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Preparing for High Altitudes – Treatments for Potential Sickness

I will be visiting Colorado in February, and countless friends continue to share their tales of high-altitude sickness with me.  My best friend, Dave, told me he was up all night with a massive headache and shortness of breath while camping in the Colorado Rockies at 8,500 feet.  He also provided more detail than necessary regarding the fluid he developed on his lungs.  I am uncertain how my body will respond, as I’ve never ventured higher than an elevation of 7,300 feet, while hiking in the White Mountains of New Hampshire.  I’m certainly not alone.  Every year, millions of thrill-seekers go skiing, hiking, climbing or traveling to high-altitude destinations seeking adventure.  Approximately 25% of Americans who ascend to such thin-air environments experience symptoms of altitude sickness such as headaches, fatigue, nausea and vomiting, caused by the lack of oxygen at high elevations.  Altitude sickness not only hinders your trip, but it could also lead to fatal consequences.  In rare instances, it can result in lethal swelling of the brain.

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Numerous treatments for altitude sickness are sold to Rocky Mountain visitors: oxygen therapies, vitamins, oils, pills and wristbands, to name a few. They come with claims of averting or reducing altitude sickness, many of which aren’t supported by research, or concrete evidence. Nevertheless, many snow sports enthusiasts are willing to spend freely on these treatments, and perhaps it’s not shocking. People can be desperate to salvage their vacations when the thin air causes headaches, nausea, fatigue, dizziness, or worse.  Acute Mountain Sickness (AMS) can be a serious condition, so it benefits travelers to recognize that it can often be prevented – and that if AMS strikes, not all remedies are equal.

Over the past 20 years, more than 30 people have died in Colorado from the effects of high altitude, per data provided by the Colorado Department of Public Health and Environment.  Additionally, the data indicates that there were approximately 1,350 trips to the state’s emergency rooms for altitude sickness in 2015, with 85 percent of those patients coming from out of state. Not everyone is affected by altitude.  Among visitors to Colorado’s Summit County, where several popular ski resorts are located (Breckenridge, Copper Mountain, Arapahoe Basin, Loveland and Keystone), 22 percent of those staying at 7,000 to 9,000 feet experienced AMS; and at 10,000 feet, that number rose to 42 percent, according to medical studies cited in an article by Dr. Peter Hackett and Robert Roach published in The New England Journal of Medicine in July 2001.

It is difficult to predict who will be affected by altitude sickness, but research has found that those who are obese tend to be more susceptible. At the same time, studies suggest that those over the age of 60 have a slightly lower risk.  To the contrary, Robert Roach PhD, Director of the Altitude Research Center at The University of Colorado Anschutz Medical Campus in Aurora, CO, states that a person’s sex, age, and physical condition do not seem to make a significant difference in how altitude affects them.  AMS is caused by the lack of oxygen in the lower air pressure that exists at higher altitudes. It usually doesn’t affect people below 8,000 feet, although it can, according to the National Institutes of Health.

“It’s awful,” said Richard Matzinger, 39, who, despite living half of the year at 5,000 feet in Boulder, CO, is one of those regularly affected by higher elevations. Early on, it makes Richard nauseated, while concurrently making him feel as if his head “is being cracked apart,” he said. Once, after roughing it out on an overnight hiking excursion to approximately 9,500 feet near Aspen, CO, he wound up so ill he required assistance in his descent.  According to Richard, “It’s similar to being drugged.  I feel almost delirious.  It affects my ability to think clearly and comprehend what others are saying to me. My cognitive functions suffer.”

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Richard’s doctor prescribed acetazolamide, sold as Diamox, one of the few proven AMS drugs. Acetazolamide, which requires a prescription, is generally given in a dosage of 500 to 1,000 milligrams daily, beginning 24 to 48 hours before ascent. One problem with it, however, is that it can have unpleasant side effects. In Matzinger’s case, he described feeling “off-balance and shaky” on 250 milligrams a day, the lowest dose.  According to doctors and pharmacists, Diamox causes users to breathe more frequently and it accelerates the rate of altitude acclimatization. The faster a person acclimatizes, the quicker and more likely they are to resist mountain sickness.  Acetazolamide can also treat mild and moderate altitude sickness, even after a person is suffering from the symptoms, according to research cited in The New England Journal of Medicine article.

Studies involving other hopeful AMS treatments have yet to show solid evidence that they work. These include ibuprofen (a study published in the December 2012 issue of the journal Wilderness and Environmental Medicine), Ginkgo biloba (in that same journal in March 2009) and nitric oxide (the April 1, 2012, issue of Free Radical Biology & Medicine).  Nonetheless, products containing these and other ingredients are sold for altitude relief throughout ski towns and on the Internet.

Oxygen is the focus of many cures and treatments marketed to visitors for high­ altitude issues.  Some rental homes in Telluride, CO, offer oxygen-­infused bedrooms that attempt to replicate the atmosphere at lower altitudes.  And these bedrooms aren’t inexpensive – on average they cost $1,400 per night.  The St. Regis in Aspen, CO, has an “altitude concierge,” who recommends that guests feeling the 8,000 ­foot elevation start at the hotel’s oxygen bar, available with a $50 per day pass to the spa. “If they needed something a little bit more, then I would do an oxygen concentrator to sleep with,” said the concierge, Stephanie Madrid. They rent for $100 a night, or $300 a week.  According to Mr. Roach, inhaling oxygen at a bar might provide some temporary relief, but has no lasting effect. 

Some of the skiers we spoke to use portable cans of high-purity oxygen call Big Ox O2.  While the effects of high-purity oxygen are short-term, the portability factor makes it a great means of treating altitude sickness in the moment.  According to Richard Matzinger, “portable high-purity oxygen cans are kind of like bringing the oxygen bar with you to the slopes.  These days, I always have a few cans of Big Ox O2 packed with my gear, along with my drinkable fluids.”  According to WEB MD, National Health Service (UK), eMedicineHealth (and other reputable sources), giving supplemental oxygen is the #1 recommended remedy for the symptoms of altitude sickness caused by the deprivation of oxygen to the body.

Regardless, it is still agreed upon that the best way to avoid altitude sickness is to ascend gradually, and either stop at a lower altitude for a night or return to one to sleep. Additionally, those who suffer from altitude sickness should avoid alcohol and plan their vacations so they don’t overexert themselves in the first 48 hours.  According to the Centers for Disease Control and Prevention, it’s also important for visitors to know the signs of AMS, and, the C.D.C. cautions, “A person whose symptoms are getting worse while resting at the same altitude must descend or risk serious illness or death.”

Ultimately, it time is the best way to combat altitude sickness.  Within a few days, you’ll increase your breathing rate to take in more oxygen. Other systems in your body adjust as well; for example, your kidneys will excrete more bicarbonate in the urine in order to accommodate your faster breathing rate. That will cause you to urinate more frequently. After several weeks, your body will produce more red blood cells to become more efficient at transporting oxygen.  I will certainly be prepared for my pending trip and recognize that I might need to take things slowly – patience is a virtue. 

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