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#5272 - 06/15/10 11:22 AM Re: Dexamethasone and HAPE [Re: Rod]
Steve C Offline


Registered: 09/22/09
Posts: 7872
Loc: Fresno, CA
Rod wrote:
I see it as a real and dangerous problem that people think they can short cut their physical preparation and acclimation

Rod, people are time-challenged. Most of us try to do the most we can with the least amount of time spent preparing. Aren't most things in life like that?

It is just a fact that serious altitude issues hit a small minority of people in the Sierra. Unfortunately, these people don't have any way of knowing before hand that they are so much more susceptible to the trouble than all the rest. If they did, they could either spend the necessary extra time acclimating or else avoid going to altitude. And since most people do ok at the altitudes, why would anyone expect themselves to be so much more susceptible than the average?

The reality is that these people do get themselves into the seriously dangerous situations. And if someone brought a medication along that could save their life, wouldn't that be a good thing?

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#5274 - 06/15/10 11:37 AM Re: Dexamethasone and HAPE [Re: Steve C]
Bulldog34 Offline


Registered: 11/12/09
Posts: 1255
Loc: Atlanta
All seriousness aside, I still like Rod's thought about the potential use of other vasodilators in mountaineering. If the INFS would issue a couple of Viagra to each hiker with their permit, climbing Whitney might be harder more difficult, but the TRs would be eminently more intriguing . . .

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#5275 - 06/15/10 11:42 AM Re: Dexamethasone and HAPE [Re: Rod]
Harvey Lankford Offline


Registered: 11/10/09
Posts: 1024
Loc: Richmond, Virginia
Originally Posted By: Rod
I see it as a real and dangerous problem that people think they can short cut their physical preparation and acclimation knowing performance enhancing drugs might get them by without putting the actual study,and preparation necessary.


That is not the use of dex suggested here.

and

all of the study, preparation and acclimatization in the world will not prevent all cases of AMS and its complications. As an example, after his success on Everest in 1953, Ed Hillary later went to Makalu and developed HAPE. If it can happen to Sir Ed, it can happen to me and you.

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#5277 - 06/15/10 01:29 PM Re: Dexamethasone and HAPE [Re: Rod]
DUG Offline


Registered: 09/22/09
Posts: 370
Loc: Wildomar
Originally Posted By: Rod
That is my opinion and I am entitled to that.


Amen brother! Too many times it seems like we can't give our own personal opinion on a topic without being accused of something. Of course, that statement there is just my opinion..............................................DUG

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#5279 - 06/15/10 03:17 PM Re: Dexamethasone and HAPE [Re: Rod]
Ken Offline


Registered: 10/29/09
Posts: 742
Loc: Los Angeles
Rod, you don't seem to understand that my answers were directed to very narrow questions, and you have responded as though I am discussing a much larger issue, which I'm not. I am addressing myself to the title of this thread, and to a lesser degree to HACE, a related problem.

You then asked a "bait" question about what physicians (of which I am one) would do, then, flatly stated after I'd answered, that that is not what physicians would do (of which I don't think you are one).

Why on earth would I have a problem with your responses?

Do I advocate dex for simple AMS: no

Do I advocate dex as a substitute for acclimatization: no

Do I advocate doing everything possible to avoid a death: yes

Would I recommend Diamox for a person who has a history of HAPE: yes, in addition to acclimatization.

Would I recommend that a person with a history of HAPE carry dex: Yes, they are at high risk, and it may save their life.

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#5281 - 06/15/10 04:21 PM Re: Dexamethasone and HAPE [Re: Ken]
Harvey Lankford Offline


Registered: 11/10/09
Posts: 1024
Loc: Richmond, Virginia
This might be a good time to :
(1) Conclude this thread (please)
(2) provide some references for those who want to learn more, and for those who need to learn more.

