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toejahm
Trad climber
Chatsworth, CA
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Topic Author's Original Post - May 13, 2008 - 06:41pm PT
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I'll make this short.
Reid and I attempted Mt. Humphrey on Saturday. We made it to just over 13300, but were turned back by severe headaches and nausea. So close!
I've communicated with Brenda Powell of the Cleveland Clinic in Ohio, she specialized in High Altitude Medicine. Brenda suggested Diamox to counter the affects of rapid elevation change.
The Question.
Has anyone here tried the drug?
Any unwanted side affects?
Thanks
p.s. If I can figure out how to post a photo I'll be happy to share.
Take it easy,
KR
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bobinc
Trad climber
Portland, Or
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May 13, 2008 - 06:53pm PT
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I've always had trouble with altitude if I ascend quickly from near sea level. Tried Diamox once on a climb of Mt Hood; didn't really get teh relief I expected and it also caused some tingling/numbness of my lips and face (kinda weird). I would expect it affects others differently. The only thing that works for me is time-- a few days at intermediate altitude, etc. Using this approach I was able to function well above 15k feet years ago.
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apogee
climber
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May 13, 2008 - 06:59pm PT
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Diamox (acetazolamide) is a carbonic anhydrase inhibitor, which stimulates renal/kindey function, thereby helping to normalize ph imbalances that occur due to normal hyperventilation at altitude. It also has a stimulant effect on the respiratory drive (mostly at night, when the drive is naturally slower), which assists in the long-term acclimatization process.
It's diuretic effects will have you peeing like crazy, so be sure to chase it with plenty of water. It is a sulfa-based drug, which many people are sensitive to. One of it's curious side effects is that it will make carbonated drinks taste really bad, since you are tasting the carbon dioxide.
Edit: oh yes, it is known to make one's face and extremities tingle a bit, too.
Years ago, it was recommended to be used prophylactically (before attaining a new altitude), use it for a day or so at that new altitude, then repeat when a higher altitude is expected. The last advice I heard from Peter Hackett was to use it as needed, if symptoms appear while at altitude.
In my opinion, it's use is emphasized far more than appropriate acclimatization. For example, in the Sierra, most of the cases of altitude sickness one hears about occur on the east side, usually as a result of the 'Friday-night-Hwy 395-death-drive' to tick some weekend objective. In 10 years of leading Outward Bound mountaineering courses on the West side, and hundreds and hundreds of students, I can't think of a single case of altitude sickness in the program. This was certainly due to gradual ascent rates- no Diamox required.
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matisse
climber
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May 13, 2008 - 07:26pm PT
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what he said (except that it doesn't really stimulate kidney function-it blocks an enzymatic function that converts between bicarbonate and CO2-but close enough for discussion) . I'll only add that most people are using lower doses 125 to 250 mg twice a day or so. seems to work as well with a lower incidence of side effects.
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toejahm
Trad climber
Chatsworth, CA
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Topic Author's Reply - May 13, 2008 - 08:14pm PT
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The 395 is a mad house.
I was in LV and drove the 168 into Big Pine. (much nicer drive)
Thanks for the input everyone,
KR
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crazyfingers
climber
CA
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May 13, 2008 - 11:02pm PT
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I usually need two nights of sleep at half the final elevation in order to avoid AMS.
Times when I have gone up too fast and started feeling like DEATH, I've taken a single dose of Diamox and then felt great the remainder of the trip. I've even taken as little as half a pill and felt better.
I've never had any side effects. The warning about sun exposure does concern me though.
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summerprophet
Mountain climber
Cali Via Canada
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May 14, 2008 - 12:29am PT
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I got AMS at 18500, and have experienced altitude sickness ever since, beginning around 10000.
Daimox, for me it is the wonder drug, and here is all I can tell you about it.
Firstly, the usage has not been extensively documented for altitude sickness, but rather it is just a use for an existing drug that seems to work.
I start a dosage of 2 pills per day, a day and a half before arriving at altitude, and continue until down.
You should be aware, that if you are attempting to aclimitaze, diamox is just going to screw that up. Using the drug at altitude essentially does nothing to train your body to deal with the elevation. In my case, I am dependant upon the drug, as the AMS screws your body up for years.
The side effects include, tingling in the extremities, usually hands and feet. Strong enough to be distracting but not painful. Lots of peeing, and it actually makes carbonated drinks taste terrible, so the post climb beers are out if you are on diamox.
