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Altitude Sickness Trip Report and Re-Attempt Questions
#27480 09/05/12 03:45 PM
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Yesterday my father and I set out for a "day" hike of Whitney. We stopped at Lone Pine Lake to nap and hopefully further acclimate before our Midnight permit became active.

Both of us felt great as we began our trek. At some point I began to complain of a very mild head ache. I was being careful to hydrate, had hiked a ton this summer and am in very good shape and I hoped the nights stay at about 8,000 feet after my flight from Alaska would be enough to acclimate. My dad and I also hiked Dana last year and had no effects.

Well at some point my headache worsened and I felt a little nauseous. We made it to Trail Camp under a gorgeous Full Moon that was literally blinding in its brightness. At this point, 12,000 ft. I knew my summit effort was in jeopardy. I took some aspirin, we rested a bit, and then headed up the 97 swithbacks. Not long after (maybe 200 ft. Elevation) I made the call. The nausea was scaring me and I had never experienced altitude sickness. About 10-15 minutes and heading down the nausea overcame me and I violently vomited including dry heaves (sorry to be so graphic but I am hoping others can learn or give advice). At this point the headache was massive and to be frank I was VERY scared. Thoughts of rescue were dancing through my head and it was still dark. All I could think of at this point was advice I've read to get down! So I rushed down as much as I could. Several times the headache, fatigue and nausea would overcome me and I would find a place to almost lay down on the trail. I was also cold and stopping too long I would tremble with shivers. I never did vomit again but I believe I fell asleep a few minutes several times on the way down. I was also doing my best to stay hydrated but the taste of water digusted me, it tasted bitter but I forced myaelf to drink.

By the way, my 67 year old father was doing great. Disappointing him and ending his summit attempt was the toughest part of my decision.

Since I am writing this you know I am okay. I am at 8,000 ft again and feeling great after resting all day today. I hate we didn't make it but am happy to be safe and healthy. My thoughts are about all the maximum 7-8,000 ft mountains there are in Alaska where I never had to experience this again. It was a very scary experience and I've never felt that type of sickness before.

I posted the above trip report at a Yosemite Site but am hoping you all can help with some advice. I am contemplating a return trip to Whitney at the end of September. The trip will have to be on a tight schedule but based on everything I read here I think it is doable:

Wednesday: Fly from Alaska to Ontario arriving 10 am
Wednesday: Acclimate somewhere
Thursday: Acclimate somewhere
Friday Night: Begin Hike
Saturday: Complete Hike
Sunday: Fly from Ontario to Alaska at 6 am

Questions:
1. Any advice based on the schedule above on where the best place to acclimate is? Drive all the way to Mammoth and stay there?

2. I believe based on everything I have read that our chances for last minute permits are fairly good. We would need to get permits at 2:00 pm on Friday correct?

3. I am planning to go to doctor and get Diamox. Planned dosage on Thursday, Friday before hike and during hike as needed. Any suggestions here?

Any other suggestions? Prolonging the schedule won't work so I have to make it fit in the above schedule or just not do the trip. I need to buy plane tickets very soon so I am hoping for quick comments. Thanks so much.

Re: Altitude Sickness Trip Report and Re-Attempt Questions
Chicagocwright #27484 09/05/12 04:54 PM
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We're glad to hear that you made the right decision and descended.

Diamox might help, but you ought to try at in a less challenging altitude before using it at Whitney...just in case you don't like the side-affects. Perhaps try it on some high-altitude hikes in Alaska; you've got some big mountains up there.

You might consider camping at the Whitney Portal camp ground for several nights (more than two) before starting up the trail.

Also...and this is very important...watch the local weather forecasts very carefully. Major storms can and have occured at the end of September. Storms at Whitney can prove to be deadly. The Sierra Nevada isn't always "gentle" in the Fall and Winter.

Re: Altitude Sickness Trip Report and Re-Attempt Questions
Bob West #27485 09/05/12 05:04 PM
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Thanks for your comments.

My dad and I hiked Mt. Dana together last year and had no problem. There really are no accessible high altitude hikes near me in Alaska (if accessible at all other than a full scale mountaineering treks.) I routinely hit snow at even 3,500 ft. in some places and other places climb 4-5,000 ft. but starting at sea level.

I know I'll be taking a risk booking a flight with such a tight timeframe but that is what I have to work with. Weather with have to play in our favor as well as actually landing the permits.

Re: Altitude Sickness Trip Report and Re-Attempt Questions
Chicagocwright #27486 09/05/12 05:08 PM
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1) If you can get to 12k somewhere in Alaska in the next week or two, that will carry forward. Good job you don't live in Florida, where the highest point is in MouseWorld. Also, Horseshoe meadows for your acclimatization days.

3) Diamox makes beer taste weird. Do pay attention to experienced summitters who use a fraction of the glaucoma dosage. YMMV.


