Mt Whitney Zone Forums Trip Reports Kilimanjaro Trip Report (Jan. 8-17, 2012)

sounds like a really great adventure. And a testiment to proper planning and preparation making it an enjoyable experience. (and it sounds like your preparation with electrolytes probably made things better for a few of your group).

I can really relate to your comments about how people train other than doing climbing. One guy in our group of 7 was from Kansas and all he did was bike alot, no altitude or any real uphill or downhill hiking. He was mid 40s and 5 of us were 50-73 with one 32. Going downhill was the worst as he used a wooden hiking stick to control his descent and went at best 1/4 to 1/3rd mph. He actually got a jeep ride down the last part of the Mweka Route as the group had been waiting hrs for him to get down with his guide. He said : " I never prepared for downhill at all and using different muscles wiped me out completely."

We went up the Western Shira Plateau, spent 7 nights on the Mt and came down the Mweka Route. This was 1994 and I used Mt Madness when Scott Fischer was still alive. Whoever mentioned that their admin people were poor, I would go one step further and say they were the worst I have come across as they made alot of mailing mistakes and put out incorrect info to several of the 7 on the trip. I do not know what the company is like now as it has changed hands since my trip. The African tour group that Mt Madness used was Excellent.

I enjoyed your pictures as your route was very similar to the one we took as the routes merge after the 2nd day and then split off again above Lava Tower. We entered at Londorossi and passed Lava Camp, Arrow Camp and went through the Western Breach, camping in the inner crater at 18,800'.

We met Kyle, who was born with no arms or legs, on the mountain, a few minutes after he summited Kilimanjaro. Here is his story.

http://www.missionkilimanjaro.com/overview.html

Akichow, you mentioned taking frequent oximeter readings. In this thread http://www.whitneyzone.com/wz/ubbthreads.php/ubb/showflat/topic/1433/gonew/1 Harvey, Ken and George all discounted the use of the oximeter in predicting AMS and HAPE. How and why did you use the oximeter?

Brent N

The outfitter/lead guide organized nightly oximeter and pulse readings. The readings were not specifically "used" for anything per se while we were on the mountain(though I suppose if someone's readings had been really low, perhaps that would have informed action somehow). I found, personally, that that readings correlated with other indications of how well I was doing with altitude (e.g., the quality of sleep I would have that evening, likeliness of headaches, tendency to spaciness, etc.).

More than anything, it was the extremeley horrible, pulsating, frontal lobe headache that I experienced during a rest stop just as we were nearing our camp (at 16,300') the afternoon before our summit attempt that encouraged me to revisit my very low Diamox dosage (when hiking in the Sierras, I usually take about 1/4 to 1/8 of the "normal" dosage, specifically to address periodic breathing at night, which I do experience above 11,000 feet). I had never, either on Kili, or anywhere else, experienced such a headache before. I observed that, after I increased my Diamox dosage on Kilimanjaro, not only did I feel better, and not experience any further headaches (whether mild or pulsating), but my readings also improved substantially (91% 02, 62 resting pulse, at 16,300 feet, up from 74%, and a 105 resting pulse). I am not suggesting anything scientific, like direct cause and effect, of course, but just reporting an observation.

Congratulations on making it to the summit! I was on the mountain when you were! I summitted on January 10th. It is such an amazing adventure. We hiked via the Machame Route and used Good Earth Tours. I didn't take Diamox and did experience some AMS symtoms, but it didn't stop me. Thanks for sharing your pics!

Congrats to you too! Small world! Big mountain!

Karin, congratulations on your trip.
Some thoughts:

If the O2sat had stayed too low for many hours and unresponsive to rest and rehydration, then HAPE would have been the explanation.

Your relatively fast response at the rest stop (for how long? 1 hour?) suggests you had "desaturated" with overexertion at 16,000 ft, something that does not happen at sea level.

The fact that you improved all the way back up to 91% at 16,000 implies good acclimatization, in fact, really good, at least as far as that component of high altitude living is concerned.

