Mt. Whitney Portal Store & Hostel Forums General Mt. Whitney Portal Store Message Board Swelling at altitude?

For a number of years now, I’ve noticed that my hands and face swell after I’ve been at altitude for a few days, and stays puffy the duration of the time I'm in the mountains. I’ve tried to find information on-line, but what I have found hasn’t been very helpful – info available says that it should go away after a few days (which in my case, it doesn’t) or gives dire warnings about it possibly leading to cerebral edema.

I don’t notice it on day hikes… it usually takes a few days to notice the swelling, and I’m wondering now if it might simply be too much salt in my diet. I use very little salt in my every-day life (memories of Paul Bragg’s “bland is best” approach to healthy eating), but when I’m backpacking I REALLY crave salty foods.

It takes a few days after I come down from the mountains for the puffiness to go away, but I don’t know if that’s because I’m no longer at altitude or if it’s because I’ve simply gone back to my normal way of eating. My blood pressure is good… actually tending to be a little on the low side at 94/60. It’s not changed since I was in my 20’s. I don’t normally get headaches when I’m hiking, other than from glare, and sunglasses alleviate that.

Bottom line – I wondered if others experience this. My concern is if there is puffiness/swelling occurring on the surface, is it possible that there is some swelling occurring elsewhere that could lead to problems... the "proverbial time bomb", so to speak?

Hi Rosabella,

I experience this frequently in the Sierras. It really does not make be too concerned, but my gloves and shoes sure fit more tightly, especially later in the day. There seems to be some relief after sleeping (horizontal) overnight.

I figured at least three factors might contribute:

(1) I have observed that water likes to flow downhill, but must be pumped uphill. In the Sierras I am standing 14+ hours a day (unlike back in "civilization"). Perhaps my hands and feet swell because gravity has overwhelmed my ability to pump blood uphill back to my central circulation.

(2) I typically hike 15-20 miles a day. Thus an increased blood volume is flowing through my extremities. This (as well as gravity) might be contributing to a "backlog" of fluid in the dependent extremities.

(3) I will let the Wilderness Medicine experts debate if capillary leak at altitude could also be a contributing factor here. But I do check that I can still think straight and can breath adequately, as if I am high up there is always some (remote) consideration of HAPE and HACE accompaying the observed swelling in the hands and feet.

Hope you have a great 2012 hiking season.

Jim F

PS-I always enjoy your posts on the WPSMB..

I received an email from Ernie to answer this one. Tough to explain. Incompletely understood. Here is one brief description I found.

Edema of Altitude

Peripheral edema and facial edema are relatively common. If seen as an isolated finding without other symptoms of AMS it is not considered AMS, and is not a contraindication to ascent. It is likely to worsen with ascent, and is more common in women than men. It resolves rapidly with descent. Treatment, if necessary, is symptomatic with either acetazolamide or low doses of oral furosemide

This quote was from the NORMAL physiology section of:
http://www.high-altitude-medicine.com/AMS-medical.html#edema

I can tell you one story. A friend brought back pictures from his trip to the Himalayas. He was up on the Lhotse Face and turned around at 24,000 ft. His face was incredibly bloated. He did not need to tell me what altitude he was at-it was obvious. Lots of folks look like that up there.

Now why lesser degrees of facial or peripheral edema occurs at moderate altitudes like the Sierras is presumably an individual susceptibility to that particular altitude effect. Other effects, like pulmonary hypertension and risk of HAPE, are likewise highly variable as to what altitude they occur at. Some people get it, some don't.

You can get this edema independent of your salt intake. A healthy body (young, no hypertension, good kidneys) at high workload can handle a lot of salt just fine, extra calories, too. Enjoy it.

As far as dependent edema is concerned (gravity pulling and trapping fluid in lower areas of the body) yes, there may be some of that. But much of it (especially in the face which is near the top of the body, whereas the legs are much lower) is presumably a poorly understood change in membrane permeability. One of the main reasons steroids (like dexamethasone) help altitude and other illnesses is because they are potent membrane stabilizers.

Hope this helps.

How often are you peeing? What color is it?

Dehydration can lead to both the swelling effect and the salty craving (electrolyte imbalances and such).

I have always experienced some swelling at elevation. It usually manifests itself in my fingers, and my wedding band gets tight.

