Mt. Whitney Portal Store & Hostel Forums General Mt. Whitney Portal Store Message Board Doctor altitude medication exp. in Orange County

I did not summit in August, due to altitude sickness, really bad vomiting, headache and sleepiness. This was after 4 days acclimatizing at Mammoth. I got to 13,000 ft. Since then I have had other problems including only getting to about 10,000 feet at San Jacinto this weekend. I am looking for a doctor to talk to about Diamox etc. My current doctor does not know anything about this. Can anyone recommend a doctor in Southern Orange County CA, that I could talk to?

Thank you

Sounds like you have some serious altitude issues. Next time, try acclimating by camping at Horseshoe meadows and day hiking into Cottonwood Lakes.

There is not much expertise about Diamox. It will give you a little help, but certainly won't cure your trouble.

Good luck finding a doctor. Seems like most should be willing to look up Diamox and its altitude effects, and write you a prescription.

You might look into an opthamologist - the main use of Diamox is for glaucoma.

Oh yeah - what about Ave Revolucion (Tijuana)?

yes, it is a glaucoma drug, but an eye MD will have no knowledge with its use, benefits, and side effects at high altitude any more than any other MD unless they have an altitude interest or experience. However, prescribing it is the simplest piece of action. See below:

Diamox is not a panacea, only a help. There are people who just do not acclimatize well in 3-4 days, or even ever. This becomes a practical problem (as well as medical) ie, how much time do you have to acclimatize before going higher?

Also, sleeping at progressively higher altitudes AND walking progressively more hours, starting gently, both seem to help, more so than Diamox. For some, that means starting on day/night one as low as 7,000 (you mentioned Mammoth which is about 7,800 I think) and a one or two hour hike before moving up progressively on both counts.

For more info, see http://www.ismmed.org/np_altitude_tutorial.htm
Hope this helps
Harvey

5 symptom experiences are the pits of the world.

I've had altitude problems since I first went beyond 10,000', my worst was on White Mountain after a couple of days over 10,000'. Like you, my doctor knew very little about how to dose Diamox, his first recommendation was to take it 250 mg. twice a day every day over 10,000'. This was in 2001. Since that time, I've wandered around in the wilderness searching for a dosing scheme that works for me...and the key phrase is works for me. I found what works for me in 2006...five years after my first prescription. I rarely have symptoms associated with being at higher elevations and the usual side effects...excepting carbonated beverages tasting horrible and an occasional tingle of the extremities.

First thing to do is a search for Dr. Peter Hackett and Diamox. This will give you a starting point on how to dose. I will tell you the current recommended schedule does not work for me.

wb
do you think there was some significant learning curve and behavioral modification by you regarding your own body's acclimatization rate that is different from others? I'd say yes.

Diamox may speed acclimatization up some, but ultimately it is your own rate that matters the most.

The subject of Diamox is a favorite pastime on this message board from both pro and con sides. yes I have used it,too.
Harvey

Mandy....I have worked as an Optometrist for over 20 years. It turns out NO ONE really uses Diamox as a glaucoma drug in the United States. Since it is an oral pill, it just has too many side effects to be used for a chronic disease like glaucoma. The newer medicines over the last 10-15 years have made it obsolete for glaucoma.

Most of my MD Opthalmologists that I work with don't really know anything about diamox being used for alititude sickness....unless they have some personal experience.

Consequently it is now very hard to get through normal suppliers for medicine connected with the eyes. When I wanted to get some (in 2004) I tried to order some through my connections. No one even listed it as available. Eventually I wrote myself a prescription and ordered it from some Canadian pharmacy.

If you want to have some, read and research its use, benefits and side effects from what has been written on this board. There has been much written. Then go to your MD and ask them to get you some. If you know what it is, and why you want some...they will most likely get it for you.

Mandy, can't say I know anyone in your region personally, however, you might take a look for a Pulmonary Medicine specialist, that also does some general primary care (many do). You may or may not find an expert, but they will know this use of the drug.

Others of a more technical bent may find the following interesting, from the Mountain and Wilderness Medicine World Congress 2007:

http://www.worldcongress2007.org.uk/programme.html
and click on "HAPE: Pharmacologic intervention, new and old"

taking diomox makes beer taste like my old mother in laws cooking

yeachhhhh

the first few days on the drug makes you feel like you have the flu, and you cant enjoy a cold brew.

Did i memntion you cant taste a cold brew!

