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#51971 - 09/01/17 11:21 AM Need feedback on Diamox
Kumar12 Offline


Registered: 02/01/17
Posts: 12
Loc: Bay Area, CA
My Whitney day hike is on 9/11, this is my first trip. I am still debating whether to commit to Diamox or not. I had been to Tioga pass this year and did some short hikes around the area and did not feel any AMS symptoms but it is just 10k-11k elevation.
We are doing some pre-hikes on 9/9 at Tioga pass (Mount Dana) and Acclimating at Whitney Portal/Horseshoe Meadows on 9/10. I am thinking whether I can start the Diamox prescription after Mount Dana hike on 9/9 only if I feel AMS symptoms around 12-13k elevation. Is it too late if I start the Diamox starting 9/9 night or 9/10 Morning for the Whitney hike on 9/11? I never taken Diamox before so I am worried about the side effects and also prefer to hike without it if not needed. Any prior experience or feedback is really appreciated.

Thanks

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#51972 - 09/01/17 12:19 PM Re: Need feedback on Diamox [Re: Kumar12]
Wiff Offline


Registered: 07/23/14
Posts: 24
Loc: LA
I have no experience with it. I've pre-loaded with Advil and never had any elevation problems. Personally I would not venture into a new drug under those physical conditions.

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#51973 - 09/01/17 01:28 PM Re: Need feedback on Diamox [Re: Wiff]
Harvey Lankford Offline


Registered: 11/10/09
Posts: 984
Loc: Richmond, Virginia
Originally Posted By: Wiff
I have no experience with it.
That does not help him much.


Diamox (acetazolamide) works best as a preventative starting 1-2 days before you need it and/or before any additional significant change in altitude (especially sleeping altitude) - even then it is not a very powerful drug despite a variety of medical studies. I have used it from here to the Himalaya. Sometimes not. It does not help everyone, some not at all. Proper dose is half of a 250 mg twice daily.

Yes, test doses before going up are advisable to be sure of any side effects AND actual drug allergy. They DO happen. Ask my wife.

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#51975 - 09/01/17 01:52 PM Re: Need feedback on Diamox [Re: Kumar12]
WanderingJim Offline


Registered: 02/09/15
Posts: 185
Loc: California
I've used Diamox on all four of my 14k+ hikes.

For acclimatization, they usually recommend starting at least 2 days before you start your high altitude hiking. (1 tablet twice a day). You only need to take it for 2-3 days in the days before your hike, then only need to take more if you start showing symptoms. You don't want to be taking it throughout a long trek if you're not having symptoms.

So far, only the 2nd hike using it did I have to abort my hike due to AMS symptoms. And I'm pretty sure that's since I didn't spend enough time acclimatizing. Just a single afternoon and night at 10,000 feet before going up to 12,000 feet on day 1 and then Mt Langley on day 2.

The other three, I was successful with my high altitude hikes. 2 x Whitney (including sleeping at the summit this past month) and 1 x Salkantay to Machu Pichu (with 16,000 and 14,000 foot passes and sleeping at 14,800 feet).

All three successful hikes were also with at least 2 days of acclimatization time, so the Diamox may or may not have helped.

At some point maybe I'll chance a high altitude hike without it, but I usually come down on the side not wanting to chance my hike failing and take it just in case it does help me.

Only side effect I've had directly from the Diamox is the first time I had some very nasty diarrhea when I started taking it. Haven't had issues with that since then.

I did have some diarrhea and long dizzy spells on my Salkantay trek, but those were after 2-3 days of not being on Diamox so I think they were general attitude issues or the Peruvian food. The dizziness was probably due to coming DOWN from high altitudes too fast (kind of reverse AMS).

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#51976 - 09/01/17 02:15 PM Re: Need feedback on Diamox [Re: Kumar12]
Hobbes Offline


Registered: 03/28/14
Posts: 109
Loc: The OC
I use it whenever I head to the Sierra. I live at sea level in SoCal, and due to my schedule, I never have any spare days to acclimate. Rather, I leave home in the morning and start hiking in the afternoon (it takes 4 hours to get to Lone Pine from my house).

I usually only go 3-5 miles on the first day, which would be roughly equivalent to getting to Outpost camp. When I hiked Whitney this past May, I decided to spend the first night @ the Portal, then hiked to Trail camp the next morning.