Thank you all for your input and sharing your experiences. I honestly can't say if I've ever noticed any other hikers on the trail with "puffy eyes", but that doesn't mean that they weren't there... I was probably looking at the amazing views and all the while thinking I'm the only "puffer-face"

Harvey, I really appreciated reading this statement, as I'm quite sure this is my case - I only exhibit one symptom... I don't often get headaches, and when I do they are almost always due to glare; no difficulty breathing, etc.

I've really only had one case where I was probably putting myself in a bad situation... a couple months after my younger son died, I felt that I HAD to get away... "to go up to my mountains"... and drove down to hike the Onion Valley to Whitney Stretch.I stayed in Bishop and the comfort of Laura, then I started that next day, rather than acclimating at the OV campground. By the time I was over Kearsarge Pass, I was showing symptoms, but I made it to Charlotte Lake, hoping that by getting lower, it would be OK. It wasn't, and I started throwing up. George Gurkee (the Charlotte Lake Ranger) was so kind and checked in on me a few times. He convinced me to go back the next day... and he was right. I was not in a good place to be hiking that segment alone.

I am also glad that it most likely NOT my salt intake causing the swelling. Quote: "A healthy body (young, no hypertension, good kidneys) at high workload can handle a lot of salt just fine, extra calories, too. Enjoy it. Well... I'm young in my mind , but I have excellent blood pressure, and have NEVER had a kidney issues

Laura, I really try to drink a lot of water while I'm backpacking...when I am really exerting I will stop every 15-20 minutes to drink to be sure that I'm getting enough.... but maybe it's still not enough? Next time I'm on a long day hike, I think I'll check the color of my pee and see what it looks like. I DO take a NuuN electrolyte tablet every day.

Thank you, Jim, for wishes for good hiking this summer, and you as well! Maybe we'll run into each other up there this summer. Thanks also your kind "PS"

And you, Ernie... I think you are the hidden "Trail Angel" of this board, always wanting to make sure everyone is taken care of and that your friends are OK. Thank you for being who you are.

Rosie

Rosie, I noticed my fingers were red and puffy as sausages yesterday, but I chalked it up to heat and dehydration. Hadn't noticed that before except when I didn't have hiking poles, but then again I have been a slacker of late.

Right: you may be drinking enough water but not enough to replenish the electrolytes, especially if you are craving salt when you don't normally. Plenty of articles pop up if you google "dehydration and swelling" and "hyponatremia and swelling", like this one. Both suggest nausea and vomiting as being the stronger symptoms of a true problem, but add that swelling can be an indicator.

I like the suggestion in the article: to drink 1 liter of sports drink to every 2 liters of water. Perhaps a plug to the sports drink industry?

-L

Rosie, I have always had a bit of what feels like swelling at altitude but felt it was due to a bit less atmospheric pressure pushing on the body. I have a friend that had lasik surgery in the early days of such surgery and the opthamologist had a bit of concern as to how her vision would be when there was less pressure on the eye at altitude allowing the eye to swell.
We are accustomed to a certain containment by pressure on our body, when it changes i think we all adapt a bit. JUST MY OPINION.
Dave

It would be interesting to know how many of us get hand swelling just walking around. Feet we might easily understand just from gravity effect and not-so good veins to return fluids back "uphill" in our bodies. Arms and hands also have different anatomy but the same gravity gradient.

Now for some veterinary medicine. The reason cattle with high altitude illness called Brisket Disease get swelling in the brisket (chest) rather than the legs is that the various connective tissues in their legs are different and tighter than humans and they cannot swell there.

I know one runner who carries a baton with him. I asked him if it was to fend off dogs. He laughed, said yes, that too, but mainly to flip it back and forth from one hand to the other every now and then, first squeezing one hand and then the other. Makes me wonder if the two-walking pole people who get hand swelling get it because they clench both hands in isometric tension, rather than rhymthmic activity. I use a single walking staff and alternate hands. I only do this from long-time habit, but wonder if I accidentally get the same result of avoiding swelling as the baton guy?

Otherwise my earlier post emphasizes the facial edema problem of high altitude. I'm glad the quote I listed gave rosabella some reassurance.

Hi Along with the see 5 new trees, flowers and wildlife the standard walk talk was every so often put your arms over your head and move them around moving your fingers shaking things out. Then lower and move your arms across your chest with a tight fist twisting left to right or if your are from the other party right to left.
This is another head game , think about just walking better said not thinking you body will disconnect and just repeat repeat..... so to lock the right side /left side back in rhythm every so often you need to send a signal HEY wake up and join the sides. We call it cross signal commands.

