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AMS on White Mountain Peak: looking for advice for Whitney
#39119 07/28/14 08:53 PM
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Long time lurker first time poster. (I have a Whitney question list coming up, but first thing first).

My girlfriend and I are attempting Whitney in September. We've taken the "prep" pretty seriously and have been hiking/working out every weekend possible. (Meaning 12 hikes under our belt since we found out we won a lotto spot).

Hikes have ranged from 3 miles to 16 miles in length and normally carrying 20-25% of our body weight in our packs. We live in Glendale California and hike the San Gabriels when home. Our second home is Aspendell (above Bishop) and we're there 1-2 times a month. Aspendell is 8500 feet roughly.

July 11th was hike #12 and we decided to give White Mountain Peak a try. We wanted to see what the elevation was going to feel like.

I'd say we're are reasonably smart and we research a lot of variables before tackling things. In this case we thought we had enough knowledge to avoid AMS on this. Obviously we failed. Or rather, I failed, badly. smile

We've hiked the mountains behind Aspendell a lot. Playing anywhere from 9500 feet and all the way up to nearly 11000 feet at Upper Lamarck. I've never had an issue at these elevations. I've never had an issue on Mammoth Mountain and I'm a regular up there too.

I got hit with AMS real hard and real bad at White Mountain Peak. I'm going to list the variables I recall and what I think I can do better next time. I'm curious if someone with some solid AMS experience, or knowledge, can chime in and maybe point out anything I'm missing.

My variables:

  • Spent ~36 hours at 8500 feet prior to starting White Mountain Peak (we generally spend a day or two at 8500 before we climb anything above 9500).
  • Ate breakfast of oatmeal and started pounding water right away.
  • Out of Aspendell by 4am and driving to the gate at White Mountain Peak (~12000 feet?)
  • Took maybe 2 aspirin before hike.
  • Started have a very minute tiny fuzzy headache after Barcroft station.
  • Fuzzy headache got worse, very slowly, until we started the switchbacks up White Mountain Peak.
  • We made sure we took a 10 minute break every hour. Took off packs even and just lounged.
  • We believe we were doing really good with water & food, but after the hike was over... it's possible we weren't doing as well as we thought on the water portion (we had too much left over we think).
  • I'd guestimate about a mile from the peak I got really nauseous and vomited (the nausea had been slowly building up).
  • My first mistake was not stopping when the fuzzy headache became a real one. After I vomited, I think I made a real bad mistake.... my second mistake. After I vomited I felt fantastic. I felt great. Something analogous to throwing up when you're really drunk... you just feel good afterwards wink
  • We wondered if maybe I had an upset stomach from food or aspirin.
  • It's embarrassing, but I'm listing the facts. At this point my girlfriend started getting hit with diarrhea (I mention this because I don't recall diarrhea being associated with AMS).
  • Made it to the peak and right near the end my symptoms returned.
  • We cooked up some Beef Stroganof at the peak to recharge ourselves, fuel up, and warm up. I ate a couple spoon fulls, and started on a banana and out of nowhere: more vomit. And the girl was nailed by more diarrhea.
  • At that point I said we need to get down and off this mountain (I was in a lot of pain).
  • One more bout of vomit for me and then near diarrhea too by the time I finished getting down all the switchbacks.
  • From the first time I hurled I was no longer keeping down water or food. So I was still hiking and not replenishing my calories I was burning.
  • Probably one of the single most painful headaches I've ever had.
  • It took me a few hours to make it to Barcroft. One of the students was heroic and hooked me up with a ride down to the gate (2 miles) when he saw how wrecked I was.
  • The ride out and back to Bishop was hell. I curled up on the backseat. Every jostle on that dirt road just flared an already killer headache.
  • Ended up at Bishop ER. Doc said yes to AMS. Stayed there for about 3-4 hours while they pumped IVs into me (2 liters).
  • Finally started feeling better and checked out.


I'm sorry this is long, but with Whitney coming up, this is pretty important to me to tackle this scenario better.

