The Altitude Experience: Successful Trekking and Climbing Above 8,000 Feet

Table of Contents

Acknowledgments     xv
Introduction     1
How to Use This Book     2
For the Non-Scientist     3
For the Scientist     4
Recommended Reading     4
The Altitude Challenge     7
Human Responses to Altitude     8
You Are a Unique Individual     9
How High Is "High Altitude"?     9
The Air, the Body, and Oxygen     13
Altitude and Atmospheric Pressure     14
Biological Differences     15
The Quest for Oxygen     19
Respiratory System     19
Mechanics of Ventilation     22
The Control of Breathing at Low Altitude     23
The Control of Breathing at High Altitude     24
Cardiovascular System     26
The Structure and Function of the Heart     27
The Flow of Blood through the Body     28
Blood Pressure, Heart Rate, and Cardiac Output     28
Blood     29
Transport of Oxygen and Carbon Dioxide     29
Carbon Dioxide Transport     29
Oxygen Transport     31
The Oxygen Cascade     33
The Cascade at Sea Level and at Rest     35
TheOxygen Cascade at Altitude     37
The Effect of Exercise at Low and High Altitudes     37
Increasing Oxygen Delivery to the Tissues at Altitude     39
The Biology of Exercise     47
Skeletal System     47
Muscles     48
Types of Muscle Fibers     48
Muscle Control and Strength     49
Arrangement of Muscles, Muscle Actions, and Types of Contractions     49
Concepts of Exercise Physiology     51
Limits to Performance     51
Factors That Determine Performance     52
Maximum Oxygen Uptake and Muscle Limitation     54
Oxygen Supply to Other Organs     56
Muscle Fatigue     56
The Brain     56
Biomechanics and Economy of Movement     57
Lactic Acid and Performance     58
So, What Really Limits Performance?     59
Fatigue, Will, and Performance     60
Direct Environmental Stresses     61
Physiological Stresses     61
Indirect Psychological Stresses     62
Will and Motivation     65
Acclimatization     71
Factors Affecting Acclimatization     73
Changes That Occur during Acclimatization      75
Acclimatization versus Deterioration above 5,500 m     76
How Quickly Do You Deacclimatize after Return to Lower Altitudes?     77
Age and Sex     77
Sex     77
Older Travelers     78
Children     80
Acclimatization Strategies     80
Preacclimatization     81
Practical Advice     83
Specific Situations     84
Day Hikes/Climbs     84
Overnight Backpacking Trips     85
Trekking     85
Climbing Expeditions     86
Drugs as Aids to Acclimatization and Performance     88
Altitude Illness     91
Encountering Illness at Altitude     93
Physicians at Altitude     93
A General Approach to the Potentially III     94
Primary Symptoms of Altitude Illness     95
Prevalence of Altitude Illness     95
Risk Factors for Altitude Illness     96
Acute Mountain Sickness (AMS)     96
High-Altitude Cerebral Edema (HACE)     97
High-Altitude Pulmonary Edema (HAPE)     97
High-Altitude Retinal Hemorrhage (High-Altitude Retinopathy, HAR)     99
Treatments for Altitude Illness      99
Other Medical Issues at Altitude     102
Experiences at Altitude: Circulation, Respiration, Nervous System, and Immunity     105
Circulatory System     105
Carbon Monoxide Poisoning     106
Respiratory System     107
High-Altitude Pulmonary Edema (HAPE)     108
Periodic Breathing     108
Cough     108
Pleurisy     109
Smoking     109
The Nervous System     109
Behavioral Effects     111
Critical Altitudes     113
Peripheral Nervous System     113
Sleep     113
Practical Advice     114
Daytime Somnolence (Excessive Sleepiness)     115
The Immune System     117
Practical Advice     118
Experiences at Altitude: Food, Digestion, Hydration, and Hygiene     121
Appetite, Digestion, and Weight Loss     121
Appetite     122
Digestion     123
Cellular Respiration and Fuel Supplies for the Cells     124
Insulin and Other Hormones     127
Energy Expenditure by the Body     128
Fuel     129
Practical Advice      130
Diet and Supplements     132
Performance-Enhancing Aids     134
Oral and Gastrointestinal Experiences     134
Mouth and Throat     134
Gastrointestinal Issues     135
