Based on my prior two trips up Whitney's MT (one with AMS that started at around Trail Crest) and the second where AMS set in just below Trail Camp, I know that I have altitude issues with or without Diamox. I have tried aspirin, Diamox and everything else. Acclimatization is my only hope. Rather than acclimatize along the MT camping at Outpost and Trail Camp, I would like to look for a new backpacking route that would also achieve gradual acclimatization. I would like the trip on the trail to last three days and finish at the Portal. Any recommendations on where to begin and paths to travel?

Brent, this is not what you asked for, but my favorite mode of acclimating is to go up to Horseshoe Meadows and camp two nights prior to hiking up the Whitney trail.

Horseshoe meadows is at 10,000', and has walk-in camp sites. There are several easy trails to hike where you gain a 1000 to 1500', so you could do that to enjoy the area.

I am sure others will have some good suggestions, too.

Brent, I have to mirror Steve's thoughts on this. I don't have a route for you, but the last time I went to Whitney, sleeping at the Horsehoe Meadows area really helped. Only thing is, I didn't stay there for two nights. I stopped there after getting my permit. I started walking the area for a few hours before retiring in the evening. I woke up the next morning and headed for Whitney. I still got a headache the next day, but it was not debilitating.

I have issues with AMS as well. I went to San Jacinto the last two Saturdays and got monstrous headaches both times.

Baldy isn't too far from Orange County. You might consider overnighting up there one night for a couple of weekends before doing Whitney. That's similar to Steve's suggestion, but it won't require nearly the driving.

Brent, a couple of questions: what did your sleeping-at-elevation picture look like prior to those two AMS episodes? Were these dayhikes or overnighters? Some people are wired to go from sea level to 14K' without a hitch, but most of us need to sleep high to go higher without AMS. The body does it's real acclimation work while you're at rest for an extended period at elevation. Even something as simple as one night at the Portal (8.5K'), one at Outpost Camp (10K') and one at Trail Camp (12K') should have most people ready to get up to the summit and back down to the Portal without a problem on the 3rd trail day.

I know you said you'd prefer not to do this, but it gets you 3 nights at elevation and doesn't push the envelope based on your history. Virtually anything else in the area will have you sleeping that first night very close to the elevation where you've experienced AMS in the past.

Also, what was your Diamox dosage and schedule?

Not to be picky, but it is actually it is the best hope, better than Diamox anyway.

The official definition of threshold of altitude illness is "only" 8,000 ft.
In my family, two can just go, but two need those extra nights around 8,000 before they can get over 11,000.

BY THE BOOK (and some need even more conservative schedule, beginning at 8,000 ft rather than 10,000)
- you should spend at least one night at an intermediate elevation below 10,000ft
- above 10,000 feet, your sleeping elevation should not increase more than 1000-1500 feet per night.
- Every 3000 feet you should spend a second night at the same elevation.
http://www.ismmed.org/np_altitude_tutorial.htm#goldenrules

Brent, again this doesn't quite answer your question, but I've done this hike in preparation for another 14er before.

Go to the June Lake/Lee Vining area and sleep for the first night. Depending on which area you decide to sleep at, the altitude is in the high 6,000 to mid 7,000 ft. After a good night's sleep, the east side of Yosemite and Mt. Dana is literally less than 30 minutes away. Mt. Dana is over 13,000 ft. The elevation starts at around 10,000 and the round trip hike is only about six miles. You'll have a great hike and fantastic views.

Now, drive down South on the 395 and camp near the trail to White Mountain Peak. It's a long but relatively easy hike. Very gradual trail on a +14,000 ft. peak.

If your quads are up to it, you'll be fully acclimated I think. For me, instead of doing Whitney after WMP, I went to Bishop instead.

There IS another option not mentioned yet: Hike from Horseshoe Meadows, over New Army Pass or Cottonwood Pass, and then north on the PCT to Crabtree Meadows.

Then, climb Whitney from the west. You could probably do it in 3 - 5 days, depending on your hiking speed. By the time you got to Mt Whitney, you would certainly be well acclimated.

