Dolphin breathing and altitude sickness. Hiking Mauna Loa - Part 3 of 3

We'll discuss what we (and much less I) know about altitude sickness, some fun facts about dolphins, and some numerical data on a limited case study with my data.  I propose in this article methods for consciously controlling breath patterns to keep blood oxygen levels high and heart rate low, and training techniques.  If proven effective these might be useful to limit altitude sickness, and prevent the deadly HACE and HAPE that kill people every year.

Dolphins

The first half of my vacation was freediving with dolphins and a freediving class that helped shape the rest of this post.  If dolphins could hike up a mountain they wouldn't get altitude sickness (they are also smart enough not to go).  We are fortunate to have both automatic breathing we don't have to think about, and manual breathing that allows us to control our respiratory rate.  Unfortunately our automatic breathing is broken when we go up in the mountain and I believe is the main cause for altitude sickness.  It is great we can use a manual override, but that works only when we are not asleep.  

    Dancing with Dolphins Video

Each breath a dolphin makes is a conscious act.  Conversely, dolphins in captivity or in "The Cove" can commit suicide by not taking their next breath.
* Please, please don’t buy tickets to dolphin shows to end dolphin captivity.

Dolphins shut off a half of their brain to sleep, while the other half maintains their breathing.  They swim in circles with the outer eye looking for danger while the half associated with the inner eye is asleep.  This is the key ability that we unfortunately don't have.  I would be able to get much better sleep if I could teach my automatic breathing to quickly keep up.  

Altitude sickness: AMS, HACE, HAPE

Presently we do not fully understand how hypoxia causes altitude sickness.  What is certain though is that hypoventilation, and decreaseed breathing response to hypoxia are strongly correlated with it.

Partial pressure of oxygen gets exponentially lower with higher altitude.  Lower partial pressure makes gas exchange in tissue and alveolar capillaries more difficult.  Our short term adaptations to hypoxia (really reactions to high levels of CO_2) cause tissue vasodilation (expansion of capillaries in tissues), and in later stages pulmonary vasodilation (capillaries in alveoli).  Both of these improve oxygen delivered to tissues and replenishment in the lungs.  However, they come at a cost of swelling, and leaking fluids from the cell walls.

In the brain the expanded tissues putting pressure on the skull trigger even more swelling in a vicious cycle - HACE (high-altitude cerebral edema).  In the lungs the expanded capillaries for gas exchange leak more fluid and usable area is depleted even more rapidly - HAPE (high-altitude pulmonary edema).  

Both conditions can be fatal within hours.  About 1% of people ascending above 3000m get HACE, and ~1.5% get HAPE.  Milder versions of these are experienced as AMS - and affect more than 40%.  Symptoms of AMS include nausea, dizziness, vomiting, headache, lethargy, fatigue, stomach illness, rapid heart rate and poor sleep.

Hydration

Leakage in blood plasma increases blood viscosity, which requires the heart to work harder and blood pressure to rise.  Higher pressure further increases leakage.  Good hydration lowers viscosity and cuts the vicious cycle early.

Hemoglobin binding

Oxygen is carried bound to hemoglobin and dissolved in plasma. Just having highly oxygenated hemoglobin is not enough, we want it to quickly release oxygen in the tissues. Blood acidity H+, CO2 and temperature are correlated to higher oxygen release.  Hypothermia and alkaline blood (low CO2) make it harder to deliver oxygen to the tissues.  That's why high in the mountain it is critical to eat and drink to keep hypothermia at bay, and make sure to not hyperventilate if you are breathing to compensate!

Every year people die from altitude sickness

A very experienced at high altitudes climber died earlier this year on an attempt to summit Mt Shasta (4,322m).  They were forced to camp ~4000m in a snowstorm.  HACE was just too quick and too deadly, there was little his partner could do to save him.  My conjecture is that the snowstorm made all the difference - much lower barometric pressure has decreased the O_2 partial pressure. Furthermore they likely have been dehydrated if they didn't boil enough snow as they had to dig emergency shelter.

Our goals from the above research should be to maintain slightly higher blood acidity, lower blood pressure, and lower blood viscosity.  I believe we can control these with conscious diet, exercise pace, and breathing choices.

Diet choices

I think a diet high in carbohydrates should be recommended, and moving at a faster pace as long as hydration is sufficient. 

What you metabolize affects the Respiratory Quotient - the ratio of CO_2 produced over O_2 consumed.  What you burn depends on what you eat and the pace at which you are exercising. 

Carbohydrate metabolism produces 1 CO_2 for each O_2 molecule therefore R.Q. is 1.0, protein R.Q. is 0.81, and fat R.Q. is 0.7.  Since the respiratory rate is mostly a function of CO_2, eating mostly carbs will either 1) accelerate the course of AMS and acclimatize or die faster, or 2) increase the respiratory rate to provide sufficient oxygenation.

My theory is that the body is normally calibrated to expect ~0.8 R.Q. (calculated from 70% fat, 30% carb at rest) so we should expect 2).

Anyways, theory accidentally matched well with practice.  I forgot to buy nuts!  I was supposed to start this hike a day later and intended to buy fresh macadamias from the farms... 

