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Altitude adjustment strategies

post #1 of 42
Thread Starter 
I live in Connecticut near water, i.e., pretty much at the sea level. From this coming weeked, I will travel to Arapahoe Basin, Colorado, and ski four days. I am not sure if I will have some altitude problems or not when I get there, but I would like to be prepared. Does anyone I have any suggestions or strategies in terms of preparing for the altitude change.

I spent a few months in summer of 1987 in Bolder, CO, but never had any problem as far as I remember (although I did not do any vigorous exercise).

During this upcoming trip, I will get in Denver Satuaday night and ski in the morning of Sunday to see how I can adjust. Then, I will attend three-day ski camp from Monday to Wednesday.

Or, am I worrying too much. A few of my frieds say they never had any problem skiing over there.
post #2 of 42
I don't think you need to worry, from what I've read there aren't particular rules for who will or who won't get altitude sickness. One of my friends, who was considerably fitter than I was at the time, got it a couple of years back in Breck, but apart from that he's be fine.

There are the usual pieces of advice: reduce the alcohol & caffeine content of your diet, increase the amount of water etc which probably help, but I'm no doctor.

post #3 of 42
We just returned from five days in Utah and four of the six of our group suffered from altitude sickness in varing degrees. A very unpleasent experience to say the least. If you do a Google search under altitude sickness you'll find some informative articles on the subject. About twenty percent of those who ascend to altitude are affected. As Fox said avoid alcohol and caffine and drink plenty of water before you arrive.
post #4 of 42
My wife and I live a stones throw from the Whitestone Bridge, we are flatlanders like yourself.
I skied Chile over the summer (9000-11000 ft) and Colorado early December (10,000-11,500 ft.). I got altitude sickness both times. I am a very fit 30 yr. old non-smoker. I abstained from alcohol in CO, and drank lots of water, but it didn't help. My wife suffered worse than I did. She had bad headaches the whole time, no appetite, and chronic fatigue. I had headaches, decreased appetite, and shortness of breath.
Neither of us could sleep for sh!t. maybe 2 hrs./nite.
I still managed to have a great time, but my wife is not headed back real soon.
We tried taking Ginkgo, as many have suggested, in advance and while there with no effect.
On my next Western ski trip (MT, Feb.) I will try the prescription drug Diamox as recommended by some.
You may feel no effects, or you may fare worse than we did. There's no way to tell. But I would recommend the following measures:
Get a scrip for Diamox
No alcohol
No (or less) coffee/cola
plenty o' water
Lastly, positive attitude. Yeah, I felt like crap, but I was in CO sking legendary mountains! That kept me going and feeling good. My wife got too hung up on her symptoms and let it ruin a great trip for her.
Good luck!
post #5 of 42
I addition to what Xdog says, best advice is sleep low when you ski high. Stay in Silverthorne, 8700 ft and ski at A Basin.

I went out last April with a friend of mine. He is a fit army ranger who suffered severe altitude sickness above 10,500 ft but was near normal in Siverthorne at 8700. Me, I'm not all that fit and absolutely come alive above 10,500ft and don't suffer altitude sickness until above 16,000ft. I live at 1,200 ft MSL.
post #6 of 42
The thing about drinking water is you can't start pounding it on the way up the mountain. You need to start hydrating months in advance.
post #7 of 42
Actually, the last response is incorrect. Months in advance will make no difference; a couple of days in advance may. One should remember that it is common for those who arrive by air to be somewhat dehydrated on arrival, so drink plenty on the plane.

There are several crucial risks for the development of Acute Mountain Sickness (AMS). First and foremost is the rate of ascent, which, for skiers, arriving at a resort by plane/ car/ whatever is considerably more rapid than mountaineers who are ascending by foot. Intermediate stops are most helpful, and your stopping in Denver overnight is a good idea; even longer in Denver if AMS has been a problem for you would be better. Second is hydration status, as previously mentioned- the more dehydrated you are, the more likely you will have problems. You get more dehydrated at altitude, too, and the need for extra fluids is often underestimated. Third is the variable physiology of the individual. There are some people who are just more prone to AMS. They may do better with slower acclimization, or may just find it hard to tolerate the transition to higher altitude no matter what. They may also be helped by medications. The mountaineer's dictum of "climb high, sleep low" is a good one- stay at a hotel at a lower altitude if possible. Even 500 ft may make a difference for some, but remember, the lifts speed your ascent, too- you can gain 2500 or more vertical feet in 10 minutes, as opposed to the climber's 1000 vertical feet per hour under good conditions.

