.

HACE is equally scary, as fluid shifts cause the brain to swell. Unfortunately, if the brain swells too much, because it is in a confined space (the skull) the only place for the brain tissue to go is out the foramen magnum, which is the large hole where your spinal cord exits your skull and enters your neck. This is called herniation and it is almost always fatal because the brain stem becomes squished into that hole (foramen magnum), which damages the respiratory center and causes breathing to stop, leading to death unless the person can be intubated and placed on a ventilator. This is why strokes and “brain bleeds” can be so deadly, as they increase pressure in the skull and lead to herniation.

In summary, I would personally refuse to hunt with someone who had the attitude of “I’ll just puke and keep going” because no hunt is worth risking your life over and I would not want to spend my hunt trying to save my partners life due to something that is 100% avoidable. Additionally, if you are concerned this could happen on a hunt you’re going on, your best chance of surviving HACE/HAPE is a rapid descent, which is best accomplished via helicopter, so I’d strongly recommend having a satellite beacon such as Garmin, Zoleo etc. to get evacuated quickly.

 

[Poser]

I experienced a mild case of HACE at 18,500 back in 99/2000. I was living a few hundred feet above sea level at the time and we rushed the summit day by a few days to take advantage of the weather. It was absolutely horrendous.

Even living at 6500 feet and spending 90% of weekends, long holiday weekends + ~3 weeks worth of vacation time above 10,000 feet hiking, backpacking, hunting, skiing etc. Even then, I start slowing down a bit at 11,500. I’m seldom above 13,000 feet, but did some 14ers this summer and was surprised by how much harder that extra 1,000 feet of elevation was.

 

[WoodBow]

I experienced a mild case of HACE at 18,500 back in 99/2000. I was living a few hundred feet above sea level at the time and we rushed the summit day by a few days to take advantage of the weather. It was absolutely horrendous.

Even living at 6500 feet and spending 90% of weekends, long holiday weekends + ~3 weeks worth of vacation time above 10,000 feet hiking, backpacking, hunting, skiing etc. Even then, I start slowing down a bit at 11,500. I’m seldom above 13,000 feet, but did some 14ers this summer and was surprised by how much harder that extra 1,000 feet of elevation was.

A guest on the valley to peak nutrition podcast recently said you lose about 3% of your work capacity per 1,000 feet of elevation. That seems about right in my experience. I am always frustrated by how poorly I feel I physically perform at high altitude even after a lot of prep and maintained fitness.

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[Mike 338]

I absolutely wrecked my 16yr old son last year. It was his first time going to the mountains hunting. We left home which is 1600ft at 6:00pm. Drove 12 hrs straight thru. Pulled up to the trail head, threw on our packs and hiked 3.5 mile in 1hr 15min at 9000ft. It was 4th season rifle in Colorado so it was fairly chilly. I think it was 11° when we left the vehicle. When we got back in there and were hunting he told me he didn't want to say anything but his head was pounding so bad he couldn't even think straight. He said he could feel his heartbeat in his forehead. He is a runner and his resting heartrate is 38-42bpm. His heartrate never got under 100bpm for over 8hrs. (He didn't tell me that until we were in the motel room that night.) So I stopped to give him some Ibuprofen and I strapped his pack to mine and we headed back to the truck. We didn't make it a quarter mile and the snow moved in and was so thick you couldn't see 100yds. After watching the snow blow and a headache he got BAD. The high temperature that day was the low 20's and he hiked that 3.5 miles back to the vehicle in nothing but a short sleeve t-shirt during a snow storm.

This year driving out a day and a half early to mess around and scout and make sure he gets good night sleep in a motel room before going hunting. Hopefully can truck camp after that. But will not think twice about going back into town and get a room if he isn't feeling good. I know you dont want to lose time from hunting. But give it extra time and I think you will be more productive from feeling better than the time you will lose from not wanting to lose time.

Smart...

Sounds like you've come to terms for what is a fairly straight forward answer to a situation.