I did have some fats in Cliff bars, the rest of my food was mostly carbs on the trail and lots of carb and protein at camp.

Acidity

Acidosis (low pH) limits red blood cell travel.  Alkalosis (high pH) makes red blood cells 'greedy' and lowers hemoglobin exchange.

Overall I think we should try to cause mild metabolic acidosis.  Protein metabolism create additional acidity from amino and organic acids.  I'd assume that effect would be short lived and blood acidity is quickly buffered,  but some protein is anyways good to have in the diet.   Drugs or maybe extra water/proteins can be used to limiting the kidneys ability to make the blood more alkaline.  

Hydration and electrolytes - I need 3-4 L a day, usually less with electrolytes.  Temperature impact - from scorching sun to subfreezing temperatures, both demand additional water.

For lower CO_2 I think you want higher flow rate through the kidneys, not having enough electrolytes will force your body dump extra fluids.  I'd also be worried that higher Na and water retention might increase fluid leakage.  For good or bad, I also forgot to pack my electrolytes - I normally have Endurolytes capsules, and water dissolved Nuun.  

Case study

Subject: me

This was the second time I was at 4000 m.  36 hours earlier I had been at 0 m.

Location: Mauna Loa Cabin

The cabin was at 4039m, where standard barometric pressure is 63 kPa (0.62 atm). This means that there is 62% of the oxygen available at sea level.  Latitude impact and actual barometric pressure aren't included in the above estimate.

Weather: temperature outside -5C(23F), weather fronts.

  The key factors to consider are O_2 partial pressure, and humidity.  I definitely wasn't excited to wait the impending snowstorm at the summit cabin.  It seemed wiser to get off the mountain before it hits.

Equipment: Pulse oximeter (Nonin GO2)

The one I have is easy to use, portable and cheap.  Yet it is not officially certified accurate above 4000m (where I usually care to use it for hiking), nor under 70% SpO2 (and I get below that for freediving breathholds).  We used this at the Stanford/UCSD Prevention of Altitude Illness with Non-steroidal anti-inflammatory Study (PAINS) at White Mountain.

Medications: Last time I was on Ibuprofen (administered double-blind, I didn't know if I am on placebo during PAINS), and now on Naproxen (non-blind, self-administered for ear-PAIN!).  Naproxen may have suppressed headaches.  NSAIDs impairment of kidney functions is considered beneficial in this case as that leaves more CO_2 in the blood and increases respiratory rate.

Symptoms: insomnia, short sleep cycles.  Nothing else!  This time I was feeling much better than last time at this altitude.

Signs: low SpO2, high heart rate

Physical condition:

Last time I was in much better aerobic condition as I had just peaked my Ironman training.  Now I had been training for freediving, and I was in better anaerobic condition.  The linked dolphin pictures and videos are from my up to minute long freedives and underwater swims with dolphins.  Being conditioned to exercise in hypoxic conditions was probably beneficial to feeling great at altitude.  

I can hold my breath for 6 minutes without blacking out (as I would frantically be writing down ridiculously low SpO2 values after clocking out).  I had good hypoxic tolerance but probably decreased automatic response to hypoxia (low O2).  Indeed I was most worried that I have a decreased automatic response to hypercapnia (high levels of CO2), e.g. later urge to breathe.  I was hoping Naproxen would counteract that by keeping CO2 levels high.

Data: middle of the night

Waking up: 70% SpO2

Resumed breathing: 80% SpO2

Deep breathing: 95% SpO2, HR 70bpm - likely hyperventilating.  Hyperventilated blood will not actually deliver oxygen from hemoglobin even though SpO2 is high.  Needed oral intake.

Tidal breathing: 90% SpO2, 62bpm - good target for resting breathing

'Dolphin' breathing: 86% SpO2, 56bpm - low heart rate was a good way to fall asleep.

  relaxed diaphragmic breathing, nasal intake, 2 second inhale, 4 second exhale

Data: at sunrise

Me 75% to 79% automatic, up to 90% conscious breathing, at 70bpm standing

Davie 80%, avg 115bpm very erratic heart rate

Further processing: these should be compared to calculator models of SaO2

Altitude sickness suggested prevention

Suggestion #1: 'Dolphin' Breathing when sleeping

If you are not sleeping well anyways, it is best to at least keep your tissues oxygenated and avoid HACE and HAPE.  Get a Pulse Oxymeter.  Find a good breathing rhythm and volume that allows you to keep high oxygenation, without hyperventilation and a low heart rate.  From the few methods I've tried while falling asleep looked like keeping a low heart rate with no hyperventilation was more important than very rich SpO2 but still higher than autonomic.

Definitely needs more research.  The key question is can the automatic system maintain the manual style after you fall asleep.

Suggestion #2: Breathe consciously when moving

Find a good rhythm and just like each step has to be conscious until you get in the 'zone' same should be each breath.  Breathe through your nose to keep moisture in.  Continuous breathing is easiest to maintain.

