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I need help with altitude sickness. Please.
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Ron McCarthy
(quadster2005)

Locale: So Cal
I need help with altitude sickness. Please. on 08/14/2011 16:19:01 MDT Print View

I live at about 1450 ft above sea level and would describe myself as in very good shape. I regularly hike the hills in my area with no problem. I have had a Mt. Whitney trip planned for about a year now and decided to climb at altitude to get ready.

I first decided to climb Mt. Baden Powell which is 9400ft. I was doing fine up till about 8000ft and I got really sick. The nausea was horrible and the headaches were pounding. I had to rest multiple times and was finally able to reach the top. As soon as i submitted, I threw up, but felt much better. I felt fine when I started to descend.

The next week, I had a Mt. Baldy hike planned. I got a prescription for diamox and took 1 125mg tab twice daily for 48 hours prior to my ascent. I stayed plenty hydrated, carb loaded the day before, ate a healthy breakfast the day of, and even hiked at a much slower place than Baden Powell. When I got to about 8000ft, I got the same symptoms I got on Baden Powell but worse. I threw up at 8600 ft but decided to keep going. I hiked all the way to 9600ft and knew I had to stop. I was not able to summit. I felt better the lower I got, but then suddenly the nausea came roaring back and at about 7500ft, I threw up violently again.

My Mt. Whitney hike is in 1 week. We were going to camp at the base camp at 8600ft the night before and then hike the mountaineers route. Is there anything else I can do? Did I just have a bad reaction to the diamox? Should I let my friends down and not go? I really want to go.

John Jensen
(JohnJ) - F

Locale: Orange County, CA
Re: I need help with altitude sickness. Please. on 08/14/2011 16:34:25 MDT Print View

If I got that sick at 9 I would not go to 14. Have you talked to your doctor about the poor result with diamox? I'd think that means a genuine risk at higher altitudes, but I am not a doctor.

Jennifer McFarlane
(JennyMcFarlane) - MLife

Locale: Southern California
Altitude sickness on 08/14/2011 16:37:44 MDT Print View

Ron
I also get altitude sickness- but only with exertion at altitude.
You could tent camp at either Horseshoe Meadows (about 10,000 feet) or in the White Mountains at similar altitudes to acclimate for a few nights before attempting Mount Whitney. Horseshoe Meadows is supposed to be one night only but there are so many empty campsites every night it has never been an issue when we have stayed 2 or 3 nights. Do some short day hikes while there and see how you respond. Even when I do all of this beforehand- when I start ascending- I still get the nausea and vomiting but not as bad.

I found not eating before starting is helpful. Once I start throwing up, I just move even more slowly than I usually do- but keep moving forward. I stay hydrated with both water and electrolyte drinks.
I don't get the headache but I do take an anti-inflammatory for arthritis which may be preventing the headache.
Once I am wherever I am headed, I drink electrolyte drinks and am usually able to eat dinner. At most, I might eat some energy gel things but my favorite is a mid morning Snickers bar.
Your situation is a little different since you are trying to summit Whitney.
I'd say do your hike, but if at any point you are unsteady/can't think well or develop difficulty breathing, begin descending immediately.
I'm sure others will be able to offer other suggestions. You should probably discuss with your physician that gave you the diamox.

Edited by JennyMcFarlane on 08/14/2011 16:39:21 MDT.

Bob Gross
(--B.G.--) - F

Locale: Silicon Valley
Re: I need help with altitude sickness. Please. on 08/14/2011 16:41:29 MDT Print View

First of all, you said that you got sick before the Diamox, and then you got sick with the Diamox, so that doesn't prove anything bad about Diamox. I don't ever remember seeing anybody get sick from Diamox. On the other hand, some people are allergic to sulfa drugs. YMMV. Your symptoms do not sound like a side-effect of Diamox.

You don't say much about acclimatization. Before I did Whitney on August 2, I spent five days somewhere high in the mountains, just to make sure that my body was used to the elevation. In fact, on the second day of that, I hiked up another 14,000 foot peak with zero problems, so I do not seem to be a good candidate for altitude illness. You, sir, may be a good candidate, but that doesn't mean that it has to stop you. You just need to learn how to tolerate or resist it.