My working assumption(s) are this:

1. Even staying ~36 hours at 8500 that was probably not good enough climatization to hike to 14000+ feet from 12000 feet. Especially when you drive from 8500 to 12000 in.. what... an hour'ish?
2. I'm suspecting the fireroad didn't help. It never dawned on me until afterwards, but for those unfamiliar with White Mountain Peak, it is basically a fireroad from gate to peak. It is very easy walking. What this means is I believe one might tend to walk faster compared to backcountry hiking on skinner, sketchier, rougher, single track type trails. We believe the fireroad accelerated our rate of ascent possibly.
3. I didn't hydrate enough. I'm pretty dang good about this, but I think I failed. I was carrying a full 100ounce camelbag and two 32 ounce nalgenes. Now granted I was unable to hold down water the majority of the hike, I still only went through 3/4 of my 100 ounces. That was it for all my water consumption during the hike. I thought for sure I was going to burn through the 100 ounces on the uphill and then use the remaining 64 on the downhill.

Now my Mt. Whitney hike is September 2-4. I plan on being in Aspendell as early as August 28 to stay several days at 8500 feet and possibly get in one casual hike to something like Blue Lake or Upper Lamarck prior to Whitney.

Because of the AMS experience on White Mountain I'm really looking at what I can do to stem this off. Right now I'm almost certainly going to head down to Lone Pine on September 1st and stay ~24 hours at Horseshoe Flats. Basically stay there all day Monday and sleep there Monday night. Tuesday drive to the portal and start my hike. The goal is to hike to the Trail Camp and then relax and sleep the day/night away. Day two attempt summit then come back down and head to Outpost Camp and stay there the night. Day three head back down to portal.

I'm hoping several days at 8500 feet, nearly 24 hours at 10000 feet, and then a slow ascent to Trail Camp will help. That's my current game plan.

I can't go to Horseshoe flats on Sunday because I need to see the demolition derby in Bishop smile It's tradition.

I also thought about camping at Outpost camp on the first night up, but that doesn't work our in our schedule properly. Our goal was to break the return hike up because we didn't want to go from Trail Camp, to peak, to Portal in one day.

Again, I'm sorry about the length of this, but just researching a better game plan for the next round.

Thanks!

Re: AMS on White Mountain Peak: looking for advice for Whitney
Lambecc #39120 07/28/14 09:18 PM
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Wow, THOSE are some symptoms! The diarrhea might indicate something else was at work -- a little food poisoning maybe? That could certainly aggravate AMS symptoms. How long did it take for that to resolve?

Now, get yourself a prescription for Diamox (acetazolamide) Start taking it 24 hours before you go to Horseshoe Meadows.

As for water consumption: You should be able to pee every several hours, and it should be more clear than yellow. More and you're probably drinking too much. Less means drink more.

Electrolyte tablets: I discovered Nuun for my last hike. They settled my stomach every time.

Maybe the night before the demolition derby, drive up to the end of the road at Rock Creek and sleep in or by your car. It's also at 10,000'

Another thing: Try hiking to Mono Pass from the end of the Rock Creek road. That will put you at the 12k elevation of the White Mountain gate. Hang out there several hours. See if you get similar symptoms.

Re: AMS on White Mountain Peak: looking for advice for Whitney
Lambecc #39125 07/28/14 09:45 PM
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Might want to try another peak in the interim, maybe with a Diamox assist. Maybe Mt. Dana, a nice 13K peak you could do in a day from your Bishop place? Might help to build your confidence after your experience on White Mountain.

If you had an independent stomach issue, perhaps that dehydrated you and heightened your susceptibility for AMS....

I'm also a fan of Nuun tables. Electrolytes replenishment can be critical at altitude (where people tend to pee a lot), and particularly so if you are on Diamox.


Re: AMS on White Mountain Peak: looking for advice for Whitney
Akichow #39135 07/29/14 04:40 AM
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Little to add to the good answers already here.

Sounds like intercurrent GI illness and AMS.

Might not happen next time, but for all the good that Diamox and hydration do, the most important factor is more time to acclimatize.
Some people need one day, others a week. Highly individual.

Re: AMS on White Mountain Peak: looking for advice for Whitney
Lambecc #39142 07/29/14 08:48 AM
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White Mountain remains my worst AMS episode and afterwards I sought a prescription of Diamox. During that attempt, I was fine all the to the peak, after being above 8,600' for 48 hours. Once I took my first bite of food, my world started to go sideways...nausea, headache, lack of appetite and malaise. Thank God for wifey being there. This wasn't my first experience, just my worst. After a slow arduous walk back, drive down the hill and about 2 hours in the Big Pine Motel...I finally started to feel human again.