Verum audaces non gerunt indusia alba. - Ipsi dixit MCMLXXII
Re: Altitude Sickness Trip Report and Re-Attempt Questions
wagga #27487 09/05/12 05:44 PM
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I am new to Alaska and I know this sounds strange but I am pretty sure there is no accesible elevation. The mountains are huge but they all start at zero elevation and become snow bound very quickly. Just across the Turnagain Arm from Anchorage are mountains where the snow is at sea level still. I've heard that Denali (Mt. McKinley) may be "bigger" than Everest because Everest starts at a much higher elevation.

So as far as elevation I may as well be in Florida.

Re: Altitude Sickness Trip Report and Re-Attempt Questions
Chicagocwright #27491 09/05/12 06:20 PM
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Your proposed schedule should work.

Agree with Horseshoe Meadows (10k), with day hikes higher that will not wear you out. Onion Valley would be an alternative. Mammoth is too far, and too low.

This is exactly the scenario that I like the use of Diamox.
By the way, you can simple take a dose or three at sea level to evaluate your tolerance....the side effects are identical at all elevations. I recommend this.
1/2 tab before bed, two nites before your hike.

One other thing. Every hour, take a 10 minute break, sitting down. This allows the body to "catch up" somewhat, and gives your leg muscles a break. It pays off for some people many hours later.

Make SURE you pee within the first three hours. A good habit is to down a quart of gatoraide at the trailhead before heading out. (I'd give up the coffee, as it is a mild diuretic you don't need that morning) Most people are dehydrated, and it doesn't help.

Best of luck!

Re: Altitude Sickness Trip Report and Re-Attempt Questions
Ken #27492 09/05/12 07:09 PM
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For those recommending Horseshoe Meadows, what do you recommend we do while there? I don't know anything about that location. What kind of dayhikes are available?

By the way, I booked the tickets so I am in. Now on to the final hurdle---getting the actual permits. Any special strategy besides everything written on the #6 of the other page?

Re: Altitude Sickness Trip Report and Re-Attempt Questions
Chicagocwright #27493 09/05/12 07:45 PM
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Horseshoe Meadows is the trailhead for both the Cottonwood Lakes trail and the Cottonwood Pass trail. Either make a nice warm-up hike for Whitney. Neither are very strenuous, and Cottonwood Pass is close to 12K'. If you're feeling adventurous, the Cottonwood Lakes trail will take you to Army and New Army passes, as well as to Mt. Langley. That would be overkill though - you don't want to burn out on gain right before your second shot at Whitney.

No matter which trail you take, be prepared to slog through some beach sand at the outset. A real PITA the first mile heading up to the lakes.

Good luck with round two!

Re: Altitude Sickness Trip Report and Re-Attempt Questionsa
Chicagocwright #27494 09/05/12 07:47 PM
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You need a plan. Without one, you'll conk out.

I "trained" in HM for two days prior to my ascent.

Day 1: from the parking lot, Mulkey Pass to Trail Peak to Cottonwood Pass and back to parking lot.
Day 2: parking lot to Cottonwood Pass to Cirque peak round trip.

Both days, I had bkfast and lunch followed by a nap and a hour listening to my audiobook at HM. Pretty sure this greatly helped in acclimatization.

My ascent was on 8/14. Other than the expected fatigue, it was a breeze.

Never even considered taking Diamox. And I am a 47 y/o guy with a desk job.

I prepared a year ago running 5K and 10K three times per week. Lost 20+ pounds in the process.

Again, have a plan. Do NOT just show up thinkIng you'll show the mountain who's boss. Wrong attitude.

You're smart. You can do it. But don't overdo it befor your big day. Save your strengh.


Re: Altitude Sickness Trip Report and Re-Attempt Questions
Chicagocwright #27498 09/05/12 08:58 PM
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1. Where to acclimatize

For camping, I agree with Horseshoe Meadows (10,000') or Onion Valley (9,600'). Onion Valley gives you a wonderful opportunity to acclimatize by climbing up to Kearsarge Pass (11,760') or just hanging out at one of the lakes between the trailhead and the pass. Personally, I think it would be a bit aggressive, if staying at Horseshoe Meadows, to go for Langley or Cirque; if it were me, I'd go hang out in the Cottonwood Lakes Basin, maybe even get a fishing permit.... (For photos of the area, see the trip report I posted yesterday). I stayed at OV for two nights before my first Whitney Climb in 2010.

If you don't want to camp, consider high altitude lodging like the Rock Creek Lodge, which is near 10,000 feet. Really fantastic acclimatizing hikes nearby out of Mosquito Flat trailhead. They have relatively reasonably priced cabins (the cheaper ones being more rustic but at least having a kitchen, though shared bath). I stayed at Rock Creek Lodge for two nights before my second Whitney Climb in 2011.