Suggestion #3: Breathing or hyperventilation when stopping

Don't forget to breathe when you stop!  In fact, after heavy exertion if I stop to eat or drink, I'd sometimes get a headache in the back of the head.  That is likely due to high CO2 - e.g. as heart rate stays high for a while.  The easiest way to reduce that is with controlled hyperventilation (upper chest) to remove extra CO2.

Training #1: Low oxygen tolerance tables

This is training you can safely do at home in your bedroom, by gradually increasing the time you can hold your breath to accustom the body to extremely low levels of oxygen.  

For freediving training this is alternated with high carbon dioxide CO_2 tolerance tables.  Learn more at a freediving class

To avoid any risk of reduced urge to breathe, if you are only interested in high altitudes, I'd stick only to O2 tables.

Altitude sickness prevention

My take is that the critical time to check for HACE and HAPE progression is in the morning.  Never leave someone behind early on.  HAPE gets worse with exercise, and victims will need support for safe descent.

Having a partner is not always of much help once HACE and HAPE hit.

It's always best to be self-sufficient and track early symptoms, prevent, and act conservatively.  

It's still better to have others as poor judgment due to HACE will prevent proper action (e.g. descent), and you can't exert yourself with HAPE.  Share your symptoms with your partners.  

Don't ascend with worsening AMS when others go up, while you should be descending.  

Don't treat insomnia - not waking up to breathe will only make things worse!

I think having a good sleep in the early days in the mountain may be dangerous.  

Overall tiredness may make one less capable of manual ventilations.

* Avoid alcohol

* Avoid Diphenhedramine, e.g. for ear problems, or poison ivy

"Climb high, sleep low" should make acclimatization faster. In this case the summit was not that much higher than camp.  

Ascend slowly.  Above 3000m the recommended daily gain is 300m (1000ft) for safe acclimatization.  This is the advice most ignore and pay for.  The Mauna Loa route required three times faster than prudent ascent.  It is probably better to stay two nights at the first cabin.  Although for maximum acclimatization to living on Mauna Loa one would need 48 days.

Acetazolamide helps improve acclimatization.

I haven't taken it, but I carry in case of need for treatment to help descent, or in case of delay at altitude (e.g. snowstorm, or injury) with worsening AMS.

I haven't had a severe AMS before, and while side effects are mild I'd rather not use drugs for helping ascent.   If you do know you get AMS it definitely sounds like a good choice for a preventative drug.   

Freediving and Mountaineering

After further research, I overall think that freediving conditioning and high altitude climbing are very complementary activities with great cross-training potential.  Awareness to one's breathing, and

knowledge of effective breathing patterns to increase oxygenation and lower heart rate, I believe are critical for one's performance and enjoyment whether deep in the ocean, or high up in the mountains.  I think we need to take a lesson from the dolphin's playbook and take over our breathing.  All medical studies have been too interested in prevention via drugs and analysis of automatic breathing patterns.  I'd be very interested in what, if any, breathing techniques have been studied.

Further research

High carb diet was found protective in one study but not in others

Endurance training may reduce AMS, but others find high VO_2 max uncorrelated to AMS.

* Peter Bärtsch, Erik R. Swenson, André Paul, Bernhard Jülg, Elke Hohenhaus. High Altitude Medicine & Biology. December 2002, 3(4): 361-376. doi:10.1089/15270290260512846.

http://www.liebertonline.com/doi/abs/10.1089/15270290260512846

Study showing that without any difference in hypoxic and hypercapnic responses at sea level some hikers do get AMS while others do not, which implies no correlation. I'd still suggest not overtraining hypercapnic (high CO_2) tolerance training.

* West, et al.  http://jap.physiology.org/content/61/1/280.extract

Research of periodic breathing at an Everest expedition high camp (8050m) showed cycles of (20s breathing and 8s not-breathing).  Subjects weren't able to distinguish breathing patterns in sleep vs nonsleep!

Everyone at their own pace. Hiking Mauna Loa - Part 2 of 3

I had just made it to the cabin in part 1.  Yet it was obvious we have to go out and try to find Davie as the sun was setting.  I knew he was least experienced in the mountain, least prepared, and while younger, not very well conditioned.  The problem was it had been a while since Martin had last seen him, and we had no idea how far back we may have to go.  We grabbed extra headlights / flashlights, I got some hot water and food in case he needed some, and my mini aid-kit was on me.  I was most worried he had altitude sickness or an injury. He hadn't managed to get through 11 miles in 10 hours - granted that was 3,000ft gain and a lot at 13,000 ft (4,000m) even without the extra 5 miles to the summit.
We were just hoping he is still on the trail.  Worst case would be if we missed him and went farther down.

Hike photos

Discuss signals with your partners.  We had no established communication signals or devices.  Walkie talkies are nice but also not reliable (and he didn't have one).  I always have a whistle (actually 3 - on my jacket, backpack, and compass), so we could at least announce ourselves.

Good that all our worries were unfounded : we got to him not too far, still on the trail, although his headlight wasn't really lighting up much.  He was alright just a little under the altitude.  We grabbed his backpack and made it back as the mountain was falling in darkness and winds howling - shelter thermometer at 27F(-3C).