 

[Grousehntr]

I hunt up to 10800. That is about the max where I start to feel light headed. Probably could get past that elevation with some time but haven't been able to make it yet

 

[5MilesBack]

Yeah thats gonna be from some poorly filtered water IMO

It wasn't the water. I always drink Arrowhead bottled water when I'm hunting. I'm a water snob......LOL. Unless I'm packing in, then I have to filter. It's weird though......it happens and then as soon as I'm done, I'm good. No intestinal issues with it, and I feel fine after it's done. It's only happened once per season.......a few times. Although it also happened one time up in BC on a fishing trip. But I am a nail biter and don't even know when I'm doing it. So I could be giving myself all kinds of stuff to make me sick out there.

 

[Marbles]

Lots of great advice in this thread so far regarding the main solutions (Planned acclimatization and/or Diamox) and it seems you have your answer regarding your friends attitude towards implementing them. That said, I’m hopeful a lesson in the dangers of being at high altitude for prolonged periods of time will benefit others following along. I’d also like to highlight the dangers associated with the attitude of “I’ll just puke and continue on” in hopes others will not follow in your partner’s footsteps.

For anyone who likes data/sources, what I write is based on my own medical education in family, sports and wilderness medicine, most specifically the Advanced Wilderness Life Support (AWLS) course put out by the Wilderness Medical Society (WMS). Another good source would be the National Outdoor Leadership School (NOLS), though I have not done any of their training yet. Both WMS and NOLS have a wealth of information on altitude medicine and I would encourage anyone curious to explore these resources and educate themselves.

Let’s start with what the major illnesses that can occur at altitude, which are:
- Acute Mountain Sickness (AMS)
- High Altitude Pulmonary Edema (HAPE)
- High Altitude Cerebral Edema (HACE)

AMS is generally characterized by headache, nausea and fatigue that occurs when someone gains too much altitude too quickly. In simple terms, their brain is making them feel unwell because it is not tolerating the abrupt increase in altitude and associated drop in oxygen. We can compensate to some degree for this decrease in oxygen by breathing faster (Hyperventilation) which occurs subconsciously. However, when we sleep, we naturally breathe slower and the compensation is less effective, which is why sleeping at altitude is worse than being at altitude while awake.

When someone develops symptoms of AMS, the ONLY cure is to descend or modify their environment to simulate descending using things like oxygen tanks and pressurized chambers, which are usually not available. Taking Diamox once symptoms develop will not help as it takes time (24-48 hours) for the medication to affect your physiology and help your body compensate.

If someone has AMS and ignores their symptoms, choosing to either remain at that altitude (especially if sleeping), or worse, continue ascending despite their symptoms, they run the risk of developing HACE or HAPE. In simple terms, their body is no longer able to compensate for the lack of oxygen and the strategies their body attempts to use as compensation can lead to large shifts in fluid from inside to outside their cells. This fluid shift is what causes the edema referenced in the names HACE/HAPE.

HAPE could be thought of as drowning in your bodies own fluid. If you’ve ever seen someone with heart failure and “fluid on their lungs”, HAPE would be a very similar experience. Lungs filled with fluid cannot absorb oxygen or transmit it to your blood and this leads to hypoxia (low oxygen) in your tissues, which will be fatal if it continues too long.

HACE is equally scary, as fluid shifts cause the brain to swell. Unfortunately, if the brain swells too much, because it is in a confined space (the skull) the only place for the brain tissue to go is out the foramen magnum, which is the large hole where your spinal cord exits your skull and enters your neck. This is called herniation and it is almost always fatal because the brain stem becomes squished into that hole (foramen magnum), which damages the respiratory center and causes breathing to stop, leading to death unless the person can be intubated and placed on a ventilator. This is why strokes and “brain bleeds” can be so deadly, as they increase pressure in the skull and lead to herniation.

In summary, I would personally refuse to hunt with someone who had the attitude of “I’ll just puke and keep going” because no hunt is worth risking your life over and I would not want to spend my hunt trying to save my partners life due to something that is 100% avoidable. Additionally, if you are concerned this could happen on a hunt you’re going on, your best chance of surviving HACE/HAPE is a rapid descent, which is best accomplished via helicopter, so I’d strongly recommend having a satellite beacon such as Garmin, Zoleo etc. to get evacuated quickly.