2. Diamox

This can help, but like others said, test it out at home first. And avoid the glaucoma dose of, what, 250mg 2x a day, that some doctors ignorantly prescribe for altitude. Caveat: I am no doctor (others here are), but generally, the recommendation seems to be no more than 125 mg twice a day for a male. I am female and, when I take Diamox (which is increasingly rarely now), I take just 62.5mg before bed (Diamox does some of its best work when you are sleeping and not consciously breathing or working).

3. Other

Hydration is important, and flying can dehydrate you. While you don't want to overdo the water intake, you do want to arrive in California well-hydrated, which is especially important because of your flying. For myself, I try to drink at least 1 gallon of water the day before I go to altitude, and I lay off the diuretics at altitude (which means no caffeine).

Also, I take electrolyte supplements at altitude. I find that, for the first few days I am at altitude, I tend to pee more, with or without Diamox in my system. Electrolytes can be very important.

Re: Altitude Sickness Trip Report and Re-Attempt Questions
Chicagocwright #27503 09/05/12 11:37 PM
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Originally Posted By: Chicagocwright
2. I believe based on everything I have read that our chances for last minute permits are fairly good. We would need to get permits at 2:00 pm on Friday correct?

There is a chance that day hike spaces will become available before 2pm from group size reductions, if you show up early. Yes, 2pm is the time when day hike no show spaces become available.

Re: Altitude Sickness Trip Report and Re-Attempt Questions
VersatileFred #27507 09/06/12 08:44 AM
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Wonderful info from all who have posted. Thank you so much for your help.

As I noted I have my tickets now and arrive on Wednesday morning in Ontario at roughly 10. We are now discussing whether or not we should try for permits on both Friday and Saturday.

This would increase our chances of getting a permit. But if we get the one for Friday it also means one less day of acclimizing.

As it is, my plan is to get from Ontario to Horseshoe Meadows as quick as possible and either hike around some or just read a book.

I'm also setting up a doctors appointment to get some Diamox.

Re: Altitude Sickness Trip Report and Re-Attempt Questions
Chicagocwright #27509 09/06/12 09:00 AM
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Originally Posted By: Chicagocwright
Wonderful info from all who have posted. Thank you so much for your help.

As I noted I have my tickets now and arrive on Wednesday morning in Ontario at roughly 10. We are now discussing whether or not we should try for permits on both Friday and Saturday.

This would increase our chances of getting a permit. But if we get the one for Friday it also means one less day of acclimizing.

As it is, my plan is to get from Ontario to Horseshoe Meadows as quick as possible and either hike around some or just read a book.

I'm also setting up a doctors appointment to get some Diamox.


Hi Chicagowright,

I cannot tell from your post if you are seeking Overnight Permits, or Day Use Permits. The reason I ask is because the issue/release date is different for the two permits. For Day Use, you need to pick up the permit the day prior to entry. I "think" for Overnight, you can pick up the permit the day of entry. For Day Use permits you should enter and exit the zone on the same day, so in your earlier post you mentioned starting on Friday, and completing on Sat. This would not be "legal" using a day pass. In your most recent post you are considering a Sat. hike, which I think would have to be a Day User Permit, which would mean picking it up on Friday. Also, to do the Friday Day Hike, you would need to pick up the permit on Thursday.

I "think" I have this correct.

Re: Altitude Sickness Trip Report and Re-Attempt Questions
John Sims #27510 09/06/12 09:21 AM
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I'm looking at day permits. By a Friday start I mean basically Friday night-Midnight Saturday.

Re: Altitude Sickness Trip Report and Re-Attempt Questions
Chicagocwright #27511 09/06/12 09:31 AM
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You have done fine on Dana (13K) and had trouble at Trail Camp (only 12K). Possibly the excitement and lack of sleep contributed to your troubles. I would consider starting later.

Altitude sickness tends to show up when people are resting and especially if they are sleeping. This is because an un-acclimatized person doesn't breathe enough while resting at altitude.

Ken isn't the first person I've heard recommending a 10-minute break every hour. I just don't buy it. It is better to go slower but KEEP MOVING. Yes, you should stop frequently for a byte or two of food. Drink, pee, and take pictures as often as you like. But don't spend one sixth of the day sitting on your butt letting your legs stiffen up and your breathing slow down until you get AMS again. The tortoise beats the hare every time.

Diamox may help. Remember that the correct dosage of any medication is the smallest does that is effective. 250mg is the most common tablet, but I don't think anybody needs that much for AMS. It's common to take it for a few days before going to altitude, but half a tablet when you start up will probably get you to the summit and back down low enough that you won't need any more.

The more time you can spend at 8K - 12K before you head up Whitney, the better. Moderate exercise at altitude is key.