The resolution of symptoms could have been some unknown combination of rest, rehydration, refueling, and the Diamox. Just curious, did you carry any steroids like Dex for emergency use?

Harvey

Hello. Yes, I did carry steriods (Dexamethasone). The lead guide also had steriods. I did not use them. Had the pulsating headache persisted, I would have given up on further climbing and possibly broken out the Dex--there was no ambiguity about the pain.

I want to emphasize that my biggest surprise and takeaway was how amazingly great I felt on summit day, all the way to 19,300' feet. I did not know it was possible to feel so great at such a high altitude. The relatively small issues I experienced were in the days before the summit, and I believe tied to a number of issues (Diamox dosage, GI issues/dehydration, acclimatization, etc.).

What occurred was little more complicated, with a few more factors, than what my prior postings conveyed. For those who are interested in the details of such things, here is some more context. For those who are not...please ignore!

The first time my 02 dropped during the trip into the 70s (i.e., 78% oxygen sat) was on Day 4, when we camped at around 15,000 feet. I was battling dehydration, caused by a bad GI reaction to water treatment used by the outfitter (PUR water treatment packets I think). That night I had a mild, diffuse headache (nothing scary), was a bit spacey (and aware of it), and did not sleep well. My appetite stayed high,though. I rebounded by (1) doing my own water treatment from then on (Steripen), (2) taking a single dose of Immodium,(3) swigging water and electrolytes like there was no tomorrow, (4) taking a pre-dinner acclimatization hike up to Arrow Camp before sleeping on Day 4, and finally (5) having the benefit of a good acclimatization route, as on Day 5, we went back down and slept at 13,000. So by day 5, I was back in the 90s.

Then we went up to 16,300' (Crossover Camp) on Day 6. I did not take Diamox that morning when we left 13,000'(a mistake, I came to believe). I was fine for most of the hike up to our lunch stop, except as we got close to our lunch stop at Barafu Camp (15,400'), I started getting mild headaches whenever we stopped moving for rest breaks. I could manage the headaches to a tolerable level by staying in motion while everyone rested, and doing some pressure breathing. After our lunch break at Barafu Camp, though, I ran into trouble. We had another 800-900 feet or so to get to Crossover Camp. As we got close to our destination, we had a small scramble, and then a short rest, and during the rest, my head exploded into a pulsating, frontal lobe headache. Moving slowly and pressure breathing helped, but it was still scary. When we started climbing again, the headache subsided. When we got to Crossover Camp, everyone else got into their tents for a nap. I just circled the campsite slowly for an hour, not wanting to stop moving right away. The headache did not come back, but I did feel a little spacey, and was back in the 70s (74%) at dinner when we were tested. My appetite remained good. Everyone else was in the 80s or 90s, and everyone else was taking full doses of Diamox.

That night, which was the night before our summit, I took 62.5 mg before going to sleep, and but experienced periodic breathing. So, at midnight, I decided to up my Diamox dosage, and took another 62.5 mg, which did solve the periodic breathing problem. After talking with the guide in the morning, I took another 62.5 six hours later (i.e., 6:30 a.m.), and another 62.5 mg after lunch (12:30 p.m.). I had no more headaches. I felt great going up to the summit. I literally danced at several points on the trail I felt so great. I had a good appetite for lunch at 19,000 feet. I was astounded by how good you could feel at 19,300 feet. Except for not wanting to run fast, I felt 100 percent the entire day. That night, my numbers reflected how good I felt...I was back in the 90s, and my pulse was way low.

I have some thoughts about what was going on here, but I am not a scientist or a doctor. What I think I will do in the future, based on my own experience, is continue with my low dosage of Diamox at sleeping altitudes below 13,000 feet (i.e., 62.5 mg once a day before sleep), but increase my dosage when sleeping above 13,000 feet (to 62.5 mg twice a day). This is what seems to work for me, based on my gender, weight, genetics, physiology, serendipity, what-have-you....

This is a great report. Thanks.

