Altitude Sickness - tidbits

Let me preface this by stating I am no expert in the field of "Altitude Sickness", have never personally suffered from it, nor do I know everything about it. I simply want to provide a location where you might have some valid resources to:

1) Better understand the physiology behind it
2) Understand the different degrees/syndromes of Altitude Sickness and their severity (Acute Mountain Sickness, High Altitude Pulmonary Edema, & High Altitude Cerebral Edema
3) Know the best ways to prevent it
4) Provide some current evidence based articles regarding the treatment of it.

One of the best resources I have come across online is www.Altitude.org. This website provides as in-depth a description of what Altitude sickness is, it's pathophysiology, interactive charts showing altitude effects on oxygen carrying capacity etc. It essentially has it all. They also have created a "registry" for people that have suffered from a severe form of Altitude sickness known as "High Altitude Pulmonary Edema (HAPE)". I would be surprised if this website does not answer or address most of your questions regarding this topic. Another good source is the CDC. They talk about in what situations a person should or should not consider using Acetazolamide as prevention.

I will defer from re-writing definitions, causes, etc of Altitude Sickness since the website does a great job at answering those.

Current recommendations for "PREVENTION" of altitude sickness are the following:
- Acclimatization: above 8,000ft, ascend no faster than you bodies ability to acclimate. Usually 24 hours for every 1,000ft above 8,000ft (some variation in consensus here).
- Once above 10,000 ft. move sleeping altitude to no more than 1,600ft in a day. Sleeping at high altitude produces the most hypoxemia; day trips to high altitude with return to low altitude are much less stressful on the body.
- Avoid vigorous/strenuous exercise at elevation until acclimated (roughly 48 hours). Even after acclimatization, go easy, giving your body time to recover.
- Don't smoke, drink alcohol or use medication such as tranquillisers and sleeping pills while you're at altitude, as they could make any symptoms of altitude sickness worse.
- Stay well hydrated.
- Consume a high calorie diet
- Only two evidence based medications effective for prevention of Altitude Sickness currently that I am aware of:
a. Acetazolamide - 125mg dose twice a day, started 24-48 hours prior to altitude exposure. This is the "go to prescription medication". Higher doses have no added benefit per research studies. Common side effects are tingling of the hands, toes and face, nausea, & drowsiness. If allergic to Penicillin or Sulfa drugs, this maybe contraindicated for your use.
A few supportive Articles:
http://jtm.oxfordjournals.org/content/19/5/281
http://www.bmj.com/content/328/7443/797

b. Ibuprofen - 600mg three times a day, started 6 hours prior to altitude exposure. Contraindicated if you have a history of stomach ulcers, GI bleed, liver or kidney failure among others. (Not as widely accepted as a preventative medication but support is growing).

A few supportive Articles:
https://med.stanford.edu/news/all-news/2...chers-find.html
http://www.wemjournal.org/article/S1080-6032(12)00274-8/fulltext

- If you start to develop mild symptoms stay at current altitude or descend
- DESCEND, DESCEND, DESCEND - only truly effective prevention once symptoms present

Current recommendations for TREATMENT for altitude sickness are:
- DESCEND, DESCEND, DESCEND

Really nothing else needs to be said regarding treatment. Once you have true symptoms if you don't descend, much of the above including medications aren't going to have a big impact. You have to descend down the mountain.

As for herbal remedies ie. Gingko biloba - has had widely conflicting results and is not currently recommended. Anti-oxidants (Vit C, E ,& Alpha-lipoeic acid) and magnesium have not shown to be effective. Other remedies/treatments are out there but there is little to no valid literature to support it's use. That's not to say they are not effective. Some haven't been studied in small or large trials.

I have experience using both Acetazolamide and the Ibuprofen regimens. I personally did not experience any side effects but obviously some do. In the end, use what works for you. Nothing will work for everyone. Common sense and educating yourself is key. I would seek medical advice prior to taking any of the above as each of us have our own problems/issues. Self medicating can get us in trouble even when it comes to herbal remedies or over the counter medications. I would encourage you to look at the Altitude.org website. Some extremely valuable information there.

Im no expert but I go to Breckenridge every year and its High enough people do get sick. I typically get some pretty mild headaches. Anyways what I have learned that works for me is EmrgenC and a ton of water.

