Ibuprofen may ward off altitude sickness

I know it helps headaches when in the high sierra, so does coffee. Does this study
show it helps at real extremes, Denali or higher? And does it have any effect on
pulmonary edema and sleeping issues?

The study was from 4k –> 11k ft. A bit more details can be found at http://med.stanford.edu/ism/2012/march/altitude.html

The study that Rick referenced is the same as the second reference, and it went up to 12,570 feet elevation, not 11,000.

I can't remember the last time that I used any OTC painkiller on the White Mountain Road.

–B.G.–

2 Ibuprofen and 1 Alleve = "IBlleve" (I believe) in mountaineers' lexicon of pain relief.

The IB reduces inflammation and the Alleve reduces the pain.

Drink lots of water with these meds as they can be hard on the kidneys.

Symptomatic relief of pain is one thing, but other issues that may be life threatening?

Just being dopey enough to tie in wrong due to spending time at altitude is a danger I doubt NSAIDS are helpful with.

Didn't we go though this before with Penberthy and antacids?

I know I am stating the obvious, but probably worth reminding anyway — drugs affect different people differently!

I wouldn't suggest people mixing drugs for the first time when they are already in dire straits at 15K elevation. OTOH, unless you have preconditions that you know about — if you are intrigued by the supposed added speed and/or effectiveness of mixing Ibu. and aceno. — why not give it a try, in the safety of your own home, the next time you have a headache — and see for yourself? And if it works for headaches and doesn't seem to hurt you in any way… then maybe you can carry some with you the next time you do summit hikes and see if the mixing will help up there as well.

I did — and the mixing worked wonders for me. Unless you try, you won't ever know for sure. Obviously, "common sense" caution is implied here. Don't try anything that borders on recklessness.

>Symptomatic relief of pain is one thing, but other issues that may be life threatening?

AMS is essentially just symptoms. Annoying, sometimes painful ones, although I suppose if the nausea gets so bad you actually throw up or even just reduce your diet, then it would start to effect your performance as well. Similarly, if AMS causes you to not sleep well.

Nothing in the article implied ibuprofen would help with HAPE or HACE. And if people go higher faster because they've avoided a headache, then the risk of serious conditions would likely increase.

> Just being dopey enough to tie in wrong due to spending time at altitude is a danger I doubt NSAIDS are helpful with.

Is that a reference to Marty Hoey? I took a class from her at RMI and was saddened to hear of her death on Everest.

It seems likely to me that ibuprofen wouldn't help mental clarity much at all (although headaches can be distracting). Avoiding a headache doesn't mean you're well-perfused with oxygen. Brains work better with oxygen and that comes (imperfectly) with acclimitization.

So I see this as helpful info for sea-level types who suffer from AMS and who want to bag intermediate altitude peaks (48-state stuff) quickly. But not as a way to do serious altitudes anymore quickly or with any less acclimitization.

Here's a non-UL way to avoid AMS: Put 75 pounds on your back and don't drive to the trailhead. In the 3-4 days it takes you to get to 12,000 feet, you'll have had some time to acclimizatize a bit and largely avoid the window of AMS suspectibility.

Alternately (and I'd recommend this route instead): bring a lawn chair and a good book to the 8,000' trailhead and hang out two nights and one day before starting off with your 8-pound pack.

I'm always skeptical about single studies involving only a small group. However, this study appears to indicate that further research is warranted. The study was conducted by a wilderness medicine specialist at Stanford and financed by the American Alpine Institute, and, from the article in the Stanford Medical News cited by Mark Verber, it appears to be a proper double-blind study published in a reputable medical journal.

I've contacted my son-in-law-the-ER-physician (who, I'm sure, subscribes to Annals of Emergency Medicine) to see if he can get me a copy of the original article.

Despite my skepticism, if I can make it to the Wind Rivers this summer, I'll probably try the ibuprofen to see if it helps with the symptoms I get, primarily fatigue, lassitude and loss of appetite–although the latter for me is actually beneficial! :-) I still plan to do several days of acclimatization beforehand, though.

