Preventing Mountain Sickness

[Kevin S]

Are there techniques for preventing mountain (altitude) sickness? My 20-year old son, who is very fit at sea level, has suffered every time we go on a backpacking trip or ski trip. We have tried acclimatizing slowly, proper hydration and nutrition, climb high and sleep low. No joy. He has. Great attitude and a strong work ethic. I’d really like to share the mountains with him, so I’d welcome any tips or experiences.

[Dan]

How high are you going, and how did you try to acclimate?  Given enough time, he should acclimate.

There are also devices (hypoxic chamber, altitude chamber) that can be used to simulate altitude at home, which could potentially jump-start his acclimation. I have no first-hand experience with them.

[Kevin S]

8000-14000 feet on various trips. Acclimatizing has been at least the night before at the trailhead, but once it was over a week camping in a cabin around 8500 feet.

[Paul Wagner]

The basic answer is yes and no.  Or yes and know.

Among the things that contribute to altitude sickness are:

> Quick changes in altitude from lower to higher elevations. Solution? Climb up slower, and ideally go up and back down a few times before trying to stay high. Even sleeping at 4,000 will help you adjust to climbing up to 10,000 the next day. 6,000 feet would be better.  Even better is to “hike high and sleep low” to help you acclimate.  Always sleep a couple thousand feet below your highest point of the day.

> Dehydration. Solution: drink and take electrolytes.  Air at higher elevations holds less water, and consequently dehydrates you more quickly.  You won’t notice until you do.  And then it’s too late.

> Physical condition. If you are out of shape or not feeling your best, the elevation change may hit you a lot harder.  Solution: get in better shape and stay healthy.

> Genetics: some people are inherhently more susceptible to altitude sickness. Solution: get better parents.

> Dumb luck/pure chance: even the best and most famous mountaineers have sometimes reported problems, depite the fact that they have done everything right, and have not had problems in the past.  Solution: Go back down and settle for a lower altitude adventure–and come back another time.

General solutions:

Diamox is a medication that can ease the symptoms of altitude sickness. It has significant side effects.  Some people swear by it, others swear they’ll never take it again.

Hydrate. Hydrate. Hydrate more than you think is necessary. Then hydrate more.

Take it easy. The slower you climb, the less altitude sickness will hit you. I know this is hard for he-men and true mountain heroes. A day of acclimatization is worth its weight in gold if you start feeling miserable. Two days is better.

BTW–I’ve always considered flying in airplanes to be a part of acclimatization. When you fly six hours to a new hiking destination, you’ve just spent those six hours at about 6,000 feet.  Good for you!

[Terran Terran]

I find it takes a couple weeks to acclimate. It gets easier with experience. Start low and work your way up. Don’t do it all in one trip. It may take several.  Don’t push it.

[Matthew / BPL]

Lots of good advice above.

You should consider joining the Altitude Acclimatization group on Facebook. It’s lead by Inga Askamit and frequented by Ned Tibbets, among others. I found some documents through that group which I took to my doctor to discuss AMS for myself and my kid.

Good luck!

[SIMULACRA]

I think maybe a good question would be, what are his symptoms? Along with, what has his doctors advice been when discussed? You say he has suffered every time, but not of what. He may be suffering from more than the condition of altitude. Perhaps pulmonary in nature.

[Brad W]

Physical conditioning is not a preventative measure. Olympic level athletes can get and do get AMS. Listen to Dr. Peter Hackett. He is an expert on AMS. Lots of videos and podcasts with him discussing this topic. Very insightful. https://www.youtube.com/watch?v=yz-fBFCs-N4

[Kevin S]

Symptoms are headache, nausea, vomiting. No difficulty breathing or shortness of breath.

[Terran Terran]

That’s why I bring saltines. They’re easy to get down. Good for nausea. I call it priming the pump. Something easy in the stomach that’ll stay down and help the appetite.

Has he tried taking ibuprofen beforehand?

[Kevin S]

I don’t think he has tried ibuprofen until there is a problem. He does like cheesits and gold fish on the trail. We haven’t tried saltines. I’m sure he’s getting plenty of water.

Thank you to everyone for the suggestions.

[AK Granola]

Some of us are just weirdos too, and don’t ever seem to acclimate. I got quite ill my first go on the JMT, even after spending a couple of days at Tuolumne. Vomiting, nausea, feeling winded like being punched in the gut. On my 2nd round on the JMT, I took half doses of Diamox and that took the edge off (no more vomiting) but I was still hallucinating at times and felt terrible nauseous. It never really eased off even after more than a week, from Duck Pass to Kearsearge. After I left trail, I felt better quickly. Two days later I went back up to over 10k and instantly felt ill again. I wondered if it was partially a mental thing?

On the TRT, which mostly stays below 10k, I felt ok. A little nausea and appetite loss the first few days and then I was fine. The brief hikes up to 10k were fine, but I always slept much lower. No Diamox.

If I do another JMT or high sierra trip where I’m consistently over 10, I’ll take full doses of Diamox all the way through. And I’ll still expect some symptoms. It sucks, but it isn’t going to stop me.

Good luck to your kid!

