Have you found a reliable prophylaxis for altitude effects?

[Rob]

In your personal experience, have you found a reliable prophylaxis for altitude effects?

Some articles on altitude sickness claim that diet changes or enzymes taken prior to a hike will delay onset of altitude symptoms. Has anyone in this hiking community had success with using those or other methods? Often we don't have the luxury of time at elevation to acclimate for a day hike.

In the months that I've been hiking, I've been mapping my "envelope" when certain altitude symptoms (fatigue, loss of appetite, headache) appear on a day hike. If possible, I would like to push my "envelope" up a couple of thousand feet so that I can hike all of SoCal with pleasure and without restrictions.

[Hikin_Jim]

Well, you've just asked the $64,000.00 question, haven't you.

Unfortunately, to my knowledge, there's no panacea, but there are some things that you can do:

1. Stay hydrated. Dehydration can excerbate AMS (aka "Altitude Sickness").
2. When practical, drive up the night before instead of the morning of, and stay the night at the trailhead or even higher.
3. Diamox (perscription med) can be used. Research dosage and usage. Standard recommended dosage and usage does not seem optimal. Varying use based on experience appears to yield better results. Reputed best use: getting you a good night's sleep at altitude. Diamox does tend to dehydrate one. Use advisedly.
4. Avoid sunburn.
5. Try to get enough sleep.
6. Diet Coke (or caffeine in general, but Diet Coke seems to be the one people swear by). I can't remember the exact science, but I think it's a vaso-constrictor (help me out here, guys) which reduces pressure on the brain, said pressure being the source of the headaches commonly associated with AMS.
7. And, of course, stay in good shape. Good aerobic capacity can help offset the effects of altitude.

I've done "altitude training" as prep for high summits, doing high local climbs in the weeks building up to a high trip. Most say this is ineffective, but it seems to help me a bit. Definitely not the same as being fully acclimatized.

Lastly, you could use a hyperbaric chamber, but that's out of reach (and darned inconvenient) for most of us.

Happy Thanksgiving,

HJ

[magikwalt]

Jim I'd say you hit this one pretty square. The value of extra days at altitude is the biggest I've seen. The human body is pretty adaptable given time.

[Rob]

HJ, thanks for posting tips on mitigating altitude sickness.

I'll keep Diamox in mind for my next doctor appointment. It might help and is worth testing.

In my case the first symptom that appears on a day hike is fatigue (not headache). Ascending above 7,000 feet I feel like I'm operating at 50% power, and by 9,000 feet the duration of my rest breaks equals the duration of my hiking breaks (hike for 1 minute, rest for 1 minute). On level ground and heading downhill I move at full power (perhaps 2 mph, as footing allows). Since my problem is shortness of power going uphill, I suspect that my first limiting factor is oxygen transfer rate (lung-blood or blood-tissue). I think that runners would call my short spurts of energy "anaerobic." It's like after each spurt of energy I have to rest to recharge old batteries that don't hold much of a charge. In my circle of family and friends I, the hiker, am most prone to altitude sickness (AMS). I had never heard of altitude sickness until 1977 when Mt Whitney baptized me in my own vomit at only 12,000(?) feet. Thereafter, for 30 years (1977-2007), I was happy living at sea level.

Diamox might help me sleep through the nightly performance (howling) of the "Barton Flats Coyote Choir."

Trivia:

Approximately 20% of people will develop mild [AMS] symptoms at altitudes between 6,300 to 9,700 feet.
Source: http://www.nlm.nih.gov/medlineplus/ency ... 000133.htm

In a 2002 study involving ~600 trekkers at Mount Everest base camp in the Nepal Himalayas (4280-4928 m), participants in the acetazolamide [Diamox] group showed significant levels of protection. Participants included 614 healthy western trekkers (487 completed the trial) assigned to receive . . . . acetazolamide . . . . or placebo, initially taking at least three or four doses before continued ascent. The incidence of acute mountain sickness was 34% for placebo, 12% for acetazolamide . . . . . The proportion of patients with increased severity of acute mountain sickness was 18% for placebo, 3% for acetazoalmide . . . . Acetazolamide 250 mg twice daily afforded robust protection against symptoms of acute mountain sickness.
Source: http://www.bmj.com/cgi/content/abstract/328/7443/797

BTW, for those prone to high altitude pulmonary edema (HAPE), a few months ago the University of Edinburgh (Scotland) kicked off a World HAPE registry for research purposes. They're looking for names. For information see http://www.altitude.org/hape.htm (I don't suffer knowingly from HAPE -- I think that my AMS prevents me from hiking high enough to get HAPE.)