1. Get as much acclimatization as possible. The backpackers camp at Whitney Portal is at 8300 feet, and you want to get some good sleep there. Unfortunately, your neighbors may prevent that. The family campground (a few hundred feet lower) is quieter. During your acclimatization, you want to walk around a bit, but not anything strenuous. I typically walk a mile up the Whitney Trail to survey the first stream crossing, and then walk back down.
2. You want to make sure that your body is fed, but not overfed to the point where your gut is constantly busy trying to digest last night's heavy meal. Some years ago, one of my friends did the dash to the summit in 3 hours 42 minutes. When asked afterwards what is the secret to success, he said, "The night before, eat lots of noodles."
3. Some people start hiking up a steep trail, and they get an anxiety attack, and they throw up. I don't know what to tell you about that, but whatever it is, you might want to have some upset stomach remedies in an outer pocket. I can go all day long on Gatorade, but it causes some others to get stomach upset. Some hikers get upset from drinking too-cold water. This year, my total consumption on the uphill Whitney hike was about 24 ounces of Gatorade and 16 ounces of water, and nothing much solid.

If your response to this is to say, "I don't have the extra time to spend in acclimatization," then quit.

--B.G.--

jerry adams
(retiredjerry) - MLife

Locale: Oregon and Washington
Re: Re: I need help with altitude sickness. Please. on 08/14/2011 17:01:39 MDT Print View

Whenever I go above 10,000 feet I get severe headaches

When I did Rainier, which is the same as Whitney, it was terrible. I got to 14,000 feet on the summit plateau and couldn't do the last little bit. When I got back down a few thousand feet I was fine

I stayed overnight halfway up but it didn't matter. I think you need to do more like a week to make a big difference

Drink lots of water. Go slow. Some people just aren't good at high altitudes. If it gets too bad, go back down a few thousand feet.

Bob Gross
(--B.G.--) - F

Locale: Silicon Valley
Re: Altitude sickness on 08/14/2011 17:07:07 MDT Print View

Over the years on Mount Whitney, about 120 others have hiked up with me, so I have seen some minor illness in these people. The correlation of illness is highest with lack of acclimatization. Next highest is with hikers who are generally inexperienced, and they seem to worry about every step along the way, and how bad it is really going to get up high. Dehydration is a major factor. Some people are not used to hiking at high elevation, and they don't realize that sweat evaporates off your skin so quickly that you don't realize that you've been sweating, so your thirst mechanism is very slow to get you to drink. This is worse in Whitney hikers who wait until 8 a.m. to start hiking, because they will be out in the heat. Contrary to this, some people are so concerned that they guzzle too much water, like 3-4 quarts on the way to the summit. First of all, that is a lot of weight to carry, which slows you down. Then you are always looking for a bush to water. Up there, there are no bushes or trees. The worst that I saw in any of my friends was the guy who ran the last two miles up to the summit (!) and then collapsed. I got up there about 20 minutes later, and he was trying to get to his feet. On the way halfway down, he wasn't feeling good, and he couldn't walk a straight line. I diagnosed that as heat exhaustion, so we got him to sit down for a few minutes. We pulled his shirt off and splashed some cold stream water over his back. Then we had him drink an extra pint of water with one aspirin and a half of a candy bar. The dude snapped right back to life. By the time we got closer to the bottom of the trail, he took off and ran a mile to the bottom. Some people get so much in their stomach, and the circulation is temporarily diverted away from digestion and to muscles, so everything just sloshes around in the stomach. Not good. Eat a light breakfast an hour before you start walking, and go easy for the first hour until your proper pace gets stabilized.

At the last count, the success rate for Whitney, among those who hike with me, is about 95+%. I'm currently at 100%, but my days may be numbered.

--B.G.--

d k
(dkramalc) - MLife
re:altitude sickness on 08/14/2011 18:06:42 MDT Print View

If you've been doing these hikes at altitude without spending the previous night at high altitude, that's probably what's been doing it. I recommend you follow BG's advice of spending extra time up there to acclimate. When we did Whitney we arrived at Whitney Portal the afternoon before, set up camp, then went for a walk up higher on nearby trails. After sleeping at the Portal campground, we left the next morning, camped at Consultation Lake, then summited the next morning and came down. None of us had altitude sickness (which is not to say we were unaffected by altitude, but more in terms of feeling less strong the higher up we got).

