There are three types of High Altitude Pulmonary Edema (HAPE) recognized in visitors and people living at high altitudes. These include classic HAPE (C-HAPE), which involves an individual that lives at low altitude traveling to high altitude. Re-entry HAPE (RE-HAPE) is seen in an individual that lives at high altitude who travels to low altitude and then returns to high altitude. And high-altitude resident pulmonary edema (HARPE) which occurs in an individual that lives at high altitude and does not change altitude (Ebert-Santos, Wiley). While these have been extensively studied and are subtypes that people are warned of, a fourth unexpected type of HAPE has been recently described by pediatric pulmonologist Santiago Ucros in Bogota, Columbia at the Universidad de los Andes. (Ucros)
Highlanders HAPE (HL-HAPE) occurs in people that live at high altitude who then travel to higher altitudes. Though most people who live at high altitudes for long periods of time assume they are immune to HAPE, the recognition of HL-HAPE shows this is not the case. One man had a run-in with HL-HAPE during his long-awaited trip to Mt. Kilimanjaro.
A resident of Summit County, Colorado, Jonathan Huffman set out to climb Mt. Kilimanjaro with his wife Katie when he was 37 years old. He is originally from Texas, but has been living in Breckenridge, Colorado, elevation 9,600 ft, for 15 years. In preparation for the climb, he spent the summer hiking multiple fourteen thousand foot peaks in Colorado, trail running at 9,000-12,000 ft, and mountain biking.
The elevation of Mt. Kilimanjaro is 19,341 feet and the summit generally takes each group anywhere from 5 to 9 days, depending on the route taken. In September, Jonathan and Katie traveled to Tanzania where they spent two days adjusting to jet lag and preparing for their climb. They had chosen to follow the Lemosho Route which is 42 miles long with an elevation gain of 16,000 to 17,000 feet.
On the first day, Jonathan and his party started at the Lemosho trailhead (7,742 feet) and hiked up 9,498 feet to the first camp. He noticed that his throat felt dry and he found himself having to clear it often. He attributed this symptom to the dusty environment.
On the second day, he felt as though his body was fighting the dust, which had found its way into his eyes, sinuses, and throat. He also felt extremely fatigued and stated that every action felt more difficult. Though he could tell his body was struggling to adapt, Jonathan continued to push forward with full force. He made it to the second camp at 11,500 feet.
“Day three, we went from 11,500 feet to 13,800 feet,” Jonathan recounts. “After we arrived to this camp, our guides offered to allow us to take a break then hike even higher. This was [an] optional acclimatization test … but I actually skipped it. I was so tired when I got to camp on this day, I decided to just nap in the tent until dinner time.”
On the fourth day, Jonathan’s group hiked up an overpass to Lava Tower located at 15,190 feet. This was also an altitude test, and he passed. He stated that this was the highest he had ever climbed, but that he was beginning to feel more like his normal self. The group stopped for lunch at the tower, but he did not have much of an appetite. He ate the food anyways at the insistence of the guides.
“Then after lunch, we descended down to Barranco Camp [from 15,190 feet to 13,044 feet] and this is where I realized I had HAPE.”
As they were nearing the camp, he felt fluid building in his lungs that was easy to cough up. By the evening, however, he felt as though he was drowning and was unable to lay down. While the guides encouraged him to immediately hike down, he did not want to hike in the dark. He spent the night propped up on duffle bags or sitting in a kitchen chair, with his oxygen reaching as low as 67% at one point.
In the morning, he received 30 minutes of oxygen treatment before beginning his 8-hour descent. His symptoms improved when he reached 6,500 feet. He was picked up in a rescue vehicle and received further treatment at a hospital in Moshi. While he made a full recovery, he stated that he still felt the effects of HAPE while exercising in Colorado at times, up to months after the experience. While Jonathan was only about 2 days away from the summit, he knew that turning back was the best choice. He plans to re-attempt the climb in a few years.
Jonathan’s story serves as an important reminder to those living at altitude that HAPE can affect anyone. Jonathan’s wife Katie along with everyone else in the group also experienced mild symptoms of altitude sickness including headaches. Research still needs to be conducted on the cause and prevention of this condition in all types. While this shouldn’t stop hikers and climbers from climbing mountains, they should be aware of the signs and symptoms of HAPE, when to seek treatment, and the best ways to prevent it from occurring.
A map of the Lemosho route as listed on the Ultimate Kilimanjaro guide site can be found here.
