Home > Trip Reports > Nov 23, 2008, Sick puppy on Muir

Nov 23, 2008, Sick puppy on Muir

11/23/08
WA Cascades West Slopes South (Mt Rainier)
15062
26
Posted by crustos on 11/24/08 11:14am
I am writing this report mainly to thank those many people who helped me and those who offered to help me during my medical event on this trip--I€™m sure some of you are visitors to this site.

The blabbing-on is to provide details to those curious about altitude-related illness (if that€™s what it was).

As the throngs will attest, Sunday was a great day to be on the Muir snowfield. I put on boots and skis at Pebble Creek, made good time to Muir and rested briefly without removing my skis. At this point, I felt a tiny bit dizzy, not a rare feeling in my half dozen visits to Muir in the last year or so. I finished off my second liter of water, removed skins and headed down, expecting to need a rest after a few dozen turns.
When I stopped, I started to feel very dizzy and had to sit down. I soon felt mostly recovered and proceeded on. I had felt OK on the first bit of skiing and I felt OK on the next, this time dropping several hundred vertical. (Uneven coverage but great, great snow!) This time I stopped, almost fell over backwards with dizziness, and then collapsed to the snow and started puking. I got up and continued on a few more times like this. Let the record show (!) that I never fell while skiing, I just couldn€™t ski long without having to stop and throw up.
A couple fellow free-heelers were the last to stop and offer help. I told them I was having trouble but I would probably be able to make it. But after one more short stint, I was down, dry-heaving and barely able to lift my head without getting the twirlies and going into the heaves again. At this point I was at maybe 8500€™ (?) and 200€™ or so to skiers€™ right of the main skin track. I tried shuffling down the hill without getting up, but I couldn€™t even do that without wretching. I was pretty much immobilized.
I made voice and visual contact with a descending party (I waved and yelled €œhelp€), and soon I had a dozen or so people around me.
Somebody took my skis and pack and a couple people helped me up. I stopped to heave a few more times in the next few feet, but soon we were cruising along pretty well with me slumped over like I was dead drunk, with one or two people taking my arm. I kept my poles, which helped.
By the time we hit Pebble Creek, I was mostly walking on my own but still slumped.  When we passed a couple guys a bit further, I was walking upright and was embarrassed to identify myself as the injured party they were wondering about. We hit the parking lot well after sunset. I still felt sick, but not really dizzy. (I still dry-heaved three more times before getting home, but mostly I felt fine. And I never had a headache. Kind of curious.)

There were many people to thank at the parking lot, and I thank you all again. This was a thoroughly humbling experience, but I was moved by the generosity of all who helped. Among those were members of the Tacoma Mountaineers and the Everett Mountaineers, an off-duty park employee (with a walkie-talkie), and others who just happened by.

After 24 hours to reflect and do a little research, my best guess is that this was some version of altitude sickness, not food poisoning or some scarier medical problem. The noteworthy parts, for me, were the lack of headache and the lag between reaching my high point and my feeling most sick. I was just sure I would get better and better as I descended, but I got worse and worse, feeling my worst at a moderate elevation. Dizziness seemed to be the primary symptom, with the nausea being a function of the dizziness.


Sounds like an inner ear infection (violent spins and uncontrollable vomiting).  Might want to let yer Doc know.  That's not typical of Altitude sickness, and mabe not be something you want to let pass w/o addressing.  Hope you're feeling better.

Yep, sounds more like labyrinthitis, inflammation of the labyrinthine canals next to the ears, your "balance organ" or "gyroscope" for the brain. The nausea is a version of motion sickness in response to the vertigo. Typically self-limited, of possible concern if it doesn't go away in a day or so. Not related to altitude. Doesn't sound like much fun.

author=Kneel Turner link=topic=11308.msg46800#msg46800 date=1227585126]
Sounds like an inner ear infection (violent spins and uncontrollable vomiting).  Might want to let yer Doc know.  That's not typical of Altitude sickness, and mabe not be something you want to let pass w/o addressing.  Hope you're feeling better.

Yep, reading the description reminded me of a milder version of an inner ear infection I got a while ago when snorkeling - down to the misdiagnosis (I also thought it was food poisoning at first)... the day after I was bedridden unable to open my eyes or walk without falling over - if I opened my eyes vertigo would kick in and I'd dry heave my brains away... really impressed my then newish girlfriend 4 days into our 8 day vacation... took me a week to be able to walk in a straight line.

I agree with the others, go have it checked if it's still lingering or happens again. You'll probably get prescribed some antibiotics.

Thanks for these better-educated replies. Yes, it definitely seemed like an inner-ear problem. My stomach was just going along for the ride.

This now seems possibly relevant: I am at the tail end of a major head cold.

Maybe altitude exacerbated the problem? It seems like quite a coincidence that it would happen entirely at altitude, and then be relieved by descending.

