Discussion Topic |
|
This thread has been locked |
james belogorsky
Trad climber
stockton
|
|
|
May 14, 2008 - 06:33pm PT
|
i'm an internist so this is easy. take 4mg of decadron when you leave the flatland the night before. 2mg the next morning.no brain swelling , very low risk of side effects unless you're diabetic. it is used in the business for brain swelling if you have cancer inside your skull. it prevents the headache and allows pleasure until you naturally acclimate.
|
|
matisse
climber
|
|
|
May 14, 2008 - 06:45pm PT
|
James I know it is effective (and also has been show to offer some HAPE prophylaxis in HAPE-susceptible) but would you really suggest this for your patients who are going up and down every weekend?
For me diamox is where I draw the line. I'm not willing to take steroids to work or climb, although I would not hesitate to use them to treat someone in the field who was sick while I got them down.
|
|
Doug Robinson
Trad climber
Santa Cruz
|
|
|
May 14, 2008 - 06:45pm PT
|
WOW James!
To me that seems truly scary -- with all due respect to your professional qualifications; I'm sure you use it all the time and have it wired. I carry decadron too, for life-and-death use only, but I have only administered it once -- as a trial to myself (cerebgral edema vanished even as I kept ascending). And since it is one of the most powerful, system-wide drugs there is, I was deliberately refraining from even mentioning it here.
But a fellow guide had a client go down to within 8 hours of lights-out from self-administered decadron on a ski tour. Anesthesiologist, I believe. He's been taking it 5-6 days, it got away from him and the rebound was fierce. He had not informed the guide until he was gurgling in the middle of the last night. Helicopter rescue with full trimmings. The 8-hour estimate came from the ER in Bishop when he landed in their lap.
Are you sure you want to recommend it for lay use? Please help me understand why.
Thanks.
Edit -- I'm not a Doc, that's just my initials.
|
|
matisse
climber
|
|
|
May 14, 2008 - 06:47pm PT
|
DR-you and I are on the same page, (ie Yikes)
|
|
toejahm
Trad climber
Chatsworth, CA
|
|
|
Topic Author's Reply - May 14, 2008 - 07:05pm PT
|
Well Doc. that would make for an awefully scenic trip. A week to climb Mt. Humphreys, might be some kind of a record. lol
Seriously considering sleeping on Mt. Charleston the night before I leave for a trip. Just might be worth the 40min drive there and back.
KR
|
|
matisse
climber
|
|
|
May 14, 2008 - 07:13pm PT
|
Ken,
If you go up and down a bunch even day trips to lower elevations it will help. It has to do with the response called your "hypoxic ventilatory response" which controls how much you breathe in response to hypoxia. It becomes more sensitive when you are repeated exposed to hypoxia, (although how long that sensitivity lasts is still being investigated)
|
|
james belogorsky
Trad climber
stockton
|
|
|
May 14, 2008 - 07:29pm PT
|
my rx is not for other than local ie under 14,000 ft in the sierras and for only that 4mg dose- the equivalent of 20 mg of prednisone. a dose that might be used for even a week for example for acase of poison oak or asthma flare up. your anesthesiologist wasn't taking it like that. unfortunately for once or twice a month the risk is small or nil. i also have spent a whole day vomiting at iceberg lake- no thanks. is this topic recreational use of drugs? at what age do i start prescribing viagra ( not for altitude). safety is a scale. life is short.
|
|
toejahm
Trad climber
Chatsworth, CA
|
|
|
Topic Author's Reply - May 14, 2008 - 07:42pm PT
|
Matisse,
That's been my experience too. The more I ascend in succession the better I start to feel on higher ground.
Though, Still interested in the Diamox, probably will try a lower dose to see how I react to it.
KR
|
|
landcruiserbob
Trad climber
Vail, Colorado
|
|
|
May 14, 2008 - 08:02pm PT
|
I have lived,climbed, raced, & trained at 10,000 feet for over 20 years.
-Stay 35% below your max heart rate= If you can't have a conversation while peak baggin your heat rate is too high.
-My guess is your blood oxygen level was in the high 80's & that starts the headaches. At 10,000 feet normal blood oxygen levels are between 89 & 96.
-Unless you have acute Altitude sickness stay away from all drugs.
Water, Water, Pace.rg
"If you can't climb it naturally why do it"
|
|
Spencer Adkisson
Trad climber
Reno, NV
|
|
|
May 14, 2008 - 08:42pm PT
|
DR, Good for you. You gotta have that conversation with the clients. That is killer if you have had positive results with Diamox. It has been nothing but bad news for me and my clients, but, hey, whatever works eh?
|
|
andy@climbingmoab
Big Wall climber
Denver, CO
|
|
|
May 15, 2008 - 12:08am PT
|
The only time I ever got HAPE was while taking Diamox on Aconcagua. I definitely went up too high too fast - could be because of Diamox masking problems, could be because of psychological side effects of thinking i was invincible from taking Diamox. I don't know, but i'll certainly never take it again. I had never really had much in the way of altitude problems before or since, though i've only been up to 18,500' since taking Diamox. HAPE really, really sucks and is a wonderful thing to avoid.