Thanks all that helps some. I was also told that it is a high blood pressure medicine, and as I have low blood pressure anyway I wanted to find a doc with experience before taking any. By the way, when I was in Mammoth, we were hiking up to 11,000 and hanging around, so thought that would help.

Maybe I will need to do the trip next year with an overnight stop, at Trail Camp, as well as spending longer at higher altitudes.

Your hiking to 11k and staying at Mammoth for a few days would normally be enough for most people. But you are obviously more sensitive to the altitude, so you should try more aggressive conditioning. That is why I would recommend spending one or two overnights at Horseshoe Meadows.

I don't think Diamox is related to blood pressure medicine, but others will confirm this. By the way, when I use Diamox, I take 125 mg (half a tablet) twice a day starting two days before going to altitude, and continue that dosage through the last day at high altitude (or stop after 4 days if I am up that long.) If you get a prescription, I would recommend using it for two days at home just to see if you have any adverse effects.

wbtravis5152, I am curious what dosage works for you.

Mandy,
I had the same issues on a summit attempt. Took the prescribed dosage of diamox the following year and had no problem. Did have minor tingling in my toes and beer/soda both tasted flat. I received my perscription from my G.P.

Acetazolamide 250mg Tab Q8-12HP before and during rapid ascent to altitude.

Should fix your general symptoms of headache, nausea, shortness of breath, dizziness, drowsiness, and fatigue. The pack will still be heavy and the ground lumpy, though. Tell your physician you are treating acute mountain sickness (AMS). You shouldn't have a problem getting a prescription from your doc. It may not pass muster for your health plan, however. But there are both ICD-9/10 or MEDCIN billing diagnosis codes available. I made it easy and told them I was treating a sleeping disorder (Cheyne-Stokes, 125mg tabs). Perhaps even might try a pharmacist and save the co-pay if you have to pay for this drug anyway.

Should be able to just call up your doc, and tell front office you need a prescription for 28 - 250 mg tabs of Diamox to take 8-12 hours per day or as needed for AMS. As another has said, there are normal side affects that are just a bother.

If doc can't find 250mg tab, tell him to keep looking. There are 125mg and 500 at top of page.

This is a weight/size dosing drug, so you might get along just fine on 125mg. But the side affects are no different with 125 or 250. If you have the time, you should try to see if you can use the lower dose while at altitude. If not, boost the dose back up to 250. This is not a cure, only a way to reduce symptoms while your body is catching up. You should not, at Whitney's elevation, need a 1000mg a day.

You might print selected portions of links below or other things you might find on the net to give to the physician so he will know more about it. A lot only know AMS from what they see in movies.

Its a diuretic so don't plan on sleeping through the night if you are taking enough fluids to keep up with exertion AS WELL as the diuretic needs. Might best camp away from others while on medication only because of your frequent use of bushes.

Before you try it all on Whitney again, Horseshoe Meadows gets you to 10,000 quickly and the trail gets you to 12,500 at New Army Pass the next day and then up to 14,000 if you still have any steam left. Its a good trail from July on. See how you do on a three day trip with the medication. If you are still having problems, you are one of the relatively rare few who take longer to adapt to altitude. If you run into problems that can't be fixed at New Army/Langley, it is a short 3-5 hour jaunt to car and down to 5,000'. Being sick one time does not necessarily indicate you will have same symptoms the next. No good way, yet, to find out who is going to be affected and by how much ahead of time.

Taking Diamox 48-24 hours ahead of time doesn't seem to give much more help, BUT it is wise, while you are home, to take a day's dose (lots of water) to see if you have any problems. Just get the doc to give you two weeks worth. Even the crusty cases of AMS are relieved after 10 days. If it works come back for more for the next trip. The main caution is if you are allergic to sulfa drugs. That's why you want to try it at home first. You will find out quickly. Otherwise, it is a relatively safe drug, widely used for a long time.

http://www.elbrus.org/eng1/diamox.htm
General discussion for extreme altitude

http://gorp.away.com/gorp/health/ams.htm

"Dosage is 500mg to 1000mg daily, in divided doses using tablets or Sequels as appropriate. In circumstances of rapid ascent,such as in rescue or military operations, the higher dose level of 1000mg is recommended. It is preferable to initiate dosing 24 to 48 hours before ascent and to continue for 48 hours while at high altitude, or longer as necessary to control symptoms. Store at controlled room temperature (59 to 86 deg F). "

http://www.everestnews.com/stories2005/illness01112005.htm
Suggests dexamethasone. I'd guess most physicians will balk at providing dex as it is a steriod. It is usually kept in the bottom of a doc's pack for HAPE/HACE treatment.

