| Author | Message | ||
     Jamie (Rover_puppy) Member Username: Rover_puppy Post Number: 218 Registered: 05-2003 |
I heard a Doctor discussing something yesterday that TRULY SHOCKED me. What he was saying seemed "backwards" from anything I have ever heard. After thinking about it, I sure wish I could have asked a few questions about what he said. I am no Doctor, but I do have a very good grasp of medical emergency situations. That includes very detaileded knowledge about the signs and effects of hypoxia. I understand the mechanics of altitude sickness - but, I only know what one is "supposed to do" when encountering high altitude medical emergencies. For example, during altitude and elevation ascents, if someone presents with altitude sickness, descending to lower altitude immediately is critical and in acute cases there must be immediate treatment with mass doeses of steroids. This Doctor was saying that was NOT the case and that climbers carry small tanks of oxygen with them which immediately reduces the pain/headache that can be associated with altitude sickness. In addition, he was saying that if intercranial pressure presented itself along with altitude sickness that emergency field treatment is to GIVE a patient CO2, that it will immediately reduce the oxygen level inside a human, therefore reducing intercranial pressure. He was saying that climbers deal with this all the time and also carry CO2 with them so that they can continue to ascend or in worst case scenarios -- to actually survive when emergency help is unavailable. He even said that in some cases intercranial pressure is reduced by climbing even higher. WHAT??? It sounded like both O2 and CO2 are used by climbers?? Living just 2 feet above sea level, I have never heard of such a thing! Does anyone have any experience with this? Was there ANY TRUTH to what he was saying?? I know that sounds like a dumb question, but I am sincerely wondering about what he was saying. Who knows? Maybe he was not even a Doctor -- after all, I noticed that he was looking at a book while he was talking... | ||
| michael burt (Mikeyb) Senior Member Username: Mikeyb Post Number: 476 Registered: 03-2002 |
i am not an alpinist, but a climber and i have hiked at some altitide, and i can say that doing ANYTHING that reduces the O level in the bloodstream sounds like a bad idea. i read "rock & ice" and "climbing" mag all the time and i can't remember any articles that endorse that approach. if you have HACE (high altitude cerebral edema) (or however it is spelled) the best action is to go down the mountain as soon as possible. it is my understanding that the low pressure causes fluids to seap out at the cellulat level and the amount of O in the system has nothing to do with that...it is that loss of fluid at the cellular level that causes the pressure. of course at 546 feet. there is no problem with that here... there is a drug called dexameitajhelfkajndl;fkjff (or dex to those like me who can't spell) that helps while at altitude to reduce the effects HAPE (pulminary edema) (same thing but in the lungs), maybe it will also help for HACE, but i am not sure about that. there is even some indication that viagra helps too...but maybe that is just an excuse to help for other issues on the mountain. but overall, i call bullshit on using O2 at altitude for anything other than an antidote against continued living. mike | ||
| Stacey R Abend (Srafj40) Member Username: Srafj40 Post Number: 147 Registered: 03-2003 |
I have heard of, and read about the old timers sparking up a "good bowl", to help with the effects. Now with pressure tents you do not have to come off the mountain in as big of a hurry. CO2 just does not sound right at all. Stacey | ||
| Jamie (Rover_puppy) Member Username: Rover_puppy Post Number: 221 Registered: 05-2003 |
Thanks Mike, It is spelled dexamethasone. That was easy since the page is still open on the book I was referencing this morning to see if what he said was correct. If what he said was true, I couldn't help but think -- bring on the Power Tanks!! When I could not figure it out, I decided Dweb was the best place to ask!!  This is kind of funny: I was visiting somewhere when a young teenager stuck up a conversation with me and was just jabbering away about working on his Disco, ordereing parts, and off roading. That was way back before I ever even started working on mine. He must have been talking away about other subjects before I arrived - b/c when he left, I made the comment to someone there that he sure knew a lot. That person said to me that yes, he sure seemed to know an awful lot about useless stuff. I have found that ALL knowledge is useful and important to someone!! | ||
| Robin Marshall (Sirrobin) New Member Username: Sirrobin Post Number: 2 Registered: 08-2003 |