Good luck!

Re: Altitude Sickness Trip Report and Re-Attempt Questions
bobpickering #27514 09/06/12 10:32 AM
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Based on everything I've read I have a couple theories:

1. I was not well enough rested. I didn't sleep much on the plane ride and didn't sleep enough the night before the hike.

2. I did not breath deeply enough. The Alaskan hiking I've done all summer has been steep and strenuous. Somehow, switchbacks have not yet been introduced on Alaskan trails!

So I am in very good shape. My theory is that I was not exerted on the Whitney hike and simply was not breathing hard enough---I don't ever remember being out of breath and certainly didn't work up a sweat on the entire hike.

One solution would be to hike faster which would cause you to breath heavier and deeper. Most would probably not advise that. So my intent is to create a purposeful deep breathing routine throughout the hike.

3. Water--I am normally a heavy drinker on the trail (and frequent peeer) and that didn't change on my Whitney hike. But I am going to be even more careful on this hike. Instead of using my 3-Liter Camelback I am going to carry bottles so I can easily monitor exactly how much I am drinking.

Re: Altitude Sickness Trip Report and Re-Attempt Questions
Chicagocwright #27516 09/06/12 11:05 AM
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Quote:
One solution would be to hike faster which would cause you to breath heavier and deeper. Most would probably not advise that.


Agree. The best correlate with development of AMS is rate of ascent. Those who go faster are at greater risk.

You may want to look up "pressure breathing" a mountaineer technique.

However, I'm not sure I buy that "not breathing deeply enough" had anything to do with it.

Good quality sleep prior to the hike may or may not have had to do with the AMS, but it sure didn't help.

Re: Altitude Sickness Trip Report and Re-Attempt Questions
Ken #27523 09/06/12 01:10 PM
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As additional information my dad suggested I emphasize how good of shape I am in. Perhaps it will show that it really doesn't matter how good of shape you are in, altitude sickness can still get you. If nothing else a word of warning to those who also think they are in great shape.

Anyway I am a marathon runner with a PR of 3:40. Even though I didn't run this summer at all because I was too busy hiking a couple weeks ago I did run a half marathon, at the last minute a few days after major hikes, in 2:05.

I'm not sure I buy the "not breathing deep" enough excuse either, but I am looking for any excuse possible! I am looking for those "excuses" in order to purposefully identify things I can change for this second attempt.

So I am left with rest, breathing technique, water intake, and diamox.

Re: Altitude Sickness Trip Report and Re-Attempt Questions
Chicagocwright #27533 09/06/12 08:56 PM
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Quote:
So I am left with rest, breathing technique, water intake, and diamox.


Well, acclimatization. Diamox is really an adjunct to that.

But with your history you should not be under any illusion that anything but acclimatization is remotely as important.

Diamox is not a substitute, nor are any of the other things.

But I've never heard of breathing technique being important in a person who is not short of breath at all, and it is not one of the problems routinely identified that I've heard of.

Re: Altitude Sickness Trip Report and Re-Attempt Questions
Ken #27535 09/06/12 11:18 PM
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Hi everybody;

Just some FYI about Diamox;

I am an Emergency Department and Procedural Nurse. I have used DIAMOX after having extreme nausea on the switchbacks on my first day hike. NO FUN! And yes, I slept @ 10,000ft=Horseshoe Meadow

My next climb I was free of symptoms! Thank GOD for DIAMOX! Yes, a true GOD-SEND!

The dose being mentioned in prior comments (of 125mg and 62mg, 2x a day) is NOT an effective dose for "acclimatizing". What is perscribed per the doctor fallowed pharmicopia and very effective, is 500mg 2x a day. Drink as much water as possible while taking. Start 3 days prior to your hike. Stop after descent. Diamox is a diuretic, so hydration is key! You need to be drinking as much as possible, to keep your urine clear. Electrolyte replacement is just as key!

In good health!

Moderator edit: THIS dosage is very high, what may have been prescribed for its original use for glaucoma sufferers. Please see comments on the next page

Re: Altitude Sickness Trip Report and Re-Attempt Questions
Lynne #27538 09/06/12 11:54 PM
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1000mg....a day?


With all due respect to the health care industry, and to all those visiting this site for the first time: Please note that advice/information given on this site is that of the individual posters, and not vetted nor endorsed by the webmasters/moderators/WHA members.


The body betrays and the weather conspires, hopefully, not on the same day.
Re: Altitude Sickness Trip Report and Re-Attempt Questions
Lynne #27539 09/07/12 03:37 AM
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Originally Posted By: Lynne
Hi everybody;

The dose being mentioned in prior comments (of 125mg and 62mg, 2x a day) is NOT an effective dose for "acclimatizing". What is perscribed per the doctor fallowed pharmicopia and very effective, is 500mg 2x a day.

