funnyman7878 wrote:thanks for the replies. So, I can gather that what I did was not a proper or sufficient acclimatization procedure. Next time I will sleep somewhere around 11000-12000, preferably for a day or two if i'm going to summit at 14000.

Inaccurate conclusion.

Better: In addition to camping at (e.g. 7,000 feet.... would be a better approach. However, it’s possible that you may always have problem with altitude. There is no one formula, too many factors to consider.

Everyone here is right even though somewhat different; again, there are too many factors to simplify. Try various ways and see what works for you best. Proper acclimatization is obviously the best prevention but what proper for one person may not be enough for you.

For example, a few times a year I climb 14+ in a day with only a few hours of sleep at the TH at 7? and have no issue with the altitude. However, if I do overnight trip and push too much on the first day, I may have some problem later. Therefore, I always tell people: Take it easy on the first day. Unfortunately, some people who think they are full of energy go too fast and/or do crazy (physical) stuff at the base camp and usually collapse the next day. It takes about 24-48 hours before you may get really hit.

Try diamox 250mg PO bid for rapid ascent. Many of us don't have the luxury of time spending extra days or weeks to acclimatize and/or live near sea level, diamox can help minimize the symptoms of AMS in these situations.

For potentiality of getting high altitude symptoms, its severity or even death, I would write a simplified recursive formula which would have to be run once a (new) day or even every time a person starts feeling changes in symptoms or their severity.

Code: Select all

Function HighAltitudeSicknessSeverity ("starting elevation", "elevation gain", "time duration", "physical effort", "food quality intake", "physical strength", "mental strength", "level of ignorance") {

  . . .

  return "symptoms severity";
}

I did not include "acclimatization level" because it’s incorporated in the function.

The function does not include any medicine or you may include it in the "food quality intake".

The "elevation gain" and "time duration" may be the same but the "physical effort" different depend on factors such as pace and frequency and length of rests as well as "food quality intake" but not limited to.

The "elevation gain" may be negative as well.

However, some of these arguments such as "physical strength" and "mental strength may have contradictory effects, depend on their use; therefore, I included the "level of ignorance" which contributes to monitoring and adjusting (or not) factors such as "elevation gain", "time duration", "physical effort" and "food quality intake" to lower or avoid the symptoms and their severity.

Too strong mentality combined with chosen ignorance level (e.g. summit fever) may lead to catastrophic exhortation. Sometimes there is no choice but to continue climbing up to get to the "safer" exit point. Sometimes there is nothing anymore a person can do (e.g. to lower the elevation) but die.

At least this is the basic algorithm I use while climbing. The problem is we usually have to or want to push ourselves in order to accomplish the task.

Good luck or rather Climb Safe!

MoapaPk wrote:There is huge variation among individuals. Many times I have gone from sleeping at ~4000' in the Owens Valley, up to 13-14k' the next day. I live close to some 11-12k' mountains, and usually can go up one of those 3 days before a Sierra trip. I still think most preparation is mental; one learns to balance every possible move (that might be easy at sea level) against the incremental exhaustion that move will cause later in the day.

Almost any aerobic conditioning beforehand will help. But many people overestimate their conditioning. I used to lead trips, and would ask in the sign-up process, "are you in good cardiovascular condition?" Invariably people said "yes." So I put in a menu: "can you do one of these things?" The list included a few local hikes, with modest time limits, and these two:
-You can run 4 miles in 40 minutes; OR
-At the gym, you can go 30 minutes on an elliptical trainer set at 20% incline and intermediate resistance; or you can walk on a treadmill set at 15% incline and 3 mph, for 30 minutes.

A lot of folks who claimed to be in good condition, also reported they could do none of the things on the list.