This is the link I previously posted by International Society Mountain Medicine (Note: this is one of several similar sources. There are some nuances and variations as is expected for the management of a biological/medical problem where there is the mix of science, experience, and judgment.)
http://www.ismmed.org/np_altitude_tutorial.htm

By the grand old man of the mountains, Charles Houston (pronounced House-ton). He was famous in the 1950s for K2/Art Gilkey episode plus the first English language medical report attributing pulmonary edema to HAPE rather than heart failure, later Operation Everest hypobaric chamber tests, and versions of this book which reads well for laymen:
http://www.amazon.com/Going-Higher-Oxyge...2077&sr=8-1

My early-on favorite high altitude physiology book by Californian Herb Hultgren who took cath equipment to the Andes to help unravel the medical mysteries of soroche, the South American word for "ore." Why ore? High altitude miners got AMS, HAPE, reentry HAPE, and Chronic Mountain Sickness (Monge's Disease). The rough equivalent of that in cattle is Brisket disease.
http://www.amazon.com/s/ref=nb_sb_noss?url=search-alias%3Dus-stripbooks-tree&field-keywords=herb+hultgren&x=15&y=18

The most current major and comprehensive text for really big bucks by two West Coasters and a Brit.
http://www.amazon.com/High-Altitude-Medi...2941&sr=1-1

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#5285 - 06/15/10 05:39 PM Re: Dexamethasone and HAPE [Re: Ken]
Rod Offline


Registered: 09/22/09
Posts: 660
Loc: Santa Clarita, Ca. USA
Actually Ken depending on your personal understanding and knowledge of my profession. I am either a colleague of yours or your worst nightmare. I am a Chiropractor. One of 2 professions licensed to be primary care physicians. I work closely with orthopedic surgeons and medical doctors daily. All of them consider me a colleague.I never baited you with any question. Maybe you are confusing a question in this thread asked by someone else.
Harvey you are a voice of reason. Thanks for your great information.


Edited by Rod (06/15/10 05:44 PM)

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#5287 - 06/15/10 05:53 PM Re: Dexamethasone and HAPE [Re: Harvey Lankford]
Bulldog34 Offline


Registered: 11/12/09
Posts: 1255
Loc: Atlanta
Originally Posted By: Harvey Lankford
The most current major and comprehensive text for really big bucks by two West Coasters and a Brit.
http://www.amazon.com/High-Altitude-Medi...2941&sr=1-1


You ain't kiddin' brother. $150 retail, but the good news is that you can get it used for as little as $92 . . .

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#5289 - 06/15/10 06:15 PM Re: Dexamethasone and HAPE [Re: Harvey Lankford]
Bee Offline


Registered: 09/22/09
Posts: 1261
Loc: Northern California
Originally Posted By: Harvey Lankford
This might be a good time to :
(1) Conclude this thread (please)


By your command.

Folks, I think that it is time to wrap up this topic, archive the reference material, and perhaps continue the discussion under another thread, so that we do not lose the vastly important info contributed by our esteemed trifecta of experts (as the thread veers away from its original query.)

This does not mean that anyone's opinion is of lesser value, rather, it just makes it easier to capture the more scientific data in one thread by closing it now.
_________________________
The body betrays and the weather conspires, hopefully, not on the same day.

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#5291 - 06/15/10 06:18 PM Re: Dexamethasone and HAPE [Re: Bulldog34]
Steve C Offline


Registered: 09/22/09
Posts: 7872
Loc: Fresno, CA
Thanks everyone for all the discussion. There is very much useful information to be found in this thread.

Edit: Golly Bee, you beat me to the switch! Thanks.


Edited by Steve C (06/15/10 06:19 PM)

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#5294 - 06/15/10 07:08 PM Re: Dexamethasone and HAPE [Re: Steve C]
CaT Offline


Registered: 09/24/09
Posts: 694
Loc: Blacklick, OH (formerly SoCal)
You both beat me to the switch. cry
_________________________
If future generations are to remember us with gratitude rather than contempt, we must leave them more than the miracle of technology. We must leave them a glimpse of the world as it was in the beginning, not just after we got through with it.
- Lyndon Johnson, on signing the Wilderness Act into law (1964)

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