Long ago I drove from sea level to the Tuolomne Meadows area of Yosemite and hiked from 8000 feet to 10,000 feet that day, and got very sick on the way back down to my car (headache, nausea). Since then I have not pushed myself the first day up high, and haven't had that feeling again.

KEN LARSON
(KENLARSON) - MLife

Locale: Western Michigan
Prevention of Altitude Illnesses on 08/14/2011 18:08:48 MDT Print View

Prevention of altitude illnesses falls into two categories, proper acclimatization and preventive medications. Below are a few basic guidelines for proper acclimatization.
• If possible, don't fly or drive to high altitude. Start below 10,000 feet (3,048 meters) and walk up. ACCLIMATE AT 10k FOR A FEW DAYS BEFORE GOING HIGHER.
• If you do fly or drive, do not over-exert yourself or move higher for the first 24 hours.
• If you go above 10,000 feet (3,048 meters), only increase your altitude by 1,000 feet (305 meters) per day and for every 3,000 feet (915 meters) of elevation gained, take a rest day.
• "Climb High and sleep low." This is the maxim used by climbers. You can climb more than 1,000 feet (305 meters) in a day as long as you come back down and sleep at a lower altitude.
• If you begin to show symptoms of moderate altitude illness, don't go higher until symptoms decrease (&quotDon't go up until symptoms go down").
• If symptoms increase, go down, down, down!
• Keep in mind that different people will acclimatize at different rates. Make sure all of your party is properly acclimatized before going higher.
• Stay properly hydrated. Acclimatization is often accompanied by fluid loss, so you need to drink lots of fluids to remain properly hydrated (at least 3-4 quarts per day). Urine output should be copious and clear.
• Take it easy; don't over-exert yourself when you first get up to altitude. Light activity during the day is better than sleeping because respiration decreases during sleep, exacerbating the symptoms.
• Avoid tobacco and alcohol and other depressant drugs including, barbiturates, tranquilizers, and sleeping pills. These depressants further decrease the respiratory drive during sleep resulting in a worsening of the symptoms.
• Eat a high carbohydrate diet (more than 70% of your calories from carbohydrates) while at altitude.
• The acclimatization process is inhibited by dehydration, over-exertion, and alcohol and other depressant drugs.
Preventive Medications
• Diamox (Acetazolamide) allows you to breathe faster so that you metabolize more oxygen, thereby minimizing the symptoms caused by poor oxygenation. This is especially helpful at night when respiratory drive is decreased. Since it takes a while for Diamox to have an effect, it is advisable to start taking it 24 hours before you go to altitude and continue for at least five days at higher altitude. The recommendation of the Himalayan Rescue Association Medical Clinic is 125 mg. twice a day (morning and night). (The standard dose was 250 mg., but their research showed no difference for most people with the lower dose, although some individuals may need 250 mg.) Possible side effects include tingling of the lips and finger tips, blurring of vision, and alteration of taste. These side effects may be reduced with the 125 mg. dose. Side effects subside when the drug is stopped. Contact your physician for a prescription. Since Diamox is a sulfonamide drug, people who are allergic to sulfa drugs should not take Diamox. Diamox has also been known to cause severe allergic reactions to people with no previous history of Diamox or sulfa allergies. Frank Hubbell of SOLO recommends a trial course of the drug before going to a remote location where a severe allergic reaction could prove difficult to treat.