Make the choice if you are going to use it or not. Changing around the dosage, starting at high elevations, and starting and stopping at altitude are all to avoided. It is a medication, treat it like one.
It is not to be used as an emergency cure. If someone exhibits signs of AMS, get them down, Diamox will not help turn around AMS.
Send me an email if you need more info.
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matisse
climber
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May 14, 2008 - 12:43am PT
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Firstly, the usage has not been extensively documented for altitude sickness, but rather it is just a use for an existing drug that seems to work.
this is not true
go here:
http://www.ncbi.nlm.nih.gov/sites/entrez
search: diamox or acetazolamide and "acute mountain sickness"
read the 100+ citations
I'm generally not one to argue with personal experience but
You should be aware, that if you are attempting to aclimitaze, diamox is just going to screw that up. Using the drug at altitude essentially does nothing to train your body to deal with the elevation. In my case, I am dependant upon the drug, as the AMS screws your body up for years.
is also not true.
pubmed again:
search:
diamox or acetazolamide and "acclimatization"
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Spencer Adkisson
Trad climber
Reno, NV
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May 14, 2008 - 12:51am PT
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Kenneth, when I was a guide on Mt.Shasta we got more than our fair share of Bay Area would be climbers who came from sea level to Mt. Shasta city, and were already on the prescribed dose of Diamox. Many of them were puking in the parkinglot of the Fifth Season, and spent their trip in a tent if they went at all.
Of the entire population of climbers who were on Diamox, at least 85%, if not more were too sick to leave basecamp, due intirely to the drug. I really feel bad for them, they spent alot of time and money to have a really bad time in a tent. Diamox is not the way forward in my opinion.
I will say, that there were a handful of climbers who were not wired to handle altitude, and Diamox served them well. They trippled their water intake, and managed. But they had previous experiences at altitude, such as Killimanjaro, Aconcagua, Mt. Whitney etc. The vast majority did not fit into this category however.
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toejahm
Trad climber
Chatsworth, CA
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Topic Author's Reply - May 14, 2008 - 12:52pm PT
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Once again, thanks for various pros and cons on this issue.
I'm not one for taking a pill as an easy fix. I believe it's always better to allow the body time to adapt to a particular environment, though that makes it harder (not impossible) for higher elevation weekend trips, which is the real problem here. Maybe I need to rethink how I approach my trips! At least a few options there.
Matisse, great web site.
Huge amount of literature about acetazolamide drugs.
You noted 125 mg as a dose that worked for you. Was that taken ahead of or at the beginning of an ascent?
KR
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Majid_S
Mountain climber
Bay Area
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May 14, 2008 - 01:01pm PT
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I took Diamox at 17500 feet for a day and I hated it. it is nasty stuff. I climbed above 20,000 feet without it and had no problem.
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Doug Robinson
Trad climber
Santa Cruz
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May 14, 2008 - 02:49pm PT
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As a guide I carry Diamox and give it out freely, on the advice of Peter Hackett and other researchers. It's quite effective, and the side effects (mostly tingling) well worth it.
I don't notice Diamox interfering with natural acclimatization, but actually encouraging it. Drink LOTS of water = as important as the drug. Just flood your kidneys.
Sleep at the roadhead for a few hours of natural acclimatization. Better, since you're coming in 168 from Vegas, sleep up on Westgard Pass, breakfast at the truckstop in Big Pine, then hit your roadhead. Killer view of the Sierra at first light is a bonus -- best view of the Range of Light from anywhere.
I have seen two rare cases of altitude sickness at 7000 feet, severe enough to require evac to lower altitude.
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cliffhanger
Trad climber
California
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May 14, 2008 - 04:04pm PT
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Pranayama (breathing) from yoga can solve your troubles. Slowly breathe in, hold your breath, slowly breathe out, hold your breathe, repeat. Even at sea level this gives your body oxygen stress, adapting it for high altitude.
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summerprophet
Mountain climber
Cali Via Canada
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May 14, 2008 - 04:09pm PT
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Mattisse:
I stand corrected, apparently I am behind the times when it somes to Diamox studies, this is a relitively new development, as little as 8 years ago, there were little acceptable published studies.
I do stand by the statement that it messes up your bodies ability to acclimatize itself. If you take diamox to summit a peak, do not consider that peak to be altituide training, and assume your body is now adjusted to elevation. The meds are at work assisting your body, not your body responding to the elevation alone.