In the mountain everyone should go at their own pace

On our hike to Vihren (2916m) my friend Spas shared a good piece of mountaineering lore "In the mountain everyone goes with their own pace".

There is much truth to this for best efficiency and safety.  Yet I don't believe it should be taken to the extreme of meeting your buddies only at camp.  

Depending on the situation, frequent checkpoints are necessary.

Help in case of emergencies requires maintaining visibility and within calling/whistle distance.

If finding the best steps to make is critical then being even closer is important.

Obviously, you can have a very enjoyable hike if you are able to keep conversational pace and safely get where you need to be.

I've noticed that going slower than my natural stride and cadence hurts my knees, and overall tires me more.  I much prefer stop-and-go than having to go with someone slower. Most economical speed depends on many individual factors, and aside from balancing the load each one is carrying there is little else one can do.  Taking lots of pictures is a good way to let others catch up.

The group must not go slower than the slowest person can possibly do.  If speed is paramount, go in a file with the stronger people setting trail.  If you slow down to go with the slow ones, they may slow down even more.  Stay ahead and set a little faster pace.

Two people can get lost easier than one.

There were four people on the mountain that day all practically soloing it.

An intrepid Polish girl was day hiking from the observatory.  She had been well acclimatized but was not keeping good pace on the summit descent.   She definitely was going to have to hike back in the dark.  I hope she made it back safely as well.  Keeping someone company can lift both their and your spirits and help set pace.  

I stated half-jokingly that all the times I've been lost I've been hiking with someone.  We still ended up way off the trail several times, while sharing life and adventure stories.  It's easy to get distracted and follow natural paths in the lava instead of the faint trail or tracking the cairns.

Lesson: one person must be designated responsible for following the trail.

On self-sufficiency

Like most extreme sports it is always better and overall safer to have a buddy.  Often unstated is you must have an equally trained buddy.  In practice, when you are with partners that are not capable of rescue or delivering help to you, you are virtually solo.  

* Extreme conditions require extreme preparedness.  You must be self-sufficient, trained and prepared.  Trust your knowledge, skills, and equipment.  Self-sufficiency also means being conservative.  Plan

for contingencies: equipment, physical or psychological failures.  Hazards must be anticipated and avoided, or at worst corrected and treated.  You must track early signs and symptoms, and act conservatively while you still can.

* I have to state I am a very conservative person.  It may not be obvious from these posts ;) It is a matter of taking calculated risks. 

* I also overengineer especially for necessities.  I carry three headlights with spare batteries, and three water treatment methods.  Two methods of starting fire, two types of stoves, two shelter solutions, two hats.  A minimal first-aid kit on me, and a full first aid kit.  I still consider myself ultralight...

* Don't push to your limits in the wilderness.  You must push your body to work harder to get in better shape.  Yet you can only push yourself in a safe environment - go running, cycling, swim in the pool.  Especially if soloing, whether in the ocean or in the mountains, you must be capable to go much faster than your plan and at least twice farther.  "At the end of a day, you should be able to do it all again!"

A trained buddy can make the difference between a fatal outcome and a good story, e.g. for say near or total blackout in freediving where just a little help is needed but you can't help yourself.  There are situations where you can't get yourself out of trouble due to either impaired judgment - e.g.  HACE altitude sickness, or impaired physical ability - e.g. HAPE altitude sickness.  We'll discuss altitude sickness and early signs in more detail in part 3 of this series.

Stop, Eat and Drink. Think. Act. Hiking Mauna Loa - Part 1 of 3

I hiked 69 km (43 miles) in 49 hours (including two sleepless nights) to the summit of the largest mountain and largest active volcano.  This three post series will cover most of the experiences and lessons learned and reinforced above 4000 m - including my favorite topics of hypothermia, solo adventures, and altitude sickness.

Most of the fun started in the critical couple of hours around sunset.  I had just summited Mauna Loa 4,169 m (13,679 ft) and I was on my way to the summit cabin - 4.5 miles (7 km) on the other side of the crater at 4,039 m (13,250 ft).  I was losing sensation of my fingers - especially bad on my left hand - exactly where I had two layers of gloves!  Maybe I could last half an hour before frostbite, but it was better to take care of my fingers now than to wait until I make it to the cabin.  I do need my fingertips (e.g. to write this blog), so I had to do something about them.

Stop, Eat and Drink. Think.  Act.

A good old advice for any critical situation is to stop, think, act.  In the mountain I'd extend that stop time to always first include drinking and eating!  And at 4,000 m, don't forget to breathe!

Taking time for my freezing fingers increased the risk that I won't make it to the cabin before dark.  I estimated that the cabin was probably just a mile away, sunset in half an hour, wind was picking up  (~15-20mph), temperatures subfreezing and quickly dropping.  Windchill was bad enough, I could just imagine the fun on this stretch if you are wet from rain, snow, or your own sweat.  Good there were no rain clouds and the snowstorm was expected the next evening.  I had hopes the wind may die off after sunset.  The warmth of direct sun contact was very palpable when getting in and out of the shadows.  It was already very dark inside the giant caldera.  I thought I could make it to the cabin even on headlights and I was close enough. 