Sleep disturbance is very common for flatlanders staying above 7000 ft, and is at least in part related to disordered breathing from altitude. Headaches can be just simple AMS (more likely at CO altitudes) but can be an early sign of HACE- high altitude cerebral edema (swelling of the brain). This is generally not a problem below 10,000 feet, but can be, and is serious business, requiring rapid descent. If it is relieved by aspirin and fluids, it is usually not HACE.

The most commonly used medication for speeding acclimization is acetazolamide (Diamox). Without going into the pharmacology and physiology, suffice it to say that it accelerates some of the physiologic mechanisms that your body used to adapt to altitude. It is not without side effects, however, so I would not recommend it unless you have had problems in the past. Side effects include increased urination (actually this is something that happens at altitude to everyone- another reason you need to drink alot) and tingling of the hands and feet. People who are allergic to sulfa drugs usually have allergy to Diamox as well- it is a sulfonamide derivative. Recent data suggest that as little as 125 mg twice a day is often effective (with fewer side effects than larger doses).

Mild AMS can generally be managed with fluids and aspirin, but if you are really sick (especially if there is any sign of HACE or HAPE (edema of the lungs) you should descend- it is the first and best treatment. Even 1000 ft often makes an enourmous difference. Other treatments (oxygen, albuterol and other beta agonists, steroids such as dexamethasone) are probably more than you want to deal with when you can easily get in a car and drop down below 7500 ft.

About ginko balboa- some of my colleagues here at the U of CO Medical School and the CO Center for Altitude Medicine and Physiology are doing a controlled study of it for prevention of AMS. I, of course, was stuck in the OR and missed the seminar where they presented their preliminary results! There are a couple of promising early studies, but no definitive data yet as far as I know. I believe that you do need to start it at least a week in advance of your ascent, however.

Here's a good website with lots of information: http://www.high-altitude-medicine.com/
post #8 of 42
Ok,I exaggerated but if you have waited till you get off the plane to start drinking water you are too late.Besides,never a bad idea to stay hydrated skiing or not
post #9 of 42
Thread Starter 
Thank you for sharing your experiences and information.

Especially, dp, I appreciate your professional opinion.

Pierre, as you said, staying in Silverthorn and driving 10 miles or so to ski sounds like a good idea. If the place that I reserved at the foot of Keystone does not charge any cancellation charge, I will change my lodging to Silverthorn area.

While I enjoy drinking, I will stay away from alchol during the trip.

post #10 of 42
There really isn't much you can do. Stay hydrated, eat well and if you start feeling sick, simply get back down to base level. Once you get back below 9,000 or so, you'll feel much better. Even being at the base of Keystone or A-Basin can help if you get queasey at the top.

It's nothing to really worry about, it may never even effect you. It never hit me when I moved out, then out of the blue one day at Keystone it hit 3 years after I moved there. I went back to the lodge, rested for an hour and was fine. The best thing is to not even think about it! [img]graemlins/thumbsup.gif[/img]
post #11 of 42
I think you've already received some of the best advice money can buy. [img]graemlins/thumbsup.gif[/img]

The only thing I would add is this; buy a Camel-Back, or similar hydration system, and continue to take-in water while you ski. I started skiing with a Camel-Back several years ago and am amazed at how much better I feel - through out the day - when I am able to have a drink of water while I ride the lift.

I'm sure DP can confirm, but the hydration issue is one that should be addressed regardless of elevation.

I'm no expert, but would anybody care to debate elevation vs. altitude?
post #12 of 42
Try wearing a Breatheright strip over your nose. Wearing one will increase the intake capacity of you nasal cavity so you can take in more air. It also allows for you to breathe just through your nose when you are not in a period of high activity. Since you loose more water from you body by breathing through your mouth than you do from your nose it also helps you stay hydrated.

I refused to try them for a long time because I thought they looked stupid, but jsut about every pro athelete I have seen wears them now, and they don't have logos on them, so I don't think they are wearing them for the endorsement money.

Last year I had problems with the altitude twice. On my first ski trip of the year to Big Sky, and in May doing some backcountry around Tioga Pass. This year, I was in similar shape, and after an 11 day trip to Steamboat, Tahoe and Mammoth I did not feel the effects even once.