For you, it is time to see your doctor for a prescription but before you do, read some of Dr. Peter Hackett's work on high altitude medicine. Good luck getting the dose right.

Re: AMS on White Mountain Peak: looking for advice for Whitney
Lambecc #39145 07/29/14 09:10 AM
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from your list, one thing I don't see is what was your food and drink intake in the 36 hours at 8500 ft before the hike (is it possible you were a bit dehydrated even before you started?). "Pre-hydrating" for 2-3 days, including electrolytes (cytomax or similar powder mix is an alternative to electrolyte tabs), is just as important as hydration during strenuous exercise.

Looks like I'll just miss you at Whitney - I'll be day-hiking it on Sept 1.

Re: AMS on White Mountain Peak: looking for advice for Whitney
Akichow #39149 07/29/14 09:37 AM
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Wow Lamebecc - glad to hear to made it off the mountain ok!

Originally Posted By: Akichow
Might want to try another peak in the interim, maybe with a Diamox assist. Maybe Mt. Dana, a nice 13K peak you could do in a day from your Bishop place?


I agree! I just did Mt. Dana a couple of weeks ago.

Originally Posted By: Steve C

Electrolyte tablets: I discovered Nuun for my last hike. They settled my stomach every time.

I need to look into these. I see they only have 1 carb. I just completed my first hike with no carb intake.

Originally Posted By: Steve C

As for water consumption: You should be able to pee every several hours, and it should be more clear than yellow. More and you're probably drinking too much. Less means drink more.

On Whitney my water intake necessitates that I pee 1-2 times per hour, sometimes more. Am I drinking too much?

Re: AMS on White Mountain Peak: looking for advice for Whitney
63ChevyII.com #39152 07/29/14 10:02 AM
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Originally Posted By: 63ChevyII.com

Originally Posted By: Steve C

As for water consumption: You should be able to pee every several hours, and it should be more clear than yellow. More and you're probably drinking too much. Less means drink more.

On Whitney my water intake necessitates that I pee 1-2 times per hour, sometimes more. Am I drinking too much?

Chevy: I think I drink about a pint an hour. You?? Sounds like more than necessary, but not sure.

There IS a condition called hyponatremia that can kill people who drink too much -- occurs most often with novice marathoners. Major headache and they start to act a little drunk. It is caused by an electrolyte imbalance.

My 2-y-o grandson comes and swims, and pees every 15 minutes (newly potty trained like! ) but we think he's drinking pool water by the quart. grin

Re: AMS on White Mountain Peak: looking for advice for Whitney
63ChevyII.com #39153 07/29/14 10:12 AM
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Originally Posted By: 63ChevyII.com
On Whitney my water intake necessitates that I pee 1-2 times per hour, sometimes more. Am I drinking too much?

The mantra is to hydrate. The mantra is overdone. I will catch a lot of flack for saying that, but yes, some overdo it.

You only need 500ml of urine per day to dissolve waste products, at least at rest and suitable conditions. No one would recommend you do that, though. Enough hydration to keep urine clear is recommended while doing all day exercise. Part of that is to guarantee in advance that you do not get behind. Staying ahead of dehydration IS important. An ounce of prevention is worth a pound of cure.

Twice an hour voiding is a lot(depending on size of bladder of course.) One of my hiking friends has a 1.5 liter pee bottle that he can nearly fill up in one go. Not me.

There are indeed people who get too few electrolytes, and too much water, and become hyponatremic (low sodium concentration). Typically this would occur in extreme settings like marathoners, hot/dry environmental conditions, co-existing GI illness, etc. or other medical or psychiatric conditions, certain diagnoses, meds, or obsessively excessive water replacement.

The worst case I ever saw was not a hiker, but a small man with kidney trouble. His dutiful but much, much larger wife keep plying him with water (as told to). He developed what we call water intoxication, yes too much water. His blood sodium level dropped from normal 140 to 102 and he had a seizure.

Re: AMS on White Mountain Peak: looking for advice for Whitney
Steve C #39155 07/29/14 10:19 AM
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Originally Posted By: Steve C


Chevy: I think I drink about a pint an hour. You?? Sounds like more than necessary, but not sure.

