Mt. Whitney Portal Store & Hostel Forums General Mt. Whitney Portal Store Message Board Acclimatization Plan???

BobP, I would have to disagree on several of your statements.

First of all, you have said you have been to Denali, and the altitude did not bother you. So how can you say driving to a trail head and sleeping overnight helps you acclimatize? I am bothered by altitudes above 10000, and for me, sleeping only the night before hiking at the trail head may actually bring on altitude symptoms sooner.

Regarding Diamox -- It is NOT like aspirin that you can take to alleviate the symptoms. For it to be effective, people should take it 24 to 48 hours before hiking to high altitudes. When I take it, I use half a 250mg tablet 24 hours before, and another 12 hours before I start my hike.

You said that sleeping in Lone Pine will cause a major loss of any acclimatization. But if that is the case, then some of our weekend-climbing regulars would have altitude issues every weekend. But they don't.

Brandy should gain a significant acclimatization effect hiking two days above 10,000. Granted, also sleeping at 8 to 10k would be additional help. But unless she is one of the few who are extremely affected by the altitude, hiking two days before may be all she needs. Of course, she won't know for sure, though, until she comes and tries.

Not to confuse the subject any further, before taking Acetazolamide (Diamox) to the mountains try it at home.
Just recently I was on the medication after eye surgery to lower the pressure in the eye for healing. I have normal blood pressure but had to take it every 4hrs for 3 days. I felt faint, dizzy and could not hold my arms up at shoulder ht. Worse feeling than anything I have felt over 14k.

Some thought, then some personal experience.

In the large research study we did a couple of years back on Whitney, of the 2,000 or so climbers that we interviewed, about 41% of them met criteria for altitude illnesses. So it is common.

What mitigated the occurrance or the severity? Within the previous month, spending time over 10,000 feet was the clear winner. We were not set up to measure this, so I can't state this with certainty, but it appears that the more time spent high, the lower the risk.

I think (but cannot prove) that sleeping high is preferred. However, I STONGLY believe that the more time spent above 10k, the better. Spending 12-14 hours/day above 10k, two days before a climb will, IMHO, make a huge difference. Sleeping in Lone Pine (which is NOT at sea level) will not negate that gain.

I think spending a day at Horseshoe and climbing to NAP, and a day at Onion, and climbing Kearsarge would be two LOVELY days, (Particularly spending a couple of hours on the passes) and would do tremendous acclimatization.

Now the personal: I am afflicted with a severe tendency to altitude illness. The first couple climbs of any season are miserable for that reason, and I plan for that. I use Diamox regularly at the beginning of the season. I used to be a diehard skier, and one of my favorite places was Copper Mtn in Co, with a base of nearly 10k. I'd go for 10 days, and would be miserable the whole time. Heartrate would not drop under 110 for the whole week. What I discovered was, if I flew into Denver, and spent a nite there instead of heading straight up, I pretty much skipped the AMS after a day or so. It made a huge difference, and was trivial in nature.

Bottom line: I think the "lone pine" sleepover option is a fine approach (BTW, getting good sleep IS important, too), and will probably work fine. Would I take Diamox? yes, but I know myself well. should you? probably not neccessary, BUT it would be insurance. At 1/2 of a 250mg dose bedtime dose, the side effects are rare. I'd certainly not take more, as is required for treatment of glaucoma, for example. I do recommend trying it at home.

But don't get lazy and skip the hikes up to higher altitudes in the days before your climb!

I am also a "fan" of Diamox and would also recommend trying it at home as I have read that it really kicks the snot out of some people. I live near sea level and always try to mix mild dosages of Diamox with time spent at mid-level altitudes (anywhere from 5-8K) when going above 12K. My western agenda this year includes Mauna Kea in Hawaii followed by Whitney (got the permit!!) at the end of September. I kind of expect to ramp up the dosage a bit for Mauna Kea since we're talking about nearly 14K so close to the sea shore. But by the time I get to Whitney, I should only be doing 125 mg once a day. For me, the side effects are mild ... tingling in the toes, flat-tasting soda and beer and it makes you pee a lot. Other than that, hydrate, hydrate, hydrate.

Ken: Was that study published? Is it the same one that UMC (or whatever their current name is...) did a few years back?

