Ski Mountaineer Kit DesLauriers on Surviving HACE and Mountain Sickness
As she prepared to attempt the first ski descent of Makalu, DesLauriers began feeling sick. She faced a dilemma: continue or descend? Making the right choice may have saved her life.
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A note from the editors: Earlier this month, while on an expedition attempting the first ski descent of Makalu, the fifth-highest mountain in the world, skier Kit DesLauriers developed Acute Mountain Sickness (AMS), a condition that occurs when individuals ascend to high altitudes faster than they can acclimatize. Though symptoms of AMS are often mild—headache, nausea, rapid pulse, fatigue—they can quickly develop into High Altitude Cerebral Edema (HACE) or High Altitude Pulmonary Edema (HAPE). “When people ascend faster than their bodies can adjust, fluid starts leaking into their brains, their lungs, or both,” says David R. Shlim M.D., an expert on high altitude illness who spent fifteen years in Nepal treating trekkers and mountain climbers. Unless the individual descends—often immediately—those symptoms can quickly transform into HACE or HAPE, both of which can be fatal within hours and are often difficult to distinguish from AMS. (Primary symptoms of HACE include confusion and a loss of coordination; those of HAPE include loss of breath and fever.) When DesLauriers began experiencing such symptoms, she knew she couldn’t ignore it. “Ascending with symptoms is a prescription for disaster,” says Shlim. “But not descending when your symptoms are getting rapidly worse at the same altitude will also inevitably prove fatal.” Here, DesLauriers describes the incident in her own words.
Before September 4, I’d never experienced HACE, nor the pulmonary version, HAPE. I have, however, been affected by mild AMS. But since AMS exists on a spectrum of mild to severe, I don’t know any high altitude climber that hasn’t had at least one symptom on the mild to moderate scale. When I went quickly to the summit of Kilimanjaro in 2005 and then camped in the crater at 18,000 feet, I threw up once and had a bad headache, which I would classify as my one moderate AMS episode and definitely the worst experience with AMS I’ve had prior to the Makalu episode.
The tricky part is recognizing when altitude sickness is approaching the severe level and then started its progression to HACE or HAPE. The first time on Makalu that I had a recognizable symptom that I’d classify as being outside of ideal acclimatization was on September 2, when I developed a moderate headache after a four-hour hike from base camp at 16,000 feet toward advanced base camp, at 18,400 feet. Once back at base camp, I rested until late in the afternoon on September 3, when I felt like I’d completely recovered. At 4 p.m. I went for a shorter hike from base camp and my headache reappeared, which was a warning sign to me because, in my experience, an altitude headache comes on after exertion not during it.
Although I’d hiked alone, I talked about the headache with Hilaree O’Neill, who was the one teammate who remained at base camp while the other three had gone up to ABC. She and I agreed that I should take 125 mg of Diamox, a drug commonly used to treat altitude sickness, at 7 p.m. that evening, along with 600 mg of ibuprofen. We thought that if I took another 125 mg of Diamox at 7 a.m., I’d probably be fine for our scheduled move to ABC the next morning.
Instead, my symptoms worsened over the next few hours to include nausea and difficulty sleeping. When I woke at 11 p.m., after little more than an hour of sleep, I had an intense headache. The pain started at the base of my skull and I had a hard time moving my head because of it. I’ve been trained for over 20 years as a Wilderness First Responder, so I was aware that my condition was trending beyond moderate AMS. I decided to take the recommended 4 mg dose of Dexamethasone, an anti-inflammatory steroid for cerebral edema, along with an antiemetic (used to treat nausea). After about 30 minutes, the discomfort eased enough for me to go back to sleep and I hoped I’d feel better in the morning.
“I was scared both because of how awful I felt physically, but also because I knew that if this really was HACE and it progressed during the night, there was the chance that I might not be able to walk by morning.”
Unfortunately, I woke up at 1 a.m. with a worsened headache, unlike any I could imagine, and it hurt to open my eyes. When I did open them, I felt like the vision in my right eye was impaired, almost as if my eye was swollen. I checked my oxygen saturation and it had dropped from my norm at that elevation, about 84–86 percent, to 72-73 percent. My resting pulse hovered at around 100 beats per minute, about 40 beats faster than it should have been. I felt confused and lethargic, yet knew that I should start using supplemental oxygen so I forced myself to go to Hilaree’s tent and ask her to look for a bottle among our medical supplies.
The supplemental oxygen brought my saturation rates up and my heart rate down. When we saw this, Hilaree suggested that I had the option to wait at base camp until the morning. While I contemplated that, I observed that my headache wasn’t getting better even with the oxygen and in the past seven hours my symptoms had gone from bad to worse. My instinct was that the quick onset of was indicative of HACE. I was scared both because of how awful I felt physically, but also because I knew that if this really was HACE and it progressed during the night, there was the chance that I might not be able to walk by morning. I found myself thinking about how few flyable hours of good weather we’d seen over the past eight days of trekking, and how unlikely a helicopter rescue would be. I couldn’t shake the strong feeling that I should self-rescue while I could.
