Ibuprofen may ward off altitude sickness

FAA regs. Sec. 135.89 Pilot requirements: Use of Oxygen.
(a) Unpressurized aircraft. Each pilot of an unpressurized aircraft shall use oxygen
continuously when flying—
(1) At altitudes above 10,000 feet through 12,000 feet MSL for that part of the flight at
those altitudes that is of more than 30 minutes duration; and
(2) Above 12,000 feet MSL.
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I don't know that your body "gets rid of" red blood cells three days after returning to lower elevation. I think it simply quits replenishing them until it gets to normal concentrations. The average life expectancy of a red blood cell is 21 days or so.

–B.G.–

When climbers go too high to fast, they make themselves susceptible to altitude sickness in one of its forms. If you are with somebody else who seems a little sick this way, how can you tell? The answer is: it depends.

If they have cardiovascular problems, then it will likely show up in their blood pressure or pulse. You probably don't have a blood pressure cuff along, but at least you can count their pulse against your wristwatch. It helps to know what their normal sea level pulse is, or maybe what their pulse was at the trailhead. Generally, once they arrive in camp and rest for an hour, if the rest pulse is above 110 or 120, that is a bad sign. You can listen for respiratory problems like wheezing, and you can look for pink sputum that they may be coughing up.

The easy test is one of brain function. Some of us are glad to have any at all, but I digress… When your blood oxygen saturation starts dropping, some of the first signs are at the brain. Ataxia is the loss of balance, like a drunken driver. The test that I like can also be performed at a drinking party. You can tell who is really drunk and who is just a bit impaired.

Here is a graphic that needs to be printed in color. Have the subject look at the graphic, but not read the words as spelled. Instead, speak the colors of the words. Then watch the fun begin. Maybe print the correct response on the back side of the graphic so that the subject sees the graphic and you see the correct response. The subject must be able to concentrate a little in order to get them correct at all. If the subject is impaired, he might not be able to get any correct.

The correct response is:
Red, White, Blue, Brown, Green
Blue, Red, Green, White, Brown
White, Green, Red, Blue, Brown
White, Red, Blue, Green, Brown
Green, Blue, Red, White, Brown
Blue, Red, Green, White, Brown
Green, Brown, White, Red, Blue
Blue, Green, White, Red, Brown
Green, Blue, Brown, Blue, Red

Have fun.
–B.G.–

"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."

Interesting info. Thanks for the update.

It's amazing how many unpleasant conditions have dehydration as the cause or as a contributing factor! AMS, hyperthermia, hypothermia, just plain fatigue and a lot more!

One friend of mine had to have kidney dialysis as a result of dehydration combined with a large dose of Tylenol.

–B.G.–

I became incredibly exhausted going on an overnight to Paradise Valley (kings canyon). That couldn't have been much more than 7000 ft. I barely ate anything that night and pretty much stumbled out of there the next day. I slept at 6500 feet the night before.

On another trip it took me 8 hours to walk 3 miles to Monarch Lakes from Mineral King where I slept.
I turned around the next day after I fell over a few times walking up Sawtooth Pass. I was becoming very confused at my surroundings, getting blurred vision, and I pretty much starting to lose consciousness with every step. A sad end to a planned 5 day trip.
I also slept a night car camping at 8,000 the night before.

Apparently, I get it REALLY REALLY BAD. And I desperately want to get over it so I can do some backpacking trips in the high sierras this summer.

Justin, you might want to have a talk with your physician. You may either have to sleep up high another night before you start, or else get a prescription for Diamox (acetazolamide). Still, you need to take the Diamox pills for a day or so before you head up to the mountains. Then, you generally continue the pills until you hit the high point of your trip.

I know some guys who gobble that stuff down like it was candy, and I'm not sure that is good, although it gives them good results in the mountains.

–B.G.–

Thank you Bob.
I think it was you, or maybe someone else who recommended me Diamox in another thread but I had forgotten the name of it. I am going to talk to my physician eventually.

Justin, your physician will probably ask you if you are allergic to any sulfa drugs. Diamox is one of those. If your regular physician is not familiar with it, typically a travel medicine clinic will be familiar.

I've had Diamox prescribed on three trips, but I actually only consumed it on one trip. Some people claim that they get a good effect out of half of the standard dosage. You might discuss that with your physician. The advantage of half is that you will likely have reduced or zero side effects. But then if you have to go really high sometime, go for the full dosage.

The standard side effects include (1) increased urination for the first few days, (2) slight tingling in the extremities, and (3) strange taste of carbonated beverages. That will kind of mess up the post-trip beer.

–B.G.–

Justin –

Some advice I received and followed for a Nepal trek was to take a half tab (125 mg) at bedtime every night as a preventive step once I arrived in Kathmandu and continue doing that unless/until I started to have any mild AMS symptoms, at which point I should increase to a full tab (250 mg) two to four times a day, depending on symptom level.

