/ Kilimanjaro and Mental Illness

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lanm1192 - on 22 Apr 2017
Hello, so I'm taking a trip to Egypt and Kenya in October, and thought it would be great to make a summit attempt at Kilimanjaro while I was already in the area. Anyway I'm researching gear and needs, etc etc etc, and came over some concerning things regarding the cognitive effects of being at high altitude as well as permanent brain damage from high altitude/too fast paced summits.

So I'm schizophrenic. Reading that hallucinogenic like effects may be felt on Kilimanjaro makes me uneasy in terms of safety. Plus, I'm fairly certain I already have some cognitive decline due to former drug abuse, prescription drugs for mental health treatment, the near constant stress/strain that comes with the illness, and probably lack of adequate mental stimulation/exercise.

I don't take my medicine anymore since I found out my symptoms are pretty much the same whether I'm on it or not (after fours years of switching brands etc). And I know I read things that slow the nervous system down are not good for high altitude.

I can already get a bit disagreeable in crowds of people, but figured I could tough it out. However, now I'm not so sure, and in all fairness, I know it's not just my safety at risk.

This is the route I had been planning on taking:

http://www.peakplanet.com/routes/lemosho-10-day/#1471641021454-c8f78b60-76b21ce7-3ce7

I'd appreciate any opinions, knowledge, advice, etc. Thank you.
JayPee630 - on 22 Apr 2017
In reply to lanm1192:

Will you be able to get insurance for the trip? Will you be with a trekking company and are they happy to take you when you've explained your illness?

It's really hard to say as you know because what you say you have can cover quite a wide range of things. Are you generally OK day to day? Will you have someone with you who knows you and what's going on if your condition gets worse?

Good luck though! And nice one for posting.
lberry - on 22 Apr 2017
In reply to lanm1192:

Having been on that route and summited a few years back I think the overriding consideration is how your body responds to altitude and you'll only know that when you've been at altitudes of maybe 3,000m or more.

When I was there I adapted well to the altitude but a couple of much fitter team members really suffered and one in particular was behaving very out of character as a result. I do have a fair amount of Alpine experience up to 4,500m though and know how my body responds to altitude.

The summit day does include a lot of height gain and descent and is a very long day in total. Even when acclimatised its pretty tough on everyone's body and mind climbing from 4,650m to nearly 6,000m through the night and then descending to the Base.

I'm certainly not qualified and wouldn't want to advise you do or don't try it, fair play for researching it and putting it out there.

I'd suggest trying to learn how you react at lower altitudes first and being open about your circumstances with a trekking agency or guide.

Good luck, hope it works out for you
lanm1192 - on 22 Apr 2017
I will definitely be getting insurance, and have emailed the trekking company this morning. I probably won't hear from them until Monday-Tuesday. But I will also call my psychologist on Monday and see what she says.

I tend to get fidgety and nervous in crowds. I've gotten a bit better over the years, and am now making a more determined step to work with CBT techniques. Really, it seems one issue is not consistently working at a reasonable pace to build mental fortitude. Which, granted, is tricky, especially when it's hard to really gather your thoughts and yourself together in a safe place to work it out.

A big concern is both that I will have voices harassing me the whole time, which I can sometimes ignore and dismiss and other times tend to overwhelm me. During intense physical exertion my tolerance goes down a lot. And I suffer from some involuntary body movements which I guess are a rare form of physical hallucination where my body moves, but it doesn't feel like I am doing it. Nothing too bad, and I keep it under control by stiffening my muscles. But it had worried me to drive, and so now I am concerned about all of this combined and trying to summit Kilimanjaro. I don't literally lose control of my whole body, and I know this isn't a technical run, but it just seems like issue topped on issue that makes it a bit dangerous.

My only experience of altitude around 3000 meters is walking around Lone Pine Lake at Mt. Whitey trail in U.S. last summer. Which was one day for maybe 30 min or an hour before I descended. I felt fine then, but...

Oh never mind, I spent a little time walking around the Bristlecone Pine Forest too, but still, my high altitude experience is lacking.

Yeah, that and another post on another forum are making me think the best strategy is to spend more time at higher altitudes and gauge my abilities based on that.

mysterion on 22 Apr 2017
In reply to lanm1192:

You sound like 'too much trouble' to be brutally honest. A lot of etiquette is required and expected in such environments.
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slab_happy on 22 Apr 2017
In reply to mysterion:

What makes you think that people with mental illnesses are incapable of "etiquette"?