Walking on crumpling lava

Lava is a very treacherous terrain even when it's not melting.  Walking mostly on the established trail, I had a few ankle bites from rocks bouncing and crumpling.  Looking for the cairns - black piles of rock, on black lava - against the setting sun was plenty to think about on thin air.  Off the trail, it's a new level of experience.  You have to learn what lava textures, shapes and formations are stable and relatively safe to walk on and plan a few steps ahead.

Some history.  I was in a crater last New Year's Eve on a different adventure on the Napau crater trail.  I was again chasing the sun at sunset. I hadn't anticipated the total darkness inside the crater at dusk beyond the shadow of the crater rim.

It was awe-inspiring to know you are likely the first and for sure the last man to ever step on a piece of earth falling apart.  You have to watch for textures as some lava will crumble into dust under your weight.  Watch for shapes even if texture appears solid, a lava bridge can crumple.  Piles of crumbled lava plates on a lava lake shake with every step.  Probing ahead with the trekking pole helps find the most unstable pieces.  Yet, occasionally you still fall a foot or two.  Cracked by pressurized lava gone underneath, a lava tube can be close to collapsing.  Steaming cracks and sulfurous fumaroles are not reliable indicators what to avoid.  Sometimes you have to jump over cracks that you don't see the bottom of, and the ground is crumbling where you land.  You look back and see a half a meter hole where you were just standing.  Just keep running, just keep running...

Over hot tea last night we were sharing stories with the other two backpackers on the mountain: Martin - an ex- fighter jet pilot, and his cousin Davie.  Martin had backpacked through all 50 states and had lived for 30 years a few miles from the volcano.  His most memorable experience went back to the 1970s - he had taken a 'shortcut' through the crater of Mauna Loa after a recent eruption with the ground crumbling down 1 m deep.  I commented he still had very vivid memories after so many years, and we both agreed such thrills are best experienced just once in a lifetime.

I've already had that adventure, and a reminder of it earlier that day the few times I got off the trail getting down the summit.  This time I had a heavy backpack and I was hiking solo.  

Maybe with headlights I could stay on the trail, though it was hard enough to follow the trail at daylight. 

Two headlights with one at lower height could help negotiate the relief and avoid stumbles.  Yet batteries would likely die quickly with subfreezing temperatures.  If I got off the trail after dark, the best course of action would probably be to setup shelter for the night.  I was self-sufficient so I could overnight here if needed after getting my fingers back, so that was a good backup plan so I could afford to stop.

Freezing hands treatment plan

I stopped in a lava tube even though it was cold, as the protection from the wind was most important.  

If your limbs are freezing the best thing to do is warm up the core and get the body furnace going.  Eating some carbohydrate gels and drinking plenty of water got me started.  I also put another core layer.

I removed the gloves.  First to assess what's going on - it looked like my liners were restricting blood flow.  I left the gloves off to get maximum circulation, counting on wind protection from jacket sleeves.

I went for a quick run to generate some more heat (but not breaking sweat!).

I warmed up my hands on my biggest, close to skin arteries - going in order femoral (between legs), carotid (neck), and finally close to heart when hands were warmer.  It seemed to take a while before I regained sensation.

I increased my speed a notch to very brisk to keep me warmer and of course get me to the cabin faster.  My goal was to stay on track, and watch each step, as it would be the worst time to treat sprains or injuries.

Staying hydrated is absolutely critical for preventing both hypothermia and altitude sickness.

Fast exertion required breathing through both nose and mouth, and thin cold dry air especially though the mouth requires a constant supply of water.  

Now we can analyze what really went wrong:

Mittens vs Gloves

   The glove liner wasn't stretchy enough and was cutting circulation!  I was also gripping the trekking poles too tightly.  

   For photography and campsite chores I prefer wearing gloves vs having mittens.  If you need to take mittens off for precise tasks, you are overall more likely to get frostbite.  It's also hard to remember to put heavy duty mittens next to your swimsuit when packing for Hawaii ;)

Trekking pole technique

   My trekking pole technique is closer to cross country skiing / Nordic walking with double poling.  It had been working great to use the whole body to carry the extra weight.   I had no knee problems at all, even later on the downhills with the heavy backpack.  However, my poles were getting stuck in the cracks in the lava.  The final throw backwards with straight arm, open hand, weight on strap, was no longer that effective.  The left side of the trail was also less stable.  For both of these reasons I had started mostly gripping tightly the handles to plant better.

   Changes made: For the rest of the evening kept moving my hands and always did the catch and release.  On the final flat stretch, I switched to using the poles just when tripping and not for active support.  I held my hands on the strap instead of using the exposed grips.

Aggressive plans require aggressive execution

At 9am the previous day I had been looking for dolphins at the beach weighing whether to go freediving at -66ft or give my worsening ear infection a break.  I decided to play it safe and stay dry on the

volcano at 13679ft.  The prudent ranger at the park suggested the standard five nights itinerary, and to be prepared to stay longer in the cabins when the looming snowstorm hits.  He also said that it takes most people a full day to go around the crater even without backpacks as it is all at 4000 m.