It points up some of the multiple factors that make analysis so difficult. Are the symptoms just plain AMS, or are they complicated by dehydration, or GI issues, or fatigue, or etc? Diamox is used as both a (partial) preventative as well as a (partial) therapeutic for AMS. The exact dose and timing is not so clear, not the same from individual to individual, not even within the same individual from trip to trip. This makes the science often turn into guesswork and lots of personal opinions.

One interesting point was that you recognized the need to move around as opposed to lying still at the rest stop. "Keeping the juices stirred" a modest amount is talked about, although there is not much scientific data on this. One breathes more (relative hyperventilation) while walking around a bit as opposed to the slower breathing (relative hypoventilation) while lying down and resting. The key is how much - just a bit, enough to help, but not too much which would further worsen the issue. Furthermore, if there is any fluid in the lung from very early HAPE, it is better to be upright.

Glad you seem to have a handle on what helps you. Hope you have success on the next adventure.

So you hit the nail on the head re my untrained thinking/analysis of the rest stops. I am not aware of the literature/debate you reference. But, on the mountain, it just seemed to me that I needed to keep the rate of respiration up, and that walking and moving (even slowly) did that, and it provided immediate relief.

By the way, I am curious about your mention of HAPE. Every once in a while, I would take a really deep breath to see how my lungs were functioning. Everything seemed normal to me...no noises, lots of volume. And my energy level and strength stayed very high -- notwithstanding my numbers, I had more energy than anyone in our group for most of the trip. The pulsing headache made me worry more about AMS/HACE than HAPE...am I missing something?

BTW, I did hear about two instances of HAPE in a different group that went up the Marangu route around the time we at Crossover Camp. And I saw an incident of HACE at the summit. And a woman in a litter at Barafu camp being carried down who had recently had Lasik (!!!) and went blind at altitude -when I had Lasik years ago, I was told to avoid pressure-changing recreation (diving, climbing) for 6 months.

Not sure I can find a reference for you - but both anecdotally and in some trekkier advice on AMS a mild form of activity is often preferred rather than being too sedentary. If someone like you who has a history of altered ventilation such as periodic breathing of high altitude, then it makes sense to stay awake and consciously breathe more when there are problems. The fact that you successfully raised the O2Sat means that is exactly what you did and did not have HAPE.

Headache can be a prominent part of AMS, or AMS complicated by either or both HAPE or HACE. Some say there is is a headache continuum from simple AMS all the way to HACE/Death.
Sorry to end on that note.

edit: one more thought.
We all take breathing for granted. But at high altitude, especially while acclimatizing, our oxygen receptors, carbon dioxide receptors, and brain's control of breathing is out of sync. That is the only thing going for us while we sleep (hence periodic breathing at night) and similarly at rest and awake. With exertion and VOLUNTARY hyperventilation, we consciously increase our ventilation, a very useful way to stay alive up high. We do it all the time even at sea level. Just think how many times we have run up steps. Do we wait for a minute or 2 and the O2 and CO2 to change in our blood and our brain to stimulate more breathing? No, any athlete knows to begin breathing now. Same thing on the mountain. For example, leaning over get dressed in the tent at 19,000 ft - you know to start consciously breathing harder just to tie your shoes. In your case, with the degree of O2 desaturation, fatigue ,and whatever else was going on, it took more than a few minutes to resolve. I can remember a time when I was coming down from 19,800 to 16.500 ft and the degree of work caused me to desaturate even though I had been at altitude for 2 weeks already. It took an hour for my O2sat to come up and my heart rate to settle down.

Great job. Congratulations. Stunning pictures of Africa and it's wildlife.

In 2002 my son Bruce and I traveled to Africa to climb this mountain. We had a fine time, up to when several of us contracted food poisoning. The others recovered enough to be able to summit, but I had to turn back early on the climb. I gave my camera to Bruce and told him to make me proud. He did.

I gave it a shot again last year and, overcoming a different medical issue, succeeded. Of course, I had my camera along.

A 16" x 20" version of this picture hangs on my wall, and his:

Bruce looks cold, while Bob appears as comfortable on the peak as he ever was.