[Terran Terran]

Dramamine.

https://community.cochrane.org/sites/default/files/uploads/inline-files/minutes_reports/ccsg/Keystonerevisitingthedecisiontohold2010Colloquiumthere.doc#:~:text=Symptoms%20of%20Altitude%20Sickness&text=Altitude%20sickness%20feels%20very%20much,in%20a%20day%20or%20two.

[Dan G]

I take at least one trip per year to climb a glacier (18k-20k feet).  I work on my VO2 max for a couple of months beforehand.  In addition, I always take diamox preventively starting the day before I reach anything above 10k feet, until the morning of the summit bid.  This has worked for me multiple times to keep altitude sickness away, and worked for my 20 year old son as well on his first trip to 20k (he’d never been above 14k).  Finally, I carry dex with me every time in case I (or someone else in my group) starts experiencing symptoms of AMS.  My buddy had a pounding headache and nausea at approx 16k, he took the dex and laid down for a couple of hours, and this took care of his issue slowly as we acclimated to that altitude (this was under the supervision of our guides).

[Ian H]

You can’t always fix it. Sir Edmund Hillary got in in middle age, and could never go back to the Nepali schools he had funded, let alone the high peaks. Medications like dexamethasone and even Diamox (acetozolamide) are best reserved for emergencies like unexpected AMS, rather than as planned use for expected AMS. If you get anaphylaxis to peanuts, you don’t shoot up your Epipen and have a nice Thai Satay.

As Brad noted in a previous comment, fitness is not protective. You can’t train away asthma or anaphylaxis or tendency to AMS. Get caught at altitude by bad weather and deterioration can’t be helped.

Kevin, buy your son a sea kayak or a surfboard for Christmas, it may save his life. Kauai has some beautiful mountains you can see from the surf.

[Tom K]

“Hydrate. Hydrate. Hydrate more than you think is necessary. Then hydrate more.”

You need to be careful, if you decide to go this route.  Over hydration can lead to hyponatremia, with serious consequences.  Adding sodium in some form to your water is wise if you are drinking a lot, over 2 liters/day, the recommended daily intake, is a reasonable threshold .  There are numerous electrolyte supplements on the market, or you can do it cheaply by adding 1/4 tsp of table salt to a liter of water to provide ~575 mg of sodium.

[Brad W]

Ibuprofen protocol saved my wife from being extremely sick, dry heaving at 10K to hiking up to 12,700ft and not having the slightest symptom. She starts taking ibuprofen night before then 400mg every 4 hours of the ascent, with tiny carb loaded snack. Life changer for her.

[Morgan S]

I have been told that Ginko biloba helps with altitude sickness. Any truth to that?

[Ted C]

A lot of people think one can just tough it out with AMS.  AMS is not the only altitude illness we’re likely to encounter over 8K.  HAPE, high altitude pulmonary edema, potentially deadly if the patient can’t get 2000-3000 feet lower very quickly.  Initial symptoms are very similar to AMS.  By the time you hear rallies in the patient’s lungs, you have an extremely critical situation.  Frothing at the month may be seen shortly before death or after death.  For most of us, the only viable first aid is to move the victim to a significantly lower altitude as rapidly as safety of the group will allow.  It isn’t likely any of us will be caring pressurized oxygen, which may give you more time to achieve the evacuation.  HACE, High Altitude Cerebral Edema, HARH, High Altitude Retinal Hemorrhage, are life threatening conditions potentially encountered as one progresses upward without adequate acclimatization.  Some people even with what would seem to be adequate acclimatization may still fall ill.  Patients suffering from any of these conditions will benefit from immediate evacuation, the lower the better, the faster the better.  Drugs that we might be caring may help with the associated discomfort, but aren’t likely to deal with the root cause(s) for the discomfort, don’t rely on them, evacuate.

Kevin, if your son wants to climb above 8K (generally considered the threshold for AMS, HAPE, etc.), he should be evaluated by a doctor familiar with these high altitude disorders.  Each experience he’s had may have permanently damaged his bodies ability to sustain itself at altitude.  Masking or controlling symptoms via drugs might ultimately render him more at risk.

One may argue that AMS is not directly related to HAPE and the others.  I would argue that regardless, AMS should be accepted as the bodies early warning system for any of these illnesses.

Check out Medicine for Mountaineering by the Mountaineers and edited by Dr. James A. Wilkerson for more information.

[Ken Larson]

Along with Wilkerson’s book may I suggest Mountain Sickness Prevention, Recognition and Treatment by Peter Hackett M.D. (Dr. Peter Hackett is a world renowned high altitude expert and altitude research pioneer. He is a leading authority on altitude illness, high altitude climbing, …)

Acute mountain sickness and can be divided into three categories; mild, moderate and severe with pulmonary and cerebral edema being categorized as sever. Overexertion and dehydration seems to be a predisposing factors.

Ted…… Your comments are excellent and members should “take to heart”  if one is planning to do any 3,000 meter (10,000 feet) adventuring

 

[Terran Terran]

Wilderness Medical Society Clinical Practice Guidelines for the Prevention and Treatment of Acute Altitude Illness: 2019 Update

https://journals.sagepub.com/doi/full/10.1016/j.wem.2019.04.006

 

[Morgan S]

Thank you Terra Terran, for this reference stating ginkgo biloba is not helpful for AMS.

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