The recommended Mauna Loa itinerary (5 nights): first night at the park at 4000ft; morning start for 7.5 mile hike to cabin at 10035ft; 11.5 m hike to summit cabin at 13250ft; 9 m hike to summit 13679ft and back to the summit cabin; 11.5m back to red hill cabin; AND on the sixth day 7.5m hike to trailhead.

My aggressive Mauna Loa itinerary (2 nights) 7.5m hike to stay at 10035ft in an afternoon; 16.5m hike to summit 13679ft and staying at summit cabin 13250ft; with a 19m hike back to trailhead on third day. I assumed altitude sickness (AMS) won't get to me immediately, so I could make the 7.5 miles in 4 hours. Everything else was just best case estimates, so I reserved 2 extra nights if AMS or bad weather got me.  With this plan I carried water for only 4 days, assuming that if the snowstorm comes I could melt snow.  Everything so far had been going according to plan, except for some delays to be covered in part 2.

If you make aggressive plans, execute aggressively.  I had worried that my outer ear infection might turn into an inner ear infection, as last time I had otitis it affected my balance.  I had doddled in the morning thinking it might be wiser to hike with Martin and Davie.  They weren't planning on doing the extra 5 miles from the intersection to the true summit that day.  

Martin and I hit the trail at 8am.  I still made it to the intersection at 1:30pm so I had decided to go for the summit.

Lessons:

* Hiking at dusk should never be planned in.  The day was very short - 11 hours.

* Never waste daylight.  Wake up at dawn, leave camp at sunrise.  Next day I did that.

GPS and batteries

My GPS was dead.  I had been taking waypoints every hour and that usually burns 1% battery.  At the summit it plummeted from 59% to dead.  We can blame as much Garmin, as the wind and cold.

Lessons:

  - Never rely on a GPS.  Obviously a map and compass need little maintenance.  

  - Absolutely never rely on a wrist-mounted one.  Carry a GPS with replaceable batteries in an inner pocket if you insist.

  - Never rely on a Garmin.  I do like it for training, but the battery life is so poor it can't last a whole Ironman competition.

None of this mattered at this point, as the terrain was totally unsafe for night time off-trail hiking.

Self-sufficiency

At the last intersection I had left a note to the Martin and Davie saying I am heading to the summit.  The note had been turned, so I knew they were already ahead at the cabin.  I wasn't counting on them to come look for me.

My backpack was heavy to satisfy demands for self-sufficiency in the desolate lava.  I had 3 more days of food supplies and water (10L).  On the positive side, I was prepared to set up camp if necessary.  I expected temperatures ~20F(-7C), but high winds were a worry as there was a snowstorm expected in two days.  The cabin would be nicer and safer.

At the cabin

There was still some light to take pictures of the otherworldly terrain.  Before I entered the cabin I checked out the thermometer at the window was just below freezing not counting the wind 30F (-1C).  The temperature was rapidly falling as the daylight was disappearing.  It's fancy LED display also had last night's minimum at 16F(-9C).  (Next morning I checked this night had been warmer at 20F (-7C)).  Either way camping out of the cabin would have been cold.  I was glad I made it.

I saw a propane stove light and I was thinking about getting some hot tea as I walked in.

Martin: Where is Davie?

To be Continued...

Poison Oak and Treatments

A few months ago after a 100 mile bike ride I had poison oak rash for the first time in my life. I've brushed into a plant either on the bike or on my 'brick' trail run. Luckily it was just a few blisters and it helped to just get me acquainted with this scourge. Two weeks ago I got another reintroduction, this time it was a pretty bad rash at too many places. I've never treated poison oak before so this was another good exercise of patience and skill.

If I had at least known I had touched poison oak or ivy, I might have limited the spread. I never quite figured out how and when I got it, so I didn't do any of the immediate steps below. (My wildest theory - from handling my tomato plants that keep getting eaten by dears.  Dears might be carrying plenty of urushiol from poison ivy or oak on their fur).

Poison Oak Treatment Plan:

1. Remove as soon as possible as much allergen as possible before rash
   - Use cold water right away to wash off and close pores to reduce skin penetration  (within first two hours)
   - Use alcohol pads to remove some more oil and dry out skin
   + Do not put on the same clothes without washing.
   
   Obviously you need to see a doctor if the rash is systemic and not just on skin!
   
2. Otherwise home treatment of rash is patience and
   - Either try to leave it alone and bear it for the next 2 weeks.  Try meditation ;)
   + Hot water treatment helps - itching is all but unbearable at first,
   keep under hot water until it feels better, and then you are out of histamine for 4-6 hours of relief
   + Drugs: antihistamines, take orally to control dosage.
    I am comfortable with alternating hot water and Diphenhydramine (Benadryl):
      Start just at night for first 3 days, and then twice daily 1x25mg.  See more below.
   - Avoid sprays and creams - it is too easy to overdo antihistamines
   - Avoid hydrocortisone - in a cream it was almost ineffective, worse keeps the skin moist
   - Maybe try calamine lotion - soothing and drying effects should help, especially if blisters are bad.
        Calamine worked well when I got chicken pox (at 25!), but I didn't try it this time.

