deathzonescience wrote:

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 what 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!

Who knew Barry Bonds was a climber AND a doctor???!!!

jesu, joy of man's desiring wrote:How did John Muir ever get up anything without acetazolamide?

i'm no john muir, but i just walk and take my time. seems to have worked out so far.

deathzonescience wrote: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!

and it will likely end as successfully as your last trip.

You need to get higher on you acclimation hike. When I do Whitney in a day (MR), I camp at Horseshoe Meadow and hike to Cottonwood Pass. Try something like that next time.

I keep seeing this mantra:

"Myth #3 - Physical fitness protects against altitude sickness.
Physical fitness offers no protection from altitude illness. In fact, many young fit athletes drive themselves too hard at altitude prior to acclimatizing thinking they can push through the discomfort. They ignore signs of altitude illness thinking it can't affect them because they are fit and healthy. Everyone, regardless of fitness, is susceptible to AMS."

This unquantitative comment keeps working its way across the web. I would love to see the peer-reviewed, statistical study that proves "Physical fitness protects against altitude sickness" is a myth. Because you happen to see one person who appeared physically fit, but had symptoms you define as AMS, doesn't make this point statistically valid, especially if the conclusion that person was "physically fit" is unquantified. I do not trust the anecdotal comments of a few MDs.

MoapaPk wrote:I keep seeing this mantra:

"Myth #3 - Physical fitness protects against altitude sickness.
Physical fitness offers no protection from altitude illness. In fact, many young fit athletes drive themselves too hard at altitude prior to acclimatizing thinking they can push through the discomfort. They ignore signs of altitude illness thinking it can't affect them because they are fit and healthy. Everyone, regardless of fitness, is susceptible to AMS."

This unquantitative comment keeps working its way across the web. I would love to see the peer-reviewed, statistical study that proves "Physical fitness protects against altitude sickness" is a myth. Because you happen to see one person who appeared physically fit, but had symptoms you define as AMS, doesn't make this point statistically valid, especially if the conclusion that person was "physically fit" is unquantified. I do not trust the anecdotal comments of a few MDs.

I just got back from Colorado a few weeks ago...and the most physically fit one of our bunch - my 38 year old nephew Dave - is the one who had the issues with altitude sickness. When I hike with Dave in the southern Appalachians he is a horse, and we usually joke that we need to put a leash on him. That is 6K. He has been to Colorado 2X with me (08' and 14') and despite me being older, and not in as good as shape, once we hit 12K, I find myself waiting for him. Interestingly on this trip, he didn't have issues the first two days going up - made it to 12.9K on day 2 - but he developed his headaches on the way down, and at the end of the second day was pretty nauseous until he downed a ton of water at dinner - which he didn't feel like eating. On day three though - after a long 7.5 mile approach - he started getting major headaches at 12K. He was fine as long as he was resting, but once he started uphill (Class 1/2 talus) his head started pounding (and yes we turned around at 12.2K). He resolved the major headache issue on the way down though by downing a shitload of water. FWIW...

MarkDidier wrote:

MoapaPk wrote:I keep seeing this mantra:

"Myth #3 - Physical fitness protects against altitude sickness.
Physical fitness offers no protection from altitude illness. In fact, many young fit athletes drive themselves too hard at altitude prior to acclimatizing thinking they can push through the discomfort. They ignore signs of altitude illness thinking it can't affect them because they are fit and healthy. Everyone, regardless of fitness, is susceptible to AMS."

This unquantitative comment keeps working its way across the web. I would love to see the peer-reviewed, statistical study that proves "Physical fitness protects against altitude sickness" is a myth. Because you happen to see one person who appeared physically fit, but had symptoms you define as AMS, doesn't make this point statistically valid, especially if the conclusion that person was "physically fit" is unquantified. I do not trust the anecdotal comments of a few MDs.