I felt fine today, Thank you, considering the workout I gave my stomach (Oh yeah, and I climbed to Camp Muir yesterday). I can wiggle my head and body around without dizziness, although I do feel kind of a woozy hangover from yesterday.


The difference between you at 8k and you in the parking lot (I only carried your skis, it was the Mountaineers group that did the real work) was truly amazing. Glad you picked up speed because the thought of stumbling down Pan Point in the dark had a lot of people a bit worried.

Glad you are feeling better!
In the rare occasion that I do Muir, I get affected by the altitude at about 8000ft even in the best of shape. Not to play arm chair Dr because you never know the anomalies of the human body. Severe HAPE High Altitude Pulmonary Edema info is here and it is good to be aware of this at any level-Uhh no pun intended, really, believe me  ;D
Good to see folks come out of the woodwork in time of need!


author=crustos link=topic=11308.msg46814#msg46814 date=1227595571]

This now seems possibly relevant: I am at the tail end of a major head cold.


That sounds about right. I have had this occur three times after a heavy head cold. It comes on suddenly for me and a couple of times I have been moving around Ok and then the next minute I'm lying on the floor with the world spinning around and feeling very nauseous.  The one time I did go to the doc about it he said it was an inner ear infection. You should however still go get yourself checked out by a doc.  Glad you are OK.

sounds like classic AMS to me.

if it walks like a duck and looks like a duck it is most likely a duck.

too fast an ascent. 

have seen and treated HAPE - HACE and AMS

sea level to muir is a dramatic increase in elevation ....

meant to add the most important treatment is exactly what you did.. go down..

Alright, let's vote.  This will do absolutely no good, but let's do it anyways.

Defineately an equilibrium problem caused by a compromise of the inner ear.

sure vote.
but had the inner ear been an issue - descent would not have worked the cure... again so many cases such as this have been reported/ presented / treated ( per Hackett et) - hard not to make a case for AMS

would even go so far as to suggest HACE as he was having so much difficulty walking.. classic.  both HAPE & HACE have been reported @ 10,000 feet

labyrinthitis--or inflammation of the labyrinth-- is typically trigerred after a URI such as a cold, most often viral, occasionally bacterial. It it is characterized by vertigo--a severe spinning sensation that occurs with movement and may trigger vomitting which is different than dizzy(lightheaded). Suspect the altitude may have induced some dizziness, exacerbated inflammation of the inner ear and acute labyrinthitis took you out with vertigo. This can last from a few seconds to weeks. And can also be accompanied by deafness or tinnitus. Docs usually don't do anything about it unless it persists for longer than a month. (i know i pm'd you day of to talk to doc, no really necessary but  advisable if it keeps occurring but sounds like you are well now) the best thing was to come down and even better was how random strangers came together to accomplish that goal

because the skier is better- ear infection is ruled out. I am still sticking with AMS however, acute GI ( food issues) cannot be ruled out .  he may have puked all the bugs out.
if it was the inner ear symptoms would have persisted

Yea,!!! diagonise fight!!!!
This is getting to  be like an episode of " House MD".

author=rnbfish link=topic=11308.msg46900#msg46900 date=1227710348]
would even go so far as to suggest HACE as he was having so much difficulty walking.. classic.  both HAPE & HACE have been reported @ 10,000 feet


Especially in the cascades and the volcanos, where the elevation gain is dramatically seen, and with an accelerated pace, can induce any of the symtoms previously mentioned.

A few years back I did a solo ascent of the south climb on Adams.  My goal was to do it fast and make it back to Tacoma by night.  After making the summit, my vision was blurred, my head was pounding, and my ears hurt.  My stomach felt sick and I was breathing awkwardly.  After getting a few shots on summit with the K2 reps who happened to be testing some prototypes that day (my first introduction to turns all year), I almost sprinted back down realizing I was experiencing AMS.  Not one of my proudest moments, but it helped me realize that AMS can manifest with a number of different symtoms, including ear problems or eye problems.  One of my friends who climbed Aconcogua told me that some of the people attempting the climb also experienced AMS symtoms, including ear problems, and one person feeling like their eyes were going to pop out of their head.

Glad you're alright!

author=Scotsman link=topic=11308.msg46918#msg46918 date=1227724221]
Yea,!!! diagonise fight!!!!
This is getting to  be like an episode of " House MD".


We are bored, aren't we? Should we add exclamation points!!!, bold font, italics and all CAPS to make this more exciting?  ::)

correct you are!

i participatd in a rescue on denali with HACE climber.. took all night to get him to 17,000 but he was well after that..

on acongagua treated climber for HAPE..

while climbing fast myself in ecador ( over 20,000) i experianced blurred vision which was i think early on set of HACE.. 

cheers

author=Teleskichica link=topic=11308.msg46922#msg46922 date=1227725537]
We are bored, aren't we? Should we add exclamation points!!!, bold font, italics and all CAPS to make this more exciting?  ::)


So, Teleskichica, where would you suggest putting exclamation points??  I fe!el like the CAPS mig!ht be going a little far...I get yell!ed at for writin!g in all caps.  If I starte!d typing th!at way, lif!e could g!et interesting.