Permits are fairly easy for this route, but you would need the TrailCrest Exit permit to go out the main Mt Whitney trail.

+1

This is excellent advice and the trails are very scenic and you won't get worn out for Whitney.

First, let me thank the hiking commnity. Y'all are aweseome.

To answer the question about my first two experiences,
Trip 1: Day 1: sea level to Outpost--made camp at 3 pm or so, and slept there. No AMS symptoms.
Day 2: Outpost to Trail Crest--made camp at noon or so and slept overnight. If I had any symptoms, they weren't acute enough for me to recognize them.
Day 3: rose at 3 am or so to begin summit. Started pounding headache at Trail Crest. No appetite, but ate anyway to refuel at regular intervals along the trip. Foolishly pushed on and made it to the summit. Within minutes of arriving, vomited everything I had eaten since childbirth and feebly made it down the mountain. At around 10,500 feet, felt like superman after kryptonite was removed. I bounded down the mountain. No diamox on this trip.

Trip 2: Started Diamox 1 day before the trip. 125 MG (I'm fuzzy on the frequency, but it was either twice or three times per day). No side effects (still wondering if maybe I got a panacea). Day 1: The plan was Sea Level to Trail Camp, hike to 13000, and come back down and sleep at Trail Crest and summit the next day. I was hoping that the Diamox would help more than it did. In actuality, we went from sea level to 12000, just shy of Trail Camp. At about 11,000 feet, I started really slowing down significantly and began to be easily confused, once losing the very easy to find trail. After resting for a while and feeling like I could make it to Trail Camp, we trudged on to 12,000 feet, just shy of Trail Camp when when I vomited everything I had eaten since my last great purge on the Summit two years earlier. It was then that I noticed that I had double vision. (The brain does funny things when when swelling.)

We quickly descended the mountain. My vision and apetite were in perfect tact when we got down to Lone Pine.

I did Summit Baldy the week before with no problem, but didn't stay up there long. I really like the suggestion of trying to camp on Baldy for the two weekends before. My threshhold seems to be 10,000 feet or so. On the day or two before the summit, finding a place to hike a little above 10K and then the second day a little above 12K and then sleeping at 12K might do the trick.

It seems like your body (and others) just need more days to adjust at that intermediate altitude. You now have a good idea of where your threshold is.

Also suggest: back off on the eating. In addition to nausea being part of AMS, the need for fuel is often overexaggerated. The crazy, young marathoner might need 6000 calories, but most of us, especially going slower and taking more days, don't need to eat the whole pie. For a short trip like Whitney, you can lightly graze on some carbs, and burn your fat stores as needed.
No problem doing this unless you are on Denali for three weeks. Far, far, far more people who "run out of gas" on Whitney do so because of AMS, not hypoglycemia.

Brent, if your schedule allows, you might consider sleeping a 2nd consecutive night at Trail Camp to further aid your body's acclimation before heading for the summit. Maybe some Diamox as well.

I'm generally not a holistic kinda guy, but I've made a habit of going on ginko biloba for a couple of weeks prior to any high elevation trip. There are actually some mountaineering studies that indicate that it really does assist with oxygenation at elevation. I have no idea if it's truly worked, but it hasn't hurt.

One last question - were you well hydrated prior to starting up the trail, and drinking at regular intervals along the way?

Gary, thanks for the hydration reminder. That is the biggest thing that people forget. Dehydration can really increase the AMS problems. I find that I often forget to drink enough when I'm hiking.

On Ginko Biloba, there was some study that claimed it helped, but a few years later, a more exacting study refuted the first.

I forgot to mention hydration. I was very well hydrated--at least 8 ounces every waking hour on the hour beginning 3 days before both summits. I also did the aspirine regimen that others on the Portal Store board have recomended--the first time. I didn't do it the second time.

Regarding eating less, that is an interesting idea. Some have said that at altitude, the body doesn't put much effort or energy into digestion. I think that might be right. I certainly didn't stuff myself either time (and ate far less than the 1500 calories a day than I packed), but (turn an eye if you get grossed out easily), the peanut butter in a peanut butter and banana sandwhich that I ate 3 hours earlier didn't appear very digested.