I just got back from Colorado a few weeks ago...and the most physically fit one of our bunch - my 38 year old nephew Dave - is the one who had the issues with altitude sickness. When I hike with Dave in the southern Appalachians he is a horse, and we usually joke that we need to put a leash on him. That is 6K. He has been to Colorado 2X with me (08' and 14') and despite me being older, and not in as good as shape, once we hit 12K, I find myself waiting for him. Interestingly on this trip, he didn't have issues the first two days going up - made it to 12.9K on day 2 - but he developed his headaches on the way down, and at the end of the second day was pretty nauseous until he downed a ton of water at dinner - which he didn't feel like eating. On day three though - after a long 7.5 mile approach - he started getting major headaches at 12K. He was fine as long as he was resting, but once he started uphill (Class 1/2 talus) his head started pounding (and yes we turned around at 12.2K). He resolved the major headache issue on the way down though by downing a shitload of water. FWIW...

Maybe this story does not dissprove "Myth #3" but it proves the commonly accepted wisdom that you should properly hydrate at altitude.

MarkDidier wrote:

MoapaPk wrote:I keep seeing this mantra:

"Myth #3 - Physical fitness protects against altitude sickness.
Physical fitness offers no protection from altitude illness. In fact, many young fit athletes drive themselves too hard at altitude prior to acclimatizing thinking they can push through the discomfort. They ignore signs of altitude illness thinking it can't affect them because they are fit and healthy. Everyone, regardless of fitness, is susceptible to AMS."

This unquantitative comment keeps working its way across the web. I would love to see the peer-reviewed, statistical study that proves "Physical fitness protects against altitude sickness" is a myth. Because you happen to see one person who appeared physically fit, but had symptoms you define as AMS, doesn't make this point statistically valid, especially if the conclusion that person was "physically fit" is unquantified. I do not trust the anecdotal comments of a few MDs.

I just got back from Colorado a few weeks ago...and the most physically fit one of our bunch - my 38 year old nephew Dave - is the one who had the issues with altitude sickness. When I hike with Dave in the southern Appalachians he is a horse, and we usually joke that we need to put a leash on him. That is 6K. He has been to Colorado 2X with me (08' and 14') and despite me being older, and not in as good as shape, once we hit 12K, I find myself waiting for him. Interestingly on this trip, he didn't have issues the first two days going up - made it to 12.9K on day 2 - but he developed his headaches on the way down, and at the end of the second day was pretty nauseous until he downed a ton of water at dinner - which he didn't feel like eating. On day three though - after a long 7.5 mile approach - he started getting major headaches at 12K. He was fine as long as he was resting, but once he started uphill (Class 1/2 talus) his head started pounding (and yes we turned around at 12.2K). He resolved the major headache issue on the way down though by downing a shitload of water. FWIW...

I recommend he take Diamox next time.

mstender wrote:

MarkDidier wrote:

MoapaPk wrote:I keep seeing this mantra:

"Myth #3 - Physical fitness protects against altitude sickness.
Physical fitness offers no protection from altitude illness. In fact, many young fit athletes drive themselves too hard at altitude prior to acclimatizing thinking they can push through the discomfort. They ignore signs of altitude illness thinking it can't affect them because they are fit and healthy. Everyone, regardless of fitness, is susceptible to AMS."

This unquantitative comment keeps working its way across the web. I would love to see the peer-reviewed, statistical study that proves "Physical fitness protects against altitude sickness" is a myth. Because you happen to see one person who appeared physically fit, but had symptoms you define as AMS, doesn't make this point statistically valid, especially if the conclusion that person was "physically fit" is unquantified. I do not trust the anecdotal comments of a few MDs.

I just got back from Colorado a few weeks ago...and the most physically fit one of our bunch - my 38 year old nephew Dave - is the one who had the issues with altitude sickness. When I hike with Dave in the southern Appalachians he is a horse, and we usually joke that we need to put a leash on him. That is 6K. He has been to Colorado 2X with me (08' and 14') and despite me being older, and not in as good as shape, once we hit 12K, I find myself waiting for him. Interestingly on this trip, he didn't have issues the first two days going up - made it to 12.9K on day 2 - but he developed his headaches on the way down, and at the end of the second day was pretty nauseous until he downed a ton of water at dinner - which he didn't feel like eating. On day three though - after a long 7.5 mile approach - he started getting major headaches at 12K. He was fine as long as he was resting, but once he started uphill (Class 1/2 talus) his head started pounding (and yes we turned around at 12.2K). He resolved the major headache issue on the way down though by downing a shitload of water. FWIW...

Maybe this story does not dissprove "Myth #3" but it proves the commonly accepted wisdom that you should properly hydrate at altitude.

