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

Both blood pressure readings are within normal range. Nothing to worry about, at all.

Make sure you hydrate. Won't fix your problem, but dehydration can add to it.

Sounds like AMS. Getting out of the altitude was the right thing, but you need to get up there, and may have to yo-yo for a week to completely acclimatize. Diamox would definitely help you acclimatize faster.

G'luck!

Oops OK - maybe I will make an appointment and drive up there then

Sleep - apart from the actual night we set off, was not a problem. Never is for me! But the aerobic maybe an issue. I have hiked a lot, but don't run or do any kind of gym, or work out classes. That is worth a thought as well

I dunno. Everybody's disputing my theory on that...

Sure, ruin the placebo effect for talisman.

I just thought I should report that after three days of headaches and insomnia at night, I went back down to 500m (town) for 2 days. I then went back up to camp (4,450m) and have had no problems since. In fact, I think I am sleeping better at 4,450m than back in town.
Of course, acclimatisation would be great, but since I am working in the Atacama desert, there really is nothing between town at 500m and camp at 4,450m. Nobody lives out of town... dry dry dry...
I guess it does not help that it is only a 3 1/2 hour drive from 500m to 4,450m!

Anyways, I thought I would share the experience. Thank you all for your replies, it is nice to be able to talk to other people about altitude issues.

If anybody drops by Chile, we are in III region, we can probably show you around where we work, just for fun!

Can you share some photos of the area?

There are several other studies that come to the conclusion that Ginkgo does work in treating or preventing AMS, including:

http://www.everestnews.com/stories024/peterh.htm

http://www.liebertonline.com/doi/abs/10.1089/152702902753639522

http://altmed.creighton.edu/ginkgo/AMSStudies.htm

There was another study in the US, which I can't find right now, that tested Ginkgo in two different high altitude climbs. In the first one it worked and in the second one it did not. They then tested the tablets and found that, while both were labeled identically, the one which did not work had very little active ingredient in each tablet while the one that did work had the labeled amount of 'drug'. If you do try Ginkgo, therefore, you need to buy a reputable brand or you may just be taking a placebo. YMMV

On diamox, I think it is appropriate to understand the FDA required label advisories on this drug before you accept the advice to get just any GP to write a prescription:   http://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?id=7157

Sam points out potential side effects. The link above is for Diamox Sequels. It's a sustained release 500 mg capsule pretty much guaranteed to cause the most common side effects like tingling and bad taste, and/or more.

I made the mistake of using it once 12 years ago, despite knowing better. I used it because that was all the pharmacy had in stock at the time.

since then, I have recommended, prescribed, and used it for my friends, family, expedition members and myself in a much smaller dose of half a 250mg tablet twice daily as advised by this and other sources:
http://www.ismmed.org/np_altitude_tutorial.htm#treatment

the lower dose is tolerated much better, although there are still the same warnings and precautions regarding serious side effects as pointed out by Sam's link. These problems are independent of dose or Sequels vs tablets. The bottom line is: do the benefits outweigh the risk? Way back when this thread started, I said "The subject of Diamox is a favorite pastime on this message board from both pro and con sides." Yep.

Harvey

Just to be clear, I think Diamox has a role in high altitude medicine, so it's not that I am "con" about diamox. What I am opposed to, and what happens on this board and elsewhere, is the notion that diamox is a completely benign drug and people should just get anyone with prescribing privileges to write them a script and then head blissfully up the mountain popping diamox. Harvey makes the right point, you need to understand the risks vs. benefits and that it is not one size fits all. Just because your climbing partner uses diamox with no problems doesn't mean that you will. Most people can take diamox with little or no problem. However, some can't and there can be serious adverse consequences if you are in this group. If you need medicine to help you climb, you should find a physician who has experience with that medicine and who can evaluate your risk profile for the drug just as the original poster was trying to do. It would also be a good thing to see how you react to the drug before you get on the mountain. [soapbox away]

and I also think it would be a good thing to do if you post about the benefits of a drug that you also point out that there are some risks.

The studies that Sam cites are aged, and generally thought to be discredited.

