I'm slowly coming to terms with the possibility that technical routes above about 12000' are not realistic for me. Despite my best attempts at acclimatization, usually by 13000' I'm moving extremely slowly. Scrambling and snow-climbing seems to work out, if I schedule enough time .. but I can't imagine trying to lead, say, 5.7 feeling like that.
I've read that the autonomic nervous system is routed through the upper spinal cord, above T6 (my injury is somewhere below C4). I wonder if control of heart rate / breathing at altitude is somewhat compromised. I don't seem to have a problem at lower elevations, but am somewhat weaker than I used to be. Maybe altitude simply exaggerates this..
The first thought I had was diamox, but I wonder if that would really help .. AMS is not a problem, sluggishness is.
On a related note, do people find that they have to downgrade their lead level for altitude ? Let's say you lead 5.10a at the crags .. do you prefer to lead 1 or 2 levels down in the mountains ?