In good health!


Oy. The reduced dose I described above IS "effective" for ME when climbing Whitney (62.5 once a day with no pre/dosing before altitude). Your experience may differ. Many of us have experienced, or read about, the negative consequences that may occur from taking large doses of diamox. People need to make their own responsible decisions based on appropriate medical consult, personal testing and experience, etc.

Re: Altitude Sickness Trip Report and Re-Attempt Questions
Lynne #27540 09/07/12 04:30 AM
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Originally Posted By: Lynne
What is perscribed per the doctor fallowed pharmicopia and very effective, is 500mg 2x a day.


I have no doubt that 1000 mg/day is "very effective". Necessary for avoiding AMS at altitude is another matter altogether. Acetazolamide is a drug with very noticeable side effects, and the prescribed dosage is typically based on use with glaucoma patients. Most people who get a scrip simply to go above 12K' without incident find a nice balance with 62.5 or 125 mg twice a day: AMS is generally avoided without peeing every 20 minutes or feeling like your extremities are buzzing like a live wire (or having that celebratory beer taste like crap). These side effects can occur even at low dosage, but 500 mg at a shot is almost guaranteed to make your hike miserable without providing any additional protection from altitude sickness.

Bob Pickering's advice is sound: the best dose of any drug is the lowest at which it is effective. Your mileage may vary, but for the purpose of going high taking 1000 mg per day is serious overkill for most people.

Re: Altitude Sickness Trip Report and Re-Attempt Questions
Lynne #27541 09/07/12 05:05 AM
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Neither the sources "pharcopia" or average PCPs are recognized as knowledgeable about high altitude illnesses.

A dose of 1000 mg day Diamox will guarantee side effects, especially paresthesias, and without added benefit above appropriate doses.

Most high altitude sources recommend 125 twice daily, or at most 250 twice daily and even that is very likely to cause side effects. In the actual field, most of us in expedition medicine suggest 125 twice daily.

please see reputable source, one of which is:
International Society for Mountain Medicine


Acetazolamide Use & Dosage:

For treatment of AMS
We recommend a dosage of 250 mg every 12 hours.

For Periodic Breathing
125 mg about an hour before bedtime.

Re: Altitude Sickness Trip Report and Re-Attempt Questions
Lynne #27544 09/07/12 09:25 AM
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Lynn, glad you had a good response to Diamox.

However, what you describe in dosage is no longer recommended by physicians who work in this field. While the dosage you recommend works, a very significant proportion of people have side effects that are intelerable, and I've personally seen a number of people who had to abandon their hike, or not even start, because they were made to feel so lousy from the high Diamox dosage.

There have been a number of medical websites that are devoted to very high altitude climbing, that reflect the newer, lower dosages.

Thankfully, there seems to be little or no reduction in protection from the lower dosage.

It is important to remember that the higher dosing was NOT created on the basis of drug testing like we do these days....it was found that the drug worked, and they simply transferred the dosing used for glaucoma (the drug is hardly used for that, anymore), which DOES require higher dosages.

As a generic drug, and the relatively few people who need this drug, there will never be a large scale study of dosing, we are dependent upon those specialists in high altitude medicine who work in the field to do small scale testing to guide us.

Hope that makes sense.

For the novice reader, both Harvey and I are licensed physicians who have published articles on the subject of altitude illnesses.

Re: Altitude Sickness Trip Report and Re-Attempt Questions
Ken #27546 09/07/12 10:09 AM
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I am absolutely grateful for all the info you all have provided. I haven't visited a doctor yet but a good doctor friend with experience in the Sierra's, Tibet and Bhutan suggested she uses 250 mg twice daily, starting 2 days before ascension. I know there will be a range of acceptable answers from doctors but that seems like close to the max based on feedback here.

Several of you have referenced side effects that severely impact the hike but the only ones I have seen explicitly are tingling in extremities and bad tasting beer, which don't seem all that serious or bad. What else should I be looking for; especially as I do a test within the next week or so? What side effects during the hike should I watch out for?

As we put together our plan it seems as though we are leaning toward spending the entire day at Horseshoe Meadow, a little bit of hiking and then reading in the car, but then come down and sleep in Lone Pine. This seems like an acceptable variation for acclimizing "Climb high, sleep low." Does this plan negate the positive effects of spending the day up high?

Re: Altitude Sickness Trip Report and Re-Attempt Questions
Chicagocwright #27548 09/07/12 11:05 AM
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Originally Posted By: Chicagocwright

tingling in extremities and bad tasting beer, which don't seem all that serious or bad. What else should I be looking for; especially as I do a test within the next week or so? What side effects during the hike should I watch out for?