Antihistamines, Pros and Cons

Overall, for poison oak, I'll stick to Diphenhydramine. Mainly since Diphenhydramine is an old, well tested antihistamine and has no known long term use side effects.  I still don't like drugs affecting the central nervous sytem and Diphenhydramine readily crosses the blood-brain barrier.  Potential drowsiness and concentration impact makes its use best left for just before going to bed or midday in the office ;)  Good news that after 3 days tolerance against its sedation effects is built up[1]

Cetirizine (Zyrtec) might be a better newer choice for other longer period antihistamine needs as it is less drowsy, single daily dose.  Some other antihistamines don't mix well with some antibiotics.

   * DUI potential.  Blood levels would be minimal at the standard Diphenhydramine dose, but definitely
   + Don't mix with alcohol!

   * Import restrictions.  Good to keep in mind it is strictly prescription in Russia as an opiate base, and banned in Zambia.  In my travel medkit I have some Diphen, and I didn't even think about it for the trip to Singapore and Indonesia.
  + Hopefully just a few tablets will not get me in trouble.  Don't keep much of this on you or at home.

   * Overdose: Finally and very sadly, an MIT friend succeeded at committing suicide with Benadryl.
     Please talk to somebody, even if you intent to just ask how much it takes. Hopefully, you will find many reasons to live instead!

Freediving in Monterey and Hypothermia

Or How to Get, Treat, and Prevent Hypothermia

I had my first freediving class last weekend, and we had amazing ocean diving practices in Monterey, CA. I have yet to absorb all the knowledge of physics, physiology, psychology, and skills for efficient diving pouring from Kirk, Hawkeye, and Erin. I had used a 'floating holiday' for this 4-day weekend class, and indeed did a lot floating and even some sinking ;) (with negative buoyancy below -10m).

This post will talk mostly about hypothermia as I am better prepared to analyze everything I did right and wrong putting my wilderness first aid training to use.

The +/- comments are post-mortem analysis with a clearer head, on what to do for proper hypothermia prevention and treatment.

• Fitting freediving wetsuit
  I wouldn't have had to write a posting about hypothermia, if I could find a proper fitting 7mm Yamamoto 45 freediving wetsuit for the conditions in Monterey.

There were two appropriate freediving wetsuits in 4 dive shops in driving distance. They were either too baggy or too short and my head wouldn't fit.
- I put together a layered wetsuit combination, since it was too late to order a custom wetsuit,

• Subcutaneous fat. I have only 9% fat and most of it visceral. I probably need to add some for freediving:
  + I would have some natural insulation. The Aquatic Ape Hypotheses is partly based on the fact that humans have sub skin fat like marine mammals instead of fur like other apes.
  + I would be more buoyant and my legs won't sink like lead;
  + I would also have extra energy reserves for staying for hours in the water.
  + Having average fat would help me fit in stock wetsuit sizes

Too late to fix that even if I wanted to.

Keep in mind that the skin receptors determine whether you feel hot or cold, yet the core is what really needs to be warm.

Similarly skin controls heat loss through skin blood vessel dilation and sweating, or vasoconstriction and shivering.

No need to worry about thermoregulation effects of fat vs blood vessels in my case.

After pool session first day let's get in the ocean.

Day 2 - Monterey, CA
o 8mm suit + 5mm hooded vest inside, 5mm gloves, 7mm booties
- Lots of water sloshing and worse flowing in the suit, especially on dives or surface swimming

o Plenty of excitement from first ocean freedives, big swell, and man-sized jellyfish
o Fin kicking to keep warm with face submerged, it felt like I was warming up.
- Definitely neither of the above is helping my breathholds, as they keep my
heart rate up instead of slowing it down during breath ups.
- Worse this requires higher respiratory rate - and loses more heat
through breathing.
- Swimming is not a very effective way of warming up. Shivering is better!

o I was doing some pushups on the bar to stay out of the water.
+ Indeed good to keep the head and the body out of the water,
unless wind causes more loss from evaporation

Kirk's mentioned his competition wetsuit wasn't even wet the first half hour,

and noticed how violently I had been shaking the float ;)

- High intensity shivering uses glucose that I would quickly run out of,

while low intensity shivering uses fats

o Home care: very aggressive hot fluid intake,
I was trying not to get a cold that would completely screw up my already bad equalization.

Day 3 - Monterey, CA
It was time to make some changes. Next experiment was to put the
hooded vest on the outside.
o 8mm suit + 5mm hooded vest OUTSIDE
+ It did indeed reduce the water flow through the neck and the back zipper,

- I lost some layering on the core though as the vest was baggy.

Overall I believe this was better.

Yet every time I did a 10 count exhale around the 9th when my heart rate dropped I'd shiver from the cold...

I had lost some dexterity but I felt overall good.