Lake Louise AMS scoresheet: http://www.high-altitude-medicine.com/A ... sheet.html (What's YOUR score?)
http://en.wikipedia.org/wiki/Acetazolamide (Diamox overview)
http://www.princeton.edu/~oa/safety/altitude.html (Good discussion of treatment meds)
http://www.acupuncturetoday.com/archive ... immer.html (Overview of Eastern [Asian] perspective)

Other allegedly helpful pharmaceuticals and herbals that appear in literature include: steroid Dexamethasone (for emergency use only by physician to treat HACE?), Sumatriptan (Imitrex, Imigran, Imigran Recovery) to treat headache(?), co-enzyme Q10, tyrosine (amino acid), chlorophyll-rich foods, and high-carb foods.

Maybe I should pack up my family and move to a mountain community? It might be the easiest way to deal with altitude!

The more I read, the less I know.

[Hikin_Jim]

Interesting links. I'll have to check them out when I get time.

The 2xdaily Diamox regimen is the one I was saying wasn't necessarily the most effective. I'll try to find my notes from my WFA class and see what they said. The instructors were ski patrol members as well as a couple of nurses.

HJ

[Rob]

Today on a local trail I bumped into an older couple who swear by Diamox for their international treks above 15K feet. I should have asked what dosage worked for them.

[Cy Kaicener]

Also, dont ascend too fast. You need to acclimatise gradually. On high peaks climb high gradually and sleep low. The best cure is to descend before it gets worse.

[zippetydude]

Hi Rob. Hey, welcome back to the high country!

From what you've described, you may be running into a couple of factors that you can very successfully control. One of those is your general ability to exchange oxygen in order to facilitate work, or put simply, aerobic conditioning. I've found that altitude has less impact, say, before the holidays than after the holidays.

The other thing you can do is to consistently expose your body to exercise at altitude. The first time I tried a trail run up the South Fork trail, I stopped at the wilderness boundary (about 2 miles) and thought I was going to die. I start the same trail now and it simply feels like a warm-up. My body has gotten accustomed to the challenge, even though I don't spend days or weeks at altitude. I saw it described on a different board as a form of "muscle memory".

Incidentally, every time I try a new, longer run, I get that old "this trail is going to kill me" feeling again, so it's a step by step process. Still, it is fun learning about how my body can improve and adapt, so I hope you have fun as you perform as your own guinea pig.

Lastly, when in Yosemite there's so much to explore that I try to get out on the trails every day for greater distances than I normally do at home. The altitude is generally over 10,000 feet. I find that the night following a long run, I will wake up gasping for air. It's kinda horrifying. I now take Ginkgo Biloba, and it doesn't happen anymore. I can't say for sure that it's not a placebo effect, but if it is, I would recommend this placebo effect for others as well!

Hope this helps.

z

[Rob]

z, thanks for the advice. I'll continue to work on aerobic conditioning at altitude.

Today I picked up a bottle of CoQ10 to test on myself while I wait for a doctor appointment for Diamox. I should be able to field test CoQ10 at altitude this Saturday (hopefully I will remember to pick up my wife at the airport on Saturday evening). As for hike location, maybe I'll just play the Miller Creek lottery.

[Perry]

I would sleep at high altitude and then come back down to low altitude, then go back up to climb. The reason being, if you just sleep and climb, altitude sickness (AMS, HAPE, HACE) has a delay time for when symptoms appear. The return to low elevation seems to prevent that for me. For example, sleeping at Horseshoe Meadows at 10,000 feet, driving down to Lone Pine in the early morning, then back up to Whitney Portal to climb. If you were to climb San Gorgonio, you could sleep in Big Bear at 7,000 feet, drive down to San Bernardino (1,000 feet), then go to Vivian or South Fork trailhead.