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rhyang wrote:Maybe I should up with the dosage to 250mg, but I wonder if acclimatization is really the problem.

Taking acetazolamide has NOTHING to do with speeding acclimatization. Totally unrelated and shouldn't even be in the same conversation. Anemia is a possibility but unlikely unless you're a vegan whacko. Sounds like more of a case of getting old and losing fitness. [Insert mandatory crossfit cures everything drivel.]

It's called getting old brother. Your comeback is amazing, and you're performing at a level thats beyond most already. Stay away from that Diamox stuff.

Regarding technical climbing. Here's a breakdown of diminishing performance that makes sense to me. Scale as necessary.

5.12- on toprope
5.11 sport onsite
5.10+ trad onsite
hard 5.9 alpine
hard 5.8 alpine with an overnight pack

5.13 and 5.14 climbers in the big moutains are often giving total effort to OS hard 10 and easier 11 pitches. Likewise M12 climbers on M6 in the mtns.

I suppose anemia is a possibility if you have some remaining internal bleeding from the accident or something like that but with the anemia I felt it all the time, not just in particular situations. I also became lightheaded and dizzy really easily (e.g., standing up too quickly after picking up something on the ground) and my blood pressure was ridiculously low. You could try B supplements in the meantime if you don't want to start iron before seeing your doctor (good idea to wait.) If you end up on iron supplements, try the high dose ferrous gluconate (it wasn't on the shelf at my pharmacy but the pharmacist had it behind the counter) and take it with some citrus...otherwise it's rough on your stomach! Good luck! Hope you figure it out.

Alpynisto wrote:Taking acetazolamide has NOTHING to do with speeding acclimatization. Totally unrelated and shouldn't even be in the same conversation.

Anybody care to quote references for that? Until I see something that proves otherwise, I will tend to believe the doctors who have actually studied the issue (such as Peter Hackett and Thomas Dietz, both of who disagree with you.)

"It has been shown to accelerate acclimatization" - Dietz

"It speeds up the acclimatization process in the body" - Hackett

brandon wrote:It's called getting old brother. Your comeback is amazing, and you're performing at a level thats beyond most already. Stay away from that Diamox stuff.

Regarding technical climbing. Here's a breakdown of diminishing performance that makes sense to me. Scale as necessary.

5.12- on toprope
5.11 sport onsite
5.10+ trad onsite
hard 5.9 alpine
hard 5.8 alpine with an overnight pack

5.13 and 5.14 climbers in the big moutains are often giving total effort to OS hard 10 and easier 11 pitches. Likewise M12 climbers on M6 in the mtns.

Ah.... Source?

I am well over 16 years older than you Brendan and just finished some solid sustained .10+ alpine at 14K with clients. Spent over 6-10 weeks last summer climbing high 10's and low 11.s Trad, consistently, at 12k and above.

I believe that ones fitness level as well as the amount of time they actually spend acclimating is so very critical.

Also, we are working with Dr. Hackett on my recent client HAPE death scenario. My situ is a clear indication, according to his studies, that there are just some folks out there that are not physiologically adaptable to high altitudes.

Rob, you may just be one of these folks.

On a side note Rob, look into Cordyceps, Guarana and Taurine. Been taking them regularly for the past five years and really feel the difference in strength, endurance and 02 capacity at 10k and above.

There is no scientific evidence that Cordyceps, Guarana and Taurine help to acclimate, however there is plenty of evidence that Diamox does.
Why don't you try some coca tea. It might be somewhat difficult to come by in California but it worked great for me in Peru.

mstender wrote:There is no scientific evidence that Cordyceps, Guarana and Taurine help to acclimate, however there is plenty of evidence that Diamox does.
Why don't you try some coca tea. It might be somewhat difficult to come by in California but it worked great for me in Peru.

There is a big difference between just "acclimating" and "performing" aerobically (technical rock/ice/alpine climbing) at altitude.

Diamox is not an aerobic supplement that assists one in this venue.

joynlife wrote:Where does one start to think of altitude as a deterent? I feel it starts at 16,000 ft. If you feel the altitude at 12,000 or 13,000 ft you are doing something wrong.

I had a client die of HAPE, onset to full P/C Arrest, in 3.2 hours at 10,800', three weeks ago.

We have had several folks have to descend immediately from 9-10K due to severe symptoms of AMS.

