Problem with Altitude Acclimitization?

[Stan]

I came across this article this morning which may be of interest to some of you. Perhaps it can help save a vacation or a hike. Some people, for a variety of possible reasons, may either have difficulty acclimating to higher altitudes or take longer to acclimate than they'd like or expect. Consulting a doctor may be helpful but here's some information that can arm you for that discussion.

(note to moderators: I copied the text because the article is from a source available by subscription only and I doubt it can be opened without one.)

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Here's a link to the article. A reminder, please don't post copyrighted material, no matter the source or reason.
Link to Article

-dave-

 

[Kevin Rooney]

Thanks for posting that, Stan. Lots of people use this drug as a precaution - it's good to know there's some science behind it as well.

One thing puzzles me though. In this quote

"Acute mountain sickness is one of three major high-altitude-related diseases seen in people who rapidly ascend to altitudes higher than 3,000 meters or 9,843 feet," said Dr. Poulin. "The other two diseases are high-altitude pulmonary edema and high-altitude cerebral edema...

the author separates AMS from HAPE and HACE. I always thought AMS 'lumped' HAPE and HACE together. Does you (or anyone) know the symptons of AMS (beyond the general sense of 'crappiness') and how they differ from HAPE and/or HACE?

Thanks.

Kevin

 

[DougPaul]

One thing puzzles me though. In this quote
the author separates AMS from HAPE and HACE. I always thought AMS 'lumped' HAPE and HACE together. Does you (or anyone) know the symptons of AMS (beyond the general sense of 'crappiness') and how they differ from HAPE and/or HACE?

I'm in the process of reading the 5th (latest) edition of "Going Higher", by Houston, Harris, and Zeman. They treat AMS and HACE as a continuum, with AMS being on the milder end and HACE being on the severe end, and HAPE as being somewhat separate. That said, there may be some common mechanisims behind all three. And of course, all stem from the common cause of lack of oxygen.

The symptoms of AMS and HACE are largely neurological, and evidence increasignly supports the idea that cerebral edema plays a role in both conditions. For these reasons, AMS and HACE are now view as two regions on a continuum of disease severity.

HAPE is basically fluid leakage into the lungs.

Doug

 

[nartreb]

Pulmonary Edema = fluid in the lungs. Pretty darn serious (can be fatal).

Cerebral Edema = fluid in the braincase. Even more serious, if that's possible.

Mountain Sickness = headache, insomnia, nausea, etc.

All can be caused by a lack of oxygen and/or changes in heartrate, blood pressure, erythrocyte density, etc as your body attempts to compensate for low oxygen.

AMS is a general term which could cover any altitude-induced ailment, but if someone's got identifiable HAPE or HACE, the tendency is to use the more specific (and urgent) term (HAPE/HACE), so in practice AMS usually means the milder symptoms only.

"The hallmark of HACE is a change in mentation" - HACE is diagnosed when it's clear that brain functions are compromised.

HAPE is diagnosed from breathlessness or other symptoms of pulmonary distress.

AMS covers the remaining symptoms - nausea, insomnia, etc.

DougPaul's source, like most I've found, is arguing that most/all of the symptoms of AMS are triggered by malfunctions of the nervous system due to (slight) cerebral edema; if that's right (and it seems to be) then "HACE" is just severe AMS (or AMS is just mild HACE), and HAPE can be considered "to the side" because it's not caused by effects on the brain (but the same underlying fluid-leakage mechanism is in play).

See http://www.mmsn.org.np/mountain/hace.html

PS note that when a study concludes with a statement like "Diamox has been shown to prevent...", they're talking about a statistical conclusion that at least some illness that would otherwise have occurred has been prevented. The study does not imply that the drug is 100% effective for everybody who takes it.

 

[TomD]

I've had AMS and HAPE (similar symptoms as pneumonia, but I think it was HAPE). I have no idea what they gave me-it happened back in the 60's-but I was hospitalized on oxygen and IV's for about a week. In my case, I had flown home from college in Ohio to La Paz, Bolivia (11.5K ft.) where my family was living at the time and woke up in the morning with two lungs almost full of water. I was also coughing up blood, so it was straight to the clinic. Nothing to fool around with. My doctor said I would have been dead in about another half hour or so if I hadn't gotten to the clinic when I did.

I had something similar about a year earlier, but no idea what the cause of that was. I spent a lot of time at that altitude, so getting sick the second time was a real surprise.

 

[DougPaul]

I've had AMS and HAPE (similar symptoms as pneumonia, but I think it was HAPE). I have no idea what they gave me-it happened back in the 60's-but I was hospitalized on oxygen and IV's for about a week.

It was a while before HAPE was recognized. Before that, it was often diagnosed as pneumonia. However, treatments for pneumonia are useless against HAPE.

In my case, I had flown home from college in Ohio to La Paz, Bolivia (11.5K ft.) where my family was living at the time and woke up in the morning with two lungs almost full of water. I was also coughing up blood, so it was straight to the clinic. Nothing to fool around with. My doctor said I would have been dead in about another half hour or so if I hadn't gotten to the clinic when I did.

I had something similar about a year earlier, but no idea what the cause of that was. I spent a lot of time at that altitude, so getting sick the second time was a real surprise.

Returning to altitude is a common cause. If you have been away long enough, you have to reacclimatize as if you had never been to altitude before.

Doug

 

[TomD]

Doug, That's what I figured. I was away about 10 weeks. Other than hooking me up to O2 and an IV, not sure what else they may have given me. I was down about 10 days if I remember right. Took a while to get back to normal.

 

[sierra]

tomd,
sounds like you where lucky to get treatment.You where at a great dissadvantage as going down to a lower altitude is ussually the only treatment and it sounds like that was not an option for you. Thats why alot expeditions carry the gammow bag (sp) as there is not the option to get low fast on big peaks.

 

[DougPaul]

Doug, That's what I figured. I was away about 10 weeks. Other than hooking me up to O2 and an IV, not sure what else they may have given me. I was down about 10 days if I remember right. Took a while to get back to normal.

It can even happen with a very short (eg 1 day) visit to the lowlands, particularly for young kids. There are interesting comments on this in the previously referenced book "Going Higher".

Back in those days, you were lucky to get proper treatment. (The low-tech solution has 3 parts: go down, go down, and go down.)


Having been ok at altitude before going down makes it very easy to forget to be careful or to take one's time on the way back up.

Doug