Altitude sickness question

[Scoot]

Hi All,

I've done some digging about altitude sickness already and I'm probably in the "somewhat informed" category on the topic. I know there's a podcast (that I'm going to listen to) and I've sifted through a bunch of the old posts I found via search on the topic. I also know I could get a script for Diamox from my doc.

Here's my question-- should I get the script? I live below 1000. I've hunted as high as 10K and never had a problem. I definitely feel like I struggle to catch my breath a little for the first couple days, but no biggie and I seem to get my legs/lungs after a couple days at elevation. However, this year I'll be higher- over 12K. I've never been that high before. I THINK I won't have a problem, but I'm just curious to hear if my guess is likely to be the case or if I should use an "ounce of prevention is worth a pound of cure" kinda approach?

I'd prefer to not take Diamox. My understanding is that once you realize you should have taken it, it's too late and taking it won't help at that point (only dropping elevation will help at that point, from what I understand). I'm kind of leaning towards getting a script for it and bringing it along, but not taking it in advance. If I have a problem, I'll drop elevation until I feel better, then take it. Thoughts on this plan?

Or... am I being ridiculous and I should just go and have fun without a script? I've been fine to 10K, so I'll likely be fine to 12K... Again, I'd appreciate thoughts on the matter.
Thanks in advance!
Scott

 

[Marbles]

Will you have time to acclimate and sleep lower? Will you be very active on the first day?



This is what the WMS has to say about it.

Acetazolamide​

Multiple trials have established a role for acetazolamide in prevention of AMS.18–21
Acetazolamide contains a sulfa moiety but carries an extremely low risk of inciting an allergic reaction in persons with sulfonamide allergy. As a result, persons with known allergy to sulfonamide medications can consider a supervised trial of acetazolamide before the trip, particularly if planning travel to a location remote from medical resources.22 Prior anaphylaxis to a sulfonamide medication or a history of Stevens-Johnson syndrome should be considered a contraindication to acetazolamide.
Some studies suggest that acetazolamide may have an adverse effect on maximum exercise capacity,23 perceived dyspnea during maximal exercise tests,24 and respiratory muscle function at high levels of work.25 The small observed changes, however, are unlikely to affect overall exercise performance for the majority of activities in which high altitude travelers engage (hiking, skiing) or the chance of summit success for climbers at moderate and even extreme elevations. These changes should not be viewed as a reason to avoid acetazolamide.
The recommended adult dose for prophylaxis is 125 mg every 12 h (Table 1). Although doses up to 750 mg daily are effective at preventing AMS compared to placebo, they are associated with more frequent and/or pronounced side effects, do not convey greater efficacy, and are not recommended for prevention. A recent, small study suggested that 62.5 mg every 12 h was noninferior to 125 mg every 12 h,26 but further research with greater numbers of participants in different high altitude settings should be completed before a change in dose can be recommended. The pediatric dose of acetazolamide is 2.5 mg·kg-1·dose-1 (maximum 125 mg·dose-1) every 12 h.27

Recommendation. Acetazolamide should be strongly considered in travelers at moderate or high risk of AMS with ascent to high altitude. Recommendation Grade: 1A.

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

And what the CDC has to say

Dose​

An effective dose for prophylaxis that minimizes the common side effects of increased urination and paresthesia of the fingers and toes is 125 mg every 12 hours, beginning the day before ascent and continuing the first 2 days at elevation, and longer if ascent continues. Acetazolamide can also be taken episodically for symptoms of AMS, as needed. To date, the only dose studied for treatment is 250 mg (2 doses taken 8 hours apart), although the lower dosage used for prevention has anecdotally been successful.

High Elevation Travel & Altitude Illness | CDC Yellow Book 2024

Information about how to order the U.S. government publication about traveling titled "Health Information for International Travel" (also called the "Yellow Book"). Provided by the U.S. Centers for Disease Control and Prevention (CDC).

wwwnc.cdc.gov

My take: Someone without experience treating AMS in the field is risky (this would include me, even as a healthcare provider). Unless it must be done, if you get symptoms you need to drop altitude and likely end the hunt. Consequently, a few days of Diamox taken at the beginning could be worth it. However, carrying it for treatment of AMS, rather than taking it for prophylaxis, is a bad idea if one intends to treat and stay at elevation (the exception obviously is if you have someone experienced in treating AMS present, then I would go with their advice).

That is not to say using it for treatment and staying at altitude will not work, but rather to say the potential consequences are not worth hazarding just for a hunt.

Obviously, the final decision is between you and your healthcare provider. The above is only information.

 

[S-3 ranch]

Uhgg! It ruined one of our elk hunts
I went up 3 days in advance and then picked up the other two guys at the airport. Them flying in was a major mistake the older one suffered so badly that he never got to hunt and actually had to leave early
Me even with 3 days @ 7000 my stomach was upset up at 9-10k
I think I would try the medicine if I was going again

 

[realunlucky]

I'd spend the night at lower elevations drink as much fluid as possible to help flush your system.


