High Altitude Psychosis: A New Medical Entity?

Cross-posted at Cognition and Evolution.

A new paper breaks down cases of acute mountain sickness into several categories, including isolated psychosis with no evidence of cerebral edema (a quarter of cases!) Psychosis was more associated with accidents than the other subgroups, not surprising in retrospect. These cases were all taken from above 3500m/11,700'. It's always interesting that humans, and life on Earth generally, can tolerate some amazing extremes, but when the partial pressure of O2 drops a little bit, everything breaks.

Hüfner K, Brugger H, Kuster E, Dünsser F, Stawinoga AE, Turner R, Tomazin I, Sperner-Unterweger B. Isolated psychosis during exposure to very high and extreme altitude – characterisation of a new medical entity. Psychol Med. 2017 Dec 5:1-8. doi: 10.1017/S0033291717003397

New Projects: 1) Circumnavigate the Tahoe Rim Trail 2) Climb Shastina

Last year I finished running across California. As part of~ that project, I completed the northern ~quarter of the Tahoe Rim Trail. Of course I can't just leave that alone. So yesterday I started the rest of it, just going from Tunnel Creek Cafe up to Rose Summit on this segment. I will definitely not finish it before the arrival of snow and baby

This run at altitude was part of my effort to get back into mountain climbing shape for my attempt on Shastina, the subsidiary cone of Shasta. At about 12,000', on its own it would be the third biggest Cascade, but it's mostly a walk-up, with optional glacier travel. Years ago I climbed the main summit and was always curious about Shastina and the lakes visible in the crater. I'm aiming for September, and at this time of year it's going to be a nasty scree slog. It looks like most people start at Bunny Flat, go up to Horse Camp, then turn leftish and head over the bottom end of Casaval Ridge, crossing through Hidden Valley and then heading up the saddle. I've read good things about Diller Canyon just in terms of scenery and I'm trying to find out from the few people online who seem to know it why that isn't a preferred route. Either way it'll be a nasty scree slog this late in the season.

US State and County High Points

I'm starting to track the high points I've been to. Oddly it was going to Pennsylvania's high point that made me start doing this. Interested readers, should they exist, will no doubt want to point me to the online organizations that track country, state and county high points. I love reading about people that do this officially, but I'm not registered on those sites.

To further deflate the significance of the enterprise, it must also be said that it's silly to make a list of hills and mountains that is highly dependent on the territorial whims of the primates scrambling about their flanks at that moment. While the likes of Whitney and Elbert have some claim to being on any such list, Ebright is certainly on here only because of its good luck that on the day colonial Pennsylvania's Lower Counties asked the king for home-rule, he was in a good mood. Much more importantly, altitude is only very indirectly related to difficulty of climbing, difficulty of climate, mortality risk, and most critically, natural beauty and enjoyment of the experience, which is why we all do this in the first place. But read my list anyway.


National high points: I have none as yet, and will not be getting one for my own country's Denali (McKinley to Lower-48ers), because I've declared I will never attempt it. I did attempt Mexico's Orizaba but the altitude got me.


State high points I've been to:

California	Mt. Whitney, 14,496' (highest in lower 48)
Colorado	Mt. Elbert, 14,440' (second highest in lower 48)
Oregon	Mt. Hood, 11,230'
South Dakota	Black Elk Peak (fmr. Harney), 7,244'
North Carolina	Mt. Mitchell, 6,684'
New York	Mt. Marcy, 5,344'
Pennsylvania	Mt. Davis, 3,213'
Delaware	Ebright Azimuth, 448'

High points I care about and may at some point go out of my way to get to:
Washington (fourth highest in lower 48)
Hawaii (highest in the world if you count from the Earth's crust, but no one does except patriotic Hawaiians)
Montana
Wyoming
Utah
New Mexico
Arizona
Missouri
Arkansas


California county high points I've been to:

Inyo	Mt. Whitney, 14,496'
Tulare	Mt. Whitney, 14,496'
Siskiyou	Mt. Shasta, 14,162'
San Bernardino	Mt. San Gorgonio, 11,499'
Riverside	Mt. San Jacinto, 10,839'
Los Angeles	Mt. San Antonio (Baldy), 10,064'
Colusa	Snow Mountain, 7,056'
Lake	Snow Mountain, 7,056'
Orange	Santiago Peak, 5,687'
Napa	Mt. St. Helena, 4,200'
Contra Costa	Mt. Diablo, 3,849'
Alameda	Rose Peak, 3,842'
Solano	Mt. Vaca, 2,819'
Marin	Mt. Tamalpais, 2,576'
Sutter	South Butte, 2,120'
San Francisco	Mt. Davidson, 925'
Sacramento	Carpenter Benchmark, 828'*