Overuse of ibuprofen can cause side effects (internal bleeding and kidney damage), so it isn't exactly harmless!

If you live as I do barely above sea level, here's my doctor's advice that has served me well: OK to go right to 6,000 to 8,000 feet (like fly to Denver, drive to Estes Park, register and get to a trailhead in RMNP). But be ready to hike more slowly uphill than you expect. Stay really well hydrated. Drink 25-50% more water than you usually do. Above 8,000 feet, acclimate as much as your itinerary options allow with ideally no more than 1,000 feet higher sleeping elevation per day, though OK to go higher than that on trail during the day. Above 10,000 feet, have acetazolamide (Diamox) with you – this will need a physician's prescription, but it's not expensive – and begin treatment if you start to have mild AMS symptoms (headache, nausea, feel/act dehydrated when you are not). If you get short of breath, particularly at rest, or increasingly short of breath on trail, you may be getting early HAPE, and you need to descend ASAP.

One of the small problems of Diamox is that the shelf life isn't very long.

–B.G.–

There's a typo in the article. The highest the participants slept was 12,470 ft, not 12,570 ft. Barcroft Station is 12,470 ft. It really doesn't matter but just thought I'd point that out. These kinds of studies are always taking place up there along with a lot of other cool research (especially the stuff looking at alpine plant communities ;)

"Above 10,000 feet, have acetazolamide (Diamox) with you – this will need a physician's prescription, but it's not expensive"

The first time that I ever requested a prescription for Diamox was in 1995, and I was in my HMO physician's exam room.

He was not familiar with its use at altitude, so he asked, "Do you have a heart condition? That's a heart drug."

I had to explain to him about Diamox and where to look for reference information, which he did right then and there. Then he asked me a bunch of relevant questions:

1. How many day's worth of Diamox do you need?
2. How high do you intend to climb?
3. How high have you climbed before?
4. Have you ever had any significant symptoms from high altitude?
etc.

Once we had that discussion, he asked me what else I needed. Broad-spectrum antibiotic for internal use. Prescription pain killer, just in case.

Personally, I would never fool with Diamox for anyplace as low as 10,000 feet, but that is just me. Everybody has a different ceiling. I came to the conclusion that about 80% of the symptoms that others report from high altitude are mainly from simple dehydration, but I've seen well-hydrated hikers get pretty sick in a hurry at 16,000 feet. It isn't pretty.

–B.G.–

Slept on top of White Mountain a couple years back, it was a miserable trip, dryheaving all night (which seemed to be the majority of my trips). I always get hit by altitude sickness at 10k or higher.

Anyone know how long it takes to get acclimated? As a weekend warrior, I don't have the extra days for acclimizitation. I always assumed it was because I'm in bad shape (which is somewhat true), but during my Death Valley hikes, I was amazed at the difference of my performance compared to trips seeing 10k+.

Ibuprofen is no go for me, causes one of my eyes to puff up. So much for Vitamin I.

"Anyone know how long it takes to get acclimated?"

I don't think that there is any good way to predict this other than by past history.

Last year I drove from sea level to the White Mountains and slept at 9000 feet. The next morning, I hiked from the gate, which is around 11,500 feet, to the summit and back. No symptoms at all.

If I had tried to go from sea level to the gate and hike to the summit on the same day… then that would be tempting fate.

Among the California hikers that I hike with, I see zero having a problem anywhere below 10,000 feet. It is generally 11,000-13,000 feet where the symptoms show up.

Doctors were trying to determine why there is a greater incidence of AMS or HAPE at the Mammoth ski area as compared to Lake Tahoe. It is because the base level at Mammoth is around 8000 feet, and at Lake Tahoe it is around 6200 feet. That sleeping altitude is important.

–B.G.–

>"Anyone know how long it takes to get acclimated? As a weekend warrior, I don't have the extra days for acclimizitation."