In the final analysis, however, I don't think that eating less would be much help. It might reduce vomiting, but undigested food didn't cause double vision and sluggish thoughts.

Not that it matters much for AMS, but my physical fitness level is very good. My muscles and lungs felt great and I had almost no residual muscle soreness after the last summit attempt.

All these ideas from all of us

You just need Tincture of Time.

For rock climbers, Thiotimoline is magic.

Wow, Brent - it sounds as if you're doing everything right. It would appear that your body just has a tougher time than most adjusting to elevations above 10K'. I'm definitely with Harvey on this one - I suspect you just need more time in that 10K'-12K' zone before trying to go higher. A few nights on Baldy before your Whitney trip would certainly help the cause.

My wife has a similar issue. I can't count the number of times she's gone from 1000 feet (Atlanta) to 10K' within 24 hours, and never once experienced a problem. However, the first time she went above 12K', AMS slapped her silly. We eventually found that if she sleeps 3-4 nights at/above 8K', she does OK at the higher elevations. She still has Diamox just in case, but the extended time at moderate elevation seems to have done the trick for her. It could be the same with you, only the need might be to spend more time in that 11-12K' range.

Hope you get it licked - AMS is no damn fun! My one and only experience with it was at about 13K' on the Whitney main trail a couple of years ago. Eventually I realized my problem was that I was sleeping at 3600 feet in Lone Pine. Didn't matter that I was dayhiking to 12K' each day prior to Whitney - my body was not truly acclimated because I was never really at rest for any length of time at elevation.

That one episode really confused me because - like so many other numbnuts out there - I thought I was "immune" to AMS since I had never had it. Upon reflection, though, it was apparent why I had done Thirteeners and Fourteeners in the past with no issue - they were all in the Rockies, where you can't avoid sleeping high. That sold me. Since then I've been careful to always sleep high (2-3 nights) before attempting higher elevations, and have experienced zero issues. I've never taken Diamox, but always have it in my pack in case history repeats. AMS can be debilitating, but your kryptonite line was right on target - once you've descended below a certain elevation it can quickly go away.

Bulldog34, it sounds like you and your wife's experience both suggest that being at altitude isn't nearly as important as sleeping at altitude and staying there a while--for me, maybe multiple days. I seem to do ok at 10K. I think I'll try staying at 10K+ I really like the idea of sleeping a couple nights on a couple of weekends on Baldy in the few weeks before the summit.

Steve, I'm the same way. Even with a CamelBak, I'll forget to drink if it's not hot - sometimes it takes that initial stitch in the side to remind me that I need to hydrate. When I'm heading over 12K', though, I'm so freakin' conscious of AMS that I become a water bladder carrying a pack instead of vice versa. That isn't good either, as I tend to not eat much above 10K', and salts/minerals get flushed and not replaced. To combat that I try and drink 16 oz of Vitaltye or a sports bev every few hours.

On the ginko, I wasn't aware of that follow-up study, but I'm not surprised. Probably a placebo effect at work. This past summer in the Sierra I did the ginko thing as well as aspirin before ascending each day. Bottom line, 5 nights sleeping at Mammoth Lakes while dayhiking to 12K' (before tackling Whitney) was almost certainly the brass ring. The one night at Trail Camp before summitting probably didn't hurt, and I recall feeling just as good at 14,508' the next day as I do at sea level.

Us folks "back east" (or "down south", if you prefer) don't enjoy the wonderful privilege of having 10-12K' mountains around locally to train on and pre-acclimate with. Having a plan to deal with altitude and acclimation properly has to be Job One when putting together one of these hiking trips "out west". Someday I'm gonna take a stab at the Steve C Acclimation Program, and sleep on Whitney's summit. The problem there is that you get well-adjusted to 14K', but there's nowhere higher to go the next day!

