Mt. Whitney Portal Store & Hostel Forums General Mt. Whitney Portal Store Message Board When do you really notice the altitude?

Agreed. As I stated, "Yep, stay below your AT"

Sorry I did not make it clear how much below, but able to converse makes for a good rule,
thanks Sam.

Sir Edmund developed HAPE in 2001 at Khumjung Nepal at "only" 12,000 feet and had to be evacuated. Others did too, when they flew into the now-abandoned airstrip above Namche, also at 12,000 ft. The Lukla strip, were most people enter now, is at 9,000. I think Sir Edmund had other episodes of HAPE and had to give up climbing long, long before this 2001 episode when he was about 70 years old or so.

Harvey

I have only hiked twice to altitudes above 12,000, once to the top of Whitney and just recently to the top of Rainier. On neither occassion did I notice any symptoms of sickness at all. I was tired, but both were difficult climbs for me. On Whitney we spent the night before at the portal campground, summitted the next day and spent the night at trail camp before coming to back to the portal the next day. On Rainier we did the usual hiking to Camp Muir on day one and summitting the next morning. Is this unusual to experience no real adverse symptoms? I live in the east at about 1100 feet.

rm, one study (Dean AG, Yip R, Hoffmann RE. High Incidence of Mild AMS Sickness in Conference Attendees at 10,000’ Altitude. J Wilderness Med 1990; 1:86-92) found that 42% of unacclimatized people going to 10,000' contracted AMS. A corollary should be that 58% did not. So your experience is not surprising.

Question for Richard P: I think the regulation says you're only allowed to barf in the Wagbag or at least 200' from the trail. Were you able to plan appropriately before becoming ill?

Just kidding, of course. Man, you're tough. I hate that feeling, and hate throwing up even worse. It's amazing you've fought through it anyway.

Incidentally, I'm not sure the biloba is a dud. Every year I spend a week or so at Tuolumne Meadows. As it's at 8500 feet, the air is a bit thinner, but the only time I notice it is when I wake up panting in the middle of the night. It usually wrecks an hour or two of sleep starting at around 1:00 a.m.

This year, I began taking Ginkgo Biloba two weeks before going and while I was there. I didn't wake up panting. I don't know that it was the biloba - I'm about 10 lbs. lighter this year, and I'm eating healthier, so that could be it also, but I was happy with the result.

z

Richard,

"This year has been a completely differnt story. Almost every trip that has crossed 12,000' has caused me problems. "

It may be just aging like you suspect, but it seems like a sufficiently sudden onset to justify seeing a doctor, just in case. If it is something, you may be fortunate that your hiking tipped you off early.

Bob

zip, I was in my bag in the Kelty Dart at the time. No way I was getting out of that thing without ripping things open, so I opted for the vestibule. It was an interesting exercise in gymnastics getting out of the tent in the morning without picking up some additional smelly stains on my pants.

Bob, I had scheduled a full examination last spring, but changed insurance companies due to a change in employers, so I had to cancel. When summer rolled around, I just kept putting it off because I'd rather hike/climb than go to the Doc. A full workup is definitely due.

Zip, please just realize that gingko is the latest fad in trying to treat AMS, alto I suppose it can't hurt you, but who knows? A lot of proposed trick therapies have come and go over the years. Part of the problem is separating out anecdotal reports versus more valid results, both ways susceptible to the manipulations of the authors' comments, inferences, and statistics. Remember Mark Twain who said there are 3 types of lies: lies, damn lies, and statistics. Diamox remains the gold standard, but it is not perfect. Harvey

From International Society for Mountain Medicine
http://www.ismmed.org/np_altitude_tutorial.htm#goldenrules

Ginkgo biloba extract

Some early work with Ginkgo biloba extract was encouraging with regards to its use in preventing AMS, but some recent large, well-designed studies have shown no benefit.

AMS Prophylaxis:
Acetazolamide (Diamox®)
125-250 mg (depending on body weight; persons over 100 kg (220 lbs) should take the higher dose) twice a day starting 24 hours before ascent, and discontinuing after the second or third night at the maximum altitude (or with descent if that occurs earlier). Children may take 2.5 mg/kg of body weight twice a day.

h: I'm not convinced that the biloba was what helped - my own experience was positive, but there are way too many extraneous variables to say what caused the improvement. Controlled studies are the best impartial evidence, and they don't seem to support the idea at this point in time.

Incidentally, I haven't done any research on diamox - is it supposed to improve oxygen absorption, or does it simply mitigate the symptoms?

z

from same link I posted above:

"Acetazolamide (Diamox®) is a medication that forces the kidneys to excrete bicarbonate, the base form of carbon dioxide; this re-acidifies the blood, balancing the effects of the hyperventilation that occurs at altitude in an attempt to get oxygen. This re-acidification acts as a respiratory stimulant, particularly at night, reducing or eliminating the periodic breathing pattern common at altitude."