Emergyn C is a Cure all for about everything

Awesome Stuff

I get altitude sickness at anything above 4,500-5,000 ft. Which sucks because all of my family lives in Colorado.

The main cause of my altitude sickness was a traumatic inner ear rupture while flying between LA and Atlanta 9 years ago. I had a bad sinus infection and my Eustachian Tube and Ear Drum in my left ear ruptured in the air. It took almost 5 weeks before I could walk without bad vertigo.

The best thing I have found is Sudafed D and lots of water. Sudafed D opens up the airways so you can breath and get enough oxygen. Water keeps you hydrated so the oxygen gets to your brain. Also, you have to take it before you head up elevation. Once you are there and you start to feel the effects I would recommend Dramamine. Also oxygen helps a lot. I have a couple of bottles of boost oxygen that I keep in case I need them. If you start to cramp you need to go to the ER.

I am an extreme case but when I go to SE Colorado at 4000 Feet this is what I have to do and what I carry.

Boost Oxygen

This is the link to Boost Oxygen in case you want to find out more about it. My physical therapist told me about it when trying to relearn to walk.

I made the HORRIBLE decision a few years back to fly into Albuquerque and drive straight thru to Creede Co at a breakneck pace and my friends Cabin is at 8,800 then we went up the mountain to around 10-11 and all of this happened in one day..Of course I had not consumed near enough fluids (or the wrong ones)
I cannot describe the headache and pain that came on..Not FUN

Years ago a group of Kiddos graduated and drove straight there and went straight up and one young man turned blue and passed away and have another Dear Friend that his Bride's Liver Lacerated. It's not to be taken lightly for sure.

You can also get a prescription for altitude sickness pills from your doctor. We had to get them when my wife and I hiked the Inca Trail because people have to get helicoptered out if they don't take them. If it's that big of a concern, I'd look into that. I had no altitude sickness symptoms at all. You have to start taking them a few days before you get there, though.

Went to CO a few years ago and was staying at just over 9,000 feet. We went skiing the first day there...that night I woke up gasping for breath. I opened up a window and stayed there until morning gasping for breath and then drove down the mountain. Boy, I've never been so unsettled. Thinking back I should have headed down the mtn as soon as I woke up.

Never had it, but I know you can take Ginger in a pill and it helps with no side effects. The stuff a doctor prescribes can be dangerous from what I was told.

Google it, but it works and also for sea/motion sickness. I had a state trooper sgt hunting with me one time that took it and swore by it.

Wow. Sounds painful as he11.

Good info.

Never Fun Sir...

I won't make the mistake again

Correct Sir. It's called Acetazolamide (generic name) or Diamox (brand name).

Western its not dangerous unless you have a severe PCN or Sulfa allergy or some kidney or liver issues. Common side effects are tingling of the hands, toes, & face; nausea and drowsiness. I never had any. I have taken it several times. I have prescribed it for Scout leaders going on high adventure trips. Always have a backup supply just in case. It's the gold standard for prevention.

Never heard about the ginger. I'll have to look into that. Thanks for sharing.

I guess that is why it is by prescription, then hopefully the MD/NP is aware of any underlying conditions you mentioned.

I have only seen one person suffering from AS, we thought it was a panic attack the way they where acting. Doesn't look fun I know that!

I'm older and whole lot fatter now, but I used to backpack in the high country.

I too saw some really scary things happen to folks rapidly driving up to 8-9,000' and hitting the trail up from there. I lived at the beach, so iron clad Rule Number One was to acclimate for 12-24 hours at +/-8K feet. Then head up to the high country and do a 10% to 25% of normal first day hike. Then gradually ramp up to full altitude at a slow pace. Assuming no other health problems, we were pretty much running an all cylinders on day four or five at treeline and over the higher passes.

Hint: 7-8 lpm of 100% O2 for 5-10 minutes calms the panic and reduces the hyperventilating when some folks feel like they are starving for air.

Marc

Stayed at nice cabin in FairPlay Colorado. Nice little town, but over 10000 feet. Terrible, couldn't sleep, nights drug on forever. Miserable.
Luckily, they have oxygen delivery companies in ski resort area. After that, I slept like a baby. Get me a hit of oxygen, I was good to go.