I know a little medicine ;-).. call it a day job. Altitude illness is not one distinct syndrome, rather it is a constellation of illnesses including AMS, high-altitude cerebral edema (HACE), and high-altitude pulmonary edema (HAPE). Other altitude-related disorders include high-altitude retinopathy (HAR), edema (facial and extremity), sleep abnormalities, periodic breathing, sore throat and bronchitis, immune suppression, UV damage (snow blindness, sunburn), and blood clotting problems. I assume the speaker in question was addressing AMS or HACE although it is not clear. I also suspect that the vasoregulatory properties of O2/CO2 were being addressed. I am not familiar with any research demonstrating benefit of huffing CO2 and it certainly is not a standard of care TREATMENT of altitude illness... in fact this can be a dangerous toy to play with. Please, do not breath any gas mix containing low/no partial pressures of oxygen at 1ATA or less, it would be bad (think crossing the streams in Ghostbusters). So, take the tire inflator out of your mouth... good, now put the power tank down... good, now back away, slowly. BTW-I use a small scuba cylinder instead of a power tank.. I wonder if my tires would have less of a deco obligation if I used nitrox on them? | ||
| Sergei Rodionov (Uzbad) New Member Username: Uzbad Post Number: 15 Registered: 08-2003 |
Actually doctor was right. You never should change pressure zone too fast, or matters would get worse. Its same as with deep diving - you never should just jump up, but have to spend some time on each stage so you would adapt. Overwise you might suffer serious injuries. High altitude is essentually same - you just diving up. As of oxygen - thats what you lacking when you getting high up, especially if you getting from nearly sea level (we got at least one oxygen shop in town for tourist). Unless you REALLY fit (aerobically) - simple walk for dozen yards might wear you off at 10K. So normal practice is to "dive up" in stages too (2-5K at day, depending on how young you are, and how long you ever spent on high altitude ), letting body to get used to outside pressure and lack of oxygen. I never heard of CO2 to be used as way to lower one's internal blood pressure though. Just my 0.02 | ||
| Brian Dickens (Bri) Senior Member Username: Bri Post Number: 632 Registered: 08-2002 |
Jamie, I too have never hear of the CO2 or steroids treatment. In fact any first aid that is done should reduce the amount of Co2 in the blood, since that is part of the problem. I have never hear of any mountaineer carrying Co2. Many carry O2. These days the best thing is to get them in a pressure tent as someone else mentioned. They use these extensively in many places and they will solve the problems of altitude sickness without the person going down. But where these when you need them? In a hospital or with an EMT or rescue team. AFAIK, the only cure is to get down (or pressure tent). This is the most tried and true method for curing it. In fact I do not believe that there is a "cure" other than descent and the other meds used typically only treat the symptom. Diamox can be use to help aid in in treatment, but should be used only as directed by a medical professional and is typically used before ascent, so you would have to know that you have an altitude "issue". If someone shows initial symptoms of it headache, shortness of breath, loss of appetite, nausea, flatulence, nausea, vomiting, dizziness, malaise, insomnia... get them down immediately, it will typically not go away and getting down is imperitive if you want to have a short recovery time. If you continue and let these symptoms go on to advanced symptoms you could have a life threatening situation. More advanced symptoms are: worsenend headaches (fluid in the brain),loss of breath, irratic heart beats, coughing (fluid in the lungs), irrational behavior including not acknowledging the symptoms, and balance problems. This can be relately common with athletic people and climbers. Many times a climber may know that he/she has an altitude sickness problem, will take some form of medication that masks the initial symptoms or even something like diamox that is *supposed* to help with altitude sickess. The athlete then will ignore even the more advanced symptoms until they really need help. By then you already have a very serious problem. Helped and carried a handful of these folks off the mountains before, fortunately none this year. Typically if you show any symptoms of altitude sickness you should not use any form of medication or first aid to continue to ascend, this can be fatal. Instead you can administer O2, Aspirin (unless alergic), Diuretics (promote urine and remove excess fluid) and get down. it really is that easy to treat. If you do not start feeling better quickly when down, go down further and/or get to a hospital or call 911. | ||
| Jamie (Rover_puppy) Member Username: Rover_puppy Post Number: 232 Registered: 05-2003 |
Thanks for the information. Another fine example that you CAN find out about ANYTHING on Dweb!! I was able to find out that the guy talking WAS NOT a Doctor - it was a physician assistant (wearing lots of blingy stuff). Scary... WOW! That is ALL good info to know - one of the worst things about hypoxia from flying is that as things get worse, the feeling that everything is excellent increases. A pilot can be flying upside down and be totally sure that he is flying right side up. For this reason, it is wisdom to always keep an eye on others -- if things begin to deteriorate, they will NOT be aware of it. Looks like good buddy system is critical for ascending elevation!! I have never heard of a pressure tent - it sounds like a mobile hyperbaric unit?? | ||