If this study is true, sleeping at altitude adds several thousands feet versus being in the vertical position.

http://timberlinetrails.net/ClimbingAltitudeSickness.html

"Scientists at the Barcroft Research Station on White Mountain, discovered that when someone was asleep on the summit at 14,246 feet, they reacted physiologically the same as someone who was awake at 16,000 feet. This fact verifies why people feel better at higher altitudes when awake and walking around, then when lying down.

Adhere to the old adage of "climb high and sleep low." Remember when a climber is sleeping or lying down, he or she
reacts physiologically in the same way as someone who is active at one or two thousand feet higher. So sleeping at lower elevations really does help when it comes to feeling better, and acclimating faster."

Interesting! That is a new concept to me.

My interpretation then would be that it is better to spend a night sleeping at Horseshoe Meadows than hiking around during the day up there. ...Certainly interesting.

I am not sure. Looks like you are best off being active at a given altitude rather than sleeping, in terms of acclimatization. Seems like sleeping can be a difficult part of the acclimatization process, which is why you want to sleep low (and, in my case, take diamox to ward off periodic breathing, which apparently comes in part because you are no longer consciously engaging in breathing). After all, HAPE and HACE hit more often when you are sleeping. In short, the fact that, when you are sleeping low, your body reacts as if you were higher, would appear to reflect the difficulty of acclimatizing when you are sleeping, rather than a boost to the acclimatization process per se.

"Rather than acclimatize along the MT camping at Outpost and Trail Camp, I would like to look for a new backpacking route that would also achieve gradual acclimatization. I would like the trip on the trail to last three days and finish at the Portal. Any recommendations on where to begin and paths to travel?"

Brent, sad to say, there is no such route. The problem is that the main trail is about the most direct trail route possible. There are other routes, but they are definitely mountaineering routes, needing skill.

Also, the MT is about ideal, from an altitude profile standpoint. The Cottonwood Pass/NAP route drops you down until the last night at guitar lake. Plus, you have a real problem if you have to bail. I don't think I'd like to have a "no bail" route, in the situation you describe.

With the 3 day window, you really have no option but the MT.

So, how to optimize?

I agree, getting some "high time" on SoCal mountains would help. You don't have to get over 10k to see a lot of benefit, but I'd say you want to get to 8, if you can. Spending a sat night at the Sierra Club hut on Baldy at 8200 would make a difference, particularly if you could do that a couple of sats in a row.

Taking the tram up San Jacinto, then hiking into one of the camping areas would be a lot more effort, but would do the same.

The South Fork Trail up San Gorgonio to Dry Lake (9,000), is another option.

I've done them all, and they're all fun in their own right. You might mix and match for variety. It does seems like about a month is the limit for protection from acclimatization to endure.

I also suffer from AMS, more than average. I always start my hiking summer at Horseshoe Meadow for a couple of days. But it usually takes a month of weekend trips before I am free of symptoms. I can really relate.

Oh, one other comment. Your start time from Trail Camp of 3am is VERY unusually early, and in my mind, unnecessary. I have no studies to back this up, but I believe sleep deprivation is significant contributing factor to failure to successfully summit this mountain.

If you're going to try the "weekend acclimatization program", do NOT skip the weekend immediately prior to your Whitney hike. You would probably lose all you had gained.

3 days on the trail ending at Whitney Portal, eh. Horseshoe Meadow to Whitney Portal can be done in 3 days, if you keep your pack light and if you can do a couple of big days. The problem will be sleeping at 11,700 at or near Guitar Lake.

Diamox is a fun drug. It works perfectly for some, partially for others and not at all for a few. I fall into the partial category. I still have a fitful night's sleep and a loss of appetite at 14,000' and after big days...sometimes.

I do not take Diamox day hiking in the locals. I don't have any problems to speak of during trips of this nature.

The one caveat I would add to that quote is to remember that "high" and "low" are relative concepts. While this practice is generally in place for extremely high altitude climbs, remember that the interval between "high" and "low" is often only around 2000 feet. If you are attempting 14K', sleeping at 4K' the night before is not the wisest move. Most people should sleep as high as their body can tolerate to get a reasonably sound night's sleep, while allowing acclimation to continue.

