Altitude Sickness is a Jerk

Everything I'm about to say is completely anecdotal, and is contradicted by all the scientific literature, but I'm going to say it anyway, damnit.

I think fitness helps. A lot. Maybe it's just that you get to know your limits and how to operate within them better, but I think if you have a huge aerobic base, it's extremely beneficial.

I base this on my experiences going to altitude both with and without any kind of aerobic base before hand, and watching who around me deteriorates rapidly and doesn't.

That and acclimatization. There's mixed data on diamox these days. Apparently it limits your percentage utilization of VO2 max more than just altitude alone does. So if you want to go hard in the mountains, that's a problem.

To add: I don't think fitness level makes a difference, and there have been several studies that come to that conclusion, e.g. ncbi.nlm.nih.gov/pubmed/178….

However, in my experience as someone who is very susceptible to AMS, fitness plays a huge role in just how debilitating it can be. If you have AMS and are exhausted you will feel a whole lot shittier than if you just have AMS. So, while being in good shape won't prevent you from getting symptoms of AMS, it might help you to not get totally shut down when the symptoms come on.

Mike Marmar wrote:To add: I don't think fitness level makes a difference, and there have been several studies that come to that conclusion, e.g. ncbi.nlm.nih.gov/pubmed/178…. However, in my experience as someone who is very susceptible to AMS, fitness plays a huge role in just how debilitating it can be. If you have AMS and are exhausted you will feel a whole lot shittier than if you just have AMS. So, while being in good shape won't prevent you from getting symptoms of AMS, it might help you to not get totally shut down when the symptoms come on.

From Web MD, the side effects of acetazolamide include: Dizziness, lightheadedness, and an increased amount of urine may occur, especially during the first few days as your body adjusts to the medication. Blurred vision, dry mouth, drowsiness, loss of appetite, stomach upset, headache and tiredness may also occur. If any of these symptoms persist or worsen, notify your doctor or pharmacist.

So, in some people it causes some of the exact symptoms we are trying to avoid at high elevation. Probably best to test it out at home first before using it at high elevation.

I do a lot of mountain climbing and hiking at high altitudes.  I too suffer from altitude sickness...typically above 10,000 ft.  But I know it varies from person to person.  I use a product called Big Ox O2 which is high purity oxygen in a can.  Some of the stores near me carry it, like Bass Pro, but typically I just order off of their website because I get a discount for larger volume purchases and they ship for free.  It's more expensive at the store.  It definitely helps me.  When I start to feel the symptoms coming on I put the can in my mouth an inhale the high purity oxygen.  My symptoms seem to go away within minutes.  Good luck.  Hopefully this helps.

Pressure breathing - about 1-2min of doing that at the onset of headache/nausea got rid of it every time for me above 10k on Rainier this past year

Better genes 

Good thread. Thanks all for the knowledge.

As already mentioned. Acetazolamide can work, but you have to be very careful to keep up on your electrolytes during activity. Particularly potassium and sodium. Because the drug is  a diuretic, you're going to pee.. a lot. Do not let yourself get dehydrated or you'll end up with metabolic acidosis. 

The simplest thing you can do during climbing is to take slow deep breaths with an emphasis on a long pursed lip exhale. This effectively clears more CO2= decreased migrane, and increases the diffusion of O2 into your blood = decreased shortness of breath.  AKA "Pressure Breathing."

Source- Work as a Critical Care Respiratory Therapist and regularly give Diamox to patients on life support. 

contributing my anecdote, from my trip to nepal a year and a half ago on my way to everest base camp/island peaks:

day 1: landed in lukla - 9100 ft
day 2: hiked to namche bazaar - 11200 ft
day 3: acclimatization day - stayed the night at 11200 ft to acclimatize
day 4: hiked to tengboche - 12600 ft
day 5: acclimatization day - stayed the night at 12600 ft to acclimatize
day 6: hiked to dingboche - 14400 ft, first started to feel abnormally tired at the end of this day's hike
day 7: acclimatization day - stayed the night at 14400 ft to acclimatize
day 9: woke up with ataxia (couldn't walk), helicopter back to kathmandu (4600 ft).  diagnosed with HACE (high altitude cerebral edema) and spent 2 nights in the hospital.

in my own estimation, i was very fit before the trip.  no drinking, no drugs, no smoking.  crossfit/HIIT 3 times a week.  i'd only really been at altitude (~14k) while snowboarding in CO, and while i'd gotten some pretty bad headaches, i had assumed it was due to dehydration, as i definitely didn't drink very much on those days.

on the hike, i drank 3 to 4 liters of gatorade every day and a good amount on acclimatization days too.  i ate salty foods whenever i could, although i was sticking to a vegetarian diet (they say the meat isn't good at altitude because they have to lug it up from lower).  my nepali guide espoused the hindu/buddhist focus on breathing, so i did make a very conscious effort for deep slow breaths as well.  i also started taking "altitude supplements" (Altitude Rx OxyBoost Complex on amazon) a couple days before landing in lukla ... yeah ... those didn't help ...

i didn't have any headaches or anything until day 7 or so, although i was pretty tired after hiking on day 6 for what i thought wasn't much actual physical exertion.  i also did have the runs by day 7, although i was still trying to hydrate properly.  

anyway, my take after reading (as a lay person) medical papers on HACE, after my experience, was that fitness and hydration didn't have anything to do with my HACE.  i recall reading that the conjecture was that HACE could be due to congenital physiological conditions (intracranial distance??), of which, no amount of preparation helps (damn sea level genes).  in that conjecture, i believe it was suggested that AMS was symptoms from HAPE/HACE, but again, i'll defer to someone with more than anecdotal experience and layman's browsing of medical papers...

returning to the US feeling unfulfilled (although glad to be alive...), i started rock climbing, which brings me here!

