Cool Link on Altitude Related Illness

[Thinker]

web page

[b-rock]

Cool link. Didn't know Diamox was a Sulfa drug, which I'm allergic to.

[Norman_Clyde]

This is a little off subject, but I'm curious how many of you have taken Diamox in order to prevent AMS. I've prescribed the stuff but never felt the need to take it. I have also had a few mostly sleepless nights at high camp on the WA volcanos. To me this is just part of the experience, and I'd have to feel sicker before actually taking anything, but I do wonder if I'd feel a lot stronger on summit day if I took a pill. Anybody who has tried high camp with and without Diamox who can put in their 2 cents?

[Thinker]

I climbed Rainier with a lady who had tried to summit 4 or 5 times previously, but was turned around due to altitude problems. She took Diamox the time I climbed with her and performed reasonably well. I didn't query her too much about the drug, but it made an obvious difference for her.

 

The major difference is that she had a history of pretty severe symptoms that prevented her from completing the climb....for what that's worth.

[catbirdseat]

The last time I climbed Rainier I was having yet another sleepless night in Muir Hut. I took a single 125 mg Diamox tablet at 2 am and almost immediately was able to fall asleep. I wish that I had taken it when I went to bed. I did not notice any side effects. I forgot to take another on the summit, figuring that I was "over the hump" anyway.

[ChrisT]

I experienced altitude sickness at 12,000' in the Sierras - splitting headache and nausea. Took a couple of advil, retired to my tent and felt much better in the morning.

[skyclimb]

People, Rainier is low altitude. In the scheme of things 14 isn't that high. Diamox shouldn't be used unless weeks of sleepness occur. Two nights isn't going to warrent taking pills. This is a last resort for high altitude 20+. Taking pills is another form of CHEATING. Don't lessen the experience through false means of power. Sleep is great. But deprivation is greater. A week without sleep, and there is a problem.

Acclimization can be increased by either leap frogin' or just plain increasing your endurance which allows more oxygen in, which penetrates the blood, and circulation increases, which will eliminate this problem. Don't settle for Diamox or alternatives, which are even more risky.

[skyclimb]

catbirdseat, don't ever take D and then go higher without continuing to taking it. This is how people die. You think you are "over the hump", and then the symptoms return at 14 instead of 10,500 and eliminate you. Be smart if you are going to take pills. Very risky business.

[Attitude]

skyclimb said:

People, Rainier is low altitude. In the scheme of things 14 isn't that high. Diamox shouldn't be used unless weeks of sleepness occur. Two nights isn't going to warrent taking pills. This is a last resort for high altitude 20+. Taking pills is another form of CHEATING. Don't lessen the experience through false means of power. Sleep is great. But deprivation is greater. A week without sleep, and there is a problem.

Acclimization can be increased by either leap frogin' or just plain increasing your endurance which allows more oxygen in, which penetrates the blood, and circulation increases, which will eliminate this problem. Don't settle for Diamox or alternatives, which are even more risky.

This is complete gibberish.

[Montana_Climber]

b-rock said:

Cool link. Didn't know Diamox was a Sulfa drug, which I'm allergic to.

 

It is a sulfa moiety but it is one that most people can tolerate even when they are allergic to true sulfa drugs like a TMP/SXT combination.

 

If you were interested in finding out if you were allergic, you could take about a quarter of a 125 mg pill. If you felt flushed, had any hives develop, or felt a constriction of your throat, then it wouldn't be advised to try it again. This is also something you would want to do at your home and not test it on the mountain.

 

 

Diamox (acetozolamide) is a diuretic. How it actually helps you with altitude sickness is not completely known. [i haven't read the link yet so I don't know how much of this is repeat] It is believed to have its greatest effects by allowing a climber to sleep better. This allows for the body to adjust to the conditions more easily and utilize the oxygen present more efficiently. Therefore, it should be taken at nighttime, before going to bed. Since it is a diuretic, the last water consumed should be done at least one hour before bedtime and a last trip to the pee hole is usually necessary to keep you from making several more trips throughout the night.