There IS a condition called hyponatremia that can kill people who drink too much -- occurs most often with novice marathoners. Major headache and they start to act a little drunk. It is caused by an electrolyte imbalance.


Hyponatermia is why I ask. I tend to drink way more than normal at elevation so that if possible AMS symptoms appear, I can rule out dehydration.


On Whitney in June, IIRC:
*Drank 64 oz between Portal and Outpost (2h 45m)
*At Outpost Camp I consumed 64 oz overnight (~ 9 hours)
*Between Outpost Camp and Trail Camp I drank 48 oz (1h 30m).
*Left Trail Camp with 112 oz of water. This lasted me all the way to the summit and back to Whitney Portal (carried too much obviously). Ran out as we left the trail

After this hike I read something that thought I may be drinking too much. I meant to post a question about it here, but forgot.

Re: AMS on White Mountain Peak: looking for advice for Whitney
Harvey Lankford #39156 07/29/14 10:21 AM
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Originally Posted By: Harvey Lankford
Originally Posted By: 63ChevyII.com
On Whitney my water intake necessitates that I pee 1-2 times per hour, sometimes more. Am I drinking too much?

The mantra is to hydrate. The mantra is overdone. I will catch a lot of flack for saying that, but yes, some overdo it.

You only need 500ml of urine per day to dissolve waste products, at least at rest and suitable conditions. No one would recommend you do that, though. Enough hydration to keep urine clear is recommended while doing all day exercise. Part of that is to guarantee in advance that you do not get behind. Staying ahead of dehydration IS important. An ounce of prevention is worth a pound of cure.

Twice an hour voiding is a lot(depending on size of bladder of course.) One of my hiking friends has a 1.5 liter pee bottle that he can nearly fill up in one go. Not me.

There are indeed people who get too few electrolytes, and too much water, and become hyponatremic (low sodium concentration). Typically this would occur in extreme settings like marathoners, hot/dry environmental conditions, co-existing GI illness, etc. or other medical or psychiatric conditions, certain diagnoses, meds, or obsessively excessive water replacement.

The worst case I ever saw was not a hiker, but a small man with kidney trouble. His dutiful but much, much larger wife keep plying him with water (as told to). He developed what we call water intoxication, yes too much water. His blood sodium level dropped from normal 140 to 102 and he had a seizure.


Thanks for the info Harvey!

I also take Diamox on my Whitney hikes, I am not sure how much that affects the frequency.

I say water above, but I probably should say liquid. About half of my intake is an electrolyte replacement. I also use S-Caps (http://www.amazon.com/SUCCEED-S-Caps-100-capsules/dp/B004L7P2P6) on hikes like Whitney and Skyline/C2C.

Re: AMS on White Mountain Peak: looking for advice for Whitney
63ChevyII.com #39157 07/29/14 11:09 AM
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Does anyone have any idea what percent of hikers attempting the summit gets hit with AMS?

Re: AMS on White Mountain Peak: looking for advice for Whitney
63ChevyII.com #39160 07/29/14 12:40 PM
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Originally Posted By: 63ChevyII.com
Hyponatermia is why I ask. I tend to drink way more than normal at elevation so that if possible AMS symptoms appear, I can rule out dehydration.

On Whitney in June, IIRC:
*Drank 64 oz between Portal and Outpost (2h 45m)
*At Outpost Camp I consumed 64 oz overnight (~ 9 hours)
*Between Outpost Camp and Trail Camp I drank 48 oz (1h 30m).
*Left Trail Camp with 112 oz of water. This lasted me all the way to the summit and back to Whitney Portal (carried too much obviously). Ran out as we left the trail

After this hike I read something that thought I may be drinking too much. I meant to post a question about it here, but forgot.


Well, since you are taking electrolytes with your water, probably not a big risk of hyponatremia. But... 64 oz is half a gallon -- that's the size of a standard carton of milk!

It is probably not extreme intake, and as long as water is available, you're probably ok. It is pretty sure that you don't NEED that much water. You might try: Cutting back by 1/3, even 1/2. Use Cliff brand shot blocks and other things (I like Everlasting Gobstoppers candy) to keep saliva in the mouth. When climbing, your mouth dries out fast due to the thin dry air. Dry mouth does not always mean you need more water.