Ken, thanks for the trip reports about alternative routes up to the Summit, especially the notation about the lack of a retreat option. Unfortuantely, I have needed the retreat option. You and I have spoken before, but I wasn't aware that you have similar acclimitization problems.
So, it sounds like weekend overnight 8-10K sleeping opportunities prior to the hike are important, including the immediate weekend before are key. And it sounds like the MT is my best option.

As for the comment about sleep deprivation, both my experiences would make for good anecdotal evidence for your theory. On that first trip, when we left that early, neither I nor my sister were able to sleep much. The winds were fierce at Trail Camp that night and we hardly slept at all. We both made the decision that we might as well get up hiking. On the second trip, I probably slept 4-5 hours the night before. I'm normally a very sound sleeper, but not the night before a big hike. My mind is too busy anticipating what is to come.

I disagree with this part of your post, and am not sure what's unnecesary about it. I use 3AM as a goal for Whitney dayhikes via the main trail. I never make it, as usually it's closer to 3:30-4AM before I actually get on the trail, but invariably there are others above me who left much earlier. Occasionally I'll overtake someone, and compare notes with departure times. Sometimes I'll learn they left as early as midnight.

Getting an early start has much to commend it, as it's safer to hike up in the dark when you're rested than to hike down in the dark when you're tired. Sometimes when I'm having a strong day I'll be back by 3PM, but sometimes it's 6:30PM, especially if I visit with too many people. And, since I'm frequently affected by AMS, I have ample time to stop, take a drink of water and rest for a few minutes, letting the headache "twinges" subside before pushing on without feeling the pressures of time.

There's lots of good advice to give people, including "slower is better", not only because it can minimize the impact of AMS, but because you're less likely to exhaust reserves of glycogen. The conditions of the permit allow the dayhiker to leave after midnight.

Getting enough sleep is very important, as is proper food and hydration. But, going to bed at 7 or 8PM the night before the hike will, in my experience, offset the early start to a large degree.

As always, everyone's MMV.

Kevin,

In responding to Ken's post, are you disagreeing with his "too early" opinion of a 3am start time from Trail Crest or 3am from the Portal? I know Ken mentioned 3am from Trail Crest, but your response to that almost sounds like you thought he was referring to starting at 3am from the Portal. Can you clarify? Just curious. Thanks.

CaT

My response was based upon a start time from the Portal, not Trail Crest.

In skimming the thread, I realize now that Brent's initial post asked for advice for a 3-day backpack.

Hopefully my post above hasn't created confusion. Thanks for noting the disconnect.

I just read this webpage in detail for the first time, and the comment about atmospheric pressure changes intrigued me:

The cause of high altitude sickness is two fold, less oxygen and less pressure (they go hand and hand). At sea level, we have a reading of 29.92 inches of mercury, but this drops to 20.57 at 10,000 feet. This means that at 10,000 feet above sea level, you will have about 1/3 (31.25%) less pressure. Now if a low pressure weather system moves in, this can drive the above numbers down a bit lower. Meteorologists estimate that low or high pressure systems can make up to a 3 to 4 percent difference in the barometric pressure. Those who find themselves highly subject to altitude sickness may want to consider this when planning for a trip to higher altitudes.

I suppose it's possible that the 3-4% difference in atmospheric pressure during a low pressure event could account for someone who summits Whitney just fine one time, but suffers AMS another trip - even though their acclimation regimen, diet, hydration, etc. may have been the same. I had never given much thought to the effect of weather on AMS, but I suppose it stands to reason that AMS might be more prevalent during a low pressure sytem than when a high is in place. That 3-4% may not sound like much, but for those prone to altitude issues, it may be worth bearing in mind.

Kevin, for the record, I TOTALLY agree with the 3am or earlier start from the Portal. I STRONGLY recommend this for those who have not done the dayhike before, and know exactly how they will do.

As noted, I was responding to the the notation of a multiday hike, with a summit day beginning at Trail Camp at 3am, which I think is a waste of good sleep time.

Sounds like we're on the same page, Ken.

Ken,

I don't like later starts at Trail Camp/Guitar Lake, especially if your intentions are a drive back to SoCal after being on the summit.