Diamox
Diamox, a drug often used in the treatment of the eye condition glaucoma, is also useful in the prevention of Acute Mountain Sickness (AMS). AMS occurs commonly during visits to 3000-4500m and may cause a severe headache, exhaustion and general feelings of illness. In rare cases (but sometimes even at these altitudes), the condition progresses to cause more serious problems that are potentially fatal – High Altitude Pulmonary and Cerebral Oedema (HAPE & HACE).
Diamox reduces the headache of AMS and helps the body acclimatise to the lack of oxygen - it also probably reduces the incidence of the complications of AMS mentioned above (HAPE &HACE). Whether or not one takes Diamox is obviously a matter of personal choice - travel to high altitudes is quite possible without it. I do not recommend the drug as a routine treatment, though there is variation of opinion about this many people choose to use it if travelling quickly to altitude (eg. if flying into Lhasa).
How to take Diamox
If you decide to use the drug, I suggest Diamox 125mg (half of one tablet) is taken twice daily as a trial at sea level for two days several weeks before a visit to altitude. Assuming no unpleasant side effects are experienced, take the drug in the same dose for three days before staying at 3500m and thereafter for two or three days until you feel acclimatised, for about five days in all.

Side Effects
Like all drugs, Diamox may have unwanted side effects. Tingling of the fingers, face and feet is the commonest, but this is not a reason for stopping the drug unless the symptoms are intolerable. Dizziness, vomiting, drowsiness, confusion, rashes and more serious allergic reactions have all been reported but are unusual. In exceptional cases, the drug has caused more serious problems with blood formation and/or the kidneys. Those who are allergic to the sulphonamide antibiotics may also be allergic to Diamox.
More commonly, the drug makes many people (including me!) feel a little "off colour"; carbonated drinks and beer also taste strange when you are taking Diamox.

Some individuals no matter what they do have Altitude Illnesses issues....you may be one of them.

Hart -
(backpackerchick) - MLife

Locale: Planet Earth
Diamox Side Effects on 08/14/2011 18:15:16 MDT Print View

Ron, was that your first experience with Diamox.? Prior to the big day, you may want to try a couple doses at home to help establish whether the symptoms you experienced are not at least in part associated with the Diamox. It can make some people feel pretty crappy. However, it sounds like your symptoms, which are certainly consistent with altitude sickness were pretty much the same, with and with out Diamox. It is significant that despite using the drug for 48 hours prior, symptoms do not occur until you reach a certain altitude. Note: While the evidence base for various dosing regimens is scant, Diamox should probably be continued through out your ascent and until you are back down to a "reasonable" altitude. Diamox is often also used at a dose of 250mg twice daily -- consult your doctor first!

On the BIG mountains dexamethasone prophylaxis is becoming very common. However, there are a lot of things to consider when using this drug! How much is this summit worth to you?

Also, Diamox is a "sulfa drug". While it does not contain the amount of sulfa found in sulfonamide antibiotics, it can still be problematic for patients who do not tolerate sulfa drugs.

If your past symptoms and the corresponding elevations are anything to go by, you may well become ill at your portal camp. The effects of altitude are not linear. The difference between 13,000 and 14000 ft. can be expected to affect you more than the difference between 8,000 and 9,000 ft (sorry, that was not very eloquent). If your problem on these recent occasions was altitude sickness at 8000-9000ft which it almost certainly was, you can not expect to summit Whitney this coming week. Chances are you will again experience AMS at a similar altitude. You must also be concerned with the more serious problems of HAPE and HACE.

You may well be able to summit high peaks in the future with a slower acclimatization and/or possibly different drugs. I don't think you can get this worked out in the coming week unless you can take the week too acclimatize.

Edited by backpackerchick on 08/14/2011 18:48:40 MDT.

Bob Gross
(--B.G.--) - F

Locale: Silicon Valley
Re: Altitude sickness on 08/14/2011 18:29:53 MDT Print View

Everybody has a different threshold or trigger elevation for altitude problems. For many hikers and backpackers, they can go from sea level to 5000-6000 feet, sleep a night, and have zero problems the next day. However, if they drove straight up to 8000 feet and try to start, there is a small risk. Generally, they feel the lethargy and nausea setting in within a half day. Sometimes it hits them around dinner time at the end of a full day. I can easily drive straight up to 10,000 feet, and then hike up to 12,000 feet, but now I am operating on the risky edge of things.

Physiologists have determined that the best indicator of how you will do at high elevation in the future is the history of how you have done in the past. So, you probably want to zero in on the cause now and get it licked.