| Brian Dickens (Bri) Senior Member Username: Bri Post Number: 635 Registered: 08-2002 |
Yep that is correct, but it really is much more than a tent. They are used extensively in Nepal, due to all of the people experiencing AMS. http://www.high-altitude-medicine.com/AMS.html http://www.high-altitude-medicine.com/hyperbaric.html | ||
| Todd Nash (Nash) New Member Username: Nash Post Number: 26 Registered: 02-2003 |
Just a quick thought. When head injured patients have high ICP's (intracranial pressure), we intubate them, increase their respiratory rate, and "blow off" their CO2. Reducing their CO2 from normal (40) to approx. 30 reduces their ICP. So, adding CO2 sounds pretty dumb and down-right dangerous. | ||
| Brian Dickens (Bri) Senior Member Username: Bri Post Number: 639 Registered: 08-2002 |
That sounds right to me Todd. What is your profession? | ||
| Alec Wallis (Alec_w) New Member Username: Alec_w Post Number: 33 Registered: 05-2003 |
I hiked the Himalayas (Annapurna range) a few (17) years ago. We reached an altitude of 18,200 feet at one point. Back then the advice on altitude sickness was basically acclimatization and evacuation (i.e. going back down) in the event of altitude sickness. Before hiking up to 18,200 feet we acclimatized for 4 days at 14,000 feet. We then hiked over the pass and back down to about 13,000 feet in the same day. That was one of the longest days in my life 4,000 vertical feet up and then 5,000 feet down in a day with a 35lbs backpack was not that much fun to be honest. | ||
| Brian Dickens (Bri) Senior Member Username: Bri Post Number: 648 Registered: 08-2002 |
I have never been up to that altitude, but hope to some day. That would be a very long day at that altitude. I do >3000' quite regularly (usually 10k-13k/14k'). Its not that fun for the first mile or so, but once you are in a groove and get used to the pain, it gets better. Acclimating is pretty important even for what I do and I come from mile high area. Day hikes of that magnitude can be done a lot easier since you do not *have* to carry a 35lb pack. From all of my experiences, the best remedy is to descend. Some people descend a certain amount and see if it gets better. Depends on the situation. If you need to continue hiking to reach a destination or something, this might be a good thing to try, but if you can easily descend to a base camp, vehicle or something else safe, do it. Even if you are really trying to reach a destination, descent would be better than death. Always be prepared for the worst with plenty of water, some xtra food, clothes and a water filter. Another thing that can affect people is summit fever. If you really want to reach a summit, you can ignore many important things. AMS+Summit fever is not a good thing. Summit fever is just delusions, when you MUST get to the top at all costs. People die from this as well (i.e. '96 everest expedition). For me the goal is to get back down. Not reach the summit. | ||
| Alec Wallis (Alec_w) New Member Username: Alec_w Post Number: 34 Registered: 05-2003 |
Brian, I am guessing we live in the same state. Any advice on an appropriate first 14'ner (or less) to try out. Up and down in the same day with an emergency day pack. I would consider myself to be slightly above average for my age (39) when it comes to fitness. Yes that was a long day; you run out of breath after every 20 steps (10 towards the top) and have to rest for a few seconds to catch your breath. Darn, but I still remember the feelings vividly of reaching the summit, there are no words to describe the feeling. Actually it was not a summit and is considered a “pass” as there were 25,000+ foot peaks on either side. You’re right on about summit fever. A lot of folks die up there each year. That particular pass is bad because it’s around a 100 mile trek to get to either side of it. A long ass walk back the way you came plus the thought of not completing the trek killed a lot of (ignorant/stupid) people. No roads, no phones/communication, no electricity, no ER within a 2 week hike, one airstrip that I remember. They only way out of trouble was a helicopter evacuation which cost $1000 “cash only”. That route out is extremely dependent on the weather conditions and not even a possibility above 14,000, as I remember. Now I think back, my old man must have been freaked out when I told him I was going to hike 200 miles in the Himalayas, then bum about in India for a while. Dad, I am going on vacation, see you in 6 months. In case you are interested I recently scanned in some of the pictures I took, they are kind of crappy because the negatives sat in a box for years and I scanned them with a cheap scanner. This is my buddy at the top http://www.alecwallis.com/Photos/97787a5de8e546b2b149b5c12aa1801a/PhotoGallery1/ 089.jpg This one is of my other friends about an hour behind us. You have to look closely; you can see their shadows on the trail towards the bottom left. http://www.alecwallis.com/Photos/97787a5de8e546b2b149b5c12aa1801a/PhotoGallery1/ 080.jpg Here’s the entire trek, pages 4 and 5 are of the area near the pass. http://www.alecwallis.com/TemplateGallery.aspx?P=97787a5de8e546b2b149b5c12aa1801 a I bet it has not changed much since then, I would say "go for it Brian", it's a once in a lifetime experiance. Sorry if this is not totally related to the thread, I thought there maybe some interest given the subject. | ||