When I was younger, I would just power on through mild AMS symptoms. In my case, they were never more than feeling flat & tired. I'm still in pretty good shape, but I decided I didn't want to deal with altitude induced fatigue anymore. (Not to be confused with being tired from the physical exertion of hiking - I know my own limits, and know what I can & can't do. If I'm @ altitude and just can't shake feeling lethargic, I know it's mild AMS.)

My usual routine is take the first dosage after dinner the night before I leave. Then it's two per day (morning/evening) until the last day I'm in the mountains.

If you're worried about possible side effects, just take the prescribed dosage for full a day long before you start on your hike. If you notice anything other than the regular weird taste effects of carbonated drinks and/or beer, then follow up according to recommended procedures.


Edited by Hobbes (09/01/17 02:18 PM)

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#51979 - 09/01/17 07:08 PM Re: Need feedback on Diamox [Re: Hobbes]
Bobby49 Offline


Registered: 07/04/17
Posts: 41
Loc: California
Originally Posted By: Hobbes

If you're worried about possible side effects, just take the prescribed dosage for full a day long before you start on your hike. If you notice anything other than the regular weird taste effects of carbonated drinks and/or beer, then follow up according to recommended procedures.


The typical side effects include numbness/tingling in the extremities. Typically that is worsened by high dosage or long duration on the drug.

I think that I had the numbness in my toes after one week at standard dosage, but it was hard to distinguish it from the effects of cold.

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#51990 - 09/02/17 08:59 AM Re: Need feedback on Diamox [Re: Harvey Lankford]
bobpickering Offline


Registered: 02/07/10
Posts: 311
Loc: Reno, Nevada
Harvey said, “starting 1-2 days before you need it” and “half of a 250 mg twice daily.” I think that’s pretty standard advice nowadays. When I climbed Denali in 1995, the guides advised starting Diamox when symptoms appeared, and that worked for me. You also may get relief with just a quarter of a tablet, and that should reduce side effects.

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#51994 - 09/02/17 12:15 PM Re: Need feedback on Diamox [Re: bobpickering]
SierraNevada Online


Registered: 09/05/11
Posts: 1100
Loc: NorCal
I've had good luck with Diamox for quick ascents of Whitney and Shasta, but taken in advance per the protocol described above. If you wait until symptoms appear before taking Diamox, be sure you're fully hydrated before you go down that path.

On the backside of Whitney coming from Bishop, I started having trouble catching my breathe and I felt a little weak. I took a 1/4 tablet of Diamox and things got much worse. Looking back, I'm pretty sure my breathing symptoms and lack of energy were related to dehydration. Diamox made me pee out any water I drank and then some. I couldn't overcome the diuretic effects, plus I had to ration water going up from Guitar Lake. A few times I actually thought I couldn't make it and considered going back down to the Ranger at Crabtree. I even thought about hitting the SOS button on my InReach. You know its bad when your mind thinks about that. It took all my strength to self-evacuate over Trail Crest, got down to the spring on the switchbacks and guzzled water until I felt human again. I was still weak and peeing all the way down to the Portal. Didn't fully recover for a few days. Learn from my mistake.


Edited by SierraNevada (09/02/17 12:15 PM)

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#52005 - 09/03/17 12:51 PM Re: Need feedback on Diamox [Re: SierraNevada]
Bobby49 Offline


Registered: 07/04/17
Posts: 41
Loc: California
When you consume Diamox, your body starts adapting to a new water balance point. To do that successfully, you will need to consume extra water. It is best to get all of that started a day or two before you reach any decent elevation so that the adaptation has run its course.

I've seen a bunch of people beg for Diamox even when there was a huge water shortage. Then they feel even worse afterward.

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#52006 - 09/03/17 02:23 PM Re: Need feedback on Diamox [Re: Kumar12]
EdHaynes Offline


Registered: 09/12/16
Posts: 19
Loc: California
When I attempted Mt. Whitney last year from the main trail I spent two days between 8 and 10 thousand feet to acclimate. However, I got headaches and nausea after reaching near 12,000 feet. I had to turn around before reaching Trail Crest.
This year I spent a few days in the back country by starting off through the Cottonwood Pass and this time my doctor gave me Diamox. The Diamox worked. I did have to pee a lot more and I drunk as often and as much as I could but my backpack was too heavy and I traveled really slow to the point I had to ration my water for one day. I ended up getting constipated and didn't do my business for five days. As a result, I turned around and headed back before making it to the summit. I did end up doing a nice loop over the New Army Pass.
It should be noted that I am 70 years old so my body can't do the things it use to do. <G>
I'll be trying again.....
Meanwhile, if using this drug I'd suggest staying well hydrated.