Jenny mentioned electrolyte drinks. I agree. When I first arrive after the drive up from sea level, I drink fruit juice. After sleeping the night, I drink more fruit juice along with breakfast. Then, after driving an hour to a trailhead, I am good to go.

There is a short paper that you might want to read:
Mt. Whitney: Determinants of Summit Success and Acute Mountain Sickness, 2008.

It was written by a bunch of physiologists, medical types, and sports medicine types. They were on the Whitney summit a few years ago collecting vital signs and taking surveys from those reaching the summit.

On the other hand, assuming that you are not allergic to Diamox, then it probably is not going to hurt you. There are some very minor side effects. An ordinary general practitioner physician may not be very up-to-date, but some sports medicine specialists might be better. For these kinds of altitudes, I would think that a very low dosage of Diamox might be OK, although one fellow I know takes more than the maximum dosage of it and thinks that it works pretty good. YMMV.

I've had prescriptions for it three times, but I've only actually consumed the stuff once, and it seemed to have a beneficial effect. But then, I was going very high. Diamox (acetazolamide) is a carbonic anhydrase inhibitor. I'm sure that makes it as clear as mud.

--B.G.--

Bob Gross
(--B.G.--) - F

Locale: Silicon Valley
Re: Diamox Side Effects on 08/14/2011 18:43:06 MDT Print View

"Note: While the evidence base for various dosing regimens is scant, Diamox should probably be continued through out your ascent and until you are back down to a "reasonable" altitude. Diamox is often also used at a dose of 250mg twice daily -- consult your doctor first!"

I agree. I've seen people taking all the way from 125mg daily to 1000mg daily. You need to start it a day or two before you get very high, because it takes your body that long to assume a new water balance point along with the other biochemicals.

When doing one big mountain, most of us started on 125 twice daily on the day before we arrived at a 9000-foot trailhead. That was intended to start our bodies into the adaptation process. Then when we went above 14,000 feet, we upped the dosage to 250 twice daily, and we continued that over the course of a week until we summited. I stopped the dosage at that time, because I was down to safety two days later. On the other hand, one fellow who was not taking Diamox collapsed with what was estimated to be High Altitude Cerebral Edema, which can be fatal in single digit hours. He recovered.

I would be reluctant to consider Whitney in the exact same category as big mountains, so all of the risks and remedies are scaled down.

--B.G.--

Ron McCarthy
(quadster2005)

Locale: So Cal
Altitude on 08/14/2011 18:57:46 MDT Print View

The plan was to drive to Whitney Portal next Sunday morning and spend all day and the night there. Then the next day we would hike the mountaineers route. I am in very good shape it's just the altitude. I can't go up and stay there on Saturday night too because I work that night. Somebody told me to drive up to altitude a couple nights and just sit there to get acclimated.

Hart -
(backpackerchick) - MLife

Locale: Planet Earth
Test the Day before on 08/14/2011 19:15:48 MDT Print View

Ron,

The day before the hike, you could walk up to Lower Boy Scout camp on the Mountaineers Route -- no permit required -- and see how you do getting to 10,300. Good little warmup anyway.

Horseshoe Meadows Campground is at 9,600. You could drive up there and ascend a bit and see how you feel.

Yes, hanging around/sleeping at high altitude counts towards acclimatization.

Also, consider any other drugs you are taking!

Edited by backpackerchick on 08/14/2011 19:33:16 MDT.

John S.
(jshann) - F
Re: I need help with altitude sickness. Please. on 08/14/2011 19:31:50 MDT Print View

Whether high-altitude illness occurs is determined by:
1. rate of ascent
2. altitude reached
3. altitude at which an affected person sleeps (referred to as the sleeping altitude)
4. individual physiology

Risk factors include:
1. history of high-altitude illness
2. residence at an altitude below 900 m
3. exertion
4. certain preexisting cardiopulmonary conditions

Diverse interactions between genetic factors and the environment most likely explain individual susceptibility.

Physical fitness is not protective against high-altitude illness according to the New England Journal of Medicine paper of 2001, with this reference given (http://tinyurl.com/yvs526).