In plain English, you feel bad not so much from low oxygenation alone (at say 10,000 ft) but from the metabolic consequences of hyperventilating.

So Diamox helps restore this balance through its' kidney action. Possibly more important is its' action to stimulate breathing centrally (in the brain) which may be more complex than the description above states.

It is interesting that sea level people with sleep apnea syndrome have episodes of low oxygen saturation levels when they breathe abnormally at night. This pattern looks very similar to that of sojourners to high altitude, and, at least in the case of the latter, it is improved with Diamox.

Hope this helps. Harvey

For the full scheme, here it is, from same link:

A Review of the AMS treatment options:

::::::::Descent
Pro Rapid recovery: trekkers generally improve during descent, recover totally within several hours.
Con Loss of "progress" toward trek goal; descent may be difficult in bad weather or at night; personnel needed to accompany patient.

::::::::Rest at same elevation
Pro Acclimatization to current altitude, no loss of upward progress.
Con It may take 24-48 hours to become symptom-free.

::::::::Rest plus acetazolamide
Pro As with rest alone, plus acclimatization is accelerated, recovery likely within 12-24 hours.
Con Recovery may take 12-24 hours; side effects of acetazolamide.

::::::::Rest plus dexamethasone
Pro Faster resolution of symptoms than with acetazolamide (usually in a few hours); minimal side effects; cheap.
Con Can hide symptoms & thus give a false sense of security to those who want to continue upwards. Does not accelerate acclimatization.

::::::::Rest plus dexamethasone & acetazolamide
Pro Fast resolution of symptoms from the dexamethasone, plus improved acclimatization from the acetazolamide.
Con Side effects of acetazolamide. Same cautions as above regarding ascent after taking dexamethasone.

::::::::Oxygen or Hyperbaric Therapy
Pro Very rapid relief of symptoms (minutes).
Con Expensive; hyperbaric bags are very labor-intensive; rebound symptoms may occur if treatment is too short - several hours are needed.

--- Some early work with Ginkgo biloba extract was encouraging with regards to its use in preventing AMS, but some recent large, well-designed studies have shown no benefit. ---

I could say the same thing for many (most??) drugs that have been approved by the FDA and/or EMEA. The fact is that drugs have variable effects and side-effects in different people under different conditions. In some trials they are positive and in others they are negative. Doses, people and conditions vary. Typically, we don't know about them for many years or sometimes at all. It was only few years ago that we finally came to understand how one of the oldest and most commonly used drugs, aspirin, works. Irrespective of the published data, you are a clinical trial of one when you take any drug. Every drug has some adverse reactions and some non-responders - you typically don't know which group you fall into until you try it. The published data only tell you the probabilities, but not where you will fall on the probability curve.

Where I come out on the debate about what to do to prevent altitude sickness is to try the least complex things first: acclimitization, hydration, nutrition. If those don't work for you, try gingko. If all else fails and you really want to climb higher, try diamox (but only after consulting a physician with experience in high altitude medicine who knows your medical history. Taking diamox based on a "prescription" from this board is not smart). Best to try any of these on some training hikes so you don't find out that you have an adverse reaction halfway up Whitney.

I think my plan will be to definitely get some Diamox, but not to try not to take it for my high altitude "prep" hikes a few days before Whitney unless I find that I really need it. If I am getting even slight headaches or any nausea, then I'm going to start popping the pills for the rest of the trip.

If it is just a matter of me being tired and sluggish, then I'll have to guage how big of an issue it is and then I may still try the pills. I'll just have to play it by ear but I will definitely have the pills available in case I think I "need" them.

saying that dexamethasone has "minimal side effects" is very misleading. Known adverse events associated with it include:

* upset stomach
* stomach irritation
* vomiting
* headache
* dizziness
* insomnia
* restlessness
* depression
* anxiety
* acne
* increased hair growth
* easy bruising
* irregular or absent menstrual periods
* skin rash
* swollen face, lower legs, or ankles
* vision problems
* cold or infection that lasts a long time
* muscle weakness
* black or tarry stool

dexamethasone is a very powerful hormone which, among other things, suppresses your immune system. When you're living on the trail, knocking down your immune system is not a great idea.

Finally, dexamethasone is not used to prevent AMS, but as a treatment for it when it occurs, generally in more severe cases.

Sierra Sam, please don't just read from a side-effect list. It is more important to know the likelihood of those.

Yes, those potential side effects do happen with dexamethasone or any other cortisone-like drug such as Prednisone. But it would be unusual for those side effects to occur with short term usage as proposed and recommended for treating AMS. Can they? yes. Likely? no.

Just think of all the successful treatments that you or others might have done with cortisone-like drugs for poison ivy (another outdoor illness).

I am not expounding the use of dexamethasone, in fact, it is not commonly used for AMS where Diamox is more routine. It is, however, useful in more advanced cases such as HAPE or HAPE. For a short term trip up Whitney, acclimatization for a few days first is best, and Diamox is an adjunct Rx.