Bottom line, though: You're probably not hurting anything drinking that much.

Re: AMS on White Mountain Peak: looking for advice for Whitney
Wiff #39161 07/29/14 12:42 PM
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I would add three things here.

One is simply more acclimation time. Two nights minimum at 8500 - 10,000, and as little time low in between as possible before the trailhead. In other words, from Horseshoe I would recommend first night at Whitney portal, to reconnoiter, maybe a very slow, relaxed day hike to LPL and second night at Horseshoe, with no trip into Lone Pine in between.

Two is to be better prepared to back off. If I am reading your account right, you began to develop pretty clear AMS symptoms well before that first vomit stop. Continuing was risky. Going on after the first vomit was a very high risk move. It's not easy, I know, to turn around a mile from a summit, but it is well to remember: you don't have to go up; you do have to come back down.

OK, three, on how to keep hydrated and avoid hyponatremia. Harvey can check me on this, but I use urine color as a gauge. I keep drinking until pee is very pale to colorless. In my first few days on the JMT last year, I didn't get into balance until day 4 or 5, and the color test coincided exactly with my overall improvement in endurance and feeling of well-being.

Last edited by saltydog; 07/29/14 12:52 PM.

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Re: AMS on White Mountain Peak: looking for advice for Whitney
saltydog #39163 07/29/14 01:13 PM
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Originally Posted By: saltydog
...OK, three, on how to keep hydrated and avoid hyponatremia...urine color as a gauge...


Co"pee"ous & Clear...


Journey well...
Re: AMS on White Mountain Peak: looking for advice for Whitney
+ @ti2d #39173 07/29/14 05:13 PM
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I've seen a few 20,000 ft peaks with dark yellow urine stains.

I have not been to the top of Everest, but a little known fact is that Edmund Hillary peed on the summit. I imagine his was dark. Physiologist Griffith Pugh (at basecamp) tried to teach them that hydration was important, especially up there when just breathing is dehydrating: lung air pumped out like a race horse at 98F and 100% humidity, and replacing it with inhaled cold, thin -20F and 5% dry air.

I mention this because it is not a yes or no situation...while dehydration is to be avoided, some degree of it can sometimes be tolerated for a while even with extreme situations. On the flip side, hydration alone will not prevent AMS. But it does reduce the risk. Risk management.

Salty mentions getting into the groove at about 5 days. Sounds about right.

Re: AMS on White Mountain Peak: looking for advice for Whitney
Lambecc #39185 07/29/14 07:04 PM
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Try not to be discouraged, several days of acclimatization will probably clear everything up. When I leave sea level in New England and do White and Whitney I land in Las Vegas and stay at the Mt. Charleston Resort (7000') (It cost me $42 dollars a night two weeks ago.) Then a night at Grandview Campground (8000'+), then a night at the gate (11,000') before hiking White. After that maybe another night at the gate or Grandview and then a day or two at Horseshoe (10,000') I find that takes care of it. Although I have used acetazolamide (diamox) in the past I found that I do not need it when taking 4 or 5 days at altitude. Good luck in September.

Re: AMS on White Mountain Peak: looking for advice for Whitney
Marty #39198 07/30/14 06:34 AM
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Originally Posted By: Marty
Although I have used acetazolamide (diamox) in the past I found that I do not need it when taking 4 or 5 days at altitude.
Bingo!

Re: AMS on White Mountain Peak: looking for advice for Whitney
LindsayN #39215 07/30/14 10:06 AM
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Originally Posted By: LindsayN
from your list, one thing I don't see is what was your food and drink intake in the 36 hours at 8500 ft before the hike (is it possible you were a bit dehydrated even before you started?). "Pre-hydrating" for 2-3 days, including electrolytes (cytomax or similar powder mix is an alternative to electrolyte tabs), is just as important as hydration during strenuous exercise.

Looks like I'll just miss you at Whitney - I'll be day-hiking it on Sept 1.


Plenty hydrated and feeling good...it was wifey who was taking tough on the way up. It all started on the summit after the first bite of food.

AMS is really hard to predict. I have had it as low as 7,500'...June Lake, and not have it on Mt. Whitney. After the experience on White, I went to Diamox and have not looked back.