Sounds like it's time two ski one peak

joynlife wrote:

The Chief wrote:

joynlife wrote:Where does one start to think of altitude as a deterent? I feel it starts at 16,000 ft. If you feel the altitude at 12,000 or 13,000 ft you are doing something wrong.

I had a client die of HAPE, onset to full P/C Arrest, in 3.2 hours at 10,800', three weeks ago.

We have had several folks have to descend immediately from 9-10K due to severe symptoms of AMS.

And you as a guide should have seen on oncoming affects and had a backup guide to take them down as not to ruin the rest of the trip for the others.Some outfitters on Kilimanjaro have a main guide and usually 2 assistant guides if not 1 for this reason, on Aconcagua they usually have one head guide and one assist. Please The Chief if you have never been over 16,000 ft you really should`nt be talking about altitude, Keep the all knowning stuff to the clients of yours at the trail head and at the stream crossing rest stops.

We did have a TWO GUIDES. The Symptoms became observable were pronounced within a very short one hour time frame. We agreed on immediate descent and I was in process of assisting the client to an immediate emergency descent to below the mandatory 5K when he collapsed.

Final Official Autopsy results... C & P Arrest due to full onset of fluid in the lungs from altitude/lack of 02 intake (HAPE). Official time from onset to death, 3.2 hours. Obvious pronounced symptoms were observed only 38 minutes prior to his full collapse as he was descending. I administered CPR for 1 hour and 22 minutes before we pronounced him.

So far this season alone, 14 people have been officially evac'd in the Eastern Sierra due to severe AMS symptoms at 10-11K'.

According to Dr. Peter Hackett, HAPE & HACE can affect , become pronounced and become fatal from 8K' and above. He notified me that it is a complete misnomer within the Climbing Community that one has to be at 15K' and above to be affected by these two. Most recorded cases became pronounced at the 9-10K' level. He also advised me that I did everything by the book and this incident may be a record setter.

Anyone out there willing to play with the odds. My incident has clearly indicated that HAPE can be fatal if not attended to immediately. In this case, nothing could have been done to save this individuals life after the HAPE accelerated so quickly to the point of no return.

Hey Chief, good on ya for tooting your own horn there. We don't disagree; I was trying to provide some insight for weekend warriors, who have limited time to acclimitize, about how their ability to pull down might be affected. Couple the lack of acclimitization with the anxiety/mental discomfort inexperienced alpinists feel, and peak climbing performance drops like a rock.

Folks like yourself, with exceptional mental control, and extensive physiological adaptation to altitude, lose very little performance wise up to 5000meters or so. Hell, I've onsighted 5.9 with a 50lb pack at 21,000ft, in boots, when 11- was my OS max. But I'm a stubborn SOB, who was well acclimitized, and got lucky. Tooted my own horn a little.

In my experience, Diamox does more harm than good. Acclimitization takes as long as it takes, short for some, long for others. Physical performance suffers accordingly. Mental toughness (which Rob must have in spades!) can compensate to a point. Sometimes you have a really crappy day, and some day your number just comes up.

But hell, 'just take this pill' goes over with people a whole hell of a lot better than 'train harder, take enough time to acclimitize, demand mental fortitude from yourself.'

Brendon...

Good post and we do agree completely on the Diamox issue.

May I also add...

It is not a Guides responsibility to to prepare you physically, emotionally and mentally for your adventure when on a guided trip.

It is yours!

The Guide is only responsible to "Guide" you on your adventure. He/She guarantees absolutely nothing other than doing their best to make the trip a technically safe and enjoyable one.

If you are not physically, mentally nor emotionally ready to get on the hill, don't go!

joynlife wrote:Where does one start to think of altitude as a deterent? I feel it starts at 16,000 ft. If you feel the altitude at 12,000 or 13,000 ft you are doing something wrong.

If you don't feel the altitude at 13,000', you are either totally out of touch with your body or are a liar (unless you live that high). I live over 9,000' and notice the affects of altitude at 13,000'.

Thanks for the encouragement. I've got a blood test scheduled for Thursday, so we'll see how that turns out.

I was talking to a physical therapist friend last night, and she reminded me again how slow neurological recovery can be .. one of her patients is four months post brain injury and just now learning to sit up in bed Sometimes we all just need a little perspective ..