/// Sam, there is a big difference between Diamox and Ginko Biloba -- one is a drug which is controlled by the FDA and requires a prescription from your doctor. The other is a plant extract sold over the counter in health food stores. I have a hard time understanding how someone could put the two in the same category. It is similar to saying a faith healer is just as effective as a physician.///
I think you completely missed my point. I was pointing out that all therapeutic compounds, irrespective of how they are regulated, have variability in their response and side effects. In response to your point, however, I will point out that many medicines that we take today started out as extracts of plants or other organisms, including aspirin (willow tree), the anti-cancer drugs taxol and taxotere (ewe tree), the heart medicine digitalis (foxglove), penicillin and other antibiotics (molds/bacteria) and I could go on and on.

///While the effectiveness of G.B. has been refuted, Diamox has repeatedly been shown to have a positive effect.///

If one negative clinical trial "refuted" the effectiveness of a drug, we would only have a very few drugs available to us today. That was my original point, many of our most effective agents have a mixed clinical history of success and failure depending on a number of factors. It's not until a drug has gone through multiple trials, and sometimes not until it gets on the market, that you really see the clinical picture emerge. Thalidomide and Vioxx are but two of many examples that I could point to. So one one trial where gingko works and one where it does not doesn't really tell us anything. The question is why.

///I don't know why people here are so negative about Diamox -- Just get a prescription and try it for one or two days at the 125mg twice a day dosage, and see if you experience any adverse reactions. If you do, stop taking it. If you don't, then maybe try it for a Whitney climb. It seems pretty simple to me.///

Because every drug has toxicities and adverse side effects and why should people risk it, especially when there is ample evidence that Whitney can be climbed safely without it.

/// Sierra Sam, please don't just read from a side-effect list. It is more important to know the likelihood of those.

Yes, those potential side effects do happen with dexamethasone or any other cortisone-like drug such as Prednisone. But it would be unusual for those side effects to occur with short term usage as proposed and recommended for treating AMS. Can they? yes. Likely? no.///

Because it's a game of Russian Roulette with a powerful drug. While each of those side effects has a low probability, a significant number of people will experience one or more of them. I think it is irresponsible to recommend a powerful oral steroid and known immunosuppressant to people to climb Mt. Whitney, especially when it is not recommended to prevent AMS, but only to treat it. Going to a lower altitude is a far better way to treat AMS. Surely you are not suggesting that someone take dexamethasone and keep climbing with AMS???

PS - you know better than to compare a topical steroid to a systemic one.

Sam, rather than dwelling on the negatives, please think positive.

What about those who already proven to really need/benefit from it?

What about those wanting to lessen the risk on their first time to altitude?

What about those going higher than before?

What about those who because of travel or time constraints don't have time to acclimatize?

What about those who through unexpected Acts of God just get AMS anyway, on day 1 or day 8 ?

I'll copy part of Bob R's earlier post:

one study (Dean AG, Yip R, Hoffmann RE. High Incidence of Mild AMS Sickness in Conference Attendees at 10,000’ Altitude. J Wilderness Med 1990; 1:86-92) found that 42% of unacclimatized people going to 10,000' contracted AMS.

h_lankford- You asked the right question: the reason that I posted those points is that the previous posts discussed only the positive aspects of these medications without disclosing the negatives. It is important for people to understand that there are both positives and negatives about these, or any, drugs. In order for people to make informed decisions they need to understand both. A breezy attitude of "just pop a couple of these" is just plain bad medicine and I wanted to be sure that people understood that. If people consult a physician with high altitude medical experience who knows their medical history and prescribes a drug with an explanation of the potential risks and benefits, then I have no problem. My concern is that people read a one-sided post on this board and then ask a doc to just write a prescription (or borrow a few pills from a friend) and then get sick on the mountain as a result.

Can someone with no prior experience grab an ice ax and crampons, pop a few pills and head up the Mountaineers Route in icy conditions and make the summit - yes, it is possible. Is it responsible to tell people on this board that it's no problem if they want to try and do that - I think one key value of this board is for experienced climbers to share a balanced view to help people climb Whitney safely.

I encourage anyone interested to read from the link I posted earlier from one of many good sources on high altitude. There are others of course:

http://www.ismmed.org/np_altitude_tutorial.htm#goldenrules

No, I am not recommending dexamethasone, it was only included as part of options for drug therapy (with a short list of pros and cons) but Diamox would be the most likely one used for the Whitney hiker or climber. I have never personally seen steroids used in that setting for "simple" AMS alone. With more advanced illness at any degree of high altitude, yes of course.

"PS - you know better than to compare a topical steroid to a systemic one." You should know that not just topical steroids but large dose oral steroids (Medrol Dosepak) is used to treat poison ivy. I think we have said enough. I don't think that I will mention that Viagra has been studied to treat HAPE. Harvey