That list should be the minimum physical requirements. I can do those with ease and still sometimes feel worked depending on the terrain/load being carried.

the most important factor for me is constant and frequent exposure to altitude. looking at my stats, over the last six months, my last 26 summits have all been over 10,000' elevation, and i've never gone more than 2 or 3 weeks without being over 10,000'. which certainly helps explain why i did not feel the altitude at all on my t/w trip.

i took my gf to do whitney this year, and we acclimatized in onion valley immediately prior. we saw literally a half dozen people - all dayhikers - on the whitney trail that were either throwing up, or bent over getting ready to, or just plain looking half dead staggering down the trail. my gf struggled a little bit the last ~800' or so, but it was her first 14er, and we took a couple breaks and she easily made it. it really put things into perspective for her, how relatively easy the trip had been for her with proper acclimatization.

(deleted, just muddying the waters)

bscott wrote:the most important factor for me is constant and frequent exposure to altitude. looking at my stats, over the last six months, my last 26 summits have all been over 10,000' elevation, and i've never gone more than 2 or 3 weeks without being over 10,000'. which certainly helps explain why i did not feel the altitude at all on my t/w trip.

i took my gf to do whitney this year, and we acclimatized in onion valley immediately prior. we saw literally a half dozen people - all dayhikers - on the whitney trail that were either throwing up, or bent over getting ready to, or just plain looking half dead staggering down the trail. my gf struggled a little bit the last ~800' or so, but it was her first 14er, and we took a couple breaks and she easily made it. it really put things into perspective for her, how relatively easy the trip had been for her with proper acclimatization.

Frequency is very key....good point. I think the rough figure is 2 weeks to lose acclimatization for the average human. Obviously, the longer you're at altitude the more your body makes semi/permanent changes to blood cell count and lung function. It's a fascinating subject for sure.

deathzonescience wrote:Try diamox 250mg PO bid for rapid ascent. Many of us don't have the luxury of time spending extra days or weeks to acclimatize and/or live near sea level, diamox can help minimize the symptoms of AMS in these situations.

whatever you do, don't do this.

bscott wrote:

deathzonescience wrote:Try diamox 250mg PO bid for rapid ascent. Many of us don't have the luxury of time spending extra days or weeks to acclimatize and/or live near sea level, diamox can help minimize the symptoms of AMS in these situations.

whatever you do, don't do this.

Placebo-controlled clinical trials have shown that prophylactic administration of DIAMOX at a dose of 250 mg every eight to 12 hours (or a 500 mg controlled release capsule once daily) before and during rapid ascent to altitude results in fewer and/or less severe symptoms of acute mountain sickness (AMS) such as headache, nausea, shortness of breath, dizziness, drowsiness, and fatigue. Pulmonary function (e.g., minute ventilation, expired vital capacity, and peak flow) is greater in the DIAMOX treated group, both in subjects with AMS and asymptomatic subjects. The DIAMOX treated climbers also had less difficulty in sleeping.

deathzonescience wrote:

bscott wrote:

deathzonescience wrote:Try diamox 250mg PO bid for rapid ascent. Many of us don't have the luxury of time spending extra days or weeks to acclimatize and/or live near sea level, diamox can help minimize the symptoms of AMS in these situations.

whatever you do, don't do this.

Placebo-controlled clinical trials have shown that prophylactic administration of DIAMOX at a dose of 250 mg every eight to 12 hours (or a 500 mg controlled release capsule once daily) before and during rapid ascent to altitude results in fewer and/or less severe symptoms of acute mountain sickness (AMS) such as headache, nausea, shortness of breath, dizziness, drowsiness, and fatigue. Pulmonary function (e.g., minute ventilation, expired vital capacity, and peak flow) is greater in the DIAMOX treated group, both in subjects with AMS and asymptomatic subjects. The DIAMOX treated climbers also had less difficulty in sleeping.

first of all, you're not a physician, so you should not be recommending dosage levels and times.

but more importantly, you cherry pick one study that you believe supports your position. unfortunately, it does not. while i'm awfully impressed with your ability to copy/paste data from drugs.com, diamox has a narrow use, and this discussion (the op's original question) does not qualify under either of the two criteria for which diamox is recommended. the authority on climbing, the UIAA, clearly and unequivocally state that drugs should be avoided and a proper acclimatization schedule should be followed.