Noel Villegas wrote:

...
anyway, my take after reading (as a lay person) medical papers on HACE, after my experience, was that fitness and hydration didn't have anything to do with my HACE.  i recall reading that the conjecture was that HACE could be due to congenital physiological conditions (intracranial distance??), of which, no amount of preparation helps (damn sea level genes).  in that conjecture, i believe it was suggested that AMS was symptoms from HAPE/HACE, but again, i'll defer to someone with more than anecdotal experience and layman's browsing of medical papers...

returning to the US feeling unfulfilled (although glad to be alive...), i started rock climbing, which brings me here!

There's a few prophylactic things -- we can try to effect a pH shift, alleviate the pulmonary hypertension, nsaid dosing. 

Here is link to overall review:

http://www.wemjournal.org/article/S1080-6032(14)00257-9/fulltext  

this is the abstract from the HACE/AMS paper i saw.

The diagnosis, treatment and prevention of high altitude cerebral edema (HACE) are fairly well established. The major unresolved issues are 1) the pathophysiology, 2) the individual susceptibility, and 3) the relationship of HACE to acute mountain sickness (AMS) and to high altitude pulmonary edema (HAPE).

In the context of the two types of cerebral edema, cytotoxic (intracellular) and vasogenic, a leaking of proteins and water through the blood-brain barrier (BBB), a recent MRI study in persons ill with HACE (16) suggested a predominantly vasogenic mechanism. Causes of increased BBB permeability might include mechanical factors (loss of autoregulation and increased capillary pressure), ischemia, neurogenic influences (adrenergic and cholinergic activation), and a host of permeability mediators. Once vasogenic edema develops, cytotoxic edema generally follows, and although likely in HACE, this is still unproven. Symptoms of HACE are related to increased intracranial pressure (ICP), and death is from brain herniation. Treatment is directed both to lowering ICP by reducing the volume of intracranial contents, and to stopping the vasogenic leak.

Evidence is accumulating that established moderate to severe AMS is due to cerebral edema, but whether this is true for early AMS (headache) is unclear. New work suggests that the brain swells on ascent to altitude, but that this is unrelated to AMS. Preliminary data showing that those with less cerebrospinal fluid volume (a tighter fit of the brain in the cranium) were more likely to develop AMS supports the hypothesis of Ross that those with less ability to accommodate the increased brain volume are the ones that suffer AMS. The blood-brain barrier and intracranial hemodynamics are the two key elements in the pathophysiology of HACE and AMS.

I would second those that advocate for a gradual acclimatization schedule.  If you live in the Front Range, you should be able to do that.  For me, gradual acclimatization effects last about two weeks but usually no more.  I live in Denver and can usually go to 8.5k (Bear Peak or Mt. Falcon) or so without any prep.  The next week go to 10k or 11k.  The next week go to 13k or 14k.  If you feel lacking, be less ambitious, add another week or two.  If you feel good, the following week (or maybe two) you'll still be acclimatized enough to feel good at 13k or 14k.  This process will allow you to learn the limits of your body, a valuable skill if you plan on doing this again in the future.

This is probably as good a thread as any to bring this up.

I recently went to cham and while I was there I gave mont blanc a go, nothing serious just wanted to see how far I could get from the valley floor.

I went from 1200m to 4200m over about 10 hours then turned back, no acclimatization.  I had a headache, was struggling to balance and I appeared to have lost the ability to walk and think at the same time, now i wasn't exactly showing any real signs of altitude sickness the balance issue probably being the only major concern. So my question is, was i right to turn back? I could have went further sure but do you think the extra 500m might have put me at significant risk? I ask because as it may be obvious i hadn't done that kind of thing before so would like some feedback on the call i made.

Jan Tarculas wrote: Fly to peru and bring home bags and bags full of coca leaves. They chew those leaves up non stop and all day long. It helped me up to 14K ft hiking to machu picchu without issues

Or coca tea. Great stuff for altitude. 

that guy named seb wrote:

This is probably as good a thread as any to bring this up.

I recently went to cham and while I was there I gave mont blanc a go, nothing serious just wanted to see how far I could get from the valley floor.

I went from 1200m to 4200m over about 10 hours then turned back, no acclimatization.  I had a headache, was struggling to balance and I appeared to have lost the ability to walk and think at the same time, now i wasn't exactly showing any real signs of altitude sickness the balance issue probably being the only major concern. So my question is, was i right to turn back? I could have went further sure but do you think the extra 500m might have put me at significant risk? I ask because as it may be obvious i hadn't done that kind of thing before so would like some feedback on the call i made.

whether it's disequilibrium vs ataxia is difficult to say with a self-diagnosing bias. If you feel like you made the right call, that's really all that matters. Nobody can say at 500m more, that's where you would die, but  498m you would have been fine. People suffer hace every year because they thought they'd be alright when they weren't.