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#52009 - 09/03/17 05:56 PM Re: Need feedback on Diamox [Re: EdHaynes]
Kumar12 Offline


Registered: 02/01/17
Posts: 12
Loc: Bay Area, CA
Thank you all for sharing your experience and providing valuable feedback, greatly appreciated!
Since this my first time, I am planning to acclimatize for couple of days and plan to go slowly (plan to take 8-10 hours for ascent). I am hoping that this is good enough to avoid AMS symptoms. I still want to carry Diamox and but don’t plan to use it this time unless I really need it. It looks like from couple of feedback, I can still take 125mg Diamox if I experience AMS symptoms while hiking Whitney if I am drinking plenty of water?

Thanks

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#52010 - 09/03/17 07:02 PM Re: Need feedback on Diamox [Re: Kumar12]
bobpickering Offline


Registered: 02/07/10
Posts: 311
Loc: Reno, Nevada
Kumar12:

In the “old days,” nobody took Diamox before symptoms appeared. Nowadays, most people start it a day or two in advance, but you CAN wait and see how you do without it.

Years ago, I read something in Consumer Reports that I thought was really important: The correct dose of any drug is the lowest dose that is effective. This applies to Diamox and any other drug you take. The lower the dose, the less the side effects.

People disagree on taking regular breaks. Here is MY advice: If you have a reason to stop (get food, remove a jacket, drink something, answer the call of nature, etc.), by all means stop and take care of that need. However, it’s best to pace yourself and keep moving. If you can’t comfortably go ten minutes, and preferably twenty minutes, without stopping, you’re going too fast. Read that sentence over and over. If you keep moving, you’re less prone to AMS. Moderate exercise helps you acclimatize. Sitting on your ass and “catching your breath” doesn’t.

Good luck and have fun.

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#52012 - 09/03/17 08:16 PM Re: Need feedback on Diamox [Re: bobpickering]
SierraNevada Online


Registered: 09/05/11
Posts: 1100
Loc: NorCal
Bob,I agree with pacing, but for me that's more about heart rate and cardio momentum than acclimation. When I'm "in the groove" and climbing steadily at a comfortable pace, my heart rate stabilizes within a range, my breathing gets rhythmic, and my endorphins keep me in good spirits. When I stop and start again, I have to go through an equilibrium process all over again. This is quite different than altitude sickness. Taking a break or not doesn't really matter, a body either handles it or it doesn't. At some point going up is not a good idea at any pace.

With all the peaks you've climbed, I wonder if you ever had any amount of AMS?

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#52014 - 09/04/17 12:17 AM Re: Need feedback on Diamox [Re: SierraNevada]
bobpickering Offline


Registered: 02/07/10
Posts: 311
Loc: Reno, Nevada
Originally Posted By: SierraNevada
This is quite different than altitude sickness. Taking a break or not doesn't really matter, a body either handles it or it doesn't. At some point going up is not a good idea at any pace.

With all the peaks you've climbed, I wonder if you ever had any amount of AMS?

It's well established that we can climb higher than we can sleep. When you’re not acclimatized, and you stop to catch your breath or (even worse) try to sleep, your breathing may slow down to the point that you’re not getting enough oxygen. That’s when you may get sick. If you hike at a moderate speed, you will breathe correctly, even if you’re not acclimatized yet. Keeping a steady pace is not only the most efficient way to climb, I believe that it actually helps avoid AMS.

When I did my “Whitney Double” in 2010, I stopped as often as needed for water, food, clothing, potty breaks, etc., but I only took two “sit on my ass and rest” breaks the entire day: one at Whitney Portal between trips and one at Trail Crest on the way down the second time.

I had mild Cheyne Stokes breathing above 14,700’ on Denali. I took 125mg Diamox and I was fine within a few minutes. I actually felt pretty good on the summit at 20,320’. I have never had any issues in the lower 48 states. When I climb 14ers, I usually don’t even notice the altitude, and I never get sick. I’m very lucky!