In the first example, the study was discredited by the author himself:

http://www.wildsnow.com/544/davenport-fourteeners-and-peter-hacket-lecture/
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In the second one, it lists references in which it is cited, which are linked. If one links to one of the later ones and read it, it says:
". A most recent large trial with Ginkgo biloba clearly showed that this drug does not prevent AMS in a low-risk setting in which acetazolamide in a low dose of 2 × 125 mg was effective. Therefore, acetazolamide remains the drug of choice for prevention and the recommended dose remains 2 × 250 mg daily until a lower dose has been tested in a high-risk setting and larger clinical trials with antioxidants have been performed."

http://www.liebertonline.com/doi/abs/10.1089/1527029041352108
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The third article is not really a scientific article, as it did no statistics on the results, did not use standard research criteria for AMS (the Lake Louise Consensus, even though those criteria had been adopted by researchers in 1991), and is quite old to be cited as authoritative. The site citing it cites no studies since 2005, although there have been many, revealing much. In spite of that, the site states:

"The research shows that Ginkgo is effective in treating AMS, but when compared to Acetazolamide, it is not as effective."

Of course, the Ginkgo part has since been discredited.

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The fourth study that Sam aludes to, but can't find, is in fact, the first study that he cited.

========================

One of the more recent guides to high altitude medicine that attempts to keep up with the more recent changes says:

http://www.high-altitude-medicine.com/hot-topics.html

"Ginkgo initially appeared to be a promising new drug for the prevention of altitude illness, but much more data has now been accumulated in multiple well-designed studies, and there is no demonstrable benefit to taking Ginkgo. Ginkgo is no better than placebo for prevention of AMS, and Ginkgo plus acetazolamide (Diamox) is no better than acetazolamide alone."

==============================

Using any sort of foreign substance to alter the body's reaction to it's environment is a non-trivial thing. One should use such a substance only after consulting with a professional trained in, and experienced in supervising people on that substance in that setting. With Diamox, that would be a physician, who if not personally experienced, is trained to understand the issues, and who has available to them consultants who have such experience.

With herbs and supplements, it becomes more problematic. To think that they are benign and free of side effects and potential dangers, though, is naive. It should be noted that the most common cause of accidental child death from poisoning, is from multivitamins with iron. (It's the iron).

You probably want to know the background and experience of the person advising the use of a supplement. I think it is quite problematic to accept advice from people who are somewhat mysterious in their background and training, and appear only to ply their trade on the internet.

I went to a talk by Peter Hacket and his interpretation was very different from Ken's. What he said was that he thought the lower response rate in the second study was likely due to a lower amount of active ingredient taken by the second group, though he obviously could not prove that. You choice of the word discredited is an interesting and misinformed one - the author pointed out a weakness in the study - can you show me a single human clinical study that does not have a weakness (that is obviously rhetorical - they all do).




I agree that diamox has shown more positive results and in more studies than GB. diamox also has more documented adverse events. The more you study any drug, the more adverse events you are likely to find. I have no doubt that GB would also show adverse events if it were subjected to a large well controlled study. GB has worked in some studies and not worked in others. I have used both diamox and GB myself and know many other climbers who have used both with effectiveness as well. YMMV.




You seem to like that word, discredited. It would appear that you don't have much experience with pharmaceutical clinical trials. By your definition, every drug trial ever run has been discredited, because they all have been shown to have flaws and weaknesses upon further study.



That is the author's opinion and he is obviously entitled to it. Note that he cites no references. I would actually argue that GB has never been tested in even one real well controlled clinical study as they are all small and with unknown amounts of active ingredients. The FDA would laugh at anyone bringing data like this in for a drug approval. For better or worse (usually worse), nutraceuticals are essentially untested and unregulated by the FDA (by law the FDA is given limited purview over these compounds) and many of the claims for them are false or misleading.



Bravo - I agree with both statements. Nice to see someone point out the potential risks.



I would go a step further. Any medical advice you read on an internet chat board should not be believed until you can confirm it with validated sources. Anyone can claim to be anything here.

To further demonstrate what I meant when I said that I didn't think any of the clinical trials for Ginkgo were adequate, I ran the published numbers of one trial that showed 7 of 21 Ginkgo subjects had AMS and 13 of 19 placebo patients had AMS through a standard statistical analysis used for clinical trials. Here is the output:

With 21 patients on treatment A
and 19 patients on treatment B
there will be a 0% chance of detecting
a significant difference at a two sided .05
significance level. This assumes that the response rate
of treatment A is 7 and the response rate
of treatment B is 13.