We have been on the summit at dawn 2 of our last three trips then home that night. There is nothing like being on Mt. Whitney at dawn.

WB, I can see that goal, and in that specific situation, that'd be the right call.

In the situation being discussed, though, where the climber has had two failed attempts, I'm looking at it from the standpoint of what can he do to maximize his chances of FINALLY getting on top of the ol' rock.

Also, people certainly vary, but I'd much rather try that drive after a very strenuous day, having gotten a full night's sleep....with only a few hours, for me it would be a major struggle to drive. Nap on the side of the road! Certainly nap after Portal snack!

However, main thing was increasing chance of summit safely, was what I was thinking.

Altitude discussions can go on forever. I'm not going to get into any endless debates, but here are a few quick points from an old guy with 242 summits above 14K (including Denali):

Don't let anyone tell you that you don't need to eat while climbing. Eat a little bit often, rather than a lot all at once. Eat what you like, but take it easy on the fat. Digesting fat takes a lot of oxygen that you probably can't spare.

Conditioning and acclimatization are better than drugs, but some people need a little help. If you expect trouble, start Diamox a day or two before you start up. If you consider AMS to be a possibility, rather than a probability, you might want to bring Diamox and see whether you can do without it. Diamox DOES work when you wait until the onset of symptoms, and that's how everyone used it 15+ years ago.

"Climb high, sleep low" is a slogan we hear all the time. It applies to climbing big mountains expedition-style. You spend one or more days carrying loads to a higher camp, sleep at a lower camp, and finally move yourself and the last of your gear to the higher camp. Repeat until you're high enough to tag the summit and return to camp (or lower) in one day.

Some people like to chant "climb high, sleep low" without understanding it. The best acclimatization hike is one that takes you as high as possible without exhausting you or making you sick. What many people don't understand is that the best sleeping altitude is the highest altitude at which you don't get symptoms. You will always be able to climb higher than you can sleep, but BOTH should be as high as you can comfortably tolerate.

Edit: I somehow miss-read the timberlinetrails.net article that I commented on. It wasn't backwards at all, so I deleted that paragraph. Sorry for the "senior moment."

Many years ago I did Whitney with a group of friends, none of whom had been to 14K before. Shortly above Lone Pine Lake, one of them pulled up and said he felt terrible, and just looking at him we could see he was hurting. He was ready to head down, but we convinced him to have some food and water, and rest for 30 minutes, and then make a decision, assuring him at least one of us would return with him if necessary. He took a couple of Diamox as well, and 30 minutes later he was much better and decided to continue. We all kept a close eye on him, but he seemed to get stronger as the morning wore on, and made the summit (and back) without further trouble.

Have always wondered about that incident, and the role that Diamox might have played. Your post confirms what I suspected, that it might have helped, at least to some degree.

Bob,
I have not studied the article, but perhaps (???) the authors were somehow trying to say that the lower oxygen saturation that naturally occurs when one is hypoventilating (under-breathing) while sleeping at 14,000 results in similar O2sats as if one were awake at the lower pressure 16,000 (?)

I rather doubt that. The significantly lower O2sats seen while sleeping are far more than the drop that would occur by going from 14,000 to (and being awake) at 16,000.

Finally, a reason sleeping altitude is so important to acclimatization is that it is a prolonged exposure to the lowest O2sat one will experience (if not ill,dehydrated, exhausted, etc) at that altitude. (Note that we all have lower heart rate and breathing rates while sleeping.)

PS your advice and experience is appreciated. Harvey

Hi Brent, a relative of mine got severe altitude sickness (pulmonary edema) at under 10K and the following year successfully climbed Whitney main trail with me with no issues or discomfort. But it took more than 3 days. The recipe was:
1. Took physician prescribed Diamox (single dose of 125 mg and Nifedipine slow release 30mg daily). Did *NOT* start Diamox several days early, it is apparently a faster-acting drug than once believed, so starting it early is apparently a deprecated approach, as is taking huge doses that cause side-effects.
2. Slept the first night at Lone Pine lake.
3. Slept the second night at Outpost camp.
4. Slept the third night at Trail camp.
5. Summited Whitney on day 4 and returned to Trail camp.
6. Packed up and hiked out on day 5.
I would try something like this before trying to reduce the length of the trip to 3 days.