A brief article on altitude illness prevention
http://www.dallassierraclub.org/page.htm?outingscorner200705

Edited by jshann on 08/14/2011 19:36:01 MDT.

Bob Gross
(--B.G.--) - F

Locale: Silicon Valley
Re: Altitude on 08/14/2011 19:34:20 MDT Print View

Driving up there to sleep helps a little. Driving up there and then strolling around helps a little more, in my opinion. Doing something strenuous on the first day would be counterproductive.

Long term acclimatization is what happens when Everest climbers spend three weeks above 18,000 feet, and that has to do with increasing your red blood cell count.

Normal weekend mountaineers don't need that. All you need is short term acclimatization, and that is mostly a respiratory thing. Your body must automatically breathe slightly deeper and slightly quicker. But, you can get screwed up if your carbon dioxide is not vented off at the correct rate (which is why we were talking about carbonic anhydrase inhibitors). Most people know that they want to get in more oxygen, but if the CO2 gets in the way, you won't feel good.

That is why I always felt that the mild wandering around on the first day was a help. Your body will assume a new respiratory pattern before it gets too stressed.

Oh, by the way, no alcohol until after you come down.

--B.G.--

Hart -
(backpackerchick) - MLife

Locale: Planet Earth
NEJM article on 08/14/2011 19:34:26 MDT Print View

John,
That is still a great article even after a decade.

John S.
(jshann) - F
Re: NEJM article on 08/14/2011 19:41:22 MDT Print View

Heck yeah!

Bob Gross
(--B.G.--) - F

Locale: Silicon Valley
Re: Altitude on 08/14/2011 19:43:27 MDT Print View

Once almost thirty years ago, I was trekking in Nepal, and the group was nearing the Trekker's Aid Post at Pheriche which is around 14,000 feet elevation. There were two western doctors in there, and they really had their act together. They treated the local Sherpas for normal illnesses, and they treated western trekkers for high altitude problems and the like. They had seen it all. They probably saw so many trekkers complaining of standard high altitude symptoms that they had the regimen perfected. Aspirin for this. Diamox for that. And Flagyl for diarrhea from Giardia.

They probably went through Aspirin, Diamox, and Flagyl by the case.

--B.G.--

Edited by --B.G.-- on 08/14/2011 19:46:26 MDT.

Hart -
(backpackerchick) - MLife

Locale: Planet Earth
Diamox on 08/14/2011 19:58:41 MDT Print View

Bob,

Actually, "scant evidence" was generous. There is no good evidence to suggest Diamox is effective in the prevention or treatment of AMS, HACE, HAPE, etc. at any dose.

The physiology makes sense however and the drug is cheap and generally well tolerated. Diamox causes the kidney to hold onto H+ there by causing a metabolic acidosis. It is theorized that this metabolic acidosis should offset the the respiratory alkalosis (the result of blowing off too much CO2) experienced at altitude. Beautiful acid-base physiology...in theory. Diuresis may play some role as well.

Edited by backpackerchick on 08/14/2011 20:04:52 MDT.

Bob Gross
(--B.G.--) - F

Locale: Silicon Valley
Re: Diamox on 08/14/2011 20:37:13 MDT Print View

Way back in the 1968-1976 time frame, Larry Penberthy (founder of MSR) noticed that lots of Rainier climbers got sick and could not summit, and he thought that he saw correlation between success rate and who had a hot stove. He theorized that simply having a stove hot enough to supply plentiful water (avoiding dehydration) was part of the magic, which is how he got into designing hot stoves. At the same time, he theorized that a climber's blood pH was getting fouled up, but he couldn't pin it down. He had Rainier climbers urinating onto pH test paper with the hope of finding correlation. Of course, blood pH is one thing, and urine pH is another, and they may or may not be linked. He wrote articles and tried to promote his theories, but the professionals looked down their respective noses at his methods. I think he had some good ideas, but if you get everybody mad at your ideas, you don't accomplish much.

Back then (prior to 1981), there wasn't a tremendous amount of uniform knowledge about high altitude physiology, so an American Everest expedition went up then in 1981 to explore more of this medical stuff. The body of knowledge started in earnest then and continues to this day.

--B.G.--