Yes, lanm1192 has got to figure out whether he can safely manage his issues while dealing with the challenges of altitude and a group situation, and what supports he might need to get in place for it to be workable, but he seems to be going about that very thoughtfully and responsibly.

> You sound like 'too much trouble' to be brutally honest.

That's not "brutally honest", it's just insulting and offensive.

I'm guessing you don't think your lack of "etiquette" bars you from trekking, though ...
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mysterion on 22 Apr 2017
In reply to slab_happy:
Are you serious, just read what he wrote. And piss off snowflake.
Post edited at 20:14
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slab_happy on 22 Apr 2017
In reply to mysterion:

> And piss off snowflake.

Sensitive to the cold, are you?
1
Greasy Prusiks on 22 Apr 2017
In reply to lanm1192:

As a bit of general advice I always think you should try and test as many of the individual components of an expedition as you can before you start on your trip. That's everything from techniques to equipment to fitness. For example if I know I might be doing some long days then being able to put a tent up in the dark is pretty handy so I'll do a few dry runs in the garden at home.

If you get the go ahead from the right doctor/s ect perhaps you should try applying that approach to your condition?

Best of luck whatever you decide.
jethro kiernan - on 22 Apr 2017
In reply to lanm1192:

I am not speaking from personal experience but I have spoke to several relatively experienced people who had concerns about the height gain and the chivvying along of people who were obviously suffering from altitude sickness and probably should have been sent down.
This is second hand info and obviously different operators and guides do things differently.
Good luck with it
Snoweider - on 22 Apr 2017
In reply to lanm1192:

First up, I think you are asking in the wrong place, I doubt there are many folk on here who know much about your condition at altitude. I think it would be a very good idea to talk to your psychologist, as you suggest. It sounds like you are able to manage your condition very effectively yourself, and that you know when you are getting close to your limits.

Secondly, does it have to be Kili? Have you looked at Meru (4500m)? An equally beautiful, if not as high peak, its just next door, with fewer people, and less time spent on the mountain, and may be a more enjoyable option than Kili- for anyone to be honest... Its actually a wee bit more technical with a short section of scrambling on the ridge to the summit.

The only other thing I'd mention is your anti malarials. All have some odd side effects, but Larium in particular has serious mental health issues associated with it for some people. Hopefully you will discuss side effects with your doctor.
veteye on 22 Apr 2017
In reply to lanm1192:

I found Kilimanjaro less of a challenge than I had expected. I went by the Umbwe route, which I chose since it seemed more interesting, and certainly I really enjoyed going up through the trees. Would that be a peaceable route that would have a settling and less stressful effect on you? I wanted to go up the scrambling route up from Barranco valley,but there was unstable rock at the time and we ended up swapping over to Barafu. The only time I felt the effects of altitude were a slightly heady day going from Barranco to lava tower and back down again to acclimatise, but I was lucky as I dictated what we did as I had my own guide with no other clients.(This was because I was there in the rainy season, and there were no tourists around in Africa at the time due to bombing of the US embassy in Saudi Arabia)
Would it help to stay 2-3 days at one camp as you acclimatise, as it possibly would be less stressful? Would you be able to go with a friend who knows you?
I made sure that I was really as fit as my job would let me before I went. So I did running, and I fell-walked with a heavier rucksac. I found that I did not need as much fitness as I expected, but it helped, and certainly on the last day I zoomed up from Barafu to the top. No-one else was remotely as quick, and that may help you. That is because if you are in a group, no doubt you will find other people less fit and less into climbing/walking than you, so the group pace will not be as swift, which reading your notes means less stress.
I and am sure a few others are gunning for you, albeit that sentiment may show some naivety on my part. It may well be that if you do it, that it will be a positive in your experience-fallout, for some time to come, and may be a building block to other goals.
lberry - on 22 Apr 2017
In reply to lanm1192:

I don't recall crowds being an issue at all, certainly not when I was there. The walks up to all the lower camps could be spent in reasonable isolation if that's what you wanted. It's only summit day where you will be walking in line with other folks and even so, it's a big mountain and I didn't find it at all crowded. You'd be walking in the dark with only the light of a headtorch too - being in a group may feel reassuring? The Guides we were with all started singing together in the dark on our summit day, that was a pretty special experience.
lberry - on 23 Apr 2017
In reply to lanm1192:

Thinking back I think Barranco wall can feel a little crowded also
slab_happy on 23 Apr 2017
In reply to Snoweider:

> I doubt there are many folk on here who know much about your condition at altitude.

To be fair, there probably aren't many folk anywhere who know much about the effects of high altitude on pre-existing mental illnesses -- it's a bit of a niche topic!

