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Altitude Sickness Prevention

post #1 of 29
Thread Starter 
My first post!! [img]smile.gif[/img]

I'm heading to Breckinridge in a couple weeks. Other than exercise, what are the best ways to prevent altitude sickness? My search turned up some good advice, but nothing much less than two years old.
post #2 of 29
There are drugs but I've never taken them. There is some good advice if you search the net and take note of the high altitude mountaineering medicine sites. Be careful of anedotal, self medication. I think there has already been a thread on epicski. Try searching here.

Stage overnight at a lower alittude. When you get there, ease off on the sodas and fatty foods especially if you get any symptoms. Leave twice as much time to move around as you think you'll need. Be gentle on yourself the first day. Sit down if you feel rough or queasy.


See also
Altitude thread
post #3 of 29
DP, whose posts you can read in the altitude thread, gave an excellent presentation on altitude sickness at the epicski academy. In this thread;f=9;t=000147
he lists some good reference sites.

welcome to epicski! :}
post #4 of 29
I skied Colorado this season for the first time in a few years. I'm a flatlander and on the far side of 50. My lung function isn't what it used to be, so I was curious about the effect the elevation was going to have on me and did a little prevention homework. This isn't very scientific but here's the key tips I followed with success:
- spend a night at altitude before skiing/boarding
- go a little easy on the first ski day
- I took about 4 aspirin spaced throughout the day for the first 2 or 3 days
- carry a bottle of water and drink from it often during the day, refill as necessary. Do this all week.
- go easy on alcohol, especially early in trip
-hopefully you've been working on a little pre-trip fitness back home, so you don't arrive as a complete couch potato.

I noticed that I did the most huffing and puffing in the mornings while I was gearing up in the parking lot or base lodge to begin a ski day. (Got a family of 6 so there's a lot of gear.) Once we hit the slopes I had very little discomfort, but I'm mostly into cruising these days or single black diamonds at most. One thing I did that is different from your stay at Breck - I slept each night back near Denver at elevations varying between 5-7K feet. You'll be at 9.5K all week, maybe you won't have the mini daily adjustments I seemed to have for the first 3 days or so. BTW, I had a moderate, but noticeable case of altitude sickness once about 10 yrs ago when I did everything wrong (for susceptible types): flew in the morning to NM, skied the same afternoon at Ski Santa Fe (10K base) and ate a big southwestern style dinner with beer afterwards. Didn't sleep much that night, felt pretty lousy and didn't get the most out of the mtn the next day while skiing the one chance I've ever had at Taos Ski Valley.
post #5 of 29
I'm asthmatic, but my season at Keystone was trouble-free. However many of the people I was teaching would suffer from altitude. Eat breakfast, and include some carbs as they help with water retention. Drink water...carry a bottle of it. When someone rolled their eyes up, we'd get them a cup of water, and it made a vast difference to their condition.
post #6 of 29
Most of the advice given above is good. The best (although sometimes impractical, depending on your schedule) way to reduce the risk of AMS (acute mountain sickness) is graded ascent- a night or two in Denver first will help your acclimatization. Breck has the problem of being situated at a higher base altitude than most of the CO resorts (about 1300' higher than Vail, for example), so you run a somewhat greater risk there. That being said, many people have no problem at all- there are genetic factors at play, and you may be lucky! If you have had problems with AMS before you should consider graded ascent and perhaps prophylaxis (drug treatment) more seriously.

Several things that will help- and several that won't:

1. there is some evidence (not conclusive, but persuasive) that a high carbohydrate diet begun at least 3 days prior to ascent may be helpful.

2. drinking plenty of fluids WILL help with the problem of dehydration (which is considerable at altitude, for multiple reasons), but has NOT been shown to retard the development of AMS. You certainly should play close attention to adequate hydration, and dehydration can mimic the symptoms of AMS. Indeed, if you have a headache and vague nausea, drink a liter or more of fluids and see if you feel better. If not, be much more wary of how you feel- you may be developing AMS.

3. Take it easy on your first day- avoid over-exertion for at least 24 hours.

4. The issue of alcohol and altitude is complex. There is a long-standing adage that alcohol has more potent effects at altitude, but that appears to be a myth. There is some evidence that it may slow your speed of acclimitization, however. Also, be wary of dehydration- alcohol may cause this. This is also the only real problem with caffeine. If you are strongly affected by the increased urination (diuresis) from caffeine keep a close eye on your fluid intake. Otherwise, there is probably no reason to avoid caffeine.

5. prophylaxis- the use of acetazolamide (Diamox) has been proven in many studies to accelerate the acclimitization process (at least 75% effective). Lower doses than recommended in the past appear to be as effective in most people- 125mg twice a day. Side effects include tingling of the fingers and toes, increased urination (got to watch for dehydration again!), and it imparts an unpleasant taste to carbonated beverages. People with sulfa allergies cannot take this drug (the chemical structures are related). It is available by prescription only, and should be started 24 hours before ascent. A new approach that has not been completely validated, but has some preliminary positive results is the use of ginko biloba (120 mg twice a day, beginning 4 days before ascent).