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[Scoot]

Recommendation. Acetazolamide should be strongly considered in travelers at moderate or high risk of AMS with ascent to high altitude. Recommendation Grade: 1A.

Thanks for the help, fellas! Marbles, I think the quote from your post mostly sums up part of what I'm wondering-- am I at "moderate or high risk for AMS"? I'm unclear what factors increase risk. Even if I know the factors, I'm unclear what category of risk they will put me in. I'll take that info and do a little more digging though. Thanks again.

To address another question- we'll sleep at about 3K feet elevation on the drive out, then camp at about 12.5K the next night. The first 2.5 days will be pretty light duty- we'll be scouting (mostly with glass and not so much boot leather) and doing a bit of driving and checking out a lot of areas that don't require much hiking. Even after that, I don't expect this to be a terribly physical hunt- we're hunting from a base camp that is at the pickup. I'll be well hydrated when I get there and I'll stay well hydrated. Alcohol consumption will be minimal (until we're tagged out- then it might be out of hand for an evening!)

Thanks again for the replies and info!

 

[Marbles]

I'm wondering-- am I at "moderate or high risk for AMS"?

It looks to me like you fall in the high risk category.

WMS categorizes risk as follows: https://wms.org/magazine/magazine/1252/2019altitude-cpg/default.aspx#:~:text=Table 1.,High

Table 1. Risk Categories for Acute Mountain Sickness

Risk Category Description

Low

• Individuals with no prior history of altitude illness and ascending to ≤ 2800 m;
• Individuals taking ≥ 2 d to arrive at 2500-3000 m with subsequent increases in sleeping elevation < 500 m•d-1and an extra day for acclimatization every 1000 m

Moderate

• Individuals with prior history of AMS and ascending to 2500-2800 m in 1 d
• No history of AMS and ascending to > 2800 m in 1 d
• All individuals ascending > 500 m•d-1 (increase in sleeping elevation) at altitudes above 3000 m but with an extra day for acclimatization every 1000 m

High

• Individuals with a history of AMS and ascending to > 2800 m in 1 d
• All individuals with a prior history of HACE or HAPE
• All individuals ascending to > 3500 m in 1 d
• All individuals ascending > 500 m•d-1 (increase in sleeping elevation) above > 3000 m without extra days for acclimatization
• Very rapid ascents (eg. < 7 d ascents of Mt. Kilimanjaro)

AMS: Acute mountain sickness; HACE: High altitude cerebral edema; HAPE: High altitude pulmonary edema

Notes:

• Altitudes listed in the table refer to the altitude at which the person sleeps
• Ascent is assumed to start from elevations < 1200 m
• The risk categories described above pertain to unacclimatized individuals

Gradual Ascent: Controlling the rate of ascent, in terms of the number of meters/feet gained per day, is a highly effective means of preventing acute altitude illness. In planning the rate of ascent, the altitude at which someone sleeps is considered more important than the altitude reached during waking hours.

 

[Scoot]

Oh damn! I didn't expect that to be the case, actually. Shoot! Thanks for that info, Marbles. I've got an apt with my doc in a month or so and I'll have to ask about a script for diamox.

 

[svivian]

One of my buddies who lived at moderate elevation his whole life (5,000 -8000ft) joined the military and was stationed the majority of the time at sea level. Towards the end of his service he came back to join me on a high country mule deer hunt where we decided to camp at 11,800. He got super sick and was vomiting constantly. ended up having to come down early, once he got back down to about 8000ft again he was back to normal.

I would bring something to be safe....

 

[ThorM465]

Has anyone hear tried bringing supplemental oxygen to treat symptoms?

 

[Beagle001]

I got the script for it, took it for a day, but didn’t like the side effects (tingling sensation, hazy pee and lots of it) and was worried it was doing more harm than good. Had mild altitude sickness- mostly a headache that came and went- but was better by the second full day

 

[realunlucky]

I got the script for it, took it for a day, but didn’t like the side effects (tingling sensation, hazy pee and lots of it) and was worried it was doing more harm than good. Had mild altitude sickness- mostly a headache that came and went- but was better by the second full day

Urination helps with acclimating to elevation, it's a big part of the process.

I'm going to go back and review some of the mentioned podcasts.



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[Marbles]

Urination helps with acclimating to elevation, it's a big part of the process.

I'm going to go back and review some of the mentioned podcasts.

This is really picking flies, so more incase anyone finds it interesting than because it matters.

The literature does mention the the diuretic effect of acetazolamide (Diamox) potentially helping with HAPE and HACE, however I question the validity of that theory. It is based on the idea that edema is fluid were we do not want it, and for many conditions that cause edema a diuretic helps resolve the swelling. Why I don't think this is true of altitude sickness is that using better diuretics (loop diuretics such as Lasix) is not used as the concern is dehydration and being properly hydrated is a big part of preventing AMS. But, in conditions were we treat edema with diuretics, we also use fluid restriction as another tool to shift intravascular fluid volume and osmolality.