(Google tells me there has been a tiny bit of research on living at high altitude as a risk factor for suicide in people with mood disorders, but not much.)

Obviously the person the OP most needs to talk to is his psychologist, but since he's already going to be talking to her anyway, other people might at least be able to throw out things to consider. For example:

> The only other thing I'd mention is your anti malarials. All have some odd side effects, but Larium in particular has serious mental health issues associated with it for some people.

I'd not thought of that at all, but yeah, GOOD CALL. Choosing an anti-malarial which minimizes the risk of a bad psychiatric reaction would be super-important.
syv_k - on 23 Apr 2017
In reply to slab_happy:

Lariam is prescription only and full of warnings never to prescribe to those with significant mental health conditions, so I am sure the OP will be given something else.
JayPee630 - on 23 Apr 2017
In reply to mysterion:

You really come across as a nasty arsehole. Do you know that?
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Snoweider - on 23 Apr 2017
In reply to syv_k:

You'd think so but I've seen quite a few clearly inappropriate anti malarial prescriptions over the years, and witnessed first hand the distress and danger of a psychotic episode caused by Lariam.
trouserburp - on 23 Apr 2017
In reply to Snoweider:

You might reasonably skip antimalarials if you're coming in from Kenya: http://malariaspot.org/wp-content/uploads/2016/02/malaria-kilimanjaro-map.jpg

You know your specific risks better than anyone on here - minimise them paying extra if you have to, spend time at mid-altitude beforehand to see how you get on, organise a small group with someone who knows you, guides fully informed, acclimatisation day etc. Retreat early if you have to. Don't make any change to meds shortly before you go.

We all take considered risks following our passion (including risks for our climbing partner) - nobody here is in a position to judge yours to be too high. Just have to be honest with anyone else affected and let them say no if they're not happy (I suspect they will be ok with it, most people have a friend or family member with significant mental health issues)

Good luck!
Toerag - on 23 Apr 2017
In reply to lanm1192:

If you really think you'll endanger others why not go for making the ascent in a straitjacket? Would be a novel way to raise funds for a mental health charity!
PS. I think you've done the right thing by asking on here, and it would appear that you know yourself and your limitations which is a good thing. Best of luck with whatever you choose to do!
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slab_happy on 24 Apr 2017
In reply to lanm1192:

Sorry for the rather belated reply, been pondering this.

> Yeah, that and another post on another forum are making me think the best strategy is to spend more time at higher altitudes and gauge my abilities based on that.

That sounds extremely sensible. Test it out in much shorter stints, and see how it affects you.

It's not my area of expertise, but a quick Google found that some places seem to recommend doing some shorter "acclimatization peaks" while you're in Africa as part of preparing for Kilimanjaro anyway, so you can acclimatize more gradually.

I also noticed that the company you're looking at will rent out supplementary oxygen systems:

http://www.peakplanet.com/high-quality-equipment-service/

Going for that on Kilimanjaro would mean extra cost but much less worry about the effects of altitude.

Things to think about (drawing on my experiences with severe depression and anxiety plus autistic spectrum stuff -- so, obviously not the same, but I've had to work out what I can and can't cope with on climbing trips, as a person with some mental weirdness):

Are you usually aware if your mental state is starting to deteriorate, or does it take someone else to point it out?

It could be worth thinking about having an "exit strategy" in place, so if things start getting bad during the trek, you have a mechanism to enable you to turn back and leave (and get somewhere safe where you can get yourself together) with the minimum of hassle, rather than having to continue along with the rest of the group.

The last thing you want is the situation jethro kiernan mentioned hearing about, where you're doing badly but get herded along because the guides just want to get the job done.

JayPee360's suggestion about having someone along who knows you sounds like a very good idea. If not, making sure that someone in charge of the trip is briefed seems critical.

Obviously my issues are different, but for me, when I'm having a meltdown is when I'm least able to start explaining to strangers the details of my diagnoses and mental state and what kind of support I need from them.

I know it's really unpleasant feeling like you have to disclose your medical history (particularly to people who may be misinformed and need to be educated about what your issues actually mean), but it's better than having people misunderstand and over-react if things go bad for you. Especially if you have stuff like involuntary movements which people may notice anyway.

> A big concern is both that I will have voices harassing me the whole time, which I can sometimes ignore and dismiss and other times tend to overwhelm me. During intense physical exertion my tolerance goes down a lot.

Yes, that sounds like one of the biggest concerns. Definitely worth getting your psych's take on that, possible coping strategies, and whether it's realistically going to be manageable or not.

