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Re: Altitude Sickness Trip Report and Re-Attempt Questions
Lynne #27538 09/06/12 10:54 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 02:37 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 03:30 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 04:05 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 08:25 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 09:09 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 10:05 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 10:21 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 11:26 AM
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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 02:15 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


Mark Rimmer
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Re: Altitude Sickness Trip Report and Re-Attempt Questions
MarkRimmer #27559 09/07/12 03:20 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 04:07 PM
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Interesting little reference article Mr. Lankford.

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

Mark


Mark Rimmer
Temecula, CA.
Re: Altitude Sickness Trip Report and Re-Attempt Questions
MarkRimmer #27563 09/07/12 04:13 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 10:42 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 10:49 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 11:09 AM
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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 12:11 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 12:26 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 02:23 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 04:00 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.

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