Yes, we're just bored.

This one's for you, Scotsman! ;)

I was thinking of the fact that crustos made good time to Muir, felt OK, took a break, started skiing down (motion) -felt dizzy, sat down (no motion) -felt better, skied again then had sudden onset of dizziness resulting in nausea.

In his own words- "noteworthy parts, for me, were the lack of headache and the lag between reaching my high point and my feeling most sick. I was just sure I would get better and better as I descended, but I got worse and worse"

-felt OK during ascent and at highest elevation
-wan't significantly affected by altitude in the last half dozen trips to same destination in recent time frame
-sudden onset while descending
-the "twirlies" followed by vomiting
-continued to feel sick and dry heave 3 more times on the way home -assuming this is at an elevation of a probably a few hundred feet.

Labyrinthitis can be self limiting, so not ruled out because of getting better.

I've never had labyrinthitis, but the posters who have, and the many patients I've seen seem to agree-  Its the horrible sensation of spinning out of controll caused by loss of equilibrium that is causing the nausea.

Again, from crustos- "Dizziness seemed to be the primary symptom, with the nausea being a function of the dizziness."

Glad you're feeling better crustos.

AND FOR YOU CHICA!!!

author=Scotsman link=topic=11308.msg46918#msg46918 date=1227724221]
Yea,!!! diagonise fight!!!!
This is getting to  be like an episode of " House MD".


I loved the episode where all the skiers were in the emergency room, arguing with each other about the diagnosis for most of the show.  At the last minute before the show ended, Dr. House walked in, said "Broken leg," and walked out.  He's such a genius!  Man, I love that show!

* Note to self: Stop posting sober, it doesn't work.

Hey Crustos,
I feel your pain.  Literally.  Happened to me yesterday on Muir, not as rough as you had it.  I think my case was triggered by poor visibility/motion sickness.  I also tried to keep skiing, but once that kicked in, I was pretty much toast.  When my brain was telling me I was stopped, not moving, but my skis were still moving - backwards - then my stomach started chiming in with it's own agenda.

Thanks again, Ed and Chris for hanging with me when you could have been ripping along down the hill.


Wow, I’ve been away for a while.
I also enjoy playing detective, in this case way out of my depth. But I am the patient, so I get to play.

The International Society for Mountain Medicine says of AMS: “universally present is a headache” But I didn’t have one.

Still, it’s hard to shake the idea that altitude had nothing to do with it. Mostly because it happened way up there and I live way down here. And it went away, eventually, as I descended.

None of my brief research today made a connection between altitude and labarynthitis symptoms (although they were connected in discussions of perilymph fistula (a tear or defect in the membranes between the middle and inner ears)--doesn’t sound like I have that, though). I read nothing that made me think there couldn’t be a connection between them.

But if altitude + labarynthitis = vertigo, it’s unlikely that I would have been fine at 10,000.’ I would have had all the ingredients I needed to feel bad. Which makes me like the idea, and I paraphrase here, “It ain’t just the meat, it’s the motion.” Maybe the pressure changes of a rapid descent--especially at high altitude--exacerbated the inner ear problem. So the equation would then be altitude + rapid altitude change + labarynthitis = vertigo. Which seems to fit the data, but of course might make no scientific sense.

Anyway, thanks for the helpful words and kind deeds. Strangely enough, the unpleasant experience of last Sunday has left me feeling happy as ever to be a backcountry skier and especially happy to be a member of the human race.

By the way, here’s a better word for vomit: retch. Sorry if I offended any wretches. Enjoy your turkey.


hey crustos
glad your feeling better.

check out dr. charles houston (the grandfather of mountain medicine)  last book " men, mountains & oxygen" - something like that title.. great up dates on AMS et. 

the biggest " clue" here is that when you went down you got better....

cheers
rob

Dear crustos,

Not a medical person, but I have suffered from both HACE and the inner ear inflammation. HACE in Bolivia at about 18,000 ft. wiped me out, terrible head ache needed help to descend and improved during the next two days at about 14,000 ft. Your symptoms sound exactly like my inner ear experience which improved in a matter of hours. My doc explained it is possible for movement to help with the inflammation. Something about the fluid in the inner ear gets lumpy and needs to be moved around???!! I think its inner ear based on my own experience, which I recognize is only one data point. Both are very scary.

greg

i get Labyrinthitis after a head cold or sinus infection.  Luckly I've never had it on a climb because I react just as you did. 

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