Altitude can also have other, slightly less serious effects on the body. At other points during the trip, both Toby and Jim experienced swelling of the face and hands.
We thought Toby had AMS. At 13,000 feet he was dizzy, vomiting, lethargic. He couldn't keep down any food and could only slowly sip electrolytes in water. I was most worried that in the mornings Toby wouldn't have gotten much sleep and wouldn't have eaten the night before. To my utter shock, he seemed to rally each morning. He didn't just rally each morning, he was charged. Once we were up, we ate, packed up and were headed farther up the mountain. Toby's spirits seemed high in our 3rd day. He was determined to summit, and at least each morning, showed no signs that he'd been ill the night before.
We would find out weeks later, after the trip was over, that Toby actually had High Altitude Cerebral Edema (HACE). You see, your blood vessels are actually porous. They have microscopic holes that help with blood profusion. With enough pressure though, blood can squeeze out of those holes and into the spaces in between the brain and the skull. I've heard this called "leaking" or "micro-bleeding" before, though I don't know if those are medical terms or not. Blood leaking out of the vessels and into the spaces in your brain creates further pressure and if untreated can amount to sever brain hemorrhaging not to mention severe headaches, dizziness, nausea, vomiting, etc.
Acute Mountain Sickness or AMS can develop into High Altitude Cerebral Edema (HACE) or High Altitude Pulmonary Edema (HAPE).
Weeks after he got home, Toby began to notice vertigo like symptoms along with severe dizziness and Nausea even though he was back at sea level in Tahoma. The few study's on the long term effects of altitude sickness are fairly inconclusive. For one thing, the sample size of humans climbing above 14,000 feet is rather small. In fact, the studies i've sighted above only looked at 36 and 35 patients respectively.
The short version of his recovery is his doctor put him on a steroid that made him feel terrible for a while but much better after about 2 months. The symptoms have almost entirely abated.
Acute Mountain Sickness (AMS)
“Getting to the top is optional. Getting down is mandatory.
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When you have AMS, it is suggested that the quickest, most effective way to mitigate the symptoms is to descend in elevation. The lower you are the more oxygen there is, and the less pressure there is. The more oxygen, the better. The higher you go, the less oxygen there is. Toby's symptoms began at around 8,000 feet of elevation and consisted mostly of a major headache along with mild lethargy. I wasn't too concerned that first day; we were all exhausted by the time we got to our first camp on day one. By day two, at 13,000 feet, nausea, vomiting, dehydration compounded Toby's symptoms. AMS can progress in severity to High Altitude Cerebral Edema (HACE) or High Altitude Pulmonary Edema (HAPE). However, just because you have the symptoms of AMS, doesn't mean that progression in severity will absolutely occur, though it has been shown that AMS leads to HACE which then leads to HAPE as a progressive condition. in only rare cases will a climber who experiences High Altitude Pulmonary Edema not have experienced some symptoms of Cerebral Edema and AMS first.
The research suggests that there is no way to tell if one person is more or less prone to reacting severely to an increase in altitude or not. Myths 3 and 4 on the Institute for Altitude Medicine at Telluride website stick out in my mind as an avid mountain climber:
Even prior athleticism has little impact on whether someone will experience AMS, HACE or HAPE. The only way to prepare, which is still no garauntee, is to spend time at altitude before moving higher.
The only real treatment for AMS, HAPE or HACE, is rapid decent in elevation.
Back to Toby and his body's reaction to altitude on Rainier, it certainly slowed us down. His condition, at times frustrated me. But it also made us stop and think every movement about our ascent, about our decisions on the mountain. It made us all more thoughtful and deliberate. Cormack McCarthy once said, "you never know what worse luck your bad luck has saved you from." It grounded 3 very ambitious mountaineers, and it made the whole experience real and meaningful. The fact that we were that close to turning around made our summit and our return home that much more fortunate and rewarding.