*Behind private property barrier by about 100', but I count this one because screw them


I was interested to learn that I have not yet been to the high points of Santa Cruz or San Mateo Counties (I thought I had). Besides those, I also care about Fresno County's (higher than Shasta), and the ones in the coastal counties, except for San Diego, which is privately owned and I'm not going to pay dammit. Also, like many I have long dreamed of making it to the high point of Berks County, Pennsylvania, which is on the Appalachian Trail...perhaps one day!

The Mortality of Aircraft Wheel-Well Stowaways

Cross-posted to my cognitive science blog.

The FAA gives a report of 11 known stowaway incidents from 1947-1993.

Of these 11, 6 died. 2 of them had definitely frozen to death. 3 more fell after the plane made it to cruising altitude, and could have frozen to death. Another fell on takeoff. This means that you have a 55% chance of dying if you attempt this, and if you die the chance is 33-87% that you will freeze to death.

Of course it's likely that other fatalities occurred but were not discovered because the plane was over water or the body landed in an unpopulated area; it is also likely that people stowed away and were not discovered, so it's hard to say which way the sample is biased.

The mechanism cited as probable pathway to fatal hypothermia at altitude seems very likely to be the same one that explains the strange behavior of high altitude mountain climbers who succumb to a similar fate, and are found having taken off most or all of their layers. Under conditions of low ambient O2, the hypothalamus becomes hypoxic and can longer thermoregulate. In climbers, their frontal lobes are hypoperfused, and they feel hot and can't reason themselves out of/inhibit themselves from taking their clothes off in the middle of a glaciated mountain. Stowaways are crammed in and can't move anyway.

Management: don't be in a plane at cruising altitude outside a warmed and pressurized cabin.

Sherpa Everest Guides: Eleven Times Deadlier Than Being a U.S. Soldier in Iraq

Ain't nobody getting up Everest without Sherpas. It's over 11x more deadly to be a Sherpa guide on Everest, as of the last 10 years, than to be a U.S. soldier in Iraq 2003-2007.

Years ago, we didn't used to count Sherpas' ascents on Everest. Go up with someone else who's carrying your stuff, it counts...go up carrying your own AND someone else's stuff, it doesn't Go figure! It sometimes seems even in the case of the first two people who summited, we've done our best to remember the non-Sherpa, and forget the Sherpa. This, despite the non-Sherpa constantly reminding everyone that he was part of a team of two. Neither Norgay nor Hillary could have done it alone.

The thing that made me personally so angry about this tendency and the most recent tragedy, and at the continued lack of recognition of what the Sherpas do in getting people up old Sagar Matha ("guide" doesn't begin to describe what they do) is that without Sherpas, there would be no climbing season. Every year these guys lay ladders across the Khumbu Icefall, a treacherous place of crevasses and seracs - which do sometimes move. Every year these guys put up fixed ropes. Ever climb a glaciated Cascade? I bet you didn't have fixed ropes there, or (obviously) people risking their lives to fix them for you. For climbers who come from outside Nepal, ultimately Everest is a big lark; they're there for fun, and that's all there is to it, no matter how big the words are they use to describe it. It's not like they're delivering critical medicine to someone at the summit (or something equally important). For the Sherpas, it's how they support their families and create a better life for their kids.

So today, take a few seconds to think of the people who dedicate their lives to the outdoors in a very committed and profound way, far beyond anyone who travels to the Himalayas to score a personal point.

"This Was a Terrible Mistake"

From economist Dan Ariely on mountain climbing: "...if people were just trying to be happy, the moment they would get to the top, they would say, 'This was a terrible mistake. I'll never do it again. Instead, let me sit on a beach somewhere drinking mojitos.'"

The first time someone runs a difficult race or class of race, they generally have that reaction near or at the finish line. Then that night, they're looking for online running calendars to find the next one.

It must be said that the beauty if you go climbing in Latin America, mountains and same (or next) day beach mojitos are not mutually exclusive. You can get mojitos in Washington State and drink them on the beach but somehow it's not the same.