6. DON'T SMOKE! If you do, stop at least one week prior to ascent. Smokers have high levels of carboxyhemoglobin (essentially carbon monoxide poisoning), and you will need every bit of hemoglobin you have to carry the little oxygen that is in the air up here. The constrictive effects of nicotine onthe blood vessels is not good either, but nicotine patches are preferable to smoking. A related issue is that if you are anemic, get treated before you ascend, so your oxygen-carrying capacity will be optimized (benefits of iron will take a few weeks).

7 I almost forgot- although exercise and fitness will help you perform better, it actually does little or nothing to reduce your risk of AMS.

If you really get sick, see a doctor (there's a clinic right at Breck). The optimal treatment of AMS is DESCENT. Even descending 1000ft (that is about the level at Dillon or Silverthorne) may be effective.

Have fun and pray for more snow! Even though it has been alot warmer than usual, it was great at A-Basin yesterday! And don't forget your sunscreen.

(note to Ant- many asthmatics actually do better at altitude. The lower density of the air may be a benefit (less resistance to flow in the airways). Also, albuterol, which most asthmatics use as a first-line treatment when they wheeze, has been shown in a very well conducted study to be very effective in helping to treat HAPE (high altitude pulmonary edema, the lung disorder that can occur at high altitude)
post #7 of 29
DP, Great post with some very good advice for all. I've been going to Colorado as many time a year as possible since the late seventies. The tip that might be the best is to sleep at the lowest possible altitude. No matter where you ski, sleeping at a lower altitude certainly makes a difference.Our usual ski trip starts with a stay in Steamboat for various reasons, but the base elevation is a couple thousand less than Summit County. Couple that with the fact that the skiing's great there makes a good start.

What I want to say is even though all the precautions are taken, all the advice is followed, and you are in good physical condition, you can still have a problem. While there a few weeks ago, I developed the worst headache when I left the airport and it didn't matter what I did, it didn't go away till I got home. There is a first time for everything I guess. I'll be out there in two weeks and we'll see what happens. If it developes again my next step will be a visit to an oxygen bar.
post #8 of 29
Oh, and in Summit some of the medical places have Hyperbaric chambers for acute cases!! I don't know if they actually used them. One of the shops in River Run at Keystone had one on display.

One funny thing was how fast the effects hit. I was chatting to a very happy lady one day, and she suddenly just collapsed, just like that.
post #9 of 29
Lars- you may be better off taking some diamox; you can't carry the oxygen bar with you!
post #10 of 29
dp, is the avoidance of caffeine still in line with current thinking?
post #11 of 29
comprex- it probably is fine to use caffeine. The thinking behind avoiding it is primarily based on the diuretic effect, so if you pay close attention to hydration there is probably no reason to avoid it. Another thing- people who are regular caffeine users will often get withdrawal headaches from stopping, so unless you detox yourself for a week before ascent, you will probably feel worse avoiding caffeine anyway!
post #12 of 29
i have used Gingko Biloba with good success. GB has been proven in many tests to alleviate Altitude sickness . just google it and you will
find many studies that corroborate this.
post #13 of 29
Whitney- I am afraid you have overstated the case quite a bit. There are a few studies in the medical literature (only 2 published thus far that are randomized and 2 abstracts that are not yet indexed) that have suggested that ginko biloba may be effective in preventing (not treating) AMS (no good studies on treatment have been published that I am aware of), but the numbers of patients studied and some methodologic issues prevent an absolute conclusion that it is effective. The data are encouraging, yes, and I would not discourage someone from using it, but I think to say that it is a proven fact is overreaching. By the way- google searching on medical issues will often lead you to a lot of junk as well as information of value- hard to sort the wheat from the chaff. Much better to start at pubmed . A good site for altitude related issues is here .
post #14 of 29
& gingko does interact with some prescription meds to...
post #15 of 29
There are other issues regarding self-medication with gingko biloba.

1/Are you on any prescription meds?
2/What is your medical history?
I believe one of the actions of gingko biloba is to increase blood flow (including the brain). This means there are contra-indications with many prescription and none prescription drugs.
Disski posted some stuff I think. I hope she reads this as she is qualified to comment.
post #16 of 29
I am very susceptible to AMS, so I tried 3 routes.

1. Acclimating to local environment/elevation.

2. Ginkgo

3. Diamox

#1 was effective, but for me the most difficult. I can't be a short hop from Alta in SLC, and just waste a day of my vacation. Avoiding alcohol and caffeine is part of this process as well.

#2, didn't do squat for me.