As a side note, I've seen two cases of HAPE in people taking Diamox -- the symptoms were apparently kept at a very low level and the people were able to do a long trip. Don't know what their dosages were or, obviously, if their symptoms would have been more critical without the Diamox. But interesting. Flew one out; helped the other out over a nearby pass.

Thanks,

George

The ideal way to prepare for Mt. Whitney is to climb a bunch of smaller peaks first. Working your way up to 14,000 feet a little at a time is both good conditioning and an opportunity to learn how you tolerate altitude. Many of the people who attempt Whitney are beginners hiking up the trail, and many of those people come from sea level and "acclimatize" in Lone Pine, nearly 11,000 feet below Mt. Whitney. That may explain why Ken's study found so many people with symptoms.

I've been on Denali twice. The first time, we turned back at 18,360 because two clients and one guide couldn't perform at altitude. The second time, with a better guide service that actually screened its clients, all eight of us just marched up the West Rib up to the summit.

Both guide services required everyone to bring Diamox. Both guide services told us not to take it until we needed it. Everyone eventually used it on both trips. Everyone's symptoms improved or went away with Diamox. Nobody had any annoying side effects. (I was lucky enough to be the last person to need it. I had mild Cheyne-Stokes breathing but no other symptoms. The symptoms disappeared in a matter of minutes.) By the way, Diamox helps to alleviate symptoms, but it can't turn anyone into superman.

The usual dose for climbing at altitude is half of a 250mg tablet every 12 hours. Side effects are rare at this dosage. Ridgeline was taking six times that much. It wouldn't hurt to try it at home if you're concerned about side effects.

I studied everything I could get my hands on when I was preparing for Denali. Here are some of the things I learned:

We can all climb higher than we can sleep. Moderate to strenuous exercise forces you to breathe deeply. Resting, especially sleeping, allows an un-acclimatized person to breathe too shallowly, bringing on various symptoms. This is part of the reason for the often quoted "climb high, sleep low" advice.

Everyone's body undergoes physiological changes in response to a change in altitude. When we go up, we acclimatize. When we go down, we lose acclimatization. The key point here is that we gain and lose acclimatization at about the same rate. Spending a few hours above 10,000 feet helps. Spending 8-12 hours in Lone Pine erases some of that benefit. We can debate how much acclimatization you lose in Lone Pine, but you WILL lose acclimatization.

I'm one of the lucky ones regarding altitude. I never have symptoms in the Sierra. With Diamox, I considered doing jumping jacks on the summit of Denali. However, that doesn't mean I don't gain and lose acclimatization just like everybody else. On the few occasions that I've had to sleep in Bishop or Lone Pine, I've been noticeably weaker at altitude. When I can spend two consecutive nights above 12,000 feet, I feel much stronger.

Sleeping altitude matters. The key is to sleep as high as you can without developing symptoms. Most people can sleep at Whitney Portal without a problem. If you aren't one of those people, I would take some Diamox and sleep there anyway. You will be stronger the next day.

as usual, this topic is a perennial favorite, with lots of anecdotal reporting plus correct and well-meaning but misinformed information all mixed together. The unpredictability of AMS, the wide-variety of individual-sensitivities to altitude, the threshold at which it happens, and the use of and response to Diamox insures this.

Rather than discuss, argue, or expound on my own experiences at high altitude, including being an expedition physician, I encourage anyone interested to please read this one official high altitude tutorial, including comments about Diamox (Of course, there are other sources of information) :

http://www.ismmed.org/np_altitude_tutorial.htm

As for the original question, Brandy is wise to ask for advice to reduce the risk on the mountain but the ultimate answer will only be found in the old British dictum that one must first go rub ones nose in it.

Hope this helps. Harvey

WOW! Well, Thank you everyone who replied and spent time giving me advice and doing the extra research! I did find the information helpful... I love that everyone is so willing to share their thoughts and experiences...

I got some great ideas for day hikes and am more excited than ever!!

Anyway,
Thanks,
Brandy

Great summary. Thanks. Maybe that ought to be made a sticky attached to What Can Go Wrong on Whitney??

At the risk of taking this discussion slightly away from the original question, I thought I'd add a few observations on AMS, HAPE & HACE made over the years that might be helpful.

I've found that the individual who's got HAPE or HACE (but not AMS) doesn't recognize the seriousness of their problem. It's usually someone else in the party who asks for help and by the time that happens, it's acute. So it's important for everyone in the party to be aware of signs and symptoms. Maybe a pep talk and review before starting a trip.