Below: two awesome beaches.
As an exercise, reason out on which a mojito is best consumed.

A Nifty Rope Swing

Ranchers Conserving the Open Wilds of Southern Colorado

While I was driving through the amazingly empty southern Colorado/northern New Mexico area on my awesome trip a few weeks ago, I got curious about the mountains to the west of I-25.  It's an interesting ecological area, the border region between the Chihuahuan Desert, the high plains, and the Rockies, and among those empty mountains are 14ers and dinosaur tracks.


You've never heard of any of these; they're kinda sorta the Front Range of the Rockies but way down in southern CO, called the Sangre de Cristo Mountains. From Sangres.com.

Turns out the army is trying to expand their little-known base there, and in a familiar theme, the local private landowners, ranchers, environmentalists, and outdoors types recognize they actually all have a common interest to work together.  The story here is a fascinating (and useful one) on multiple levels.  Here's the Summitpost entry for one of those peaks (Culebra), some of which are privately owned - but accessible thanks to the owners.

The San Juan Mountains Are Neat-O

So I survived the three months of my surgery rotation only by imagining the promise of the San Juan Mountains in my future, and what a promise it was. Somehow all my wanderings around the Western U.S. had not taken me to them, and last week with trusty pal Dorothy I finally set off to correct this. Interestingly, my neglect of the San Juans and CO Rockies generally seems to be shared by my fellow Californians - we noticed a dearth of CA plates, but no shortage of TX, OK and KS. The route, which was every bit as awesome as it looks:



(Geek point: to figure out the best trip, I prioritized what I wanted to do, then used an online Traveling Salesman solver and added nodes sequentially, seeing where there were significant jumps in travel time. Not surprisingly, there was a jump in travel time for paying my respects to Caballo Blanco by going for a run in Gila Natl Forest or going to the Oklahoma Panhandle just because.  I will definitely be planning future roadtrips this way.)

You will notice on that route a visit to Flagstaff, a cool town that people are unfortunately finally discovering; Wupatki Ruins (including the ball court and wind cave that I forgot about) and finally entered the Navajo Nation, which I seem unable to permanently escape. There we saw easily the most amazing rainbow of our lives. We stopped for the obligatory fry bread and passed through Monument Valley and Mexican Hat. Notes: don't eat fry bread with honey while driving. Monument Valley is oddly unsettling at dusk. Mexican Hat has a little restaurant (the Olde Bridge Grill) with great lamb dishes overlooking the San Juan River near the famous goosenecks. And finally: the Four Corners area does in fact close at night. But eff 'em because it's not really the Four Corners anyway.

Wupatki Ruins, north of Flagstaff.   A ball-court at Wupatki.   A double-rainbow in Navajo Nation.  We seemed to be driving into the base of it for 30 minutes.  I didn't ask what does it mean.   From there we passed through Cortez on the way to Durango. We decided not to go back to Mesa Verde and Hovenweep Natl Monument. Cool though they are, especially the coded steps, my travel companion told me that where she's from there are thousand-year-old dwellings all over the place so she wasn't so impressed anyway. Durango bills itself as a Four Corners-area town but SW Colorado is the outgroup of the four states that come together in that region. Because it's higher it's greener; Durango just looks different. Once arriving in Durango we recognized that it apparently has a law that only awesome things are allowed to be there. The mountains and trails around it are of course spectacular, plus there are brewpubs and fun restaurants, plus there's a hiking train (!) plus just randomly one day there was a plane taking off with a glider in tow right next to town.  Even the flea market is awesome (see the scorpion-lamp below):

Scorpion Lamp by Ron Howell.  Check out bracelets, lamps and more here.  He's a cool guy and he only makes dragon and scorpion stuff.  Ron doesn't screw around.
The only downside is that my Jeep Liberty kicked the bucket in February and there were a number of trails we couldn't get to without a 4WD.  It's not like California dirt roads (i.e. getting to Holy Jim Falls and Santiago Peak in the Trabuco Unit of Cleveland NF) - when Coloradans say 4WD-only, they're serious.  The first day: Engineer Peak, starting at Coal Bank Pass. Every day we got chased by thunder. In California we don't usually have this problem, but in Colorado every year people are killed by lightning. Lesson from this trip: when hiking Colorado peaks in the summer, start early. Early early early!

