Mt. Whitney Portal Store & Hostel Forums General Mt. Whitney Portal Store Message Board "Chance" or other MD: Question on Diamox

I read the "Altitude Tutorial" on www.ismmed.org posted by Chance and it was very, very informative.
I still have questions regarding what a prudent use of Diamox would be...
I will be going up this Sunday and camping at Whitney Portal for one night to acclimate. On Monday, we will ascend to Trail Camp and summit on Tuesday.
I have had mild (bad headache only) AMS symptoms in the past and recently been much more susceptible to headaches since a concussion about five years ago.
My Doc prescribed Diamox on my request and felt it may be a good idea. I am a minimalist regarding meds but also realistic on the fact that I may need it in this case.

Chance: You said you take Diamox. Do you take it with a night of acclimation or just when doing an assent from sea level? Is there a middle ground where I should just take one at night before bed as preventative, rather than starting 24hrs before and taking it two times per day? Any other rules-of-thumb?

Any (qualified) opinions are welcome as well as personal experiences.
Thanks,

Mike

Even though they say to take Diamox a little early (to give you body time to absorb it), I don't. I took it the night before one time and it made my feet tingle at the portal. I had to get up and put my shoes on to sleep. If I take it now I take the lower concentration and take it right before I start. Normal meds absorb in 15 to 30 minutes anyway.

I've posted earlier about Diamox, generally recommending against its regular use. Everyone should recognize that Diamox is not a cure for altitude sickness, but a temporary bandaid. The only real cure is rapid descent. Heading up when you should be heading down because you have diamox can be a fatal mistake.

That being said, it can work well for MILD AMS symptoms. One should recognize what are mild and what are serious symptoms of AMS.
Mildest to most serious:
1) Loss of Appetite
2) Headache
3) Nausea
4) Vomiting
5) Ataxia (stumbling, balance problems)
6) Severe difficulty breathing, coughing up frothy reddish sputum, and making gurgling sounds
7) Confusion
8) Unconsciousness
9) Death

Anyone who uses Diamox when descent is available to treat anything beyond a little nausea is a fool.

Diamox does work for the milder symptoms, and can be taken both prophylactically or as a treatment. Bear in mind the necessity to stay hydrated. Diamox is a diuretic. You will need to drink at least twice as much water as you would otherwise be planning to drink.

Personal experience: A climbing partner of mine used Diamox while we were weathered in at 16,200' on the West Buttress of Denali. He drank all our water and filled all our pee bottles, but did make the summit 3 days later, without ever needing to descend. His symptoms were mild, and he only took a couple of doses of diamox.

ISurFlowers: I am happy to hear that you will be spending two nights acclimating. That is the best thing you are doing to avoid/treat AMS. You'll likely be just fine, with or without diamox.

Two recent reports would be of interest to read through. Go back on the message board to "Mechanics of Diamox" by Sherry on May 9 and "Medicine for High Altitude" by Bob R on March 26th. Certainly they made the subject more clear.

I'm glad you left room for "experiences" too.

I hiked Whitney for the first time last June. I spent lots of time on this board, in the gym, and on local trails up to 12,000 feet and felt well prepared. I did not believe I was candidate for Diamox, but felt there were other "non-prescription" methods that could minimize the effects of the hike.

I took the hydration component to be the MOST important part of the hike. I even carried up to three litres of water on our legs between water stops! I also used an herbal supplement (gingko) starting thirty days prior to my trip, and I took a couple aspirin every three or four hours whether I needed it or not.

On the ascent I experienced some lassitude above Trail Camp. I was tired and really didn't feel like hiking, but I did anyway. I now attribute that to not eating well enough.

On the descent I cut down on water consumption because I wanted to just get back to the Portal. I really felt the effects of dehydration. And of course I'd been on the trail for 12 hours.

I said all that to say this: hydration, eating a little frequently, taking prophylactic aspirin may keep you from feeling sick. And did I say drink lots of water?

New user; first time responder. Don't know anything about Daimox but have my own theories about handling altitude. #1: acclimitize! If you could even get to Lone Pine or, better yet, the Portal, Saturday that would help you a lot. #2: hydrate! If you haven't started yet, start - drink lots before you even begin the hike. How much? If you feel like you just can't drink any more, drink more. #3: aspirin and chocolate. Little bits of each every hour or so on the way up the trail. I don't know why it works, but it has for me on numerous occasions. #4: acceptance. That you will feel SOME effects and that's just the way it goes. Have a great trip! I'm jealous.

Ric I have a couple photos of you to send you that I have failed to do in the past year. I can't wait to go back up. If my 12-year-old nephew can't do it I will call you first.

Later

Hope this is helpful.

Yes, slow and natural acclimitization is best.
Diamox (acetazolamide) can aid the acclimitization process and I find it helpful on rapid ascents (I don't have the luxury of a lot of days off in a row) BUT if symptoms other than mild AMS occur you must descend. That is all very good advice given by the experienced mountaineers and hikers on this board and should be taken seriously.