Re: AMS on White Mountain Peak: looking for advice for Whitney
63ChevyII.com #39216 07/30/14 10:17 AM
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Originally Posted By: 63ChevyII.com



On Whitney in June, IIRC:
*Drank 64 oz between Portal and Outpost (2h 45m)
*At Outpost Camp I consumed 64 oz overnight (~ 9 hours)
*Between Outpost Camp and Trail Camp I drank 48 oz (1h 30m).
*Left Trail Camp with 112 oz of water. This lasted me all the way to the summit and back to Whitney Portal (carried too much obviously). Ran out as we left the trail

After this hike I read something that thought I may be drinking too much. I meant to post a question about it here, but forgot.


In mid-May I started up the chute in sub freezing temperatures, wearing just a base layer, carrying 4 L of water. The temperature all day never reached 40 F. When I reached the summit, I was well into the 4 L and was supplementing it with snow all the way to Trail Camp. I figure I went through 5 L.

I have never emptied 4 L in the summer...I am usually well into the 3rd or starting the 4th when reach a refill point.

Everything depends on ambient conditions and workload.

Re: AMS on White Mountain Peak: looking for advice for Whitney
Harvey Lankford #39217 07/30/14 10:19 AM
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I'm usually off it after a 2 to 3 days at elevation. I will come of the the trail after a long weekend being able to enjoy a beer.

Re: AMS on White Mountain Peak: looking for advice for Whitney
Wiff #39221 07/30/14 11:29 AM
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Originally Posted By: Wiff
Does anyone have any idea what percent of hikers attempting the summit gets hit with AMS?


WAGNER, D. R., K. D'ZATKO, K. TATSUGAWA, K. MURRAY, D. PARKER, T. STREEPER, and K. WILLARD. Mt. Whitney:
Determinants of Summit Success and Acute Mountain Sickness. Med. Sci. Sports Exerc., Vol. 40, No. 10, pp. 1820-1827, 2008.

Purpose:
The aim of this study was to determine the prevalence of summit success and acute mountain sickness (AMS) on Mt. Whitney (4419 m)
and to identify variables that contribute to both.

Methods: Hikers (N = 886) attempting the summit were interviewed at the trailhead upon their descent. Questionnaires included demographic and descriptive data, acclimatization and altitude history, and information specific to the ascent.
The Lake Louise Self-Assessment Score was used to make a determination about the occurrence of AMS.
Logistic regression techniques were used to calculate odds ratios (OR) for AMS and summit success.

Results: Forty-three percent of the
sample met the criteria for AMS, and 81% reached the summit.


The odds of experiencing AMS were reduced with increases in age
(adjusted 10-yr OR = 0.78; P G 0.001), number of hours spent above 3000 m in the 2 wk preceding the ascent (adjusted 24-h OR =
0.71; P G 0.001), and for females (OR = 0.68; P = 0.02).

Climbers who had a history of AMS (OR = 1.41; P = 0.02) and those taking analgesics (OR = 2.39; P G 0.001) were more likely to experience AMS. As climber age increased, the odds of reaching the summit decreased (adjusted 10-yr OR = 0.75; P G 0.001).

However, increases in the number of hours per week spent training (adjusted 5-h OR = 1.24; P = 0.05), rate of ascent (adjusted 50 mIhj1 OR = 1.13; P = 0.04), and previous high-altitude record (adjusted 500 m OR = 1.26; P G 0.001) were all associated with increased odds for summit success.

Conclusions: A high percentage of trekkers reached the
summit despite having symptoms of AMS.

Last edited by Steve C; 07/30/14 11:57 AM. Reason: fixed non-print offending characters
Re: AMS on White Mountain Peak: looking for advice for Whitney
Ken #39222 07/30/14 11:31 AM
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Thanks, Steve!

Re: AMS on White Mountain Peak: looking for advice for Whitney
Lambecc #39223 07/30/14 11:47 AM
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Lambecc,

I live in Studio City, and get bad AMS (yearly!), so I know your pain.

Although you don't mention urination, the volume of water you are discussing should be sufficient, and I wouldn't adjust that particularly. You might consider some sort of electrolyte addition, although the literature is mixed on that. I personally prefer to use 1/2 strength "whatever" you might choose. I drink more when it is flavored.