Famous image of a woman on a mountain observation deck.  Lightning struck within minutes of this picture being taken, badly injuring her. Don't put yourself in this position in CO in the summer, start early!  Here's one guy who got off easy.
Post-glacial kettle-pond On the way to Engineer Peak.

A rock glacier on the north side of Engineer.


Landscape with sasquatch.



 

The area north of Durango, around Silverton where we did most of our San Juan explorage.
Afterward we headed into Silverton, a town which I absolutely fell in love with.  Why am I so smitten by this struggling mining town full of eccentrics?

- It's full of eccentrics.
- At over 9,000', only Leadville is higher.
- It has its own 100 miler (the Hardrock 100), most recently won by Hal Koerner. (Go there for photos if for no other reason.)
- Of course it's surrounded by amazing hikes and climbs.
- As if to lure me in, the first business I walked into (an old Victorian Hotel) was showing Blade Runner, my favorite movie of all time.  (Actually it kind of spooked me.  Reminds me of that one bit from Bradbury's Martian Chronicles.)
- Finally, this tiny town has not one by two restaurants that serve Rocky Mountain Oysters. (More later.)  One such establishment helped me trick my travel companion with a Jackalope, while serving us Durango Brewing Company's excellent blueberry beer.  (Does anyone know where we can get this in CA?!?!)



Rocky Mountain Oysters, which we euphemistically called "nuts".  Someone (not me) insisted on coming back a second night in a row for these, so delicious did she find them the first time - which led to me on subsequent evenings to sleep uneasily in a protective position.
The next day, still in the San Juans, we headed up to Ice Lake, which may have been my favorite of the trip.

 If you told me the world was created starting from this place, I might not be surprised.

It was during this hike that my companion advanced her controversial theory that people of Germanic descent enjoy and are better at trail-running and hiking in temperate or boreal forest because we are after all a post-glacial forest people. My counterargument to her: say no to drugs.

This fellow was insultingly relaxed.  As in, he actually relaxed at us seemingly to prove a point. 

The lake was pretty cool, so we took some video, although we dared not dawdle due to the hail and thunder.  Don't ask me what those people were doing camping up there.




We also took video of a less-relaxed marmot who lived by the lake and who was telling us what's what.


The next day we went up to Ouray (pronounced by locals "yeRAY" - people in Denver, take it up with them, not with me), where we hiked to the Bridge of Heaven.  Not as high as the area around Silverton and a little drier - this was actually in Uncompahgre National Forest.  Ouray is where much of the original True Grit was filmed.  It was also the inspiration for Galt's Gulch in Ayn Rand's Atlas Shrugged, although there was no solid gold dollar sign hanging over the valley.  (I did once see one near Cholame, CA once, but that's another story.)   A great brewpub, real live cowboys, and of course more trails.  Ouray seems to have developed better than Silverton.

I was sure glad to get above the gritty urban hustle and bustle of Ouray.  (Above, lower right.)   

 The camera didn't believe how green these trees were.
I took a couple videos getting up near the top. When I was coming back down I decided to record a little bit of the run (sorry for the Blair Witch motion-sickness-prone among you). I had to stop and tie my shoe so as not to take the fast way back down to Ouray.



After we came back down we chillaxed by the car at the stream and looked at trees and clouds, after which time we headed up to Montrose.

Before leaving the San Juans, a geography note: Shotgun Peak in Rio Grande Natl Forest in the southeastern side of the San Juans looks very strange geologically.   See all those valleys east-southeast of the msa?  If you run across this article searching or by a news alert, and you have some clue, drop a comment - I'm curious as heck what's going on there.


Things change when you get north of Ridgway. You're out of the San Juans, and it gets very dry and flat and you feel like you're in New Mexico or Utah. Black Canyon of the Gunnison is there, and it is, as one hotelier put it, "Well...it's a big canyon." If you're in the area see it, but I wouldn't go out of my way.



It is at this point you will notice a dearth of (good quality) pictures - because Dorothy lost her phone at the Mt. Elbert Trailhead (if you see it email me! LOL!).  The upside is that there are few pictures of me with a beard, which she made me grow.  The only record is me at the summit, which a nice fellow on top took and sent to me.

So I've bagged the #1 and #2 peaks in the lower 48.  SWEET.  I also saw a pika during the climb, way above the tree or even the grass-line.  We ended up racing back down as dark clouds gathered.  Why?  Thunder.  Start early!