An other option is to try Whitney on a day trip. Most AMS problems show up about 18 hours after initial ascent to altitude (the Portal). You might be up and down before AMS catches you. If you have problems on the way up that concern you, turn around. Otherwise, make use of all that physical conditioning at near sea level in OC and make it a scenic, long, slow day.

Being exceptionally fit, can probably get some in trouble as they can go higher faster than they probably should or are acclimated to. But being as fit as you can get aerobically certainly makes the trip more pleasant.

cost is not really an issue. The generic drug costs about 25 cents a tablet.

I actually advise a lower dose to those I prescribe the drug....1/2 of a 250, once a day at bedtime. It still seems to work for most, and minimizes side effects.

I've had a number of people have significant side effects in the field with higher dosages, who resolved with cutting the dose.

Trying at home is a good idea.

There should be more research coming out shortly on all this.

Dex is a whole 'nother issue. Great drug, very safe. However, unlike Diamox, it WILL cover up the symptoms of AMS, not simply speed acclimatization. Generally speaking, the rule is that if you start on it, you stay on it, until you come down. Abrupt stopping can reportedly bring on severe AMS symptoms.

YMMV.

Wow, you guys are the best. I will print all this info out and do the research, as well as talking again to my doc. Or looking around for another. Then I will try going up and down San Jacinto and San Gregornio which are nearest to me, next year and see if I can overcome it. If nothing else works then I will need to do Whitney over a few days next year, and spend time acclimatizing as you suggest.

You spent four days acclimatizing at Mammoth, given your situation, why not spend those four days on Whitney itself?

Spend nights at:

Portal - 8,600' (or Horseshoe Meadows - 10,000')
Outpost - 10,000'
Trailcamp - 12,000'

Optional: Spend another night at Trailcamp after the successful summit, heading down next day. Or, pack up and bail same day.

Following this schedule your days will be short enough that you'll still have plenty of time to hike a little further each day to "climb high, sleep low" after you arrive at each spot and set up camp. Or, depending on how you feel, call it a day at the campsite. Yeah, have to carry more, but to compensate you get to enjoy the beauty of being on the mountain for more than a day.

vs. Taking some drug with possibility of a bunch of side-effects in order to "force" your body to do something it doesn't seem to naturally want to...

I do have severe problems when backpacking in the Sierra and day hiking well above 10,000'; however, I do not have a problems day hiking anywhere in the locals. You really have to get back to Sierra-like elevation to say with a certainty whether or not your dosing pattern is working.

On my first summit attempt I camped at Outpost and then at Trailcamp and had no symptoms. I was also well hydrated. I was actually carrying Diamox with me in my pack, but didn't want to medicate myself if my acclimitazation plan would work. Inasmuch as I wasn't suffering any symptoms, I left the Diamox at trailcamp and climbed the summit without it. However, when I got a little past Trail Crest, I started getting severe AMS symptoms, including a bad headache, listlessness, lack of appetite, and vomitting.

When I stumbled back into Trail Camp, I popped 250 mg of Diamox to see if it might help. At Trail Camp, I still felt all of those symptoms and so just wanted to get down as quickly as I could, which wasn't very fast. I felt exhausted--absolutly exhausted. Then, at about 11,000 feet or so, I started feeling great. I felt like I could leap a tall building in a single bound. At first, I thought that the lower elevation is what made the difference, which I am sure that it did in lessening my symptoms. But as I have thought about it, I don't know that the lower elevation can account for my suddenly feeling full of energy again. I wonder if that was the Diamox talking. On my next assent, I will definitely use Diamox.

Brent N.

It always bothers me when I see people talking about carrying Diamox on their trip "just in case they need it". Then they pop a pill when they feel the symptoms.

If you read some medical information on Diamox, you will see that it takes a full day for it to become effective. It acts by changing the pH of the blood by causing excretion of bicarbonate in the urine. This process takes many hours -- there is no immediate action like you might expect of a pain reliever.

It is likely that when someone feels AMS symptoms, they take the pill, and also rest and change their activity level, or even descend. Then when they feel so much better, they claim it is the Diamox that made the difference.

I can think of several instances when I've seen fellow hikers take Diamox at altitude and experience a rapid improvement in their condition. I've always attributed that to the placebo effect, but who knows? In my experience, I've seen AMS often blamed when the underlying cause may simply be dehydration, insufficient nutrition, or fatigue complicated by a lack of fitness and/or sleep.
Dave