diamox has a host of issues with it, among them the fact that it may not be as effective as previously thought (you have a roughly 14% chance of benefiting from diamox assuming you take the dosage you recommended - tripling the dosage you suggest merely increases the chance of aid to 20%). people taking diamox suffer a larger drop in Spo2 under exercise stress than those not on it, and they also report decreased exercise performance at altitude. add in the fact that diamox is a diuretic, which goes against the common wisdom of staying hydrated to help acclimatize. oh, and lets not forget numb or tingling extremities. and kidney stones.

but hey, you wanna keep farking that diamox chicken, go right ahead.

ps. you know what else results in fewer and/or less severe symptoms of acute mountain sickness (AMS) such as headache, nausea, shortness of breath, dizziness, drowsiness, and fatigue? prophylactic ibuprofen.

NOTE: anyone who would like copies of some of the studies that involve the discussion at hand, feel free to PM me and i can send you copies.

bscott wrote:

deathzonescience wrote:

bscott wrote:

deathzonescience wrote:Try diamox 250mg PO bid for rapid ascent. Many of us don't have the luxury of time spending extra days or weeks to acclimatize and/or live near sea level, diamox can help minimize the symptoms of AMS in these situations.

whatever you do, don't do this.

Placebo-controlled clinical trials have shown that prophylactic administration of DIAMOX at a dose of 250 mg every eight to 12 hours (or a 500 mg controlled release capsule once daily) before and during rapid ascent to altitude results in fewer and/or less severe symptoms of acute mountain sickness (AMS) such as headache, nausea, shortness of breath, dizziness, drowsiness, and fatigue. Pulmonary function (e.g., minute ventilation, expired vital capacity, and peak flow) is greater in the DIAMOX treated group, both in subjects with AMS and asymptomatic subjects. The DIAMOX treated climbers also had less difficulty in sleeping.

first of all, you're not a physician, so you should not be recommending dosage levels and times.

but more importantly, you cherry pick one study that you believe supports your position. unfortunately, it does not. while i'm awfully impressed with your ability to copy/paste data from drugs.com, diamox has a narrow use, and this discussion (the op's original question) does not qualify under either of the two criteria for which diamox is recommended. the authority on climbing, the UIAA, clearly and unequivocally state that drugs should be avoided and a proper acclimatization schedule should be followed.

diamox has a host of issues with it, among them the fact that it may not be as effective as previously thought (you have a roughly 14% chance of benefiting from diamox assuming you take the dosage you recommended - tripling the dosage you suggest merely increases the chance of aid to 20%). people taking diamox suffer a larger drop in Spo2 under exercise stress than those not on it, and they also report decreased exercise performance at altitude. add in the fact that diamox is a diuretic, which goes against the common wisdom of staying hydrated to help acclimatize. oh, and lets not forget numb or tingling extremities. and kidney stones.

but hey, you wanna keep farking that diamox chicken, go right ahead.

ps. you know what else results in fewer and/or less severe symptoms of acute mountain sickness (AMS) such as headache, nausea, shortness of breath, dizziness, drowsiness, and fatigue? prophylactic ibuprofen.

NOTE: anyone who would like copies of some of the studies that involve the discussion at hand, feel free to PM me and i can send you copies.

Acetazolamide prevents AMS when taken before ascent and speeds recovery if taken after symptoms develop. The drug works by acidifying the blood, which causes an increase in respiration rate and thus aids acclimatization. An effective adult dose that minimizes common side effects of increased urination and paresthesias of the fingers and toes is 125-250 mg every 12 hours, beginning the day before ascent and continuing the first 2 days at altitude, or longer if ascent continues.

p.s. I am a board certified physician, are you? Didn't think so...... but, always seek the medical advice from your own physician before taking new medications.

deathzonescience wrote:
Acetazolamide prevents AMS when taken before ascent and speeds recovery if taken after symptoms develop. The drug works by acidifying the blood, which causes an increase in respiration rate and thus aids acclimatization. An effective adult dose that minimizes common side effects of increased urination and paresthesias of the fingers and toes is 125-250 mg every 12 hours, beginning the day before ascent and continuing the first 2 days at altitude, or longer if ascent continues.

the studies, in general, do not support your position.

deathzonescience wrote:
p.s. I am a board certified physician, are you? Didn't think so...... but, always seek the medical advice from your own physician before taking new medications.

you clearly are not, or you would not be making the statements and suggestions you are.

bscott wrote:the studies, in general, do not support your position.