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#52024 - 09/04/17 06:14 PM Re: Need feedback on Diamox [Re: bobpickering]
SierraNevada Online


Registered: 09/05/11
Posts: 1100
Loc: NorCal
Wow Bob, I didn't know you did Denali. Your prolific peak bagging in the Sierra is very impressive, but Denali is another level entirely. I'm in the middle of a climbing history book on Denali right now. The weather is so extreme, that's not even on my bucket list. We seem to have a similar style of not taking breaks, but you would surely leave me in the dust.

My symptoms, described above, started while sleeping above Guitar Lake, after several days above 10,000. I should've realized it was not AMS, but rather dehydration. Bad decision on my part to take Diamox at 2am. Hopefully some one else will benefit from reading about that mistake.

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#52026 - 09/04/17 06:29 PM Re: Need feedback on Diamox [Re: SierraNevada]
SierraDave Offline


Registered: 09/03/17
Posts: 12
Loc: Sacramento, California
Asked in a thread about questions from a first timer this upcoming weekend, but may be more pertinent here:

To Diamox vs not to diamox, that is the question. If i go this route, I'll pretreat Thursday and Friday, last dose Friday night because I don't want to deal with the diuretic effect while hiking. Or maybe I just table it. I've read the respective threads on this and want to put myself in the best position to summit with a tight acclimatization schedule, while limiting side effects.

Anyone ever use Dexamethasone at this height when/if AMS symptoms appear? Its probably overkill, but I was thinking of carrying some dex as well just in case.

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#52027 - 09/04/17 09:11 PM Re: Need feedback on Diamox [Re: Kumar12]
Test123 Offline


Registered: 07/22/17
Posts: 15
Loc: San Francisco Bay Area, USA
Hi Kumar,

According to my personal experience, I highly recommend Diamox. I did my hike yesterday. 3 weeks back I did Mt Dana in Yosemite to check my AMS level and I ended having severe headache and nausea. I came back and got Diamox for Whitney, till the end I had no issues of any AMS symptoms. Couple of my group member did not take Diamox and they were fine till 12000 ft. After Trail camp during the switch backs, they started to get mild headache. They pushed themselves and summited.

Another point to note based on my experience is the AMS symptoms for men is different from women. So make your call. Last min don't suffer after 12,500 ft.

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#52028 - 09/04/17 09:39 PM Re: Need feedback on Diamox [Re: SierraDave]
Steve C Offline


Registered: 09/22/09
Posts: 7225
Loc: Fresno, CA
Sierra Dave: yours is an aggressive schedule. Take a one-day (125 mg twice 12 hours apart) and see how you feel. Some people (including myself) take half that. If you take it at home, you will see how it affects you. The diuretic effects only hit you the first day. After that, your water intake balances out.

Dex is not used much on Whitney -- at least nobody talks about it here. It's generally used if HAPE or HACE symptoms show up, which is another level of AMS over and above what most people experience.

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#52029 - 09/05/17 07:55 AM Re: Need feedback on Diamox [Re: Steve C]
SierraDave Offline


Registered: 09/03/17
Posts: 12
Loc: Sacramento, California
Thank you Steve, I appreciate the information.

For those who have experienced AMS, how accurate/often do you use the Lake Louise scoring system (headache, nausea, dizziness, fatigue, ability to sleep) to decide whether to push on or turn back, ie if you fall into the mild AMS scoring category (3-5).

I guess that's up to the individual's tolerance of risk vs the adage that headache plus nausea/dizzy/fatigue means it's time to turn back.

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#52037 - 09/05/17 10:39 AM Re: Need feedback on Diamox [Re: SierraDave]
bobpickering Offline


Registered: 02/07/10
Posts: 311
Loc: Reno, Nevada
Originally Posted By: SierraDave
Anyone ever use Dexamethasone at this height when/if AMS symptoms appear? Its probably overkill, but I was thinking of carrying some dex as well just in case.

In 1995, my guides on Denali said Dexamethasone could keep AMS symptoms at bay until all of a sudden HACE could appear without warning. They promised that if they caught anyone taking Dex, they would send him off the mountain immediately.

If you need a little help, take Diamox in moderation (125mg twice a day or less). More is NOT better; it just causes more side effects. Add OTC NSAIDs in moderation if you must. Forget the Dex.

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