We pretty much stay in and around Buena Vista Co. when we go up. It's about 8,000 ft. We spend the first day doing absolutely nothing requiring exertion and drink lotsa water. By the second day we're ready to tackle the higher elevations. Wife had one experience in Leadville area and got nauseous. She hadn't been drinking water as we usually did. Just ran her back down to 8000 and pushed water, she recovered pretty quick.

Drove from Lubbock to above Crested Butte in one day. Pitched camp at over 10,000 feet. Had grand plans to hike some Fourteeners in the area. That was quickly squashed when I woke the next morning feeling like I was coming down with the flu and a migraine at the same time. I knew what it was so we (brother and I) headed down the mountain and camped at lower elevation for a couple days. Then headed back up and everything was fine for the remainder of the trip. We managed 3 fourteeners in 10 days on the trip.

Thanks for putting this together Ringworm.

You boys heading to the high country......start increasing fluids (water) now! Helps increase red blood cells which carry more oxygen!

DON'T FORGET - If you're taking horses, THEY need to be acclimated too!

Drinking water at altitude helps, too (H2Oxygen). And smoking or dipping constricts blood vessels, which impedes blood flow, which makes altitude harder to handle.

I used to hike and work in the high country every summer and have seen a lot of altitude sickness. The #1 prevention is running. Higher altitude require more red blood cells to process lower oxygen levels. Running builds these up helps your body work with the oxygen debt. The old rule of thumb used to be be able to run 1-1/2 miles in 15 min. I found that guys that could do this and spent a least one day acclimatizing rarely had altitude sickness.

My first bought with severe altitude sickness was riding up the COG railway going up Pikes Peak a few years ago.

When we first got to camp Friday evening, I felt horrible.. could not breath, huff/puff setting up tent, etc. it compounded by Anxiety and had to take additional medicine, etc. I started drinking water like crazy and eating more, and started feeling better pretty fast. By Monday afternoon I felt I was pretty acclimated, and come Tues/Wed felt good and was hiking up/down no problems. Son drank too much Dr. Pepper and got allot of headaches.. I told him I would not buying any more sodas unless he drank 2 bottles of water each morning.

Climb high, sleep low. General rule of thumb is don't go more than 3000 feet higher than whatever elevation you are comfortable sleeping at and return to the comfortable elevation to sleep. As you acclimatize your comfortable sleeping elevation will increase.

Used this method to climb Kilimanjaro. After 7 days we were able to sleep at 18,700 feet in the crater of the volcano. Summited no problem the next day at 19,341 feet (5895 metres):



The view from my tent inside the crater at 18,700 feet:



As long as you are healthy and fit no drugs or oxygen are necessary - just takes time. In an emergency though or if your schedule is rushed diamox will definitely speed your body's ability to acclimate.

Altitude can be interesting I have seen a lot of interesting symptoms
My sister in law freaked out at 1 11,000 foot climb through the mountains. She was in the back seat screaming, thinking we were driving off the edge. It was fun to witness such a normal person flip out so.
During a motor cycle race up in Colorado we had guys crashing everywhere. We though it was just a horrible day at the track until one guy started crying about a crooked fender. We figured it was time for the flat landers to go back down the hill.

Hirogen, that is awesome

I got it twice as a kid, threw up once and never had it since. It was bad but grew out of it i guess. No one else in my familly gets it luckily. Thank goodness. Water before noon and beer afterwards.

Here's the problem with Dr. Pepper. It has caffeine in it and caffeine restricts the blood flow and the blood flow is what carries the oxygen. That is the case with a lot of drinks when up high including drinking a lot of coffee. I'm not talking about one cup in the morning, but several will be bad for you. Tell him to switch to root beer for the trip. It does not have any caffeine in it.

Great info, as mentioned previously try to limit caffeine intake and hydrate with water. Caffeine can cause your blood vessels to constrict which will slow the amount of blood you can push through your body. Another thing to remember is the atmospheric pressure is reduced which makes the oxygen level less dense or harder to breathe in same levels you can at lower altitude. Those two things can make it feel like you're starving for air because you are moving less oxygen. Once you start getting tingling feeling in your hands, feet, nose or start having trouble seeing your body is telling you you're not getting enough oxygen, so rest if nothing changes move to lower altitude. Take the time to get acclimated and if possible have oxygen available in the event you have an emergency, if all else fails get to lower altitude.

So what yall are saying is Dr Pepper is the cure for altitude sickness. RIght on!