Christopher:

As Bob reports, I've noticed a big difference in spending a single night as high as possible before starting to hike. If you have been leaving on Saturday morning, consider instead getting a campsite or or motel room as high as possible on Friday night. If you leave after work on Friday, sleep high, but don't push for a lot of miles on Friday.

Hydrate, hydrate, hydrate.

And do some stair- and hill-work while at home. And drop a few pounds – I have good success whenever I use a food-tracking app like LoseIt. Being in better shape makes it all go easier.

But as to the broader Q of "how long does it takes to get acclimated" – in 2-3 days you're past the window of AMS (but not HAPE/HACE if you're still ascending. After a week, I feel FAR more capable, maybe 50% of complete acclimitization. I always loved back-to-back, week-long, high-Sierra trips because the second one was a breeze in comparison. The literature says 6 weeks for essentially complete adaptation.

there is some anecdotal evidence among mountain runners that acclimating for 3-4 days is worse than no acclimating at all, at least when it comes to mountain racing at altitude.
would be nice to see a study for this.

"The literature says 6 weeks for essentially complete adaptation."

This is the area where so many people get confused.

There are two types of adaptation, short-term and long-term. Short-term adaptation is when you drive up to the mountains, sleep a night, and then go bag some peak. In less than 24 hours your body has been forced to adapt to a new air pressure, and it does this mostly through respiration changes. You breathe faster and deeper, plus your rest heart rate speeds up very slightly. Most short-term adaption is finished within 2-3 days, and that varies from person to person.

Long-term adaptation has mostly to do with your blood. Once your body senses that air pressure is slightly low and oxygen saturation in your blood is slightly low, it starts fixing up your red blood cells. Basically, red blood cell production is kicked up, but that takes a while. Generally 3-4 weeks is needed. That is why Everest expeditions trek up to Base Camp and then hang out for a while, and it is only a few weeks later when they are actually making a stab at the summit. Long-term adaption has very little to do with the kinds of moderate elevation that we see in the Lower 48 states. It probably means some on Denali, since it is in a different vertical class.

–B.G.–

Bob: I'm with you on the short-term (breathing rate, stroke volume, pH changes) and long-term (blood). I seem to recall the increased permeability of lung tissue (something helps deliver oxygen to the tissues but that can go awry in HAPE) was in the 1-2 week range.

I spent one summer at 5,000' and six months working at 4,000'. Peak bagging was a LOT easier those years.

"I seem to recall the increased permeability of lung tissue (something helps deliver oxygen to the tissues but that can go awry in HAPE) was in the 1-2 week range."

You have to get a certain air pressure in your lungs for the alveolar membrane to pass oxygen across into the capillaries where the red blood cells are being pumped along, and the blood pH has to be sort of correct for the oxygen to want to latch onto the hemoglobin. Then it gets pumped out to your muscle tissues for use. There, carbon dioxide latches onto the "empty" hemoglobin where it is returned to the lungs. That is where odd things can happen. If the blood pressure and pH _are_ right, the carbon dioxide will unlatch, transfer across the membrane into the lungs, and then get exhaled. If the blood pressure and pH are _not_ right, the carbon dioxide can fail to unlatch or transfer, and it "takes another ride" around the loop. That dramatically decreases the overall efficiency of respiration. So, once that happens, it is a vicious cycle, so the victim feels bad and then gets progressively worse. You will see a drop in oxygen saturation in the blood if you have an oximeter handy.

If you are a big believer in luck, then you just wait for it to get better. In some cases, the victim will recover automatically, even at some moderate elevation. In other cases, the victim will not recover on his own, and intervention is necessary. The old axiom applies: Go down, go down, go down. There is a lot of evidence that taking the victim down 3000 feet will save his life, and it is best to make that happen while the victim can still move under his own power and before he becomes a statistic.

