Interview with Toby

I want to start by saying I'm humbled by having such friends who can recount emotional experiences with such honest and objective, introspective clarity.

Also, I wish I didn't have to say this but I do; this is in no way medical advice. This is one person's observational account of their own experience with Acute Altitude Sickness and High Altitude Cerebral Edema. Even the references herein are an incomplete compilation of the formal research on high altitude illnesses.  

https://www.medpagetoday.com/meetingcoverage/rsna/36195

https://www.scientificamerican.com/article/brain-cells-into-thin-air/

Q: When did the altitude start getting to you (notice AMS)?

T: "I think for me, I didn’t really become aware until the second day above the Kautz when i started to sort of slog along and have to pace myself in short intervals. I think i realized that even though we had come up a steep pitch my energy was really low and that i was just not feeling 100%, i was pretty drained pretty quick."

Q: Jim walked back to you, Toby. What were you thinking on the traverse above the Kautz climb when Jim walked back to you to see how you were doing?

T: "I don’t really remember the conversation at all. I remember the guided team coming down the Kautz and the repel ledges they created. I remember the naked skiers that passed us above the Kautz. I remember getting a renewed energy after lunch above the Kautz but that renewed energy was only about 50% and the rest of that was just a slog. I think i was trying to push myself both physically and mentally past a quitting point."

Q: What was going through your head at 13,000 feet when you began throwing up.

T: "Uh, oh shit!? I realized that there was a level of seriousness. But given my previous experiences with dehydration and background in wilderness hiking and camping, that i had to take note of the symptoms and kind of take it as it goes. For me at that point it wasn’t clear if it was high altitude or dehydration or a combination of both. I knew i needed to hydrate as much as i could to replenish - and that was one of my concerns that i wouldn’t be able to replenish my nourishment, my energy. My main concern was getting enough fluids back into me. I think I also felt like i wasn’t pulling my own weight. It was hard for me to watch you guys do all the work setting up, but at the same time if i was going to be able to maintain my energy and replenish my energy, we all weren’t going to get up and over if I didn’t just lay down and get rest. I knew you guys knew that sometimes you have to lean on your team members and sometimes your team members need to lean on you."

Q: How did you feel the next morning?

T: "I wouldn’t say i was feeling a hundred percent but i felt better than i thought i was going to. It was clear that the heavy symptoms of either dehydration or altitude had subsided and that descent wasn’t immanent.

The point we stopped at the Ingram camp was when i was worried the most. Not at 13,000 feet, not at the summit it was when we were below the summit on our descent, i wasn’t sure how i was coming down off the mountain. I just wasn’t sure whether it was going to be by my own feet or carried down the mountain… yeah, i didn’t know. I was in negative energy point. Beyond zero."

Q: How’d you rally then?

T: I don’t know i’ve gotta walk through that in my mind a bit. I guess i just felt like i didn’t have any other option than to get up and walk. To be honest, that picture where you’re looking down on camp Muir was like the biggest welcome surprise, and it really wasn’t that far from the Ingram camp, and i feel like on the map it looked like it was gonna be further than we actually traveled.

Q: Talk to me about your symptoms getting worse after we got back to Tahoma?

T: "So it really just started off with a very minor headache. Really subtle background headache every morning. So i started taking a little bit of advil every morning. Then i found I was having to take advil twice throughout the day and the headaches kept getting worse. To the point where the advil wasn’t enough. I was pretty much taking it a couple times a day - 400 mg more than twice a day. I’ve never been a big medication person, so usually that much helped. After about a month the symptoms weren’t getting better so i went to a doctor to get checked out.

i went to urgent care and i got checked out and i explained that i thought i had high altitude issues. He was clear that he didn’t have much experience with altitude illnesses, and suggested i go to the ER. So we walked out of there and in the parking lot I ended up throwing up for the first time since coming off the mountain. So we went to the ER. They admitted me. I threw up a few more times. They gave me some pain meds, and then they did a CAT scan while i was there. They didn’t notice any real issues with the CAT scan but they said if i did have any “leaking” I would need to get an MRI.

They gave me Butalbital-acetaminophen-caffeine. That stuff messed with my head big time. The wait time to get a visit with a neurologist was 6-8 weeks. I finally found a place that was closer to 2 weeks. So i went to see her and she was definitely a well studied doctor. She didn’t have much experience with altitude but she was really driven to understand it. She recognized that i was in a pain loop (my term), both from the advil and the other medication from the ER. So she took me off them immediately and put me on a steroid. Of which i only took a half dose and it really messed up my mind. I was in a fog for a week and a half. I really felt like i didn’t have my wits about me. It was about a week and a half of that i finally got off the steroid. It took a few weeks after that to recover. The headaches were gone but i was still dealing with the pressure issues - i couldn’t stand up. It felt like heavy pressure whenever i stood up. After about another month that went away. All told i spent about two months lying on my back trying to do work."