Also, remember to wear them to bed. In the past, when I did not wear them, I would have to keep a glass of water by the bed and drink periodically throughout the night as I woke up with that parched mouth feeling. Once I started wearing them at night I stopped waking up in the middle of the night with the dry mouth syndrome.

They may look funny, but I will never ski or sleep without one again.
post #13 of 42
I have read the above posts regarding AMS and it's all god advice.
Going to higher altitudes gradually
Avoiding alcohol
Avoiding Caffine

Here are some additional things that I do.

1. I start taking timed release Vitimin C at least 48 hours before flight time, aned continue through the second full day of skiing.
2. I also take either slow release asprin that last for 8-12 hours or enteric coated asprin once every four hours, as to how long see #1 above.
3. I drink lots of fluids, that's lots and lots of fluids [bring your own bottled water to drink on the plane,] Drink nothing with caffine, sugar or artifical sweeteners.Minimize dairy products.
4. I eat light. No beef, or heavy foods. Easy on fats, but lots of good quality protein and complex carbies. This should make up most of the diet. Remember, again to lay off the pop [ including diet drinks ] continue to do this for the first 48 hours after your arrrival at altitude.
5. And this is really important.TAKE IT EASY THE FIRST DAY [ A Basin has some very challenging runs, which you may want to avoid on the first day.] It is tempting to want to do it all, but if you get AMS the first day, the next three days could be lost days for AMS recovery, rather than skiing.
6. If you get AMS, and it is really severe [and the initial treatments don't seem to work,] get to 5000 or lower ASAP
[ Denver is the mile high city.] Your brain is swelling,it isn't going down, and this is the best, and most natural way to deal with it.

7. Your last night after your skiing is done, you can celebrate in moderation, with a few beers or some wine preferrable with a meal, but only if you feel great and have been at altitude at least 4 days.

Have a grat trip you lucky dawg !!!
post #14 of 42
Thread Starter 
All great stuff. Thank you.

jhstroup, I am not familiar with Breatheright, but is it used for taking in more air? The information from the web site db recommended suggests that breathing in more air does not help since ... I do not remember the exact reason, but it has something to do with your body's ability to have blood carry oxygen ...

In any case, I really enjoy your comments. They are theoretical and empirical.

post #15 of 42
As someone else noted, lots of good info here re: altitude sickness. If you decide to look at meds, here is my two cents worth. My daughter and I have tried both Diamox and dexamethasone. Diamox had some unpleasant side effects (tingling, loss of taste)but kept the altitude sickness in check. But the dex worked better for both of us. No side effects. dp noted that you may want to use dex as a last resort and I agree. It is a steroid and needs to be used carefully. But it really worked for us. I had skied at altitude a couple of times and never got sick. When I did get sick, a doc who was with us gave me one dex for a couple of days and I was fine-----probably partially due to acclimatization and the dex. Have used the dex on two successive trips to UT and CO.

Have fun on your trip
post #16 of 42
Just a thought, but if you're a regular coffee drinker/caffiene addict of some sort and make cutting out caffiene as part of your acclimitization - won't you get a headache/symptoms because of withdrawal? I don't drink coffee or have altitude sickness problems for that matter, so this is just a wild theory on my part, but I've been around some people who have tried to quit caffiene cold turkey and they were a mess. So I'm just thinking that for some people a sudden caffiene deficiency could actually cause a headache and lethargy and such???

I'd say if you've never had a problem before, just remember to drink a little extra water and a little less alcohol (keep in mind you won't need as much for the same effect) and you'll probably be fine. It's always good to be prepared, but I certainly wouldn't spend too much time worrying about it.
post #17 of 42
[warning: very long winded post!!]
re: Wink's comments on aspirin- likely to be a good idea for some. There may be benefits from aspirin's other effects as well (on platelet adhesion, prostaglandins, etc.). Probably a couple of baby aspirins a day will give you what you really need without upsetting your stomach. In regards to his ideas about the kinds of fluids- there is no scientific evidence of any kind that avoiding fluids with sugar is helpful. In fact, I always drink water sweetened with lemonade mix when I climb above 14,000 ft in the summer- I can get extra fuel for short term exertion at the same time that I am hydrating. I'm not saying that it's health food, or that one should include sugar as one of hte 4 major food groups (well... maybe if it is with chocolate!) but I don't think that it is detrimental if used in moderation along with a reasonable diet. Taking it easy the first day is also very good advice.