#3 Very effective. But I must say, the tingling can be QUITE unpleasant. And it makes carbonated stuff taste really weird (though strangely, I kinda liked it.)

I have also functioned fine by just avoiding the no-no's, staying hydrated, and not over exerting myself.

It's really a crapshoot. I'm sure some of it is mental as well.

On my coming Tahoe trip, I'm going au natural. Will report results.
post #17 of 29
xdog- if you used 250 mg BID you can try going to half of that dose (125 BID). It works just as well in at least 70% of people and has fewer side effects (especially the tingling)
post #18 of 29
I did 125 mg 2x daily, am & pm. Are you saying 125 mg daily, period? I don't know what BID means.
post #19 of 29
I have hiked and/or skiied between 10,000ft and 14,400ft many times. all of those times i have acclimatized (at least 1 night and 2 nights if I am going above 12k) AND taken 120mg of GB a week
before my travel. I have not experienced AMS at all.

Having said that - here are some disclaimers:

1) I would not recommend that you depend entirely on GB. Acclimatization is important.

2) in all the studies i have read - No one is claiming that Ginkgo Biloba has any protective effect against the onset of HACE or HAPE. Its potential effects are restricted to AMS.

3) I have not consumed any prescription medicines along with GB - so i am not aware of any side effects that it may or may not have.
post #20 of 29
sorry, xdog- BID is doctor shorthand for twice a day. I shouldn't be using that jargon here if I expect people to understand what I am talking about! : Anyway, it sounds like you were using the low dose. There was a paper (or perhaps just an abstract or a symposium discussion) that I saw last year and now cannot find anywhere that suggested that even 62.5 mg twice a day may be effective for many people. The lower the dose, the lower the incidence of side effects, so you could even try that dose and see if it helps without the annoying tingling.
post #21 of 29
I wonder if this is a typo? Scroll down this page for the Breckenridge recreation center.
Faintness classes????
Are they trying to tell us something?
BTW, what about dogs and cats? How do they responnd to altitude?
post #22 of 29
dp thanks for your insight on this subject. a few more questions about elevation and asthma:
1. for all asthmatics is elevation a minimal or non factor in causing asthma discomfort compared to factors like dust, other particles in the air, or cold temperatures?
2. would you go so far as to say that this "less resistance" theory you mentioned makes being at elevation an actual benefit for an asthmatic?
3. any data out there about the good or bad long term effects on asthmatics from living for extended periods at elevation, e.g. at 7,000 to 10,000' above sea level?
post #23 of 29
Hi Jamesj-
1. Altitude should not be a factor for most people, unless there are other mitgating factors (other underlying lung or heart disease, etc). Cold can definitely be a factor in many asthmatics-breathing cold, dry air is certainly one of the provocative factors for some asthmatics (not all, however- I have asthma, and it doesn't seem to bother me at all) My impression is that those with exercise induced asthma may have more problems with this, but I have not seen data on it.

2. Yes, some asthmatics will actually do better at altitude. The air up here is less dense- that is, there are fewer molecules of gas in a given volume of air. Lower density translates to less resistance to flow, especially when flow occurs at higher velocity. Think of the ease at which water flows from a bottle compared to honey (there are viscosity issues there, too, but let's ignore them for now). There are some limits to the advantages, however. as the airways in in the lungs branch into smaller and smaller tubes (the farther out you go in the lung) the diameter of the airways, of course, get smaller, too, and the velocity of gas flow slows. Since asthma is primarily a disorder of the smaller airways, the effect of lowering gas density is somewhat more limited than you would first expect. Still, numerous studies in asthmatics have looked at breathing low density gasses (usually mistures of oxygen and helium) and many, if not most, have shown benifit.

3. I will have to do a literature search to look for any data on long term effects of living at altitude for asthmatics, but I can tell you one interesting piece of information. The National Jewish Medical Center for Respiratory DIseases (often cited as the top center for respiratory disease in the US) was started here in Denver many years ago, and people with asthma used to come here for treatment in part because of the altitude. I think that a large part of it is the dry climate and lack of molds ( often a big problem in asthmatics), but I know of older adults who were sent here as kids because of intractable asthma at sea level. I am not advocating living in the mountains as a primary therapy, but it is interesting historically.
post #24 of 29
I'm from 600ft Indiana so always face this skiing west. I was at a-basin last weekend after getting 2 hours sleep and not eating. I was having severe problems up top as my body tried to get its glucose from the long term stores (fat and breathing)

My friend insisted I should eat lunch before we went up. Wanting to make the most of a 1/2 day ticket I didn't. We went up and I had a lot of problem which I normally do not. So we stopped for light lunch and I got a gateraid too. What a difference. No problems next lift ride up.

I had resisted eating lunch since digestion takes some blood flow, but I was downplaying the lack of glucose effect from not eating all day. (duh) The low blood sugar was the more important effect.