Still, I thought I was functioning normally as I was joking around:

e.g. when I had blood in my nose from bad equalization technique. I was laughing that
"I am just chumming for sharks ;)"

This time I checked to know how cold I was,

as I do carry a hypothermia thermometer in the med kit.
Body temperature 34C (93.5F) => mild hypothermia

Water temperature at -7m (23ft) had been 14C (57F) according to the dive computer.

Home care:
o Virgin lilikoi margarita
+ Good choice, alcohol causes skin dilation and you just lose core heat.
Of course, overkill precautions since we are already indoors.

o Hot fish udon soup for dinner

++ Core rewarming plus food to increase heat production

Next morning core temperature 97.2 was a little low but OK.

Day 4 - Monterey, CA
o 1mm neoprene skin + 8mm suit + 5mm hooded vest OVER wetsuit
5mm surfing gloves OVER, 7mm yamamoto boots UNDER wetsuit
+ The extra skin seemed to take some of the slack, and reduce water flow.

• Predive ritual - pouring warm water in the wetsuite.

Sure feels good, but unsure whether effective in the long run.
- Skin gets warmer and will lose more body heat if the water drains out.
+ If the water indeed stays in the wetsuit, should be good: there is
no need to warm up the first batch of cold water.

At least on the first dives I was still warm and getting to the target depths with ease.

Erin: "I was getting cold just watching you there"

Colder morning, water temperature 13C (55F) at -14m (46ft?) - my deepest dive.
Body temperature 33.5C (92.3F) - no protection combination seemed to be working for this deep and long exposure.

I was functioning fine, but I took it more seriously this time.

Hypothermia self-treatment:

1. Alway keep core dry and warm, then head and finally extremities.
   + Bundled up to preserve keep created by core
   + Drank some water and a little food to keep producing heat.
   
   o Mylar wrap (emergency blanket) would have been most effective for core warming.
   -- I usually have a very convenient wrap in my beach bag, but was in the car as I had used it last week...
   
   -- No hat
   
   
2. Warm shower in the 'head' on the boat - tried to focus on core only.
   - Felt good but was definitely not going deep enough,
   may be dangerous to do on the boat if we had a long ride back.
   - Better to be shivering to generate more core heat and trap it in clothes or blanket.
   I'd skip this.
   
   
3. Turned up the heat in the car. Had a good wicking base layer to move sweat away and not get sweaty.
   + Breathing warm air is definitely a good way for core warming.
   
   
4. Tea with lots of honey. My aunt's homemade honey from the Black Sea helped me visualize warm Black Sea waters and beaches.
   ++ Hot and sweet liquids are definitely a double win on core rewarming and energy.
   ? Unclear whether visualizing calming warming will make your skin lose more heat. Can't help it ;)
   
   
5. Signed for the next class in Kona, Hawaii
   + Some excitement definitely should help get the heart rate up and increase heat production!
   
   
6. Went for a hot tub (110F)
   Warming the core through the skin earlier would have been too slow.
   My procedure to get warmed deep to the bone:

• Keep hands and feet out of the water initially.
• Always raise core temperature first. At this stage for me just best practice,
  but if this was earlier in rewarming it is critical not to warm up limbs before core.
  After that,
• Stay as long as possible.
• Once you get too hot - go out, drink some water.
• Stay out until you start shivering!
• Then get back in the tub for iterating to reaching the next level
  + My theory: core should be warming up faster since water heat exchange is faster than air, and skin permeates. Evaporation from the exposed wet skin will create an air insulation layer, so core heat should be preserved while not losing much in the process of cooling off the skin.

• Cooled off my head
  After getting out with a few stumbles and momentary losses of motion control,
  I realized I had a near blackout from overheating.
  
  This was pretty ironic given I didn't get any LMC or blackout fun at any of the dives or the static apneas (4:20 minutes).
  
  Fix: with core bundled, stayed with a wet head out in the cold air till I got back my bearings.
  + Evaporitave cooling at its best. I should write another post on hyperthermia.

What a weekend!

Ironman season 2010

Quick updates on the 2010 season. I did complete my first Ironman!

April:

I warmed up for the season by racing the Wildflower Half Ironman

(6:29). Good checkpoint - I was on track as an average 1/2-Ironman in my age group.

Definitely an amazingly strong event worth repeating as the 'A race' -

World Champion Michael Raelert finished in 3:56.

May:

I ran barefoot Bay to Breakers (12km) - I got tons of attention

yet it was a total blast to run barefoot on clean San Francisco streets.

Most of May I was swimming in the bay as often as I could

to prepare for the Alcatraz Challenge 1.5 mile swim.

The Alcatraz swim ended up being harder mentally than physically.

I had decided I would need a vacation with warm water

as a reward the day after I complete Alcatraz.

June:

I had a very exciting vacation on Papua in Indonesia:

lots of pictures and stories to share. While it derailed my Ironman training plan,

high altitude trekking and skindiving kept me in shape.

July:

I completed in July the Vineman Ironman (13:23). Running was the biggest challenge as half-way on the marathon my knee stopped cooperating, yet I still finished in the middle of my age group.

I am pleased to report I am an average Ironman distance triathlete

a year after learning to swim and starting to run.