Also, here is one of the largest diamox AMS controlled double blinded studies that I could find, conducted with 400 Himalayan porters on Lobuche (4930 m). Note that 75% of the subjects dropped out of the study (which Ken might therefore call "discredited"). 7 of 55 subjects who completed the study on diamox had AMS while 6 of 54 on placebo had AMS - essentially no difference.

http://www.wemjournal.org/wmsonline/?req...2&page=0087

Do I think this discredits diamox? No. It is typical of these small trials to get varying results.

How do I post photos?

Anyways, more about acclimatisation. I do not know if there is a placebo effect, but I found the following to help with puna (altitude sickness):

- Tea with lemon
- Keeping up carbohydrates, i.e. potato, pasta
- Sugar on my tea
- Chachacoma tea, a local herb. Works better if there is lemon
- Biting a lemon

I know, a lot of lemon, eh?

Anyways, my diet for altitude was:

Fly from sea level to Copiapo in Chile, 500m
Go up the hill for the day, at 4,450m, go down
Go up for three days and nights at 4,450m, have the worst headaches ever
Go down to 500m for 2 days
Go back up to 4,450m, fully aclimatized... priceless!

I was picking up rock samples in scree slopes at 4,600-4,700m (16,000ft) two days ago... it was hard work, but boy was it fun !

I now feel ready to tackle the 5,000m (16,500ft) peak outside camp. Next stop, volcan Copiapo (6,000m-20,000ft), if I have the time.

> How do I post photos?

First, check the link in Message posting tips

The sites listed are a bit out of date. Flickr and Smugmug are the two most used now. Flickr is free, but not Smugmug. You get an account, upload your pictures, and then link to them on the message board.

People here would really love to see any pictures you might have of the area. If you climb that peak, be sure to tell us about it.

Going up the mountain today, will be back Saturday night. I am hoping to post some pictures Sunday or Monday.

Sorry it took a while, here are some pictures:

http://public.fotki.com/chile-geo/

Hello again, I am the geologist working in Chile at 4,450m, just a bit higher than Mount Whitney's summit.

This is the third time I work at high altitude, having worked previously in Qinghai, China, at 4,250m-4,600m for seven weeks straight, and a previous 3 week stint in Chile.

I am currently approaching the end of a 6 week rotation. I am the guy that spends half the time in town (500m) for 2-3 days and half the time in camp (4,450m) for 2-3 days. My American colleague is in camp 80% of the time, for longer periods than the chilean workers.

My observation on the many people we have had through camp, bearing in mind that we drive from 500m to 4,450m in just 3.5 hours:

- Age does not seem to matter for altitude sickness, although we do not have infants or elderly in camp; I think middle aged people appear to do better than late teens-early 20s workers
- Smoking does not appear to be a factor. If anything, after 3 projects in high mountain, I find smokers appear to cope better than non-smokers, but I have not carried out a systematic study
- Excess weight is a no no for altitude, all people with excess weight, even slight excess weight, suffer
- Chileans advise fasting (not complete) to some extent for the first 2-3 days in camp; myself and others have tried this, it appears to work
- Overexertion of new arrivals appears to guarantee bad 'puna'
- If a worker does not have 'puna' by the time he arrives in camp, he will make it through, regardless of night time 'puna'
- If a worker feels sick by the time he is in camp, no matter what he will be back in town in 2-3 days
- My boss, an American, seems to be immune to 'puna' regardless of how long ago he last was in the mountains; the story goes that he was in a project in Peru years ago, first time at altitude, and that he was spitting blood, etc, all symptoms of edema, but he did not go down and eventually got used to it
- Drinking tea seems to help
- Eating lemons or adding them to tea seems to help
- In my experience and that of my chilean, canadian and american co-workers, 'puna' chill-sweats at night improve upon drinking a warm sugary drink (e.g. tea with sugar)

Anyways, these are some personal observations.

I am looking forward to going running or hiking when I get back to Canada and live again at sea level!

Cheers!