I took the preventive dose until our party got to about 13,000 feet (day 4 or 5, as I recall), at which point I started to get headaches, which are not common for me to get. At that point I went to a full tab twice a day and continued that until I got back to 13,000 feet. For me this worked very well. I got as high as 18,200 feet and slept as high as 17,100 on this 14-day trip. We ascended for the first 9 of the 14 days and descended in remaining 5 days.

Just to confirm the variability factor, my brother (8 years younger) needed about twice the Diamox that I did, and my son (30 years younger) needed none. I was 54 at the time.

"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."

Which is what I did for New Years Day this year. Drove straight from Bakersfield (About 408 elevation), slept at the Little Lakes Valley trailhead (About 10,200 elevation), got nausea/vomiting all night. We were gonna camp in Little Lakes Valley somewhere, but my friend just dayhiked and I drove down to Tom's Place the next day where I recovered.

One night wasn't enough for me for that White Mountain trip. Slept at that lower campground which is around 8k, I think? Never had enough time for staying 2 days at a somewhat high elevation before heading in.

Attempting High Sierra Trail + Whitney and a loop back with a friend this summer. Hoping I'll be acclimated enough by the time I get to Guitar Lake, but I'd like to have Diamox just in case.

So, Robert, I guess you were the old guy who made it up Kala Pattar? Congratulations.

The last time that I was there, I think I was the only one in the group of twelve that was not taking the Diamox.

For the next time that anybody is going on a trek to high elevation where part of the group might be taking Diamox and part won't be taking it, it would be neat if some statistics could be gathered. Have each group member record their rest pulse rate first thing in the morning before they get up. Then record whether or not they are taking Diamox, and if so whatever the dosage is, and any altitude symptoms that they may have. Then at the end of the trek, gather all of that and see what kind of correlation there is between Diamox and non-Diamox. I tried to get all of that done on my last trip up high, and only one out of eleven turned in the data. On another trip, Diamox gave climbers some advantage, but it was sure no guarantee of success.

–B.G.–

After reading the various stories of altitude-related issues, I feel luck to have had so few. The only time I can recall even a bad headache was driving from 2k' directly up to Tioga Pass at 10k', then immediately climbing Mt Dana at 13k'. All my other experiences have been that one night spent above 8-9k' is enough for me to be good to go all the way up to 14.5k', with no issues. I did live at 4-5k' from birth to age 17, I wonder if that would have any impact?

"I did live at 4-5k' from birth to age 17, I wonder if that would have any impact?"

Probably zero.

The native people in the Andes have lived up high for enough generations that there is a bit of adaptation. They get more of a barrel chest, and that is thought to make for bigger respiratory volume.

Yes, Mount Dana is a typical place to have altitude problems. We pulled a similar stunt there 25 years ago, and the hiker with me was almost crippled from a headache.

–B.G.–

I have found that physical fitness prior to a high altitude trek is key. Preparation is always key. Also hydration is a major component as I'm sure you all know. However, keep in mind that to fully hydrate your body take 4 days. Focus on hydrating in the 5 mornings preceding a trip as your body is like a sponge in the mornings and makes most effective use of your intake.

Finally, and I know its tough… but cut out the celebratory drinking session prior to your to the day you embark on your trip.

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While Diamox helps many for some it doesn't work. For me it just made me extremely drowsy and didn't resolve my altitude problems.

For me anything over 8000ft caused Nausia. Sometimes it would go away with rest but other times it was continuous. On one hike I was nauseous for 3 full days at about 9000ft and it didn't clear until I was below 7000ft (and it cleared very quickly). Somelimes I didn't have any problems and other times it was really bad. Doctors couldn't figure it out and eventually I stopped try to do overnight and multi day backpacking in the Sierras. I just did day hikes.

However recently I was diagnosed with an Atrial Septal Defect. This is a very common heart defect that affects about 5% of the population. Most people with this defect will live normal lives and never show any symptoms. Divers are frequently tested for this because it increases the risk of getting the bends. I would like to say that the doctor found it during a normal exam but unfortunately It was found after I had 3 short strokes (fortunately all cleared on there own and didn't last long enough to cause any damage). It took the doctors 3 days to find the defect and it ended up being a very small one.

In my case the defect caused some blood to bypass the lungs. In short at altitude I was always running an oxygen deficit. At lower levels the symptoms were so subtle. Justin's description of his problems sounds a lot like how I felt minus the nausea.

Fortunately fixing this defect is easy today. The operation lasted only about an hour and was done using catheters inserted in the leg. Recovery is fairly fast but you do have to stay on blood thinners for 6 months while tissue grows over the plug the doctors installed. Now I am like everyone else and adjust fairly rapidly to the altitude. Last summer I did a 1 week trip at 10,000ft without any issues other than being a little slow the first day or two.

Yeah, I never felt sick like I was going to throw up or had a headache. It has always just been the inability to catch my breath. I end up stopping and resting more than hiking.