From there, we headed to Boulder to see friends Dave and Jacqui. It was really good to catch up with them (thanks guys) and good to experience some actual heat. On the way from Elbert to Boulder we realized we'd never hike all the NFs in Colorado. For that matter I still haven't been to Rocky Mountain Natl Park! But Dave took me on a nice run up the Flatirons right next to Boulder.


This is the knife that cut Joe Simpson's rope - i.e. the guy from Touching the Void. In Neptune Mountaineering in Boulder.
From there, someone was too good to drive back to San Diego, so I took the Princess to DIA, leaving poor me all by my lonesome. Actually there was cool stuff on the way back. I finally got to drive up to Pike's Peak (wanted to see how the car did at 14,000'; would've run but no time); checked out the Garden of the Gods (red rocks below); and then drove the amazingly empty strentch of I-25 from the Springs to Santa Fe. There are two things out there, Jack and Sh*t, and a whole lot of 'em at that.

A special note on Santa Fe:  what a cool little town.  Again, somehow I'd passed by or quickly through this place in the past, in retrospect to my detriment.  The old town and Plaza Mayor are gorgeous and Maria's New Mexico Kitchen is in the coolest little-big adobe with the tastiest food ever.

A church door in Santa Fe's old town.

It was damn hot south of Albuquerque even at night, so I shouldn't have been so surprised to see that sidewinder crawling across the highway in my headlights. Sorry guy.

At daybreak I got off the highway at Socorro to head over to the Very Large Array (VLA), a radiotelescope installation I've been obsessed with for a while.  If you've seen Contact or 2010 or Terminator Salvation, you've seen the VLA.

This was a wall of post-it notes from visitors who wanted to leave messages for the astronomers who run the place.  Below:  this was my own helpful note, after having seen Terminator Salvation. But I think I was too late because the place was completely unmanned. I didn't see a single person the whole time I was there, even in the (open) visitor center.

Originally after the VLA I was going to head down to Gila NF to pay my respects to the late Caballo Blanco, but there had just been a fire there and it's out of the way anyway; I'll get there some other time. I'm not sad since I ended up being amazed by the greenness of western NM/eastern AZ at this time of year. This is probably the most surprised I've ever been by the way a part of the U.S. looks. They also have cool (weird) names for towns. Right after this one, I went through Omega also.

After that I paid a visit to the Mogollon Rim in Sitgreaves Natl Forest, Arizona. It was so green that there was a fern-filled valley in one place (sorry, no pics) and plenty of awesome trails; I got in one last run on my last day.



Above:  the Mogollon Rim is that green stripe. It's the southwestern edge of the Colorado Plateau. The running was fantastic but pretty hot (90 F) even at 7500'; then again, let's not get carried away complaining since after all it was Arizona in August.

During the run I saw a fire starting on a distant peak, which by the time I was getting out of the Natl Forest toward Mesa had blossomed into a full-on fire. There was dry lightning all around. The way back included normal Phoenix traffic, the endless emptiness of I-8 west of Phoenix, a sandstorm in Yuma, the fires in the mountains here, and almost hitting a flying owl on I-8. It was like a fantasy novel or something. I fought the demon horde, then crossed the Empty Quarter, survived the smothering sands, then braved the land of fire and darkness. One does not simply drive into Mordor.)


Yuma. It might actually look better when you can't see it.  Imagine all that grit in your teeth, which is what happens when you have to get out to pump gas.


Coming up the east side of the Peninsular Range on I-8.  The fires to the left (from my vantage point, south in the range, in Mexico) were much bigger than what remained of the San Diego County fires at that point, although they were less reported here.  The sunset they produced was spectacular.

This trip was a blast and was exactly what I needed to unwind after surgery.  Thanks to Dave and Jacqui for putting us up/putting up with us on Friday night, Jason for hiking tips, and Dorothy for being the best road trip buddy EVAR!


[Added later for your enjoyment if you travel in the area as well as my own later consultation:

- Dave Casler's blog, which has a huge amount of SW Colorado information.
- The Excellent 4 Corners Hikes of the Ancients.
- An amazing gallery by Matt Trappe from the 2012 Hardrock 100 Miler around Silverton.
- Hal Koerner's race report from his victory in that same race.

Thanks to those of you who put this information online to help the rest of us enjoy the area!]