I think it is the loss of bicarbonate in the urine, which increase the pH of the blood, causing increased respiratory drive and decreasing the negative effects of blowing off more CO2 with that increased drive, that makes acetazolamide work. Increased urination is just a side effect in my opinion. Now, the data is not completely clear on the mechanism of action, so this is all just theory. The important thing is we know it works, even if we are not certain on how it works.

 

[realunlucky]

This is really picking flies, so more incase anyone finds it interesting than because it matters.

The literature does mention the the diuretic effect of acetazolamide (Diamox) potentially helping with HAPE and HACE, however I question the validity of that theory. It is based on the idea that edema is fluid were we do not want it, and for many conditions that cause edema a diuretic helps resolve the swelling. Why I don't think this is true of altitude sickness is that using better diuretics (loop diuretics such as Lasix) is not used as the concern is dehydration and being properly hydrated is a big part of preventing AMS. But, in conditions were we treat edema with diuretics, we also use fluid restriction as another tool to shift intravascular fluid volume and osmolality.

I think it is the loss of bicarbonate in the urine, which increase the pH of the blood, causing increased respiratory drive and decreasing the negative effects of blowing off more CO2 with that increased drive, that makes acetazolamide work. Increased urination is just a side effect in my opinion. Now, the data is not completely clear on the mechanism of action, so this is all just theory. The important thing is we know it works, even if we are not certain on how it works.

Yep pretty indepth coverage in my podcast

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[Beagle001]

Urination helps with acclimating to elevation, it's a big part of the process.

I'm going to go back and review some of the mentioned podcasts.



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Yeah, it just felt odd to go into a strenuous hunt having peed so much before the hunt, not to mention the 18-20 hour drive

 

[Archerichards]

I move from 1000 ft to 9 to 11K several times a year. I know well what a trip-buster altitude sickness can be.

I strongly suggest you either plan to aclimatize for several days pre-hunt, or take Diamox. Diamox is an old, proven, well known drug with decades of usage history. It was first used to treat blood pressure issues. I have experienced zero issues with it; didnt even know I had taken it. My normal course it to get the prescription from your doc and then take a half dosage, which always seems adequate for me.

One more tip: first few nights at altitude, lay off of the alcohol and cut your caffeine intake by half or more. You’ll be glad you did.

 

[Outdoorsmans Team Member]

Hi All,

I've done some digging about altitude sickness already and I'm probably in the "somewhat informed" category on the topic. I know there's a podcast (that I'm going to listen to) and I've sifted through a bunch of the old posts I found via search on the topic. I also know I could get a script for Diamox from my doc.

Here's my question-- should I get the script? I live below 1000. I've hunted as high as 10K and never had a problem. I definitely feel like I struggle to catch my breath a little for the first couple days, but no biggie and I seem to get my legs/lungs after a couple days at elevation. However, this year I'll be higher- over 12K. I've never been that high before. I THINK I won't have a problem, but I'm just curious to hear if my guess is likely to be the case or if I should use an "ounce of prevention is worth a pound of cure" kinda approach?

I'd prefer to not take Diamox. My understanding is that once you realize you should have taken it, it's too late and taking it won't help at that point (only dropping elevation will help at that point, from what I understand). I'm kind of leaning towards getting a script for it and bringing it along, but not taking it in advance. If I have a problem, I'll drop elevation until I feel better, then take it. Thoughts on this plan?

Or... am I being ridiculous and I should just go and have fun without a script? I've been fine to 10K, so I'll likely be fine to 12K... Again, I'd appreciate thoughts on the matter.
Thanks in advance!
Scott

Check out the Altitude Advantage from Wilderness Athlete and see if that’s something you’re interested in as an option:

Altitude Advantage

If you’ve got questions give them a call, their customer service is awesome!

 

[NRA4LIFE]

Weed.

 

[willfrye027]

I think @Marbles pretty much covered everything and even linked some great resources

To the OP-there is a non-linear effect of going higher. The difference between 8000 and 10,000 feet is significant, but 10,000-12,000 is pretty huge. Most people are going to have symptoms sleeping that high. Also sleeping at 12.5k is way way up there. The altitude you sleep at matters most..I’d try to think about if you really need to sleep that high.

I would strongly consider adding some acclimation days in your itinerary esp if diamoxx is not happening. Get up to 10000-10500 for a night or two ideally. Going from near sea level to sleeping at 12,500 the first night…you will at best feel super shitty.

Sounds like a pretty intense hunt!

 

[tracker12]

Diamox has worked great for me the last 4 years. I don’t get sick but do get a slight headache and worst of all cant sleep. No more problems with Diamox. Start taking it a couple days before you reach elevation then a few days after.