DR:
Freely handing out any type of medication, even aspirin, could result in me losing my job when I was guiding. I hope you have extensive medical histories on whomever you are handing out drugs to, and are aware that a fair amount of the population is actually allergic to sulfa drugs.
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Glaidig
Trad climber
Menlo Park, CA
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May 14, 2008 - 04:26pm PT
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Hey KR,
I've experienced AMS at a variety of altitudes while climbing in the Sierra, the Alaska Range and the Andes. I have climbed with and without Diamox. While I agree with some things mentioned in this thread; this would be my advice: hydrate, climb slower, and pressure breathe. As for Diamox, my personal preference, when I am on the mountain, is to take a 60mg dose before I go to bed at night as this helps me to sleep better.
Guy
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Spencer Adkisson
Trad climber
Reno, NV
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May 14, 2008 - 05:37pm PT
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DR, just out of curiosity, are you giving Diamox as a preventative measure, or as a reactionary treatment to symptoms?
Also, is this Diamox that has been prescribed to you that you are freely giving out to others?
I hope you have a good lawyer, cuz if the chit hits the fan you could get hosed, big time.
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Gene
climber
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May 14, 2008 - 05:53pm PT
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I have a bit of a problem with all performance enhancing drugs. Is Diamox one?
Rather than Diamox, isn't it better to reduce altitude and let your body find its own equilibrium? Is Diamox a substitute for lack of gradual acclimatization? If it is a cure for the presentation of HAPE or severe altitude sickness, then great. But I question its use as a substitute for prudent acclimatization practices in the hills.
I ask out of ignorance.
GM
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matisse
climber
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May 14, 2008 - 06:14pm PT
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I think this is a great question. A drug is not a substitute for acclimatization, and I really do agree that the approach should not be take a pill, climb a mountain. but particularly early season it may help some people be more comfortable, especially if they are particularly sensitive to altitude. Many climbers will describe AMS early season but on repeated ascents it goes away.
I am one of the extraordinarily sensitive to altitude people. I live at sea level and I get a headache at mammoth lakes, at an elevation where most people will feel just fine. I also work periodically at the White Mountain research station and our main lab (Barcroft Lab) is at 12,500 feet. Typically we leave sea level at 6 am and by late afternoon I am setting up equipment at Barcroft. It is a 1-2 hour drive (depending on which route we take) down to Owens Valley and since we are working 14-16 hour days up there, driving down to sleep is not a very practical option.
So I do what I would NEVER suggest anyone do in the mountains, I drive up quick, sleep up high, take pills and tough it out. I take 125 of Diamox on the way up and 250 before bed. I still feel like crap but I can get my job done. IF I really feel like crap, I go sleep at Crooked Creek, which is 10k feet and 40 min away. If I feel like double crap (refried crap or crap warmed over) I go down to the valley. I have several differences in this situation than the average climber:I have medical types with me, I have a lot of experience doing this and I know myself well, and there is a road and a car if I need to go down quick.
The first trip of the season I feel awful. I might be on Diamox for the entire 4-5 days I am up. By the last trip I might only take it for a couple of days or not at all.
The upshot of what I am trying to say people vary hugely in their sensitivity to altitude, it is always better to acclimatize, but sometimes that is not always possible and provided you are aware of the risks of diamox and are smart about it, taking it isn't a terrible thing to do.
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Doug Robinson
Trad climber
Santa Cruz
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May 14, 2008 - 06:17pm PT
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Advice of altitude specialists is to give Diamox either as a preventative, 24 hrs ahead (some say longer is OK), or in response to symptoms. Like it works well before bedtime for typical altitude sleep disturbances.
My name is on the scrip, after explaining to my physician that I have been repeatedly advised by the most knowledgable researchers in how to use it.
My clients appreciate that I am giving them a prescription med; I discuss the grey area that entails for us all. Many go get their own scrips on my advice. No physician has refused, though most need educating about AMS and prophylactic diuretics.
Best of course is slow acclimatization. Timetables vary, with the most conservative being 1000 feet of ascent per day beyond 7000 feet. At that rate, you summit Mt. Humphreys in a week.
Practical experience tells us how conservative that is: we all exceed it regularly. But, we all should be ready to take it seriously when it arises -- always unpredictably -- and go down.
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