| Todd Nash (Nash) New Member Username: Nash Post Number: 27 Registered: 02-2003 |
Brian, I am a ER doctor in Winston-Salem, NC. I like the occassional 14K mountain too. I think a good first one is Mt Whitney in CA. Of course, if you live in CO its a long haul! Colorado has several easy ones, but some are really hard too. The web is full of good info on this sort of thing. | ||
| michael burt (Mikeyb) Senior Member Username: Mikeyb Post Number: 489 Registered: 03-2002 |
hey alec i don't know how you are set for a drive to new mexico, but wheeler peak, near taos is a 13,161 foot peak with a good route to the top. if you do the williams lake route, it is a mellow hike through some nice woods to an alpine lake at about 9,500 feet. then it is almost a stairstep to a saddle at around 12,500 and a nice ridgeline hike to the summit. easily doable in a day and the nice thing is you can be drinking some sweet beers at eskies brewpub off the square in taos in time to watch the sunset! if you are in pretty good shape, it is like interval training...a good warmup hike, some slogging to the top and then, if you are so inclined, a trail run down! that reminds me...i gotta get back in shape! mike | ||
| Brian Dickens (Bri) Senior Member Username: Bri Post Number: 652 Registered: 08-2002 |
Todd, You are more of a man than me, I thought you sounded like a pro. Good thing since you were talking about intubating. I would like to at least be EMT trained, in my 10 year plan we'll see if it happens. ;-) I really need to get over to Nepal or someplace with really high elevations. I keep telling my wife we should do this for our 20th, but she does not have the same idea of fun as I do. ;-( I forgot, who I was talking to and jsut realized that you are the director of the infamous wheeler lake video. Beirstadt, Quandry, Torres, Gray are all good ones to do and are close to the metro area. There is also the Evans group where you *could* bag a couple in a day or just do one. I do not have my book handy, but those are some of the first that I did. If you ever make it around Lake City and are still looking for one to tackle that is not really hard, try Uncompaghre--awesome. Have not done Whitney, but would like to (highest in lower 48 right?). The season is quickly drawing to an end, but it is still possible to do many 14ers in Sep and still have decent conditions. If you want to try one, drop me an email and we can plan for it. I am currently open this Sunday. I am a slow persistent hiker, same age as you. | ||
| Brian Dickens (Bri) Senior Member Username: Bri Post Number: 653 Registered: 08-2002 |
I can tell when I get above 12000' and anything above 13000 ft can easily be just as difficult as a 14er. One benefit of NOT doing 14ers here in CO is 13ers and high 13ers are far less crowded. Shots below are of a 13er west spanish peak. This is about 40 miles from a property that I own. It is 13,626 and is a good hike for 2.5 miles and then climbing over talus for 1 mile. One hell of a work out, but the view is absolutely amazing. I have attempted this about 6 times and made it 3 times. I have turned around becuase of weather and/or I or partners were not up for it.   | ||
| Dan Ratcliffe (Dan_ratcliffe) New Member Username: Dan_ratcliffe Post Number: 16 Registered: 07-2003 |
This was a very interesting thread! I certified a as Summer and Winter Mountain Leader (A) back in the late 80's. We climbed with pitons, chocks and nuts were really nuts from the hardware store with aircraft cable and webbing. So, my information might be dated, but the only cure for AMS was DESCEND, DESCEND, DESCEND. Even if you were going to attempt a helicopter rescue, you were required to go for a lower LZ to keep any chance of increasing altitude down. Most altitudes where AMS, HACE, HAPE, etc. occurred negated a helicopter recovery any way. There was a little leeway when making the decision. You could elect to hold the altitude you were at depending on the severity to see if the symptoms abated, but never during training. Our acclimatization schedule held that you could reach 90 percent in about 6 weeks, but it would take 6 months to reach 100 percent. Trivia question: Has anyone ever heard of the the Realized Utimate Reality Piton (RURP)? | ||
| Christopher Boese (Christopher) Member Username: Christopher Post Number: 156 Registered: 10-2002 |
I've heard of RURP's, but that's about all. Does Black Diamond make them now, or is it Trango? I think Chouinard invented them... | ||
| Dan Ratcliffe (Dan_ratcliffe) New Member Username: Dan_ratcliffe Post Number: 17 Registered: 07-2003 |
http://a1072.g.akamai.net/f/1072/2062/1d/gallery.rei.com/largeimages/471089.jpg about day two in to the course, we were given (actually signed for, we had to pay for anything we left in the rock)our rack. Several of us thought it was some sort of cutting tool. Once we found out it was a piton we knew we were in deep do do. Thank God I am to old for this crap now. :-) | ||
| Jamie (Rover_puppy) Senior Member Username: Rover_puppy Post Number: 254 Registered: 05-2003 |