Incidentally, if you drive too far from sea level up into the mountains for your first night, you might trigger this whole problem right there before you ever get onto the trail. That's why sleeping in your car at some 11,500 foot trailhead might not be smart.

–B.G.–

"Personally, I would never fool with Diamox for anyplace as low as 10,000 feet, but that is just me. Everybody has a different ceiling. I came to the conclusion that about 80% of the symptoms that others report from high altitude are mainly from simple dehydration, but I've seen well-hydrated hikers get pretty sick in a hurry at 16,000 feet. It isn't pretty."

I would agree with Bob that everyone is different and some people have little trouble with AMS while others can have a lot. I was backpacking with a group from Ohio last September in the Winds and one of the group came down with definite AMS that began for him at around 10,000 to 11,000 feet. He had been higher than this in past and no prior problems. He toughed it out but got increasingly short of breath with activity and eventually even at rest, despite the fact that our sleeping altitude was never higher than 11K. We decided when he became short of breath at rest that he was probably in mild HAPE and descended with him to a lower altitude trailhead so that he could get a ride out to Pinedale. After 2 days in Pinedale just taking it easy (Pinedale is about 7.5 K)he was pretty much back to feeling normal.

So I learned from this to not make assumptions about how high you need to go to get AMS. Its less predictable than it ought to be, unfortunately.

Robert, absolutely right.

I have heard of little old ladies with a heart condition stepping off a tour bus in Yosemite Valley (4000 feet) and started developing altitude problems immediately. But, that is not a normally healthy backpacker.

Years ago a healthy 40-year-old physician drove from sea level up to 8500 feet in Yosemite, strapped on his backpack, and headed up to Cathedral Lakes (around 10,000 feet). That was too much of a rush, so he was feeling poorly by that evening. By the next morning, he had all of the classic early symptoms of HAPE. Somebody else went for help, and they had a helicopter evacuate him before noon. By the time he had been sitting in Yosemite Valley for an hour, his vital signs were normal.

–B.G.–

"I seem to recall the increased permeability of lung tissue (something helps deliver oxygen to the tissues but that can go awry in HAPE) was in the 1-2 week range."

With HAPE, according to a text I read a long time ago, the difference in pressure between the blood and the atmosphere at higher elevations can cause fluid to leak into the lungs in susceptible individuals. I can't remember where I got this offhand, but it makes sense and should be easy to validate with a few queries. FWIW.

"With HAPE, according to a text I read a long time ago, the difference in pressure between the blood and the atmosphere at higher elevations can cause fluid to leak into the lungs in susceptible individuals. I can't remember where I got this offhand, but it makes sense and should be easy to validate with a few queries."

I agree. Guess what forces the blood pressure to be abnormally high to cause this to happen.

If the victim is very dehydrated the capillary fluid coming past the lungs is very thick, and little micro-clots happen. Well, if just a couple of micro-clots stack up there, you won't notice much. However, when those tiny capillaries are clotted and closed, that forces the fluid to flow more into the capillaries that are still open, which forces them to have even higher pressure with even more risk of micro-clots and leakage into the alveolar membrane, and that is another vicious cycle. The key to prevention, of course, is to never let yourself get very dehydrated.

Too many climbers get dehydrated. They don't want to carry any more water weight. They are maybe up too high in direct sun, so they don't realize their body temperature. The air is dry, so they have a lot of water loss to the air. Maybe their stove for melting snow isn't so efficient. That brings us back to Larry Penberthy and MSR.

–B.G.–

Small airplane pilots with unpressurised cabins are required to use oxygen above a certain elevation, I believe it is 8000 ft. I was told by the maker of oxygen supplies
for these craft, that several hours at 8000 ft can give one the same symptoms as spending
one hour at 13000 ft (headaches, fuzzy mind etc.)

While it might take a month or more to get all the red blood cells you might need for
altitude, it only takes about 3 days for you body to get rid of them when you return to
lower elevation. Your lungs and other adaptions last longer.