You said that taking diamox early was a "deprecated" approach. Is that because it lessens the effectiveness of the drug, unnecessarily prolongs side effects, or for some other reason?

Thank you for sharing your relative's experience. I really appreciate it.

I think he used the "deprecated" term to mean that people are finding that the need to take Diamox at least 24 hours before you ascend to altitude is not mandatory.

I have heard the advice to take it early for a long time. My doctor advised me of that necessity when I got my prescription. So I will assume that studies have shown that it takes this advance period for the detectable concentration in blood samples to reach full strength.

On the other hand, I have seen a few places where people carry Diamox, and then take it once they experience AMS symptoms, and report that it helps. But there haven't been any studies to support this.

I will still take my 125 mg dose every 12 hours starting 24 hours before I climb high -- I am sure the advance time can only help. And at that dosage level, most people don't notice any side effects.

We did used to recommend that people take it for a week prior to the trip, but as time has gone on, that clearly was unneccessary.

I think most now talk about starting the night before (it is usually dosed as a single daily dose for most people, as that maximizes the effect on the nightime breathing problems.)

If you think about it, the effect is to accelerate one's acclimatization. It is actually hard to do that, until one is actually EXPOSED to altitude, although getting the chemical reactions going starting the night before seems reasonable.

I'm not sure that there have been any actual chemistry measurments of all this, though, but that seems to be the "best practice" currently being used by most.

I'm not sure I'd go quite that far.

I think it would be fair to say that most people would find any side effects minor and tolerable. Most will notice increased urination (although I'd not actually call that a side effect, it is actually an ACTUAL effect of the medication, and of acclimatization), and most will have the weird taste with carbonated drinks, which can be disconcerting, if you don't expect it.

My understanding is taking Diamox days early and taking many hundreds of mg daily increases side effects without conferring any additional benefit. I'm not a doctor but the relative I posted about is, actually. My understanding from him and from reading a lot about acclimatization and drugs for prevention of various forms of altitude-related illness is that recommended practice with Diamox has changed over the last decade or two from taking relatively large dosages beginning several days in advance to taking much smaller dosages just prior to and during ascent. If I were you I would continue to use Diamox on any future attempt, but the main thing is to FORGET ABOUT 3 days and commit to something more like 5, with more nights at lower elevations. Another approach would be sleep in Lone Pine, then sleep at the Portal, then sleep at Lone Pine lake, then Outpost, then Trail camp. Way overkill for most folks posting on this board, but for anyone who has suffered the way you have, it would make sense. Eventually you might find you could do it with less nights on the mountain. The Nifedipine I mentioned was only indicated because my relative had pulmonary edema, but it sounds like you didn't have any pulmonary issues so you wouldn't need that. On the other hand, you reported severe headache, and some other symptoms that could possibly be indicative of the beginnings of cerebral edema, so that might warrant a different drug such as dexamethasone which helps prevent cerebral edema. Obviously consult a physician re any drugs, although you may find that your general practitioner is not really up on the latest best practices re off-label use of drugs for preventing altitude-related illnesses. You might have to refer him/her to material you found on the web at reputable sites like the one mentioned above by Harvey Lankford (who if I recall correctly is a doctor). I would avoid a western approach to Whitney because those are more remote and farther from help/other people etc. And I would take a SPOT or similar device.

Agree with Ken.

This is a paraphrase of what is current understanding, at least to some: The kidney-metabolic effects of Diamox might take a few days to work, but they are not the main reason Diamox helps, and why taking it a few days in advance is no longer felt to be needed. Taking it beginning day-before (to get it on board) or even the day-of your ascent seems to work well as the central(brain) and CSF(spinal fluid) effects on respiratory sensors and stimulation of breathing (when asleep mainly) works more quickly
Whew!

some general advice again:
http://www.ismmed.org/np_altitude_tutorial.htm#goldenrules