I can't imagine wanting to take drugs to go up to 13-14K. Either acclimate, or be fit enough that you can get up and down fast enough to avoid problems - and be ready to turn back if you do have problems. That just isn't high enough to be thinking about taking drugs.
|
|
Festus
Social climber
Enron by the Sea
|
|
|
May 15, 2008 - 01:19am PT
|
Landcruiserbob wins this debate going away but, for chrissakes, how is this even debatable? A guide handing prescrip drugs to climbing clients as a preventative doesn't strike anyone as a conflict of interest?! Of the worst sort?
Get your sorry ass in shape, and take the time needed to acclimate that sorry ass, or plant it on a couch in front of a bowl of Cheetos and a Big Gulp and watch Clint Eastwood climb the Eiger again.
I'd love to record a platinum album then quit the record business to play shortstop for the Cubs in the World Series and bang Elizabeth Hurley after my tenth inning homer wins game seven. Ya got a f#cking pill for that?
|
|
marky
climber
|
|
|
May 15, 2008 - 01:31am PT
|
Festus, that was an inspired post. I too wish those things for myself.
|
|
nita
climber
chica from chico, I don't claim to be a daisy
|
|
|
May 15, 2008 - 02:14am PT
|
Landcruiserbob is correct....WATER-WATER-WATER...
Plus as said before..acclimate your body..beforehand.
When I worked in Tuolumne, people would drive up from the Bay Area, unpack, go hiking.. come eat in the dinning room..then proceed to throw up at the dinner table...mmm yummy...
|
|
matisse
climber
|
|
|
May 15, 2008 - 10:38am PT
|
Although a lot of people suggest it, the water water water thing can be dangerous, and the value of over-hydration (as opposed to simply not being dehydrated) has never been shown to be helpful.
|
|
nita
climber
chica from chico, I don't claim to be a daisy
|
|
|
May 15, 2008 - 10:57am PT
|
Matisse, good point, but ... not suggesting over- hydration. I just think alot of people walk around under- hydrated on a regular basis,and when you add altitude and exercise.. you don't feel so great.
|
|
Doug Robinson
Trad climber
Santa Cruz
|
|
|
May 15, 2008 - 11:33am PT
|
Festus,
Getting in shape has nothing to do with it. Unfortunately.
Research shows that the incidence of altitude sickness is independent of physical conditioning. Which leads me to watch my clients for signs of it whether they are fit or not. And treat them accordingly.
Advising them is my prime job, in this respect. Educate them about how it works, just like I'm doing on this thread for you. Gratis. That goes for everything in the mountains. I see guiding as mainly education, and my function as a guide is to make myself useless. Far from creating more business through drugs. Teach them how to lead, how to assess risk? Sure! Including the risk, prevention, and treatment of altitude. Part of the deal.
Altitude sickness does correlate, however, with being young and male. Best guess on that is they get it more often because they are the most capable of charging uphill the quickest. Go figure....
|
|
matisse
climber
|
|
|
May 15, 2008 - 12:02pm PT
|
DR is correct. As he points out young fit males tend to have more AMS. There are a few reasons for this in addition to the charging fast up hill bit.
First, the young part. A lot of the current thinking around AMS relates to how your brain handles an increase in pressure induced by hypoxia. If you are older, so the thinking goes, you have more room for your brain to expand (your brain shrinks as you age) before you get symptoms.
Now the fit part: people who are highly endurance trained tend to have blunted breathing responses to hypoxia (hypoxic ventilatory response), the more blunted you are the more hypoxic you are at a given elevation and that affects symptoms.
Now the male part:Progesterone (which is a female hormone present in women particularly in the second 1/2 of their menstrual cycle) is a breathing stimulant, and may affect AMS susceptibility, making women less susceptible (jury is still out on this one).
|
|
headintheclouds
climber
|
|
|
May 15, 2008 - 12:23pm PT
|
Matisse beat me to the point, re; blunted hypoxic drive in well conditioned cardiovascular systems.
I've competed at a reasonably high level, in aerobic sports, for 25 years, yet with out fail I will get sick if I go above 10,000 ft. my first night.
After learning simple breathing technique, essentially breathing more than I feel the need to, I've managed many peaks well over 20,000 ft., no drugs, no O2.
Diligence in hydration (not over hydration), fuel intake, and breathing!
|
|
apogee
climber
|
|
|
May 15, 2008 - 01:08pm PT
|
DR & matisse-
I concur with both of your views of the acclimatization process, differentiating from general fitness, and medication use (acetazolamide & dexamethasone). This is consistent with the research and science I have read over the years- when it comes to altitude sickness, there is far more conjecture and anecdotal evidence than hard facts. Out of curiosity- can you cite some of your sources?
|
|
|
SuperTopo on the Web
|
Let us know!