Avoiding caffeine may be helpful, because it is a diuretic and may promote dehydration. BUT- those who are habituated to caffeine have less of a diuretic response to it. Also, Altagirl's point is very well taken- caffeine withdrawal can be a pretty unpleasant and debilatating prospect. I don't think it's a wild theory, but a real possibility. In order to "detox" you need to start cutting down about a week in advance.

The nose thingies that jhstroup mentioned probably help him by increasing humidification of the air, not by increasing the amount of air you breathe, as Konayuki correctly points out. To understand this we need to recognize that there are two things that happen during breathing- oxygenation (getting oxygen into the blood across the membranes of the lungs) and ventilation (moving gas in and out of the lungs, eliminating carbon dioxide). Now, there is a relationship between minute ventilation (the volume of gas you breathe in a minute) and oxygenation, too, especially at altitude, where your breathing rate increases. (this is one of the acclimazations that your body goes through to accomodate to altitude, and one of the things that diamox does for you). BUT the biggest limiting factor is how much oxygen is in the air you breathe, as Konayuki notes. Assuming your lungs are working properly, they will pick up virtually all of the oxygen they are presented with, and that is all you get. Your increased rate of breathing will (for reasons too complex to go into here) improve oxygen delivery somewhat, too, but opening your nasal passages will not help this- it is controlled by your brainstem. Perhaps at night it might help actual ventilation, if you are a big league snorer and have some obstruction. Better humidification should make you alot more comfortable, however, as jhstroup notes.

Inspector gadget is absolutely right about the need for ongoing hydration. I think what you mean about elevation vs altitude may refer to an atmospheric phenominon that is related to latitude. Because of the flattened spheroidal (as opposed to absolutely spherical) shape of the earth, the atmosphere is actually thinner at the poles. Therefore, at the same elevation above sea level on Denali, for example, the absolute amount of oxygen in air is actually lower than at that same elevation on Everest! So, the apparant altitude closer to the poles is higher than the measured elevation. In practice, however, I think the two terms are commonly used interchangably.

Wiskier- the whole issue of dexamethasone is very controversial among high altitude physicians and physiologists, although I think just about everyone agrees that it works, and many (who are far, far more experienced and knowledgable than I) advocate its use in the way you have described. Actually, there are 2 controversies. First- there is disagreement as to whether dexamethasone masks the symptoms of AMS or actually treats the underlying physiologic problem. The big disagreement, however, is about whether this is a good thing. Diamox is effective because it accelerates acclimization- it changes a number of physiologic factors that are the same ones that your body naturally uses over time to accomodate to living at altitude. Dex, however, doesn't cause those changes- it makes you better, but doesn't improve your acclimization. If you have worsening AMS, this could, in theory, delay descent and lead to your eventually getting much worse if the illness progresses.

Whew! I hope that wasn't too pedantic!

[ January 02, 2003, 09:58 PM: Message edited by: dp ]
post #18 of 42
Thread Starter 

I have a plenty of baby aspirin (80mg) in stock and will bring it with me. By the way, I am wondering if Lipitor could cause dehydration. I am taking 10mg/day), but I often forget to take it.

post #19 of 42
I teach at Vail and this is a common problem. The first question I ask my clients is "what day is this of your vacation?" If it's the first, then I put them back a level.

Lots of great advice here, but my main advice is this: take it easy on your first day. Ski within your limits and try not to get anaerobic. Take frequent breaks for WATER. (The Camelback suggestion is great). If you're drinking enough water then you'll have to take frequent bathroom breaks during the day. Use them to rest.

Also, rather than "avoid" caffein and alcohol I recommend NONE for at least 48 hrs.

And, sleep the first couple of nights might be a problem so bring some Melatonin. That stuff works pretty well.

Have a great vacation.

post #20 of 42
Originally posted by Konayuki:
jhstroup, I am not familiar with Breatheright, but is it used for taking in more air? The information from the web site db recommended suggests that breathing in more air does not help since ... I do not remember the exact reason, but it has something to do with your body's ability to have blood carry oxygen ...
The Breatheright strip is simply an adhesive bandage that wraps around the bridge of your nose just above the nostrols. All it does is open up your nasal passageways for more air to breathe in.