Nice write up.

 

[yfarm]

ztc92 excellent summary. This is not a tough it out situation, climbers die every year on Everest by ignoring or minimizing their symptoms. Get AMS descend. I live at sea level, drive straight thru to a little town in northern NM, sleep overnight at 6500 ft, drive in the next morning to the hunt location and sleep at 10,500 ft and hunt up to 11 without issues. Acclimation is the answer, whether he wants to hear it or not. As mentioned in a previous thread check the medical helicopter evacuation charges in the area you hunt.

 

[DanimalW]

You could always set up camp and hunt the first day or two while your buddy drives back to town to motel a night. That way you’re not losing out on hunting time and your buddy isn’t miserable.

 

[Swamp Fox]

When I was in Peru at 17,500, some compensated with tea made from coca leaves but that probably isn't an option in Colorado

From over here, I am getting the impression everything is an option in Colorado...

 

[TheHammer]

If gradual acclimation to altitude is not a reality. I would be dissecting his diet regimen to ensure it is as optimal and dialed as possible. I use mtn ops solitude. I take 1 tablet twice a day with meals 3 days before leaving. Drive the 18-26hrs to the destination and try to plan my arrival in the evening time so I can sleep around the 8,000’ mark. Then take my time getting up to 10+k. The half a day burned “acclimating” pays dividends to the body throughout the coarse of the hunt. I make sure I’m pounding electrolytes to limit any deficiencies, especially magnesium. I’m also snacking gradually throughout the day like I normally would to ensure my body isn’t to insufficient in anyway, to minimize any issues with that regard to adjusting aswell. I make sure I take a recovery supplement with my evening meal and sleep aid as well. Naproxen sodium / Alleve is known to help with some of the ailments. There’s some good information from Remi’s live wild cast with the wilderness athlete guys that a lot of us could learn some things from.

 

[Jon_G]

Jesus I can't believe I found this without even looking for it... So today I missed a pretty big hunt I was going to go on because last week I went backpacking in preparation for today and I went from sea level to about 7.5k feet and I felt like for no reason, we were booking it uphill very quickly to get to the lake. Well out of nowhere it hit me. I got nauseous and started seeing white lights kinda. Now, I know my body and I know it has something to do with my drinking as of the past 8 weeks or so, but I never though that what happened to me was a mix of both the drinking and going up to that elevation so quickly.

Today I didn't feel ready for my hunt so I didn't go. These are the moments where I'm so glad this forum exists. Thanks everyone for all the info.

 

[Phaseolus]

Not an option. We are backpacked in several miles.

If we were camping at truck we could drop elevation pretty quick, although it would be on real rough road.

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Not an option? A really bad case of AMS can result in death.

 

[ztc92]

Jesus I can't believe I found this without even looking for it... So today I missed a pretty big hunt I was going to go on because last week I went backpacking in preparation for today and I went from sea level to about 7.5k feet and I felt like for no reason, we were booking it uphill very quickly to get to the lake. Well out of nowhere it hit me. I got nauseous and started seeing white lights kinda. Now, I know my body and I know it has something to do with my drinking as of the past 8 weeks or so, but I never though that what happened to me was a mix of both the drinking and going up to that elevation so quickly.

Today I didn't feel ready for my hunt so I didn't go. These are the moments where I'm so glad this forum exists. Thanks everyone for all the info.

This raises another good point. Staying well hydrated with appropriate electrolytes (especially if exerting yourself and sweating) can play a big role in preventing AMS or at least making symptoms less severe.

Alcohol is a diuretic, meaning it causes you to urinate more and lose electrolytes in the process, which can worsen dehydration. Therefore, if you plan to exert yourself at altitude, stay hydrated and avoid alcohol to set yourself up for success.

 

[colby12]

Had this happen to me last year. 1300 feet followed by a 12 drive with a 5ish mile hike to 10k. Didn’t feel great after the first day, bailed the second for a night in town. While down there I bought some of those small o2 bottles. Sucked that down like candy when I went back up if I started feeling abnormal at all, seemed to help quite a bit.