As we put together our plan it seems as though we are leaning toward spending the entire day at Horseshoe Meadow, a little bit of hiking and then reading in the car, but then come down and sleep in Lone Pine. This seems like an acceptable variation for acclimizing "Climb high, sleep low." Does this plan negate the positive effects of spending the day up high?


the tingling (paresthesias) can be severe enough to prevent sleep all night long. Nuff said. I don't care about the flat beer, but flat diet soda is terrible.

As for sleeping in Lone Pine - and many people do, it is too low, unless you are one of those people who by experience knows you are not AMS-prone. I learned this the hard way in 1994 when my younger son could barely move above Whitney Portal. Could only get as far as Outpost Camp, had to descend next day. He subsequently proved to need a few days of acclimatization at 7-10,000 first, and after doing so knocked off some impressive miles and peaks in the Sierras. Experience, experience, experience.

That rule should be something like "Climb higher, sleep less than that but not too low"

Re: Altitude Sickness Trip Report and Re-Attempt Questions
Harvey Lankford #27549 09/07/12 11:21 AM
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Tingling in extremities ? Sounds like bad sushi grin

Re: Altitude Sickness Trip Report and Re-Attempt Questions
Chicagocwright #27551 09/07/12 12:26 PM
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Originally Posted By: Chicagocwright
Several of you have referenced side effects that severely impact the hike but the only ones I have seen explicitly are tingling in extremities and bad tasting beer, which don't seem all that serious or bad. What else should I be looking for; especially as I do a test within the next week or so? What side effects during the hike should I watch out for?

As we put together our plan it seems as though we are leaning toward spending the entire day at Horseshoe Meadow, a little bit of hiking and then reading in the car, but then come down and sleep in Lone Pine. This seems like an acceptable variation for acclimizing "Climb high, sleep low." Does this plan negate the positive effects of spending the day up high?


I concur with spending as much daytime as you can hiking and hanging at HM, and then sleeping lower. Cottonwood Pass is about 11,000 ft and an easy day hike and its pretty level for a long ways going further. I recommend the hiker's camp at Whitney Portal (8,000') to keep the acclimation going rather than sleeping way down at Lone Pine. Should be plenty of walk-in spots in late September.

Regarding Diamox side effects, the minor ones described on this forum are common and increase with dosage, but everyone should also be aware of the rare but serious ones. This is why it's a good idea to try it out before going to elevation - a lot of these side effects mimic AMS. Note the recommendation to seek immediate attention for tingling of extremities - most people consider that a minor side effect. Here's the whole range FYI:

Dizziness, lightheadedness, and an increased amount of urine may occur, especially during the first few days as your body adjusts to the medication. Blurred vision, dry mouth, drowsiness, loss of appetite, stomach upset, headache and tiredness may also occur. If any of these symptoms persist or worsen, notify your doctor or pharmacist.

Remember that your doctor has prescribed this medication because he or she has judged that the benefit to you is greater than the risk of side effects. Many people using this medication do not have serious side effects.

Tell your doctor immediately if any of these very unlikely but serious side effects occur: increased body hair, hearing loss, ringing in the ears, unusual tiredness, persistent nausea/vomiting, severe stomach/abdominal pain.

Seek immediate medical attention if any of these unlikely but very serious side effects occur: easy bleeding/bruising, fast/irregular heartbeat, signs of infection (e.g., fever, persistent sore throat), mental/mood changes (e.g., confusion, difficulty concentrating), severe muscle cramps/pain, tingling of the hands/feet, blood in the urine, dark urine, painful urination, yellowing of the eyes/skin.

A very serious allergic reaction to this drug is unlikely, but seek immediate medical attention if it occurs. Symptoms of a serious allergic reaction may include: blisters/sores in the mouth, rash, itching/swelling (especially of the face/tongue/throat), severe dizziness, trouble breathing.

This is not a complete list of possible side effects. If you notice other effects not listed above, contact your doctor or pharmacist.

http://www.webmd.com/drugs/drug-6753-Diamox+Oral.aspx?drugid=6753&drugname=Diamox+Oral

Edited to add source link from webmd.com

Re: Altitude Sickness Trip Report and Re-Attempt Questions
Harvey Lankford #27558 09/07/12 03:15 PM
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Mr. Lankford...Mark Rimmer here. I haven't posted for about a year and stumbled upon the AMS discussion. I have often contemplated if barometric pressure changes affect ones sensitivity to AMS. As a teen, I experienced it along the JMT near Garnet and Thousand Islands lakes. 48 hours later and a few doses of "Vanquish" (a med from the 70's...acetamenophen and caffeine, I believe) and I was fine. The following season after cycling to school each day (at sea level), I had no effects and seem to have had none since. Have you read any studies reguarding the barometric changes? If so, might you pass this information on?