I do not really care for the personal argument this thread seems to have turned into, but out of interest, would you mind to cite the studies that do not support the position?

As for the OP, being in good shape physically seems to help but does not guarantee anything either. For me personally, I found that interval training helped which I always picked up or increased 2-3 month before going on a trip. Also, with more trips under your belt you will better learn to understand your body and the signals it is sending you as well as finding the best hiking pace for you to deal with the altitude. Some people are faster, others are slower.

mstender wrote:
I do not really care for the personal argument this thread seems to have turned into, but out of interest, would you mind to cite the studies that do not support the position?

Probably the best place to start is Kayser and Dumont's study "Reappraisal of Acetazolamide for the Prevention of Acute Mountain Sickness: A Systematic Review and Meta-Analysis".

The findings were interesting. For climbers, the NNT for the dosage suggested earlier in the thread was 6.5.

Another way of looking at this is to say you have a roughly 1 in 7 chance of receiving some sort of benefit when climbing on Diamox. What the study, which was a meta-analysis of nearly 2,000 cases in found was this: let's say you and six of your friends go hiking, and you all take Diamox. Four of you would not get AMS anyway, even if you had not taken Diamox. Two of you would get AMS anway, despite the fact that you took Diamox. And just one of you would benefit.

One important thing to note: we are talking about climbing on Diamox. We are not talking about rapid ascent via vehicle transport or air transport. There is a more noticeable benefit in those situations, and that is in fact one of the clinical indicators of Diamox usage; when a person does not have the ability to acclimatize properly because they have immediately arrived at a high altitude situation. But once you start climbing on Diamox (ie. having arrived at your high altitude starting point, you start to revert to baseline, ie. you start to lose the benefit of Diamox.

bscott wrote:

mstender wrote:
I do not really care for the personal argument this thread seems to have turned into, but out of interest, would you mind to cite the studies that do not support the position?

Probably the best place to start is Kayser and Dumont's study "Reappraisal of Acetazolamide for the Prevention of Acute Mountain Sickness: A Systematic Review and Meta-Analysis".

The findings were interesting. For climbers, the NNT for the dosage suggested earlier in the thread was 6.5.

Another way of looking at this is to say you have a roughly 1 in 7 chance of receiving some sort of benefit when climbing on Diamox. What the study, which was a meta-analysis of nearly 2,000 cases in found was this: let's say you and six of your friends go hiking, and you all take Diamox. Four of you would not get AMS anyway, even if you had not taken Diamox. Two of you would get AMS anway, despite the fact that you took Diamox. And just one of you would benefit.

One important thing to note: we are talking about climbing on Diamox. We are not talking about rapid ascent via vehicle transport or air transport. There is a more noticeable benefit in those situations, and that is in fact one of the clinical indicators of Diamox usage; when a person does not have the ability to acclimatize properly because they have immediately arrived at a high altitude situation. But once you start climbing on Diamox (ie. having arrived at your high altitude starting point, you start to revert to baseline, ie. you start to lose the benefit of Diamox.

If you don't have the luxury to sit around at base camp for a few extra days, but want to minimize AMS symptoms then try DIAMOX. I recently went from living at 300 meters to climbing to 18,000 ft in 96 hours with only minimal AMS symptoms. Some other climbers from teams we encountered had been acclimatizing several days longer, yet were stuck at base camp with AMS. Maybe it was the DIAMOX, maybe not? If you have all the time in the world then obviously use it. For many of us, it's a luxury we will never have so cutting corners is a must. My next high altitude technical peak is just over 20,000 ft. It will be a rapid ascent and I will be using DIAMOX once again and you can't stop me bscott so ha ha ha!