It's been almost 2 weeks since I felt the beginning of the headache that would lead to high altitude cerebral edema and my eventual exit from Makalu basecamp on foot and then via this heli, followed by my departure from Nepal a few days later. I'm happy to say that I'm finally mostly symptom free which has taken far longer than I thought it would- but isn't that yet another metaphor for life? If you'd like to read about my first few days of this experience then check out the post in my profile. We're all faced with opportunities to find 'the silver lining', especially when things don't go as planned. As tough as it was, I'm grateful for having time alone in that tent at Yangri Kharka to stare at the bugs and rain drops while I contemplated my own. Thanks to all that supported me on this journey and big wishes for success to my team who is still climbing. #skimakalu2015 @thenorthface @dynastarskis @dynafit @bluewaterropes @guenergylabs @robdski @hilareeoneill @emilyaharrington @jimwmorrison @outsidemagazine #youcantalwaysgetwhatyouwant
At the moment that I was experiencing the worst of my symptoms, Hilaree and I had very limited communication resources beyond base camp. Her satellite phone was down at the village of Yangri Kharka with her husband, Brian, who needed it to coordinate his helicopter flight to Kathmandu for him and their kids, who had made the trek to base camp with us. After waiting three days for a heli, they had gone back down to Yangri in hopes of better weather. Adrian had the only other sat phone, but he was at ABC, so calling for a doctor’s advice seemed to be out of the question. We did have a radio at base camp, but we had set up a planned phone call with ABC for 7 a.m., so didn’t think that they’d answer a radio call in the middle of the night. (In hindsight, we should have tried to get through to ABC.)
I decided that the only way I could ensure that I didn’t get worse was to descend immediately. Before I left—with little more than an oxygen bottle, some water, snacks, and a sleeping bag—Hilaree reassured me that my trip wasn’t over and I could come back as soon as I felt better. She also offered to come with me, but because we had planned on making the move to ABC together that day, I didn’t want to interrupt her ability to catch up with the rest of the team. Panuru, our lead climbing Sherpa had remained at base camp with us and he, along with Bei, one of our kitchen helpers, accompanied me to the first village of Langmale. We left at 2:15 a.m.
Even though I was still using oxygen, walking was difficult for me because I had some shortness of breath, mild ataxia (a loss of coordination), and a general feeling like I wanted to lay down and not get up. Although it was about five or six miles to Langmale—which took us three hours—the elevation drop was only a little over a 1,200 vertical feet, to roughly 14,800 feet. Once at Langmale, my symptoms lessened a small amount, but I still felt dizzy and confused so decided that I should continue down further to an elevation where I had been fully acclimated during the approach trek. I asked Panuru to go back to base camp because I felt terrible about delaying his arrival to ABC, which would slow the entire team’s progress down. In that pre-dawn light I saw better weather below in the direction of Yangri Kharka and knew that the helicopter would be flying momentarily to pick up Brian’s group, so I asked Bei to move quickly down to Yangri Kharka to make sure that he got the satellite phone from Brian or whichever porter was bringing it back up higher on the mountain.
I found myself thinking about how few flyable hours of good weather we’d seen over the past eight days of trekking, and how unlikely a helicopter rescue would be. I couldn’t shake the strong feeling that I should self-rescue while I could.
For a few of those ten minutes that I stopped at Langmale, I thought I could continue down alone, but realized that that wouldn’t be safe in my condition. So, with the help of Panuru’s Nepali/English translation, I hired a local porter to accompany me to Yangri Kharka (at approximately 12,000 feet), where I arrived just after 7 a.m.
The next three days I spent mostly alone in a tent pitched outside the single occupied teahouse in Yangri Kharka, whose residents provided me with food and tea. The rest of the people in the village, and all the other lower villages beyond, had gone down the mountain until the monsoon season ended. I no longer needed oxygen at 12,000 feet and felt markedly better, but still varying degrees of symptoms remained. I used the sat phone to talk with expedition doctors and the rest of my team who were at ABC. I also called Global Rescue and was put on standby for a helicopter rescue, since the option of walking out over 14,000-foot passes with no support would have been one of increased risk.
Throughout the ordeal, I remembered Hilaree’s reassurance that I could come back up the mountain when I felt better. Both high-altitude specialist doctors I spoke with said the same thing, but the caveat was: once I’d recovered sufficiently. I’d been told that it’d probably take a few days at the very least but it could be much longer. By the evening of day three, I finally made the decision to wait for the helicopter and at least go to Kathmandu for a medical examination. I figured I could get some real rest there and then decide if I’d be able to return to the mountain.
Once in Kathmandu, I was examined at CIWEC Clinic, where the doctors confirmed that I had experienced HACE and that I’d taken the correct measures in both my medications and my descent. I was released with instructions to rest and call them if I experienced any worsening symptoms. After my first full day in Kathmandu, spent mostly laying in my hotel room, I still felt somewhat dizzy and confused. I texted with the team at ABC and learned that they were stocking the first and second camps on the mountain with food and supplies and had even made some ski turns. If I returned to Makalu, I’d have to be comfortable climbing mostly on my own since the others were so far ahead of me in their acclimatization. I was also concerned that I might risk a reoccurrence of altitude illness if I went back up. On September 8, five days after I left Makalu base camp, I made the decision not to return to the expedition and booked my ticket home to Jackson, Wyoming.
Now that two weeks have passed and I feel back to normal, I can still say that mountains are the place I most love to be, with the singular exception of spending time with my husband and two daughters. Whether I return to high altitude is a question that I don’t yet know the answer to. To paraphrase Jon Krakauer, and probably others before him that have made similar statements, there are two kinds of risk taking: too much or too little. We all face risks even when living a semi-simple routine close to home so I’m not pretending to turn my back on risk, but I will continue to cultivate an awareness of the risks that I take and try to walk the line of neither too little nor too much.