So the advice I see above to keep some level of food going is good. I've had some say protein bars, others say things with complex carbos. I don't know which is best. Both are better than skiing hungry.

Water, water, water - is good advice. It's a dry climate and dehydration will aggrevate any altitude problem. Caffine should be avoided as it lowers your water retention.

I have a camelpack I ski when I'm out west and take frequent sips from it. It's amazing how quick us un-aclimated lowlanders from the east will dry out in the colorado highlands.

Lots of people just going up to altitude from the lowlands have trouble sleeping. For me, this is traced to low humidity. Many condo's you rent you will find some sort of humidifier you can set up and use. I highly recommend doing that. If your at a hotel, just run the shower on full hot till the humidity comes up and turn of your vent so the humidity is retained.

Have a great time!
post #25 of 29
While the very low humidity is very uncomfortable for many people at night (also commonly causes nosebleeds), and I also highly recommend a humidifier, the most common reason for trouble sleeping is actually Cheynes-Stokes respiration. This is a condition during sleep at altitude where your breathing pattern varies cyclically from deeper to very shallow breaths, or even stopping breathing altogether for a few seconds, and is caused by the brain's responses during sleep to the low carbon dioxide level produced by hyperventilation. (one of the first compensatory mechanisms to adapt to altitude is to increase your breathing rate and lower your CO2 level). When your brain realizes that you are not breating enough, your level of sleep lightens and you wake up, or at least you don't get a deep enough restful sleep.

Best treatment? Some people go as far as using oxygen at night (this will also dry you out- the O2 in tanks has absolutely NO humidity); Diamox is the classic proven medical therapy. Most people get better acclimated in a couple of days and it gets better.
post #26 of 29
Thread Starter 
Thanks for all the great advice on this thread. I've got my Diamox prescription, and I picked up a camelbak yesterday to keep hydrated.

Now I just need to figure out how I'm going on vacation, and not drinking beers for a few days!
post #27 of 29
Despite my advice to be cautious with alcohol - if you feel fine after a day and night at altitude I think you can safely celebrate with 1 or 2 beers. If you feel fine the day after that...katy bar the door.
post #28 of 29
Well here's my report on how I fared without any preventative measures.

Mixed results.

I didn't use any Ginkgo or Diamox, and I drank a fair amount of wine Thurs. nite. Hopped a 7 am jet bound for SLC on 3/26. Found out it was snowing in UT, and extended my layover to go ski Alta.

So I went right to the top of LCC after starting the day at 0 ft. above sea level. Skied knee deep for 4 hours, no symptoms. Of course, my adrenaline may have counteracted the symptoms.

Back on a plane to Missoula, and 2 days of business which allowed me to acclimate to an altitude several thousand feet above my home alt.

Skied Discovery on Mon. @ around 8k feet, no symptoms. Been drinking more beer than water all weekend.

Off to Heavenly on Tues. Slept near Gondola base in S. Lk. Tahoe, no alcohol, plenty of water.

Top of Big Dipper lift on NV side found me huffin' and a puffin'. I saw some spots, had the mildest of headaches, and at the end of the day, I was zonked. So much for acclimating.

Day 2 @ Heavenly saw me struggling a bit as well. No more beer, plenty of water. I use a camelbak every day.

By day 3 @ Kirkwood, I was straight. No symptoms.
Great ski day too.

Bottom line- I consider myself to be prone to AMS, yet my symptoms don't manifest themselves consistently.

I think the best 2 pieces of advice are;

1. Hydrate and rest well.
2. Avoid Alcohol and Caffiene until somewhat acclimated.

Ginkgo? Can't hurt.

Diamox? Probably helps.

My plan for traveling directly to ski destinations over 10k feet without acclimating is;
No caff. or alc. until day 3 or so.
125mg Diamox, 2x daily, begun 48 hrs. before reaching altitude.
Take it easy the 1st day. (Doesn't apply to powder days, of course.)

I don't think its worth getting crazy over, I'm just gonna roll with that plan and hope for the best.
post #29 of 29
Thread Starter 
Got back in from Breckenridge last night. Here's my report:
Started Diamox Thursday evening at 250mg,2/day, cut back to 125mg, Wednesday pm and Thurs am, then stopped. Took it easy on the beer, etc, on Sat & Sun, but tied one on pretty good Monday, was a bit green on the bus Tues am, but kept myself hydrated, and had a good day. Drank way too many shooters Wed night, but managed pretty well Thursday. No signs of AMS.
One woman in our group got pretty sick. After a few days and a bunch of medical tests, she was given some Diamox, which cost $22US for 8x250mg, vs my cost of $13CDN for 20x250mg. Thanks to you guys, and some planning, not only did I avoid AMS, but I saved a few bucks too! [img]graemlins/thumbsup.gif[/img]
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