As far as your blood's ability to carry oxygen, I'm not so sure on. Obviously, wearing one is not going to increase your bodies natural O2 max capability, but it does allow you to take in more air, i.e. send more oxygen to the blood without breathing deeper.
post #21 of 42
I think most of the comments already mae are good ones and should be followed. One that really hasn't been mentioned is giving yourself time to adjust. I know it is hard on a four day vacation, but you should not ski the day you arrive. If you get in late at night, wait until noon to ride the lifts. There is usually lots of other things to do in ski towns that can occupy your time a little bit. When I was patrolling at PC, we saw tons of illnesses where the people flew in for a long weekend, arrived after 10:00 the night before, were in the liftline by 9:00 and in the patrol room by 10:00 because they did not give themselves time to adjust. Even a twelve hour rest helps at elevations below 12,000 feet.
post #22 of 42
scuba gear
post #23 of 42
what are you people thinking? are you witch doctors?


You can't change your RBC or hemoglobin count quickly enough to adapt and acclimate within one week, much less a long weekend.

The best you can do is combat the symptoms. As Zorro said, reduce your coffee and alcohol intake, increase your water intake, and take 2 aspirin each day. Drink much more water than you think you need. Don't let your urine get to a yellow or orange color. Keep it clear by drinking more water.

Altitude issues are a result of your body's RBC and hemoglobin levels being adapted to your home area. When you travel to higher altitudes, your brain and muscles suffer a minor oxygen debt that reveals itself in headaches, nausea, etc. Unfortunately you can't just automatically increase your RBC and hemoglobin counts. Your body needs time to respond to the new ambient oxygen concentrations. That can take as long as a month.

Just fight the symptoms and you will be okay. You won't feel top-notch, but you won't feel like a dying dog, either.
post #24 of 42
Just another thought to add to the list of fine reccomendations given above.

I have had to have emergency medical attention twice because of AMS, and each time it was following a long 'soak' in a hot tub. I now avoid them totally any time I am above 6000 feet. I think the 'heat soak' may put added stress on your body at a time when you are on the brink of 'breaking over' into active AMS symptoms.

Hope you have a great trip!!! [img]smile.gif[/img]
post #25 of 42
Interesting Feal, I felt the same way but never really associated it. A soak in a hot tub anywhere else is usually much welcomed, but @ altitude, it seems to knock the crap out of me.
Wonder what the deal is?
post #26 of 42
Thread Starter 
I really appreciate your sharing information and experiences. I just came home and now have to start packing for the trip.

My concern now is trip to Newark Airport tomorrow. This icy and snowy rain could screw up my plan. I-95, GW Bridge, a lot could go wrong.

Have a nice weekend, everyone.

post #27 of 42
Gonzo- you are only PARTLY correct. Cerrtainly, no one is going to completely acclimate in a couple of days- that takes up to 6 weeks. And the erytropoietic response (increase in red blood cells) will take a couple of weeks. BUT that is not the only adaptive response to altitude- in fact, it is not even the only adaptive response to oxygen delivery at the tissue level. In as little as 24-48 hours the metabolic and respiratory control adaptions to altitude kick in, and while they are not complete, CSF pH is back to normal within 48 hours as a compensatory respiratory alkalosis develops, bicarbonate homeostasis is altered, and the brainstem adapts to a new basal level of respiratory drive. 2.3 DPG responses (which allow the tissues to utilize ogygen more eficiently) start to kick in within a week. SO, yes, one does acclimate to a significant degree in a relatively short period of time, even though more complete adaption takes weeks longer. In some people this adaption is more rapid than others, and that is due in large part to one's ventilatory responses to hypoxia.

jhstroup- I know it sounds counter-intuitive, but you don't supply more oxygen to the blood stream in that way- you are still breathing a hypoxic gas mixture. And you don't even increase the volume of air that you breathe in- you just route it more efficiently through your nose instead of your mouth (at least when awake). This will improve humidification, and may help you at night if you have some degree of upper airway obstruction, but the minute ventilation (amount of air breathed in a minute) will not change, only the route by which it gets in (assuming no upper airway abnormalities). In the absence of an obstruction, that is controlled by your brainstem, and the airway resistance through your mouth is very small, so improving flow through your nose won't make a difference. I don't deny that you may be more comfortable however.
post #28 of 42

Gonzo will get you for that...

Be careful opening mail from now on
post #29 of 42
Disski wrote:
Gonzo will get you for that...

Be careful opening mail from now on

It's OK- I'm wearing darker glacier glasses now and have entered the FBI's new High Altitude Physician's Protection Program !

(I'm also stuck in town on 2nd call today instead of skiing )
post #30 of 42
DP, you are an incredible resource. Thank you so much! In case anything was not covered here, this was a thread we had in the fitness forum:

Definitely check out the book Altitude Man and Mountain
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