Of the symptoms listed in the article:


I'd emphasize the breathlessness at rest, extreme fatigue and fast shallow breathing. By the time they get to cough or, especially, productive cough & gurgling etc., you've missed a lot and they're really in trouble. In fact, the only time I ran into the gurgling, the person died within an hour of the party being aware of it.

Totally anecdotal, but when I see someone walking 100 or 200 feet, then bending over to breath and/or when they're still short of breath after a 10 minute rest, then I'm kinda concerned. I'd also add a tendency to sleep more comfortably with head and chest elevated -- putting a bunch of clothes under their head at night or even feeling the need to sit up. Of the maybe 50+ cases of HAPE I've seen over the years, I've only heard chest so-called rales or wheezing (with a stethoscope) maybe 5 times. The rest have been based on pulse, respiration and serious shortness of breath.

Some of you guys would know better, but I'm not aware of HAPE on a one day ascent of Whitney such that a person had to be evacuated. HAPE seems to be more common on day two or three. Classic is reporting someone who can't function on their third day (2 nights at altitude).

A new concern is a slight tendency for people to make a phone call for help from Whitney when what they really have to do is get down, however unpleasant that seems. Unless the person is unconscious or dangerously ataxic (stumbling around badly), getting down immediately is the priority.

I do know of at least two cases of HACE on day hikes. One where the guy (alone) was hallucinating and ended up descending the chutes on the west side. If you talked to him for two minutes, he seemed fine (which is why no one got too concerned meeting him on the trail). After a couple of minutes, he'd start asking about his wife's garage sale on Whitney.

So again, that's all just to say that everyone's got to watch out for everyone else, whether they're in your party or not. And, as important, no matter how long you've been getting ready for the trip, you've got to immediately go to Plan II when someone gets sick. If there's the slightest question of HAPE or HACE, you've got to go down.

When Crabtree Ranger Station is manned (mid-June through September), there's a Gamow bag there. It's been successfully used several times but it's a major pain to deploy (the bag & associated Oxygen -- really needs a couple of people. It's always at night...). When you need it, you need it, but carefully evaluate whether you can get the person down. Also, the ranger may be gone overnight if you divert to the station for help.

For all that, both HAPE and HACE are pretty uncommon. Throughout Sequoia Kings, maybe 3 to 5 (at most) cases per summer of HAPE. HACE maybe only 1.

Hmmm. Well, maybe too much information. Hope it's semi-useful though. It really helps when people on the trail are aware of this stuff such that they can evaluate and help others. The majority of reports get to rangers when the person is acute and requires a medivac. Prevention would be much preferable.

George

I added a link to this thread in the list of hyperlinks inside the AMS section. Is that what you had in mind?

I think George meant just

http://www.ismmed.org/np_altitude_tutorial.htm

Harvey, that tutorial is good, but it is lacking in one area: Prevention. It does well describing the symptoms and treatment, but with only two paragraphs on prevention -- and there it stresses "how high you sleep each night" while completely omitting what works for many Sierra hikers: day hikes at higher elevations prior to a Whitney climb. And it completely ignores the subject of how quickly acclimatization benefits are lost.

Since the title shows it is "Draft 5a", maybe you can influence the authors to give more space to additional acclimatization scenarios.

Well, it's whatever you think is most useful, but I meant just that paper that Harvey linked to. As Steve mentions, a little more detail on prevention wouldn't be bad either, but that's not your problem... .

Thanks!

George

I use it regularly when I go to the Sierra and I felt like crap when started dosing. I started 1-500 mg. pill and after a lot crappy days I finally figured out starting with 1/4 pill eliminated those feeling and reduced tingling in the extremities during the entire dosing period.

I don't recommend the use of this drug until you figure out you really need it because it does have a few nasty side effects.

I can't speak for the others but my experience is that if we go to Lone Pine one day early and then spend a few hours hiking either at Horseshoe Meadows or up at the Bristle Cone Pine forest and then up to the Barcroft Research Station on White Mountain and then sleep in Lone Pine and attempt the summit the next day, that seems to work much better than just rushing in the day before and heading up at 3 am the next morning. Again my experience is that any time you can spend at altitude the week or two before your climb will be helpful. It won't guaranty success or that you won't feel the effects of the altitude but you will feel better than you otherwise would and you will be in better shape that if you didn't do it.