WOW!! Awesome photos, I relax just looking at them. All helicopters have a "hover ceiling", so you can't always count on them saving the day... I have new question after reading posts: Are members of SAR teams tested prior to training to see if they are susceptible to altitude sickness? If team members have trouble with it, can they be acclimated to go on rescue ops without harm to themselves? | ||
| Jamie (Rover_puppy) Senior Member Username: Rover_puppy Post Number: 255 Registered: 05-2003 |
What is a piton? What do you do with it? | ||
| Christopher Boese (Christopher) Member Username: Christopher Post Number: 159 Registered: 10-2002 |
Oh THAT piton. I understand that they're not meant to take much of a fall, but they're better than no protection at all where you're on a face with only tiny cracks. Could be worse, of course. See http://www.terragalleria.com/mountain/mountain-area.ice-climbing.html. This is what I want to learn to do next. | ||
| Christopher Boese (Christopher) Member Username: Christopher Post Number: 160 Registered: 10-2002 |
Here's a good photo of someone placing a piton. He'll clip his climbing rope to it for protection while he makes his next few moves upward. See http://www.nolimitstahoe.com/half_dome/ppimages/mike_piton.jpg. Not the latest technology, and likely to jam in the rock and remain to rust away. | ||
| michael burt (Mikeyb) Senior Member Username: Mikeyb Post Number: 499 Registered: 03-2002 |
 2001...ouray ice park in ouray, colorado... they have a fest every year on mlk weekend. it is a great place to learn...the park has some pretty easy sections (called schoolroom!) and some pretty hard sections as well. schoolroom is all topropped, so the risk is minimized and that allows you to focus on your style and form. i will expect to see you there this next fest! mikw | ||
| michael burt (Mikeyb) Senior Member Username: Mikeyb Post Number: 500 Registered: 03-2002 |
http://www.ourayicepark.com/ if you are interested... mikw (formally known as mike) | ||
| Peter Matusov (Pmatusov) Senior Member Username: Pmatusov Post Number: 1044 Registered: 09-2002 |
Mike, i can attest to joy of changing a flat tire near Lake Como - having to do it pitched up 20 deg with the jack standing on two uneven rocks was more frustrating than the workout itself. | ||
| Brian Dickens (Bri) Senior Member Username: Bri Post Number: 657 Registered: 08-2002 |
Ouray ice park is a blast to watch. I have yet to try it and possibly may not. But from some of the training that I have seen there it *can* be safe. When is the fest this (coming) year? | ||
| Brian Dickens (Bri) Senior Member Username: Bri Post Number: 658 Registered: 08-2002 |
PS: Anyone up for that 14er this weekend? | ||
| Jamie (Rover_puppy) Senior Member Username: Rover_puppy Post Number: 257 Registered: 05-2003 |
Gee Whiz you guys!! That looks really cold!! I can't believe all the things you can learn about here. I've always wondered something, all those doo dads around that climbing guy -- I have seen in movies that those are attached to climb, but what happens when you run out of them?? Maybe I should go gather up some stingrays, sea urchins, shells, and sunsets for you!! What month does the snow start falling? Does it snow in Utah? Do you build snowmen?? Mike - why did you change your name?? | ||
| michael burt (Mikeyb) Senior Member Username: Mikeyb Post Number: 503 Registered: 03-2002 |
funny thing is that you don't want it to be too cold...the ice becomes very brittle in really cold weather and will break off in chunks that look like dinner plates (called "dinner plating." how about that, huh?) i climb in quebec every year as well and it was ass-cold last year, the ice was flying apart in chunks...it was like digging holes in the ice instead of just placing your ice tools. you should give it a shot, brian! it is pretty fun and ouray is the place to learn...because there are very short approaches and that means beer is never very far away! if you learn all you need to know in the park in one day, there are some great natural ice climbs on the road to yankee boy basin... jan 16 to 19, 2004 (wow, 2004...time flies, huh?) for the next one. lots of gear manufacturers, pro climbers, hubub, and whatnot...! hey peter...you know the worst thing about changing a tire on a dicey bit of ground is that you always have a hard time making a tire change sound like part of the adventure to your flat land friends, huh? ;) no one really understands! i did not *really* change my name, jamie...! i just noticed i misspelled it in my other post so, i figured i would stick with it...;) maybe i will stick with "mike." | ||
| Christopher Boese (Christopher) Member Username: Christopher Post Number: 161 Registered: 10-2002 |
That's it. It's Ouray next January. I'm seeing some good buys on ice tools around the Web right now too... | ||
| michael burt (Mikeyb) Senior Member Username: Mikeyb Post Number: 505 Registered: 03-2002 |
he he he! you will only think your rover is an expensive hobby when you start putting your ice rack together! but anyway...christopher! let me know if you are there and maybe we can grab beers! i plan to go as far as i know (being a few months from now!) and i know at least one cool dive with a mostly flat pool table. i am sure my buddy and i will spend some time in schoolroom as it will have been 2 years since he was on ice... mike | ||
| Rich Lee (Rich_lee) New Member Username: Rich_lee Post Number: 14 Registered: 02-2003 |