[Montana_Climber]

skyclimb said:

catbirdseat, don't ever take D and then go higher without continuing to taking it. This is how people die. You think you are "over the hump", and then the symptoms return at 14 instead of 10,500 and eliminate you. Be smart if you are going to take pills. Very risky business.

 

Not necessarily true. Just because you start it doens't mean that you must continue to take it. It doesn't actually relieve any symptoms per se like an aspirin would do for a headache. The best medicines on the mountain are proper hydration, proper sustenance, and proper rest. When one of these is lacking, an alternative like Diamox may be able to help restore it. In a case like lack of rest, one may feel terrible by the day's end. If Diamox is taken that night and the climber can get a good night's sleep, they should be able to recover as long as there isn't a more serious problem like HAPE. If the next day is easy and the climber continues to get good sleep, Diamox is no longer needed, even if continuing much higher up a mountain.

[Dru]

Attitude said:

skyclimb said:

People, Rainier is low altitude. In the scheme of things 14 isn't that high. Diamox shouldn't be used unless weeks of sleepness occur. Two nights isn't going to warrent taking pills. This is a last resort for high altitude 20+. Taking pills is another form of CHEATING. Don't lessen the experience through false means of power. Sleep is great. But deprivation is greater. A week without sleep, and there is a problem.

Acclimization can be increased by either leap frogin' or just plain increasing your endurance which allows more oxygen in, which penetrates the blood, and circulation increases, which will eliminate this problem. Don't settle for Diamox or alternatives, which are even more risky.

This is complete gibberish.

 

Diamox is aid

[salbrecher]

skyclimb said:

People, Rainier is low altitude. In the scheme of things 14 isn't that high. Diamox shouldn't be used unless weeks of sleepness occur. Two nights isn't going to warrent taking pills. This is a last resort for high altitude 20+. Taking pills is another form of CHEATING. Don't lessen the experience through false means of power. Sleep is great. But deprivation is greater. A week without sleep, and there is a problem.

Acclimization can be increased by either leap frogin' or just plain increasing your endurance which allows more oxygen in, which penetrates the blood, and circulation increases, which will eliminate this problem. Don't settle for Diamox or alternatives, which are even more risky.

Right on skyclimb

[Dean_Neumann]

I would like to disagree with the assertion that Rainier is too low an altitude to warrant taking something for AMS.

I have been on Rainier 3 times by three different routes, and one of those times I developed a high altitude cough and shortness of breath at rest, so I took Diamox and rested an extra day at miur, and could climb much stronger the next day than on the previous two climbs.

It worked very quickly for me, and allowed me to recover within 12 hours to feeling better than I did on either of the previous climbs.

[lummox]

Dean_Neumann said:

I would like to disagree with the assertion that Rainier is too low an altitude to warrant taking something for AMS.

I have been on Rainier 3 times by three different routes, and one of those times I developed a high altitude cough and shortness of breath at rest, so I took Diamox and rested an extra day at miur, and could climb much stronger the next day than on the previous two climbs.

It worked very quickly for me, and allowed me to recover within 12 hours to feeling better than I did on either of the previous climbs.

chill out with the drug use in muir hut. that shit ain't cool.

[minx]

skyclimb said:

People, Rainier is low altitude. In the scheme of things 14 isn't that high. Diamox shouldn't be used unless weeks of sleepness occur. Two nights isn't going to warrent taking pills. This is a last resort for high altitude 20+. Taking pills is another form of CHEATING. Don't lessen the experience through false means of power. Sleep is great. But deprivation is greater. A week without sleep, and there is a problem.

Acclimization can be increased by either leap frogin' or just plain increasing your endurance which allows more oxygen in, which penetrates the blood, and circulation increases, which will eliminate this problem. Don't settle for Diamox or alternatives, which are even more risky.

 

sleep deprivation is a dangerous thing. this is one way to ensure that you're not functioning at your best. lack of sleep diminishes the ability to make rational decisions and function at your best physically. Weeks of sleep deprivation before you seek help for it? i hope you're joking. Cults only strive for 4-5 nights of sleep deprivation before they feel they can reasonably exert mind control.