Dehydration and Thirst     136
Pathways of Water Loss     137
Effects of Dehydration on Performance     138
Thirst     139
Electrolytes     139
Practical Advice     141
Food and Water Safety     143
Practical Advice     146
Alpine Climbs, Hikes, and Backpacking Trips     146
Less-Developed Countries     146
Treks and Expeditions     146
Away from Base Camp or the Kitchen     149
Garbage     150
Heat and Cold     153
Cold     155
General Effects of Cold     155
Maintaining Temperature Homeostasis     156
Nonfreezing Peripheral Cooling     157
Frostbite     158
Practical Advice     158
Hypothermia     161
Practical Advice     162
Heat and Solar Issues     165
Peripheral Heat Injury     166
Sunburn      166
Canker Sores, Cold Sores, and Fever Blisters     168
Snowblindness     168
Overheating the Core     169
Glacier Lassitude     170
Heat Exhaustion     171
Heat Stroke     172
Interpersonal Relations     173
The Team     173
Friends versus Strangers     175
Guided Trips     176
Experience     177
Relationships Among Team Members     180
Choosing the Team     180
Interactions within the Team     182
Women and Men     185
Interactions with Teams or Individuals from Other Cultures     186
Leadership     187
Local Cultures     189
Theft     191
Gender Issues     191
Communication Issues     192
Other Advice     193
Extreme Altitude     195
Basic Questions     195
How Long Can You Stay in the Death Zone?     195
What Factors Influence Your Ability to Function in the Death Zone?     195
Supplemental Oxygen     198
Is Oxygen Ethical?     198
Style and Ethics on 8,000 m Peaks     200
Crowding      200
Fixed Ropes     200
Parasitism     202
Speed Climbing     203
Rescue at Extreme Altitude     203
I'll Rescue You If You'll Rescue Me     205
Practical Advice     205
Family, Friends, and "Why?"     206
Mental Outlook at Extreme Altitude     209
Decision Making and Accidents     213
Decision-Making Issues     213
Direct Effects of Hypoxia     213
Emotional Infrastructure     214
Indirect Stresses     216
Group Dynamics     216
Danger versus Effort     217
Intuition     218
Practical Advice     218
Accidents and Tragedy     219
Causes of Accidents     219
How Accidents Happen     221
Inadequate Equipment     221
Passion     221
Fatigue     222
Poor Decision Making     223
Luck and Fate     223
When Accidents Happen     223
After an Accident     224
Death     224
Your Responsibilities     225
After a Death     225
Preparing for Altitude      227
Limits to Performance     229
Response to Training     230
Developing a Training Program     232
Determine Your Goals     232
Determine Your Weakest Link     233
Musculoskeletal System     233
Cardiovascular System     236
Metabolic/Physiological System     237
Psychological System     237
Construct Your Training Program     237
Training     238
Debriefing     238
Practical Advice for Training     239
Where to Train?     239
General Pitfalls     240
Strength Training     240
Aerobic Training     241
Training the Ventilatory Muscles     243
Overtraining     244
Pretrip Body Weight Management     244
Before, During, and After Your Trip     247
Before Your Trip     247
Planning     247
Organizing the Trip     249
During the Trip     251
After Arrival     252
Techniques for Backcountry Travel     252
The Importance of Rhythm in Movement     253
Typical Ascent Rates during Climbs      255
Getting Up in the Morning     255
Enforced Inactivity     256
Dealing with Altitude, Stress, and Emotional Issues     258
After the Trip     259
Physical Issues     260
Immune System     261
Some Scientific Background     263
The Atmosphere     263
The Behavior of Gases     264
Biological Concepts     266
Homeostasis     266
Getting Work Done in the Body     268
How Do Substances Move from One Place to Another?     268
How Do Molecules Get Assembled and Taken Apart?     272
Lake Louise Scoring System for Acute Mountain Sickness (AMS)     275
Children's Lake Louise Scoring System for AMS     277
Literature Cited     279
Recommended Reading     297
Index     301
About the Author     311
Feet and Meters Conversion Chart     312