As with the altitude, it could be worth testing the effects of physical exertion out in smaller doses first, and try gradually increasing the duration/intensity over time (which will help with general fitness anyway).

If you're going to get overwhelmed at a certain level of physical exertion no matter what you do, ideally you want to find that out in a relatively safe/manageable context, and not when you're stuck up a mountain!

> I tend to get fidgety and nervous in crowds.

Yeah, I have a very hard time with crowds too (just too much sensory input), and for me, group activities are always challenging. Having private space and being able to retreat from other people is critical to my mental functioning.

So it'd be important to find out about the accommodation and camping, whether you'll be sharing tents, etc..

I also get some benefit from things that let me "zone out" and create my own private bubble even if I'm sharing physical space (so I have coped somewhat with shared dorm-type sleeping space with an eyemask and listening to podcasts on headphones).

On the other hand, I know some people find that sort of thing can make them feel more dissociated/spacy, so your mileage may vary.

If dealing with the group situation seems like it'd be too much or too risky (or just a really grim experience), I'd wonder about seeing if you could hire a guide or two to take you individually, or you plus a friend.

> but figured I could tough it out

Unfortunately, "tough it out" so rarely works with mental illnesses ... (been there tried that).

You sound like you have a lot of self-awareness, and you're considering the risks rather thoughtfully and responsibly.

If you're generally managing day to day, and you can cope with the stresses of travelling in Egypt and Kenya, I wouldn't rule out Kilimanjaro as flatly impossible.

But obviously there are various factors you need to test out first, and a standard trekking package might not be the best way to go.
alasdair19 on 24 Apr 2017
In reply to lanm1192:

The more time spent acclimatising the better. Commercial packages have to compete on price and often compress timings. You'll have plenty of time so figure out a way to spend 3 weeks climbing.

Id get out hiking in your local hills to try and figure out your reaction to exertion.

In the UK there is a diploma in mountain medicine for doctors. This would be a good way of finding the expert advice required. There may be something similar in the US. Good luck.

You need expert advice regarding side effects of malarial medication. Your psychologist can't help there.
PMG on 24 Apr 2017
In reply to lanm1192:
Make sure there is somebody who will stay with you or walk down with you if there is a problem, without putting any pressure.
iknowfear on 24 Apr 2017
In reply to lanm1192:

even though the Cho Oyu Video got lots of flak here:
you could try to look into hypoxic training, to see how your body and your mind react to low oxygen levels.

Best of luck in your endeavors


https://www.ukclimbing.com/news/item/71056/fri_night_video_-_cho_oyu_in_14_days
slab_happy on 25 Apr 2017
In reply to PMG:

Definitely; that's part of what I was thinking of in terms of an "exit strategy".

And for me, if I know I've got a safe exit if I need one, that can help take some of the psychological stress out of a situation -- which can, ironically, make it easier for me to cope and stay in the situation.
Doug Hughes - on 25 Apr 2017
In reply to lanm1192:

A couple of extra points to throw into the mix here...
1) With regard to not being good with crowds, you may have to share a tent for several days, or pay extra to have your own tent - it would be worth checking this with the trekking company.
2) When my wife and I did Kilimanjaro, my wife had an 'episode' on summit day - just feeling nervous and lacking in confidence. The guides took her down as soon as she said that's what she wanted. With hindsight, we have thought she could easily have continued with the right sort of encouragement, but the local guides were maybe too cautious and 'deferential'. This is a good side to err on, but it's set me wondering how important culture and language may be for your plan. Our guides had excellent English and were fantastic, but maybe were a bit shy of chivvying along a 60-year-old English lady. It will be even more important that whoever is guiding you is sensitive to cultural and linguistic nuances to pick up any potential danger signs, and this may be easier if they're of the same nationality as you.
All the best with whatever you decide to do. The level of honesty and genuine desire to help shown on this discussion has been uplifting.
slab_happy on 25 Apr 2017
In reply to lanm1192:

> And I suffer from some involuntary body movements which I guess are a rare form of physical hallucination where my body moves, but it doesn't feel like I am doing it.

Bit of a tangential comment, but -- not tardive dyskinesia, is it? As you probably know already (since you sound pretty well-informed about your condition), that's an involuntary movement disorder that some people get as a result of having been on anti-psychotics (and which unfortunately doesn't go away when you stop taking the meds).

Not that it makes much practical difference in terms of managing it, but sometimes it helps to know what you're dealing with.
lanm1192 - on 26 Apr 2017
Thank you all for the advice.

First of all, he is a she lol. I suppose it doesn't really matter, but just thought I'd correct it :p.