Thanks for your time-

Mark- FFEMT-P


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Re: Altitude Sickness Trip Report and Re-Attempt Questions
MarkRimmer #27559 09/07/12 04:20 PM
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Originally Posted By: MarkRimmer
Have you read any studies reguarding the barometric changes? Mark- FFEMT-P


great question

it seems to me if (A) some people are ultra-sensitive to just 10,000 ft and get AMS, and we consider that drop in pressure is small (it isn't, it is about 30% !) then perhaps a small change in weather -related pressure (another 3-4%) may affect them when they are up high, tipping them over the edge, so to speak.

it is talked about ( and this website has a picture of ..is that Whitney from a northerly angle? definitely has Banner and Ritter)
Timberline trails AMS

As for even higher:
it is often said that on Denali which is at high latitudes, that atmospheric pressure is already lower than a mountain at the equator and of equivalent height above sea level. The lower pressure at higher latitudes is from the atmosphere not surrounding the earth equally, or spherically lets say.
Add on top of that a storm and low pressure system, and the two factors may combine to make Denali at 20,000 ft more like a Himalayan peak. The difference may be similar to 1,000-2,000 ft higher so it does not become Everest, but the effect is said to be significant, resulting in more problems with AMS and complications.



Re: Altitude Sickness Trip Report and Re-Attempt Questions
Harvey Lankford #27562 09/07/12 05:07 PM
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Interesting little reference article Mr. Lankford.

Many thanks...perhaps we'll see you out there sometime-

Mark


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Re: Altitude Sickness Trip Report and Re-Attempt Questions
MarkRimmer #27563 09/07/12 05:13 PM
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just returned from Sierra trip #21 a few weeks ago.

Re: Altitude Sickness Trip Report and Re-Attempt Questions
Lynne #27611 09/10/12 11:42 AM
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Can anyone say if there is Cell Service (ATT) at Horseshoe Meadows?

If I recall correctly, I did not have cell service at Whitney Portal.

I am asking because this will affect our plans for acclimatizing and gaining permits.

Re: Altitude Sickness Trip Report and Re-Attempt Questions
Chicagocwright #27612 09/10/12 11:49 AM
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Most of the above is great advice. Especially watch weather reports--that could kill the whole trip.

No cell service at HM. I get service on Sprint at Whitney Portal. Verizon works too. ATT down the road a ways.

I would definitely sleep at Horseshoe Meadows the first night. There are plenty of walk-in campsites (carry your bedding about 30 yards from the car). You don't need a tent, only a 20 degree bag and pad, on a trash bag for ground cover.) Or do like me: Arrive late, sleep IN the car! The place will be practically deserted.

Drive back down to Lone Pine to get that walk-in permit the day before the hike. Or watch the on-line site for any cancelled/returned reservations in the week before. $15, but you can be more sure, and pick it two days before the hike.

I like taking a sleeping aid the first night as the first night on the ground is always difficult to stay asleep (I use otc Benadryl (Diphenhydramine), but try it once at home first.

You don't need to "camp". Just sleep on the ground, and eat out of an ice chest (kept in a bear box at parking lots.)

You don't need to hike at altitude to acclimate. Just being there reading and resting will do. Acclimatization has more to do with your cellular structure getting used to the change in atmospheric pressure and oxygen level, I think. Remember those rest days before a marathon. Here's an easy acclimation hike if you want: Trail Peak: Warmup / acclimatization hike

Diamox now comes in 125 mg tablets. I have that. With your strong sensitivity to AMS, I'd take half a tab twice a day, starting 24 hours before I arrive at HM.

With two days, you could camp at HM the first night, then either HM or maybe the Whitney Portal walk-in sites the night before the hike, get up early and start the hike.

Watch out for lack of sleep. Anything less than 5 hours for me, and I can feel nauseated the next day -- same as AMS symptoms.

Hiking too fast, lack of sleep, too little water -- all those things can help bring on AMS symptoms.

Have fun! I think you will make it this time.

Re: Altitude Sickness Trip Report and Re-Attempt Questions
Steve C #27614 09/10/12 12:09 PM
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Originally Posted By: Steve C
I would definitely sleep at Horseshoe Meadows the first night.

Steve, are you assuming the predosing with diamox will avoid sleep issues at 10,000ft camping at HM? His TR indicates that AMS was starting somewhere in this elevation range. Personally, I tend to have trouble sleeping the first night at or above 9k, getting worse higher up. Not a show stopper, but it's draining. I wake up often with shortness of breath, but Diamox may prevent this for him. I was thinking a little lower at the Portal elevation might be more restful. It's worth it to me to drive back and forth, spend the day at HM and drive back down to the portal. He has to drop down to Lone Pine to pick up the permit in the morning anyway. Just my $0.02.

Re: Altitude Sickness Trip Report and Re-Attempt Questions
SierraNevada #27619 09/10/12 01:11 PM
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Bottom line: give yourself the gift of TIME. There is no silver bullet. Medications may or may not be effective and may or may not have side effects.