Hi All, Interesting thread. Sorry for my long post, but I am very interested in what you all have said and would like share some of my experience and thoughts as a physician and climber. On Altitude Illness, Brian went into a lot of accurate detail about it. Remember, what your body wants most in thin air is Oxygen. The problem is that the only short term way to get is to breathe deeper and faster. When you do this, you are hyperventilating and blowing off CO2. The problem is that much of your involuntary signal to breathe comes from elevated CO2 levels in your blood (unless you have had emphysema for quite a while). You then stop breathing as fast until CO2 levels in your blood rise again and you are “driven” to breathe again. By then, the oxygen levels in your blood are also pretty low, and you start gasping for air, and the whole process repeats itself. This is called “Periodic Breathing”. It often occurs in your sleep if you are not well acclimatized, and you find yourself waking up frequently, gasping for air. This is a form of altitude-induced sleep apnea (just what you need) that wears down mountaineers and makes them more at risk to every kind of illness. There is no way that breathing a little extra CO2 will help this, because you need more Oxygen a whole lot more than you need CO2. One way you can correct this a little is by taking a medicine called Diamox at altitude. Diamox works in your kidneys to help you retain more acidity in your blood (metabolic acidosis), which also helps drive respiration and compensates some for acidity that you loose by blowing off all that CO2 from hyperventilating at altitude (respiratory alkalosis). The problem with diamox is that it also makes you pee like a racehorse (it’s a diuretic as well). As such, you wake up almost as often to pee as you would have gasping for air, and you risk dehydration, which sets you up for other trouble, like blood clots. If you want to use Diamox to reduce periodic breathing, use it sparingly (i.e. not the daily 250 mg sustained release, but 1/2 to 1 of the 125 mg short-acting tablets at bedtime), drink lots of fluids and be sure that you water bottle and your pee bottle are unmistakably different when you reach for them at night. Diamox does reduce periodic breathing, which, in turn helps reduce the severity of Acute Mountain Sickness (AMS), but there is not a lot of good evidenced that it directly reduced the risk of High Altitude Pulmonary Edema (HAPE) or High Altitude Cerebral Edema (HACE). If you want to prevent AMS without having to pee all night long, try Ginkgo Biloba. Recent studies have found it to work as well, or better than Diamox for the common AMS symptoms of headache, lethargy, anorexia and nausea. Ginkgo does not reduce periodic breathing significantly, but it does help one feel better overall. I used neither at Everest Base Camp in 1999 (the Ginkgo studies were not out yet), but I would surely try Ginkgo now if I were ascending rapidly above 10,000’ and would probably use both Ginkgo and low dose Diamox if I were climbing and sleeping above 18,000’. HAPE and HACE are very nasty medical emergencies that are often fatal if not treated rapidly and the best treatment is still to “GET DOWN” !(James Brown got that right). But that is hard to do if you are pinned down by weather. Breathing Oxygen helps some in HAPE and little in HACE, but you need more atmospheric pressure. To simulate this, we use a 15lb air-inflatable oversized body bag called a Gamow Bag. You can’t work on a sick person while they are in it, you have to keep it inflated with constant foot-pumping and it is rather claustrophobic inside (I tried one on for about 15 minutes once). But it may be the best you can do for someone until you can get them down. Dexamethasone (“Dex”) can reduce some of the severity of both HAPE and HACE, but it should only be used as an emergency treatment, and its effectiveness diminishes rapidly with time (3 days max.). A dangerous trend I saw on Everest in 1999 was of climbers “pre-medicating” with Dex on summit day. This may help you feel a little better during the first 8 hours of going up, but the second dose (if you even remember to take it) will not be as helpful on your way down, and you have pretty much eliminated any chance of the drug helping if you really get sick. I met one woman at base camp who did this on her summit day (on the advice of another physician) and she was totally exhausted before she reached the “Balcony”. In previous expeditions (without Dex), she felt fine at the same altitude. This time she was convinced that her bottled oxygen had run out prematurely. The problem was that she was also taking prescribed Thyroid supplement and steroids like Dex block the action of Thyroid. It was as if her body’s metabolic thermostat was suddenly disconnected, in the worst possible situation. Other drugs are emerging now for HAPE, but the evidence is small, because of the difficulty in doing an accurate drug trial at extreme altitude. I brought up Singulair, a newer pill for asthma, in the hope of using it to treat HAPE. Singulair blocks the action of inflammatory compounds that are found in the lungs in asthma AND in HAPE. I didn’t get to use it for HAPE, but was surprised how well it resolved “High Altitude Hack”. In addition to reducing inflammation in the lungs, anything you can do to reduce blood pressure in the lungs may also reduce the ravages of HAPE. In the past, we would use Nifedipine (10 mg sublingual capsules, every 8 hours, 3 days max.), but there is growing speculation that Viagra, that’s right, Viagra might reduce blood pressure in the lungs better than Nifedipine. This is due to some effect it may have on pulmonary arteries and not just because it directs blood flow “elsewhere”. If nothing else, it keeps you from rolling over onto your stomach at night and is good for bribes, er, I mean “administrative good will”. Rurps! wow, that brings back nostalgia. I have 3 or 4 in my “vintage” hardware collection, along with many other pitons from Leeper pins and short thin knifeblades to 4” aluminum bongs....all well used, long ago. My “real” climbing days were in Yosemite in the early 70’s. By age 17 I was living all summer in Camp 4 for free, supporting myself doing rescue work, “nailing” up big walls and leading 5.10 (there were no subdivisions then). My mentors (and idols) were people like Jim Bridwell, John Dill, Mead Hargis, Beverly Johnson (killed in a 1994 heli-skiing crash along with Disney president, Frank Wells) and Ned Gilette (killed in 1998 by bandits in remote Pakistan). I lost too many friends back then (and since then), but the experience both saved and enhanced my life. A lot of what went on then has been written up in an interesting book by ranger Butch Farabee. The title is “Death, Daring and Disaster: Search and Rescue in the National Parks”. I just returned from a week in Yosemite, after 30 years (and 30 lbs), this time with my wife of 23 years and my 10 and 12 year old boys. I was very happy to see us all get up a 5.9 finger crack. We also day-hiked into the high country, rode bikes around the park, fished and kayaked in the Merced River. About the most fun we have had without driving the Disco. Happy Climbing! P.S. If you do a Google search on the words “Rich Lee Everest” you will find some information on my background. | ||
| Dan Ratcliffe (Dan_ratcliffe) New Member Username: Dan_ratcliffe Post Number: 18 Registered: 07-2003 |
What great stuff. One way to keep from leaving gear in the rocks is to issue it and make them pay for it. (Marine Corps method) :-) I spent about three hours prior to course graduation trying to retrieve a nut with my climbing partner. It was the only piece of protection that didn't zipper when he fell on a 5.9 unlighted night cliff assault. The Chief Instructor finally called us off the rock and after we sorted out our gear wrote an official loss statement saying the equipment was unrecoverable. Man, those were the days. Toughest damn thing about being #2 man on a climbing team was cleaning up the protection, especially if someone fell. Someone asked what do you do when you run out of gear? Get a good belay position and switch leads. Kind of a self feeding machine. Like all of them, I do have my run out of gear story. Heard my lead climber (a guy named Standfast, great name for a Marine), yell out "your gonna love this one!" Once he was secure and on belay and I was about 3/4 up the pitch, I found a nylon runner wrapped around a stone he had hammered in to a crack. A rurp could take about 500 lbs. We used to reverse them and double praying it would help during a zipper. Never tested it thankfully. runner on | ||
| Peter Matusov (Pmatusov) Senior Member Username: Pmatusov Post Number: 1046 Registered: 09-2002 |
great stuff, Rich. | ||
| michael burt (Mikeyb) Senior Member Username: Mikeyb Post Number: 506 Registered: 03-2002 |
thanks for all the info, rich! i gotta get out more...! | ||
| Andy Thoma (Andythoma) Senior Member Username: Andythoma Post Number: 424 Registered: 01-2003 |
Jamie! "Does it snow in Utah?" try; http://www.alta.com/snow.htm Last year 438" of perfect powder snow! It snowed about 28" in the middle of June here in Salt Lake in the high elevations, some down in the city too. Average is about 500" per year at Alta. Snow starts from September on, ends about July. I've hiked and biked Moab trails in the snow. The La Sals (the mtns you can see from Moab) are over 12k feet and get lots of snow, look now and you'll see some patches still on the mountain. I've been told the ultimate multisport day is to ski the La Sals in the morning, bike in Moab in the afternoon, then float the Colorado in the evening. Snowman here are quite hard to build, low water density in the snow makes great skiing snow, but bad snowman snow. To build one, you add water to make it stick together enough for a ball, even then that doesn't work to well, slushman.  Since this thread started this way, any climbers want to try and get together and climb some time? Brian Dickens, where are you at? I'd be into meeting and climbing. I rock climb (trad and sport) , ice climb, and mountaineer. Moving to Utah has even taught me you can alpine mountain bike, talk about lung busting experiences. | ||
| Brian Dickens (Bri) Senior Member Username: Bri Post Number: 661 Registered: 08-2002 |
I am in Denver metro area. No climbing (too old for that), just long/high hiking. Still looking to do a nice hike this sunday, I will need to work off the fat from the neighborhood rib-off on Sat. Drop me an email if you want to meet up. | ||