I decided to forgo the Kilimanjaro trip for now. I want to spend more time familiarizing myself with mountain climbing/hiking and altitude effects, plus take measures to test and strengthen my endurance. And I think it'll be best if I don't lock myself into a travel date right now while I do so.

I spoke with my doctors, and they pretty much said that that's what I need to do, test myself at lower altitudes and see how it affects my body. The hallucinogenic attributes of altitude sickness can potentially exacerbate my symptoms, but nothing conclusive on whether high altitude is bad or not.

Meru is a possibility, and I certainly wouldn't have minded climbing it. To be honest, I had gotten a bit caught up in the allure of being on one of the seven summits lol. I decided that I'd rather not make the extra financial expenditure right now, and just practice more on mountains closer to home. But in the future if I do go, I think I would like to see a it more of the countryside, and do a pre-run up Meru as well.

Anyway, again, thank you all for the advice, and should I attempt this trip in the future I will keep all of this in mind!

Oh, and slab_happy, I don't think it is tardive dyslexia, but I haven't taken the time to specifically find out either. I know I was tested for it some years ago, when I was experiencing some involuntary movements, just not to the same degree as I do today. And when the psychiatrist did the physical test for it, she said I didn't have it. I asked her a little later about feeling like something else is moving my body, rather than me consciously moving it, and she said that it is a rare form of the disease. So yeah. I suppose I have been checked then I guess, just not recently. I might also point out that some of the increased effects didn't happen til maybe a year or so after I stopped my meds. I'm not sure if there can be expected to be a delayed reaction or not, but yeah.

slab_happy on 28 Apr 2017
In reply to lanm1192:

> First of all, he is a she lol. I suppose it doesn't really matter, but just thought I'd correct it :p.

Whoops, sorry! Normally I like to think I'm better about not making assumptions like that, but I think I figured from your username that you were an "Ian"!

> I want to spend more time familiarizing myself with mountain climbing/hiking and altitude effects, plus take measures to test and strengthen my endurance. And I think it'll be best if I don't lock myself into a travel date right now while I do so.

That all sounds ultra-sensible.

There's lots of info around on improving your endurance for hiking/mountaineering, and people will happily geek out about it at the drop of a hat.

Are you based in the UK or the US (or somewhere else)? We've got a bit of a shortage of altitude over here, but I'm sure people can chip in with info on where the nearest/safest options for trying a bit of altitude would be. If you're in the US, obviously you've got lots more options within the country.
ads.ukclimbing.com
lanm1192 - on 29 Apr 2017
In reply to slab_happy:
Actually, I don't think you referred to me as a he lol. Other people when talking about me where saying he. I kinda just tried to respond to everyone in one big post to save time.

Yeah, I'm in the U.S. I might go to Mt. Whitney (4421 meters) if I can get a spot. If not, I may still go because it would be nice to spend more time around Lone Pine Lake (3048 meters), plus I miss camping. (Mt. Whitney gets busy and you have to reserve a place to try to summit it. Lone Pine Lake is as far up the mountain as you can go without a permit).

I will be hiking up the mountain where I live, but my destination city rests at a little over 1829 meters.

Ah, there is a mountain that is roughly a 15 hour hike away and rests at 3506 meters. So I may do that too.
Post edited at 21:58
David Hillebrandt - on 29 Apr 2017
In reply to lanm1192:

Dear Ian M,

I acknowledge that mountain activities can be of real benefit to people with mental health issues but equally they can have negative effects. You will be far from specialised help, physiologically stressed by the altitude, psychologically stresses by the environment, culture and possibly people.

A public forum is not the place for personal medical advice although some well meaning people have made sensible cautionary comments here. I strongly suggest you find yourself a doctor with training in mountain medicine who can work with you and your own medical advisors. for a list of qualified doctors see www.medex.org.uk for holders of the Diploma of Mountain Medicine.

Best wishes

David Hillebrandt
Hon Medical Advisor to BMC
The Ice Doctor - on 19 May 2017
In reply to David Hillebrandt:

David, thank goodness for your posting!

purplemonkeyelephant - on 19 May 2017
In reply to lanm1192:

Surely the simple answer is find a mountain guide who is also versed in psychology, go with them and also someone who knows you well. This support system will allow you to test your limits in relative safety. It will be more expensive, but safety usually isn't super cheap.
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elliott92 - on 19 May 2017
In reply to mysterion:
You can poke your etiquette up your ass. It's not about the summit, it's about who you stand there with.
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mysterion on 19 May 2017
In reply to elliott92:

lol, get back to Off Belay you idiot
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