I see this more and more: I ONLY have THREE DAYS blah blah blah...

Look: you tried it this same way and failed, fairly miserably in how it made you feel/how your body reacted. I wish you the best, hope that taking the Diamox works. I would also agree that spending one night at 10K may not be sufficient.

You may also drop your pace: maybe use that pace card that someone put up here? Often, those who claim to be "in really good shape" end up pushing too hard.

-L


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Re: Altitude Sickness Trip Report and Re-Attempt Questions
SierraNevada #27620 09/10/12 01:26 PM
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> Steve, are you assuming the predosing with Diamox will avoid sleep issues at 10,000ft camping at HM?

Yes, along with a sleep aid. Diamox does help with the Cheyne-Stokes periodic breathing/apnea problem that awakens people. And the fact that they will just be driving to 10k and sleeping, not hiking should help. I am sure the strenuous exercise and lack of sleep contributed to their problems.

Re: Altitude Sickness Trip Report and Re-Attempt Questions
Steve C #27622 09/10/12 03:23 PM
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yep, Laura has it right. TIME, TIME , TIME.

This is a paraphrase of famous high altitude physician Peter Hackett who wrote about bad AMS/HAPE/HACE preferred Rx as DESCENT, DESCENT, DESCENT.

Diamox, avoiding strenuous activity, avoiding alcohol (and other drugs), getting good sleep, hydration, etc are all ideas that help, but some people are just plain slow-acclimatizers and need TIME, no matter what. Some have a low ceiling that will not let them get over while others blast on through. Some just never acclimatize at all and give up, or just do not allow enough time.

Only experience by the individual will answer the question. While AMS is said to be sporadic and unpredictable, much of that rule is about HAPE and not so much simple AMS. Some people do learn from repeated exposure that they are just the way they are and it cannot be changed. They learn what they gotta do and do it right when they return.

My mentor said:
The practice of (high altitude or other) medicine is an unending series of arbitrary decisions based on intuition and inadequate facts.




Re: Altitude Sickness Trip Report and Re-Attempt Questions
Harvey Lankford #27628 09/10/12 05:00 PM
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All of this info has been extremely helpful. Unfortunately, time is the factor I seem to have the least amount of control over so I have tried to identify everything else I can attempt to control. Maybe I am hoping Diamox will be the silver bullet but I am also hoping this trip was the aberration. As noted, my dad and I did a 13,000 ft. climb last year with no problems at all. I'm convinced the issue is partly just random and I just have to hope for good luck. Besides the fact that bad weather could blow up the entire trip.

When my dad started talking about the next full moon at the end of September and hiking himself, well I just had to get myself back from Alaska and the cheap airfare put it over the top. This is probably our last chance. The 28th is my dad's birthday in his late 60's and I'm not sure he wants to do the work to get in shape again. If we make it great, if not, maybe I'll get him to do Clouds Rest.

Re: Altitude Sickness Trip Report and Re-Attempt Questions
Chicagocwright #27629 09/10/12 05:20 PM
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Best wishes for you and your dad.

To put his late 60s in perspective, I am 61, took my 88 year old dad's funeral picture with me to the top of Whitney. He died in March, I went with one of my sons in August. My dad had introduced me to the Sierras in 1965. His picture taken to the top was trip #21 for me, no better place to say my final goodbyes.

I hope this note is seen as both sad and celebratory. You are wise to go now. Have a great time, both of you! Harvey

Re: Altitude Sickness Trip Report and Re-Attempt Questions
Harvey Lankford #27630 09/10/12 05:28 PM
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The first trip was planned before my big move to Alaska and there was some question on whether we would delay the effort. I didn't think it was wise to put it off. One more try! End of this month!

Re: Altitude Sickness Trip Report and Re-Attempt Questions
Lynne #27633 09/11/12 12:09 AM
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More thanks to this Forum! I just landed two reservations on Reservation.gov

Thanks for the outline on what to do about permits.

Now to figure out where to sleep the night before the hike...

Re: Altitude Sickness Trip Report and Re-Attempt Questions
Harvey Lankford #27635 09/11/12 07:47 AM
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Nice way to honor your father and celebrate your time with him, Harvey.

Re: Altitude Sickness Trip Report and Re-Attempt Questions
SierraNevada #27912 09/21/12 05:24 PM
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I am doing my couple days test run of Diamox. No serious side effects, and even though I don't drink much caffeine or soda, the Sprite I was just drinking is terrible! I guess its probably any carbonated drink. Anxiously watching the weather forecasts for next week which right now seem good. I am bringing plenty of stuff (layers) to ensure warmth to eliminate that as a problem.

Perhaps by this time next week, even though I will still be on the road, I'll be able to post a quick, successful, trip report.

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