| han chung (Hanchung) Member Username: Hanchung Post Number: 72 Registered: 10-2002 |
dr lee, you do have quite a background. enjoyed reading it. and to think that you almost bought my car... LOL what an honor that would'v been. han chung | ||
| Alec Wallis (Alec_w) New Member Username: Alec_w Post Number: 36 Registered: 05-2003 |
Brian, I would love to go with you this weekend but I have too many things on my "Honey do list". I'll keep in touch and would like to join you at some point (if you don't mind). Climbing is not my gig either or wheeling on narrow shelf roads. I am close to being petrified of heights but can keep it together for short periods. Rich, interesting reading thanks. | ||
| Rich Lee (Rich_lee) New Member Username: Rich_lee Post Number: 15 Registered: 02-2003 |
Hi Han, Sorry I didn't buy it, but I found one closer. Besides, I would have liked yours better before you took off all the cool stuff. Hope you got a good price for it and that you are not rover-less. Rich | ||
| Brian Dickens (Bri) Senior Member Username: Bri Post Number: 663 Registered: 08-2002 |
Alec, just give a shout if you want to go. I will be doing quite a few day hikes between now and snow season. Sep is a good month if you have light cold weather gear. I do most of my backpacking and day hikes solo, but enjoy company whenever it is there. I think I am going to try Ute Creek on Sunday. http://www.fs.fed.us/r2/psicc/sopa/trails/ute_creek_trail.shtml Not a 14er, but a nasty little trail nonetheless. On up to Bison Peak or McCurdy peak gets you close to 4k vertical. Rich, keep posting on these threads nice to have someone here with your experience. | ||
| han chung (Hanchung) Member Username: Hanchung Post Number: 74 Registered: 10-2002 |
rich... don't be sorry. i'm glad you got your disco closer. sold the disco and... http://necessiteesapparel.com/rangie/DSC01494.JPG good luck in all your projects and be safe. | ||
| Christopher Boese (Christopher) Member Username: Christopher Post Number: 163 Registered: 10-2002 |
Damn, this is the best Rover-unrelated thread ever. Thanks, Rich, for what I'm sure is the definitive outline of treatments for AMS, HAPE, and HACE. Mike, hope to see you in Ouray this Winter. Getting really impatient for snow here... | ||
| michael burt (Mikeyb) Senior Member Username: Mikeyb Post Number: 511 Registered: 03-2002 |
and it will take even longer for the ice to form up! getting amped up myself... | ||
| Alex Cabrera (Alexcabrera) Member Username: Alexcabrera Post Number: 141 Registered: 12-2002 |
Interesting reading... 10 years ago we visited Machu Picchu, Peru. I got pretty sick due to altitude. A brief consultation with the locals advised a "mate de coca". This is a tea made from the Coca leaves. This helped a lot. A few years back I also remember the Pope drinking the same when he visited Bolivia. Anyways.. this was for temp relief and not suitable for higher, extreme cases of High Altitude emergencies. | ||
| Robin Marshall (Sirrobin) New Member Username: Sirrobin Post Number: 7 Registered: 08-2003 |
Great post Rich... got me wondering. My experience runs more to the hyperbaric side of the spectrum. We occaisionally see young very healthy individuals that for some reason are CO2 retainers, gets them into trouble with the deeper stuff. We don't know why, they just are. possibly a chemoreceptor issue (unfortuately don't have prevalence numbers like we do for PFO but it's real). I wonder whether this is a described phenomenon in hypobaric environments. To my thinking an innate "retainer" (primarily O2 driven respiration) should do less periodic breathing at hypoxic PO2s. I'd love to see what their pH/pCO2 does compared to "normals". | ||
| Porter Mann (Porter) Member Username: Porter Post Number: 44 Registered: 05-2003 |
A retainer could have issues if the environment is hyperoxic and initially the person reduces their breathing rate due to the high pO2 levels. But this could cause a buildup of even more CO2, and depite being a retainer, they have to rid themselves of the byproduct, and thus breath more, compounded by the fact that the CO2 driven respiration is faulty, they could possibly respirate past their "normal" levels which causes them to pass out. The body passes out in these types of situations to reduce hyperventilation and return the blood/body chemistry back to its "normal" state - underwater this can be fatal. I'm sure narcosis also plays a part in this. With mental impairment, its possible they're not aware of symptoms associated with hyperventilation due to the symptoms associated with their narcosis. I have my own theories about what causes nitrogen narcosis in the body. just a thought | ||
| Todd Nash (Nash) New Member Username: Nash Post Number: 28 Registered: 02-2003 |
Porter, I see something similar once in a while in the ED. We have COPD patients with baseline high CO2's. If they get placed on high-flow O2 due to hypoxia, they will slow down their resp rate. They then retain more CO2 and get sleepy/drowsy or pass out. They don't overbreathe as a response to the dangerously high CO2 levels, though, as their body has lost most of this drive. Interesting, but easy enough to avoid. We just put them on low-flow O2 instead of high-flow. |