Diamox is definitely something to look towards. A small dose, (1/2 of a 125 mg tab) taken at bedtime, starting 2 days before going to altitude, is what I usually prescribe. If you've never taken it before, I recommend using it at home once, just to make sure you won't have a very unusual reaction that messes up your trip.

The diarrhea is an enigma. It does not technically fit the Lake Louise criteria:

http://www.high-altitude-medicine.com/AMS-LakeLouise.html

Which is restricted to N & V, or anorexia. However, it is part of the same system, and the criteria were developed in 1991, and there are clearly some things that are recognized as being altitude related outside of the criteria. Personally, I'd treat is as altitude related, and you lose nothing by doing so.

Re: AMS on White Mountain Peak: looking for advice for Whitney
Ken #39224 07/30/14 11:59 AM
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Originally Posted By: Ken
Steve, I can't seem to make the previous post visible. I've tried changing the things you've suggested, but can't make it work.

You once mentioned that you might be able to make such things work.....???

Fixed. All dashes need to be re-typed. I know that was one of the problems. I didn't check for any others, just used my "bigger hammer" tool.

Re: AMS on White Mountain Peak: looking for advice for Whitney
Ken #39226 07/30/14 01:12 PM
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Originally Posted By: Ken
Climbers who had a history of AMS (OR = 1.41; P = 0.02) and those taking analgesics (OR = 2.39; P G 0.001) were more likely to experience AMS.


Ken, thanks for revisiting the LL study. I read it once a few years ago, but I must have missed the part about analgesics contributing to AMS. Any conclusions as to why?

Re: AMS on White Mountain Peak: looking for advice for Whitney
Bulldog34 #39229 07/30/14 03:29 PM
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Gary, I did not re-read where you are quoting from, but association does not prove cause and effect.

For example. Those taking analgesics before hiking may have had prior headache or AMS history, other medical issues, age, etc. In other words, were they are fair comparison to the control group? (assuming their was an accurate control group.) A good study would try to take that into account. OTOH, did those taking analgesics start pills not chronically before the hike, but at the start or early into it? If so, maybe they knew from past history that they might benefit from it (for what little good it does). Again, a well designed study would take this into account.

Ken can better answer this as he has been part of an AMS study on Whitney.

Re: AMS on White Mountain Peak: looking for advice for Whitney
Bulldog34 #39244 07/30/14 06:30 PM
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Actually, that was my study. I was the fourth author (always the most important!) eek

There was no control group, this was an observational study. Needless to say, there was no money to fund a controlled study.

That said, this merely documented whether a person took an analgesic, but not why. So my conclusion is that the most likely reason for them taking it, was that they were having pain, and in this setting, most likely a headache.

Measured that way, it would be fairly amazing if the people with AMS did not have a higher rate of analgesics.

Re: AMS on White Mountain Peak: looking for advice for Whitney
Ken #39247 07/30/14 06:59 PM
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Got it. More a case of being associated with AMS during an event, as a response to the altitude headache, than a contributing cause. Makes sense when viewed in that light. I just wasn't connecting the dots. Thanks.

Re: AMS on White Mountain Peak: looking for advice for Whitney
Lambecc #39618 08/12/14 02:43 PM
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Wanted to say thanks to all for the advice.

#1 - I'm looking into the Mosquito Flats to Mono, but haven't done it yet. Had the opportunity to do a back country hike I've been long looking forward too which was: (see #2)

#2 - Did Aspendell (Lake Sabrina) to Hungry Packer Lake for an over nighter. (Beautiful, great fishing, and my #1 fave place in the Sierra Nevadas so far). Peaked at just a touch over 11,000 feet. No major issues. Just a tiny barely fuzzy headache while sleeping. I drank more water and popped some aspirin and it vanished.

#3 - I have added Nuun to my pack and on my first trial, to the hike above, I took about 2-3 complete tablets. I'm not sure if it helped, but I didn't have any side effects that I was aware of (and that was my primary test).

#4 - I have a local hike this week here at home in the L.A. area, and then the following week I'm doing the exact same Hungry Packer Lake hike. Then Whitney starting Sept 2nd.

So, again, thanks for the pointers!

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