Theoretically, a good point, but...Dave hydrated well all three days on the way up, but only had issues on day 3 on the way up. He did realize by day 3 that he wasn't hydrating properly on the way down...thus the good result on the descent on day 3 when he drank a shitload on the way down. Also, I rarely hydrate properly...generally drinking far less than I should, but fortunately haven't had AMS issues. Yeah, hydrating is important, but still, some people are more susceptible to AMS than others...and obviously have to be more proactive about managing it (BTW.. I have friends that live in Tempe. When I get back out there would love to hit Four Peaks or the Superstitons again!)

Actually, I DO remember a study years back when gym-type (treadmill, rowing machine) tests were done at several altitudes, and folks were required to be tested for VO2, etc.

Hypoxico Altitude Training tents are another option for those who don't have days to waste sitting around a high camp acclimatizing. I'm looking into getting one of their tents to toy with. http://www.hypoxico.com/products/portable-bed-tent/

There are too many factors contributing to symptoms.

Physical fitness factor may actually have a lot to do with getting or not altitude sickness but not just alone. There are more factors that play a role (check my function above). I’ve seen many strong people of various fitness and sport categories who collapsed or had a very hard time to summit a 14K. Based on my observation long distance runner may perform better than others, perhaps due to their mental strength beside endurance.

High altitude “sport” is a separate discipline and may knock out anyone at any time, simply because a person go too fast or carry to heavy backpack or spent too much time at certain (too high) elevation feeling strong at that moment (just an example). The high altitude is a beast that can patiently wait and attack the victim in the least expected moment. Not right away but over night or the next day when it is already too late for any prevention; when one just have to deal with it. A person may be very lucky developing and noticing symptoms at early stage of climbing and then taking proper steps. In some cases if a person is strong mentally may reduce and even eliminate the symptoms; in the other extremes people just die. And yes on 14,000 feet mountains too.

As of drinking water, I usually drink 1 liter (max 2) in between camps.

I don’t take any medicine! Just energy drinks

After having a longer break (several months) in climbing 14K my first attempt may be difficult and due to, as I call it, my “laziness” I give up the summit. Couple weeks later, I usually have no problem.

One time, however, I challenged my “laziness” to see what would have happened if I ignore it and force myself to continue. Here is the answerer:
Mountaineering Experiment--Facing HAPE on 14K peak?

Well, I like to have my own study - firsthand experience.

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.

Hydration, conditioning, elevation gain... all of those can be "administered" with objectivity to benefit minimizing AMS on any level... from mild headaches and insomnia to full blown HAPE/HACE. It seems most of us agree on those points. But, whenever the subject of drugs is mentioned, look out!

I did almost all of the above for some 20 years and still suffered mild headaches and insomnia the first day or two. I say "almost" because I'd go from sea level by vehicle, then park at trailheads anywhere from 5 to 9 thousand feet, and finally summit over passes from 11 to 12.5 all on day-one. I did not have the time then, nor the patience now, to go slower... kind of like a kid running into a toy store without any budget. I used to car camp at the trailhead, but I found no benefit and now have the resources to spend a night of sound sleep at the Dow Villa the night before (add "well rested" to the list of AMS preventatives). But one addition to the list of preventatives 10 years ago eliminated the annoying headache and provided a better night's sleep day-one, and that addition is Diamox. I've found 125mg every 12 hours works from me. For others it might take more or less, everyone can figure that out on their own in addition to consulting a physician beforehand. I start dosing the day before and continue dosing the first 24 hours on trail. I don't need a study to convince me.

As I've aged, I've added ibuprofen to my on-trail pharmaceuticals checklist. Not for AMS, but for my knees and low back. If I could only take one of those two drugs these days, I'd have to leave out the Diamox. That's called "getting older"... maybe I should add human growth hormone next?

I found this article interesting...
http://www.ncbi.nlm.nih.gov/pmc/article ... 7-0053.pdf

The only altitude effects I've suffered is lethargy and digestive/bowel issues, and dehydration. I figure dehydration prob caused the first two. I really like the Camelback elixir electrolyte tabs. I sweat like a hooker in church so I use those to keep my balances in line. Otherwise I cramp like a beast. Other than that, never had the more common altitude issues.....knock on wood. Living at 5k prob helps a bit.