Taking this concept a little more into the head games. Think about what signals you are sending or not sending to your body . I am fine . I have the right amount of air going in for the speed I am traveling, I have a perfect heart rate for the speed I am traveling , I always do well on high elevation hikes, I know how easy it is to walk along at this pace , I will balance the energy along the way , I have made many hikes and we always have fun. It is the perfect day, nice light breeze keeping me cool and just the perfect amount of sun keeping me warm.

Also when you start to get signals listen ! and make corrections water/ food /clothing/ resting and turning around!

Look over the photos of the trip and see yourself walking by those locations. Do that for the entire trip and this will allow you to adjust for the conditions , also places the image that OH I have been here before and that people are always doing this , I will stay focused and move along.

I have always used the swelling as a first signal of dehydration,well say the second the first is when someone comes into the store to but chap stick before going up. Thanks Doug

Only my soul swells at altitude...

amen, brother.

We were surrounded by peaks…All my pasts doubts about whether the expedition was worth the effort and sacrifice involved in it disappeared in the overwhelming joy of just being there. At this moment eventual success or failure meant nothing. To be there meant everything.
Nicholas Clinch, A Walk in the Sky page 46.

OK Doug... I'm gonna take this with me, and this time when I go over Silver Pass (the only pass on the JMT that I DON'T like) this will be my mantra.

Again, thanks everyone for the input... The conclusion that seems pretty obvious is that I need to be drinking more water. The air in the Sierra is so much dryer that what I'm used to - I'm sure I lose a lot of water by simply breathing. And Laura, I will be more diligent about the electrolytes.

As long as my only "symptom" is a puffy face, I won't worry about it. LOL! There aren't any mirrors in the mountains, and it's been a long time since I’ve worried about being "pretty" on a backpacking trip!

Rosie

Hi "I ALWAYS LIKE SILVER PASS" It will let me view the lakes and get a glance out east to the backside of Mammoth and I think it is a going down hill pass , now that gosh darn Forester....

Doug and I did a trip over Silver Pass some years ago . We made a supply stop on the way up to start the hike , bought fresh bread, cheese, turkey,ham,and the normal junk food at the summit of Silver Pass we had lunch ALL OF IT and soup we sat and ate for about an hour made coffee took a nap and then started rolling down hill. Never so sick in my life we had about 35,000 calories in our system and could hardly move.Thanks Doug

"I ALWAYS LIKE SILVER PASS" because....

-there's a really pretty waterfall on the way up from Tulle Hole
-The "chief" lakes are really cool
-I remember being there with my Dad and Ken, Marianne, Mark, Bruce, Paul, Tim and Blaise
-I remember having a great day when I went over Silver Pass on my first solo JMT trip (2001)
-within a day, I'll be at Vermillion and having great food, a shower and doing laundry for the last time 'til I get to the Portal

Thanks for the reminders Doug!

Rosie

No need to worry there, my dear Rosie. I've said it before, and I'll say it again, the prettiest gal I've ever met in the mountains...





-L

two beauties

where is that last picture? Glen Pass?

Harvey

Indeed. Can't believe that was almost 3 years ago, August 2009. I "missed out" on spending the day with the guys on the Sierra Challenge (I think they were climbing either Deerhorn or Caltech that day, or if you are Sean, both!) to get to play with Rosie for a day.

Good, good times.

Thanks Harvey! Yes, it's Glen Pass.

I was hiking the JMT in 2009 ( http://ahikeforhope.com/ )and I started having some serious foot problems. I had sent a message with a hiker who was exiting out of Le Conte Canyon to South Lake, asking Laura to please send me some ibuprofen via the packers delivering my re-supply at Charlotte Lake.

A few days later I was at Upper Rae Lake and packing up camp after breakfast when I heard someone call my name. It was Laura!! She got up early that morning and hiked over Kearsarge AND Glen Pass to meet me at Rae Lakes! You can't even imagine the surprise and happiness I felt!

The first picture Laura posted is at Upper Rae Lakes, just as we were getting ready to head up Glen Pass. Laura hiked with me to Charlotte Lake, then turned and exited back over Kearsarge Pass.

Laura went over both Kearsage Pass and Glenn Pass TWICE in one day... she's an amazing hiker, and a great friend!

Rosie