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What follows are 2 short descriptions of physiological problems we have experienced when cyclotouring at higher elevations--problems that don't respond to the usual remedies of carefully managing food, water and salt intake.

Altitude Headaches

Bill cresting Switzerland's Furka Pass at 2436 m or 7992'.

    Bill is our "canary in the mine" for altitude ill effects as when doing loaded cycling as he starts feeling the ill effects of the altitude before I do. Though we both start huffing and puffing earlier, it is right around 6,500' (about 2,000 meters) that Bill has difficulty. Full blown altitude sickness classically begins closer to 10,000' (3,000 meters). That's a more severe condition with nausea and vomiting--things that Bill isn't experiencing. But we assume his symptoms are on the continuum of altitude sickness and take it seriously.  Interestingly, if we take an effortless cable car up to 10,000' or higher and hike, he doesn't have any problems. It really takes the high exertion at the higher elevations to nail him.
    Almost all of Bill's symptoms are subtle--things he has had to go looking for to notice. He has scrutinized his physiological reaction to find the early signs of altitude effects as the later, more obvious symptoms  could be lethal: wobbling on the bike and poor judgment in traffic
    When he looks for the most subtle markers for the altitude effects, he notices:
        -decreased awareness of his body (like not noticing usual sensations like hands on the handlebars)
        -slight headache
        -funny feeling in the top of his head
        -slower organization of thoughts
        -a pleasant, spacey detachment that impairs judgment
        -impaired ability to judge if he is wobbling on the bike
        -a little wobbly when walking
As the amount of time at elevation and the absolute altitude progress, his appetite goes and his strength diminishes.

    The things that help with the altitude effects are:
        -drinking lots of water throughout the climb (something he always finds difficult) as being well hydrated especially
             helps the headaches
        -drinking or eating something sugary when he begins feeling "off"
        -eating something every 10 minutes, like sweets, fruit, chocolate, or nuts
        -stopping frequently to rest for several minutes
        -stopping longer until his head clears, not just until he catches his breathe
        -talking about his sensations and awarenesses, which helps him with monitoring his condition. The difficulty he has in
                in reporting his sensations also serves as an indicator of his state. The talking also helps bring his mind back out
                of the haze.
        -laying over at 5,000' or 6,000' for a night or 2 seems to help too

    Again, these symptoms are subtle and mild but are the earlier markers for more serious impairment. These symptoms are triggered by being somewhere around the 6,500' level above sea level and pedaling a bike and gear with a combined weight of around 100 lbs on grades that are usually over 6%.  Just hiking at that level wouldn't trigger the cascade of effects. But it does tell Bill that his visions of visiting base camp at Mt Everest are probably best left in his dreams. 

"Mountain Fatigue"
    In addition to the effects of altitude, we have both suffered what we have dubbed "mountain fatigue." Perhaps its just garden variety fatigue, but we both had 1 nasty feeling day in the Alps in 2005. I was effected at the end of a day whereas Bill was nailed from the get-go one morning.
    My episode with our mountain fatigue syndrome came at the end of a big climbing day. We had crested a high pass in Switzerland and I had done quite well. My strength was good, the circumstances had allowed me to manage my body temperature despite it being a hot day and I hadn't been particularly affected by the altitude. All seemed well and we had a long descent for the remainder of the day. But it got dreadfully hot as we dropped elevation and the little bit of pedaling we did at the end sapped us both in the 90 degree heat. When we stopped for groceries, I could tell something was amiss. I was slightly dizzy or lightheaded feeling and felt worrisomely "off." Going into the air conditioned market perked me up but when I got back outside I felt terrible again.
    We limped off to find lodging and I was surprised that even after bathing and eating I still felt abnormal. It was very odd as the usual culprits are lack of food, water or salt and none of these seemed to be the source of the problem. I felt fine after a night's sleep but we opted to layover a day to be sure.
    The onset of Bill's episode was quite different as he was affected from the first pedal stroke of the day. He hadn't a clue when we were packing up in the morning that anything was amiss but as soon as we got on the bikes, I left him in the dust. At first he assumed that I was a ball of fire that day but he quickly learned that it was the opposite, that he was dead meat.
    The previous day had been quite hot with difficult grades but we had cut the day short because of those conditions. He was totally unaware that he was depleted on that preceding day. But the next day when "mountain fatigue" hit, he couldn't shake it off. We tinkered with food, fluids and salt while on the road to no avail. The best we could do was stop every 200 yards to let him rest on the moderate climb until we got to a town with lodging. He had many of the same symptoms I had had, especially the worrisome "something's not right" feeling and being a bit lightheaded.
    We still don't know what "mountain fatigue" is but it seems to be a deep fatigue from the exertion that comes with being in the mountains combined with hot weather (though our symptoms don't fit with heat stroke or heat exhaustion.) And it doesn't seem to be a mismanagement of food or fluids. What we have decided is that rest is the only remedy and so we began taking more rest days while in the mountains. Interestingly, in 2003 we did more elevation gain in the same mountains and our only ill effects were getting really tired. But in 2003 we weren't cycling during a heat wave either.

That's what we have learned about the more subtle things that make us feel crummy in the mountains. We'd love to hear what you have learned or read about such problems.

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