 

as for the physiology, i'm sure there is someone here more qualified than i to address that.

[fern]

my understanding is that the autonomic breathing function is triggered by CO2 saturation in the blood. When CO2 levels are low breathing rate is suppressed. This is why you can pass out after hyperventilating. If you do rapid heavy inhale/exhale for a few seconds you load up on Oxygen which is good, but you blow off all the CO2 in your blood, so your body concludes it doesn't need to take another breath for a while. The oxygen you've loaded gets used up but it takes a while for the CO2 to move into the blood to trigger another breath and in the mean time you pass out.

 

Sleeping at high altitude the same thing can occur, your breathing rate is slow because you are resting, each breath brings in only a little oxygen and your CO2 levels rise until you start gasping for air, but the gasping interval blows off all the CO2 and so your breathing shuts off, even though you haven't take in much oxygen because there isn't much in the air to begin with. So you don't sleep well. Diamox works (in a way that I can't remember) with the CO2 side of things, to help re-establish a sensible autonomic breathing schedule.

 

If you are not sleeping though, you can help yourself drug-free by consciously breathing hard, fast and deep. I found that my instinct was to try to calm my breathing but I would just get really lethargic and slow. Once I started forcing my breathing I felt way more capable and strong.

 

Rainier is not a very high mountain, but taking drugs so that you can fit it into a weekend trip without feeling like crap is to me a weird sense of priorities about mountaineering.

 

edit to add that this is not my field of study and if anyone has contradictory info I would like to be corrected

Edited April 4, 2003 by fern

[skyclimb]

minx said:

skyclimb said:

People, Rainier is low altitude. In the scheme of things 14 isn't that high. Diamox shouldn't be used unless weeks of sleepness occur. Two nights isn't going to warrent taking pills. This is a last resort for high altitude 20+. Taking pills is another form of CHEATING. Don't lessen the experience through false means of power. Sleep is great. But deprivation is greater. A week without sleep, and there is a problem.

Acclimization can be increased by either leap frogin' or just plain increasing your endurance which allows more oxygen in, which penetrates the blood, and circulation increases, which will eliminate this problem. Don't settle for Diamox or alternatives, which are even more risky.

 

sleep deprivation is a dangerous thing. this is one way to ensure that you're not functioning at your best. lack of sleep diminishes the ability to make rational decisions and function at your best physically. Weeks of sleep deprivation before you seek help for it? i hope you're joking. Cults only strive for 4-5 nights of sleep deprivation before they feel they can reasonably exert mind control.

 

as for the physiology, i'm sure there is someone here more qualified than i to address that.

 

If you can't sleep on a mountain there is a problem. Taking drugs doesn't fix it. Learn your body, and your mind to be safe. Learn the remedies to prevent serious problems. Maybe someday you will loose your pills while emersed in an epic. WHAT THEN????

I am all for popping pills for fun, but when climbing don't open yourself up to mistakes.

[Montana_Climber]

fern said:

my understanding is that the autonomic breathing function is triggered by CO2 saturation in the blood.

 

Sleeping at high altitude the same thing can occur, your breathing rate is slow because you are resting, each breath brings in only a little oxygen and your CO2 levels rise until you start gasping for air, but the gasping interval blows off all the CO2 and so your breathing shuts off, even though you haven't take in much oxygen because there isn't much in the air to begin with. So you don't sleep well. Diamox works (in a way that I can't remember) with the CO2 side of things, to help re-establish a sensible autonomic breathing schedule.

 

 

You are correct in saying that the body is controlled by CO2. There are receptors in the medulla that react to CO2 levels. They also react to O2 and H+ levels but no where near the same as they react to CO2.

 

At first, with decreased oxygen available, the body's stores of CO2 increase until the blood is acidic (respiratory acidosis). In turn, the brain stimulates breathing so that you blow off a great deal of CO2. This is a compensatory mechanism.