Having said that, I personally take 125mg (half tablet usually-check the dosage of your tablets) one or two nights prior and maybe twice a day the first day of ascent- continue 125-250mg a day until descent begins. The two tablets some stated they take on this board (?500mg) is likely overkill and will only exxagerate the side effects. I used to take the whole tablet (250mg) and will if symptoms start to develop BUT the 125 mg worked very well and really made the tingly fingers and toes more tolerable

I did still get mild tingling in my fingers and toes but it was transient and you have to remember not to drink carbonated beverages while taking the drug (they will taste like #%#@#) and you should not take it if ALLERGIC TO SULFA. Otherwise, it is a benign drug- just remember it is a diuretic increasing urination and fluid loss and you must actively hydrate!

It is an individual decision whether or not to use diamox or other agent and the 'right' decision will be different for different people.
As I have said before, for me personally the benefits outweigh the small risks (it's a pretty benign drug). Any headache I get turns into a debilitating migraine which would stop my trip cold so it's important to me to avoid them. Also, avoiding the symptoms of mountain sickness helps me feel better overall and that helps me stay strong which helps keep my asthma under control...
I did the Mountaineer's Route in mid-April ascending to Iceberg Lake the first day, summitted and hiked all the way out the next day. I didn't have the slightest hint of headache and only mild nausea- I felt great. Could I have done it without diamox? Probably- but a migraine or an asthma attack would have made it hard if not impossible so I will use Diamox because I feel better when I do. If you are prone to headache and your doctor believes it could benefit you, it probably will- hydrate.

Have fun and thanks for trying to learn the facts about altitude illness and the stuff you may put in your body. Knowledge is power and there are way too many people relying on misconceptions and blatantly false information.

Screw it this is important enough... here are excerpts from the tutorial on the ISMM site. These are just very small excerpts the is A LOT more good info on acclimitization schedules, diamox and ginko biloba, and much more on this site. I don't know if anyone other than 'isurflowers' has checked it out.
So here is the site info again...
(www.ismmed.org- click on Mountain Medicine Information Center, -then 'written for non-physicians, there is the altitude tutorial)

here are some samples of what you will find...

"This simply cannot be emphasized too much. If you have symptoms of AMS, DO NOT ASCEND ANY HIGHER!! Violating this simple rule has resulted in many tragic deaths.

"Acclimatization is the process of the body adjusting to the decreased availability of oxygen at high altitudes. It is a slow process, taking place over a period of days to weeks.

High altitude is defined as:

- High Altitude: 1500 - 3500 m (5000 - 11500 ft)
- Very High Altitude: 3500 - 5500 m (11500 - 18000 ft)
- Extreme Altitude: above 5500 m

Practically speaking, however, we generally don't worry much about elevations below about 2500 m (8000 ft) since altitude illness rarely occurs lower than this.

Certain normal physiologic changes occur in every person who goes to altitude:

- Hyperventilation (breathing faster, deeper, or both)
- Shortness of breath during exertion
- Changed breathing pattern at night
- Awakening frequently at night
- Increased urination "

"GOLDEN RULE I
If you feel unwell at altitude it is altitude illness until proven otherwise.



GOLDEN RULE II
Never ascend with symptoms of AMS.




GOLDEN RULE III
If you are getting worse (or have HACE or HAPE), go down at once. "

"MYTH: acetazolamide hides symptoms
Acetazolamide accelerates acclimatization. As acclimatization occurs, symptoms resolve, directly reflecting improving health. Acetazolamide does not cover up anything - if you are still sick, you will still have symptoms. If you feel well, you are well.

MYTH: acetazolamide will prevent AMS from worsening during ascent.
Acetazolamide DOES NOT PROTECT AGAINST WORSENING AMS WITH CONTINUED ASCENT. It does not change Golden Rule II. Plenty of people have developed HAPE and HACE who believed this myth.

MYTH: acetazolamide will prevent AMS during rapid ascent.
This is actually not a myth, but rather a misused partial truth. Acetazolamide does lessen the risk of AMS, that's why we recommend it for people on forced ascents. This protection is not absolute, however, and it is foolish to believe that a rapid ascent on acetazolamide is without serious risk. Even on acetazolamide, it is still possible to ascend so rapidly that when illness strikes, it may be sudden, severe, and possibly fatal.

MYTH: If acetazolamide is stopped, symptoms will worsen.
There is no rebound effect. If acetazolamide is stopped, acclimatization slows down to your own intrinsic rate. If AMS is still present, it will take somewhat longer to resolve; if not - well, you don't need to accelerate acclimatization if you ARE acclimatized. You won't become ill simply by stopping acetazolamide."

etc, etc, etc.

Thank you to everyone, and especially Chance and Desperado.

I will post back to this board after I return and let you know what I ended up doing, conditions and how it went.

I really appreciate the help.

Time to go surfing before we go up Sunday.....

Mike