I just heard back from my son-in-law-the-ER-physician (who is also a backpacker). Here is his response:

"I actually would hesitate to embrace these findings as a replacement for acetazolamide (which is actually very cheap, although you need a Rx) as we know that acetazolamide cuts the risk and symptoms by 75% [vs. 57% in the ibuprofen study] and there is no increased risk if you stop the drug while at altitide, while we know that dexamethasone, a steroid antiinflamatory, also works and may work in a similar way to ibuprofen, is dangerous to stop suddenly while at altitude. The other problem with embracing this early study on ibuprofen is headache is part of the diagnosis of acute mountain sickness, and this study doesn't appear to break the component symptoms down, just the "development of acute mountain sickness." I think since ibuprofen definitely decreases symptoms, it's a great choice for going under 10,000 feet, but until I hear more, I would stick to acetazolamide for higher ascents with inadequate acclimatization."

He also suggests that because it is dangerous to stop dexamethasone once started for altitude sickness, there might possibly also be some problems with stopping ibuprofen. In any case, more research is indicated.

My “secret” for skiing and backpacking at altitudes over 8,000ft. is to take 3 “NO2 Red” tablets 1 hour before hiking or skiing. These are merely time release L-Arginine tabs available at GNC . L-Arginine is an amino acid that creates nitric oxide in your bloodstream.

This opens up your blood vessels like a mild form of Cialis, which many climbers of major mountains use. It greatly helps with both oxygen uptake and getting rid of lactic acid from your muscles.

Finally, older hikers are less prone to altitude sickness than younger people. So there can be an upside to aging! ;o)

This discussion is of interest to me, because next summer I hope to through hike the Tahoe Rim Trail. I live at sea level, have only hiked as high as 7,000 ft, and that was after being on the trail for 3 or four days, and I didn’t sleep that high.  I have been to a conference in the Rockies at 9,000 ft, wasn’t hiking, but definitely had some mild AMS–difficulty sleeping, headaches, was a little breathless just walking around.

Hydration is obviously key, and by then I will be in better shape.  I still should not plan big mileage days at first, I think. What I’m trying to figure out is how much advance time I should spend locally, before getting on the trail.  That’s something to think about early, as that will affect my vacation planning and rough idea of how many days this will take me.

“Finally, older hikers are less prone to altitude sickness than younger people.”

I’ll have to test that out.  I use to go above 10,000 feet and get bad headaches.

Below 10,000 feet no noticeable problem.

Specifically to Diane Pinkers:

You are fairly unlikely to have any issues on the TRT; at altitudes from 7-9K, whihc is most of the trail, most people do just fine. Maybe a little headache the first night. But if you have no experience at altitude you never know. The one thing you can be sure of is that spending a night or two at the lake will help, if only in that you’ll go up the hills easier.  So if you have the time to add a day or two to the trip for that It’s a good idea.

Personally I’ve definitely found that hydration makes a big difference, I have felt crummy at 7,500 feet on the first night because I didn’t drink enough, and felt fine at 11,000 on the first night after I guzzled water all day. My method is just to always drink more than what I am thirsty for for the first few days. The High Sierra is a dry place in general, humidity-wise, and when you combine that with breathing hard as you chug up to a pass, you lose water pretty fast, and if you are not accustomed to it, odds are that you won’t drink enough unless you make a point of it.

One little anecdote about blood changes due to acclimatization – I went on a 19 day trip in the Sierra with a friend whose baby nephew had infant leukemia. The tyke had had bone marrow transplant, and was receiving transfusions. My friend had been giving blood before the trip for his nephew. When we got back he went in right way, and the nurses were wowed by how dark red his blood was  – they said “this will cure him for sure”  “he”ll get up and dance with this in him!”

Sorry about the duplicate NO2 Red post. I ned to check for my previous posts before sounding off.

Anyway I want to emphasize the importance of hydration, specifically proper electrolyte hydration. I like CYTOMAX drink but other folks well may have different tastes. For example I can’t gag down GOOKINAID.

That said when above 9,000 ft. the most severe AMS (Altitude Mountain Sickness) is HACE (High Altitude Cerebral Edema) which is a dire emergency and requires the patient be brought down to at least 5,000 IMMEDIATELY.  This is a life-threatening condition. O2 is the best temporary pre-evacuation medicine (O2 is classified as a medicine).

HAPE (High Altitude Pulmonary Edema) is less serious in the short term but still requires the patient of to a much lower altitude, especially if the patient has asthma of any type, including exercise-induced asthma. With HAPE the patient’s alveoli fill with extra-cellular fluid that reduces the O2 uptake. This in turn worsens the problem.

Speaking as a former ski patroller who has seen AMS firsthand several times I’d recommend that a group mountaineering 1st aid kit include a battery powered oximeter to check O2 uptake on people with AMS symptoms, even milder symptoms like malaise, crankiness, sleeplessness, etc.

Ibu’s have never really helped me; I usually have some headaches above 11K early in a trip.

However for me, excedrin really wipes out headaches…even altitude headaches.