 

Diamox is a carbonic anhydrase inhibitor (blocks the formation of carbonic acid) and is a bicarbonate sink. This helps bring down the increased concentration of HCO3- that has developed due to ridding the body of all the CO2. This balancing of the CO2 and HCO3- allows the body to reduce the stresses it is placed under. This is one possible mechanism of the benefits of this drug.

[Norman_Clyde]

Rainier may not be high altitude compared to the Himalayas or Denali, but I wager that more American climbers get AMS on Rainier than on all other world mountains combined, because so many more people climb Rainier. So Rainier is pertinent to this discussion.

 

Normal respiration is driven not by low oxygen, but by high CO2 in the blood. When you hold your breath and your lungs want to burst, it is the CO2 buildup that feels bad. Low oxygen doesn't hurt, it just makes you suddenly get dizzy and pass out. People pass out from hyperventilating because blood flow to the brain is also CO2 driven, so when you lower blood CO2, you simultaneously reduce cerebral blood flow. You can reduce perfusion till you pass out, if you try really hard. Also, if you hyperventilate for so long that you have no respiratory drive, then you stop hyperventilating and forget to breathe for 2 minutes, you might pass out from lack of oxygen, but this would be even harder to accomplish.

At altitude, normal breathing doesn't give you enough oxygen, and I believe that your breathing gets driven at least partially by hypoxia. You have to breathe faster to get enough O2, which reduces your blood CO2 levels. This throws off your blood pH, and also the interplay between CO2 drive and hypoxic drive probably is part of what leads to the periodic breathing of altitude, so called Cheyne Stokes respirations, where your respiratory rate varies at rest. Diamox increases the dissolved CO2 in your blood by inhibiting excretion of bicarbonate in your urine, thereby balancing your CO2 a little bit. This seems to help correct the periodic breathing. Also, adaptation to altitude involves peeing off extra fluid, for unknown reasons, so taking a diuretic is helpful maybe just because you pee more when you take it.

[lummox]

dealing with lack of oxygen is why you train with bong loads cannon balled with olde 800. and that fuzzy lightheaded feeling get real familiar, too.

[erik]

lummox said:

dealing with lack of oxygen is why you train with bong loads cannon balled with olde 800. and that fuzzy lightheaded feeling get real familiar, too.

 

dont forget the mandatory 2 hour run immediatly after the sesh!

 

[lummox]

erik said:

lummox said:

dealing with lack of oxygen is why you train with bong loads cannon balled with olde 800. and that fuzzy lightheaded feeling get real familiar, too.

 

dont forget the mandatory 2 hour run immediatly after the sesh!

 

naw. the run around the block to the liquor stor comes before the b loads.

[Attitude]

Norman_Clyde said:

Also, adaptation to altitude involves peeing off extra fluid, for unknown reasons, so taking a diuretic is helpful maybe just because you pee more when you take it.

Oversimplifying, your oxygen saturation initially is lower at altitude than at sea level, lowering the amount of oxygen per liter of blood. So the body initially compensates by lowering the plasma volume, therefore raises the hematocrit and the amount of oxygen per liter of blood.

[Norman_Clyde]

It's true that diuresis/dehydration will raise your hematocrit, but i don't think this is the mechanism for acclimatization. Just having a higher hematocrit due to a lower blood volume will not improve oxygen delivery. You need a higher total body red cell mass to do this, which takes a few days at least. It is likely that at least some of the AMS symptoms are due to a mild degree of brain swelling, basically the near end of the spectrum with the far end being cerebral edema. Recovery from AMS symptoms, i.e. acclimatization, is often associated with a significant diuresis (volume loss through increased urination). I believe that the reasons for this are still unclear.

 

Even if you're hoping to pee off extra liquid, you should not seek to correct your fluid "imbalance" by restricting fluids on a climb. Better to drink as much as possible, and sleep with a pee bottle so you won't have to get all the way up. A Nalgene bottle dedicated to the purpose is wide enough at the mouth that women can use them without accidents. (I've seen it work.)