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cantunamunch

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I'm not an MD, but I want to reiterate what I've said before. IMHO, it is important to get enough sugar and salt (as well as water) when you might be dealing with altitude effects. Altitude changes are no occasion for fasting or low carb (or low salt). All of these things keep your blood volume and blood sugar up which helps the body deal with altitude effects.

One of my own altitude coping signs is that I get hungry for cheap calories I normally never eat. I have also learned that if I indulge that hunger the eventual symptoms will be worse and will include nausea, headache, "heavy chest" sensation and general logyness.

I have told pretty much everyone to just stop me outright if they see me diving into the choccy macadamia bag or the beef jerky bag or the protein bar stash, knock it out of my hand if they have to.
 

Wilhelmson

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One of my own altitude coping signs is that I get hungry for cheap calories I normally never eat. I have also learned that if I indulge that hunger the eventual symptoms will be worse and will include nausea, headache, "heavy chest" sensation and general logyness.

I have told pretty much everyone to just stop me outright if they see me diving into the choccy macadamia bag or the beef jerky bag or the protein bar stash, knock it out of my hand if they have to.

This is a good point that part of the conversation should be about how to recognize the signs that others are starting to get sick. Although for me Macadamia delusion is a common occurrence that I battle frequently.

The stories in Epics on Everest show that even experience mountaineers can go crazy or do stupid things at high altitude.
 

James

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One of my own altitude coping signs is that I get hungry for cheap calories I normally never eat. I have also learned that if I indulge that hunger the eventual symptoms will be worse and will include nausea, headache, "heavy chest" sensation and general logyness.

I have told pretty much everyone to just stop me outright if they see me diving into the choccy macadamia bag or the beef jerky bag or the protein bar stash, knock it out of my hand if they have to.
So you disagree with the salt/sugar theory?
 

James

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^ You can count on me not researching that.

Well there’s the Lake Louise Score for evaluating AMS. But it comes with this caveat which essentially means it’s useless:

—————————-
This Lake Louise AMS score is for use by investigators studying AMS. It is not intended for use by clinicians, professional outdoor guides, and laypersons to diagnose or manage AMS.


AMS is defined as a Lake Louise AMS score total of three or more points from the four rated symptoms, including at least one point from headache in the setting of a recent ascent or gain in altitude

2018 Lake Louise Acute Mountain Sickness Score

Headache
 0—None at all
 1—A mild headache
 2—Moderate headache
 3—Severe headache, incapacitating

Gastrointestinal symptoms
 0—Good appetite
 1—Poor appetite or nausea
 2—Moderate nausea or vomiting
 3—Severe nausea and vomiting, incapacitating

Fatigue and/or weakness
 0—Not tired or weak
 1—Mild fatigue/weakness
 2—Moderate fatigue/weakness
 3—Severe fatigue/weakness, incapacitating

Dizziness/light-headedness
 0—No dizziness/light-headedness
 1—Mild dizziness/light-headedness
 2—Moderate dizziness/light-headedness
 3—Severe dizziness/light-headedness, incapacitating

————————-
https://www.liebertpub.com/doi/full/10.1089/ham.2017.0164?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub=pubmed&
 

skibob

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^ You can count on me not researching that.

Well there’s the Lake Louise Score for evaluating AMS. But it comes with this caveat which essentially means it’s useless:

—————————-
This Lake Louise AMS score is for use by investigators studying AMS. It is not intended for use by clinicians, professional outdoor guides, and laypersons to diagnose or manage AMS.


AMS is defined as a Lake Louise AMS score total of three or more points from the four rated symptoms, including at least one point from headache in the setting of a recent ascent or gain in altitude

2018 Lake Louise Acute Mountain Sickness Score

Headache
 0—None at all
 1—A mild headache
 2—Moderate headache
 3—Severe headache, incapacitating

Gastrointestinal symptoms
 0—Good appetite
 1—Poor appetite or nausea
 2—Moderate nausea or vomiting
 3—Severe nausea and vomiting, incapacitating

Fatigue and/or weakness
 0—Not tired or weak
 1—Mild fatigue/weakness
 2—Moderate fatigue/weakness
 3—Severe fatigue/weakness, incapacitating

Dizziness/light-headedness
 0—No dizziness/light-headedness
 1—Mild dizziness/light-headedness
 2—Moderate dizziness/light-headedness
 3—Severe dizziness/light-headedness, incapacitating

————————-
https://www.liebertpub.com/doi/full/10.1089/ham.2017.0164?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub=pubmed&
Ironically, when I was at Lake Louise last summer I scored about an 8 to 9 on that scale.
 

mdf

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Many people have trouble sleeping soundly at altitude. Is disturbed sleep part of AMS, or a completely different problem?
 

Analisa

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Well there’s the Lake Louise Score for evaluating AMS. But it comes with this caveat which essentially means it’s useless:

—————————-
This Lake Louise AMS score is for use by investigators studying AMS. It is not intended for use by clinicians, professional outdoor guides, and laypersons to diagnose or manage AMS.

The caveats are mainly research related. They require a headache to be present in research because it's one of the more unique symptoms of AMS (which is a minor, non-fatal form of HACE - high altitude cerebral edema). The dizziness, fatigue, and nausea can capture a lot of other mountain illnesses - hypothermia, dehydration, a low blood sugar bonk, even a Mountain House meal that doesn't agree with you. Even requiring the headache symptom can make it hard to create a differential diagnosis.

Full on HACE acknowledges that many - but not all - people will experience headache and check all the boxes for AMS before they start having issues with coordination/speech and showing signs of confusion. And like AMS, a certain differential diagnosis is pretty impossible without being able to do a CT scan or bloodwork.

Some guides still use the Lake Louise questionnaire, but less as a hard cutoff for clearing clients for summit day and more as a pulse on who's feeling good and who to monitor more closely throughout the day. It's helpful to ask more specific questions than "how are you feeling," since a lot of clients will say they're fine, thinking that the fact that they're cold or tired is a given.

@mdf Sleep got stricken from the AMS inventory last year. It bothers people, but it only weakly correlates with people dealing with the other symptoms and the people who ultimately end up with HAPE or HACE.
 

pais alto

me encanta el país alto
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Many people have trouble sleeping soundly at altitude. Is disturbed sleep part of AMS, or a completely different problem?
Yes, probably, maybe, unless it isn’t.

Serious answer, more assessment info needed.
 

James

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The caveats are mainly research related.
I have no idea how people use it. The caveat is pretty specific, essentially the score is only for research. Is there one for diagnosing?
It is not intended for use by clinicians, professional outdoor guides, and laypersons to diagnose or manage AMS.
Not much gray area there. Maybe it's just a cya statement? saying "don't use this, we do, but we're geeks in a lab with little connection to real time human problems"
 

Analisa

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I have no idea how people use it. The caveat is pretty specific, essentially the score is only for research. Is there one for diagnosing?

Not much gray area there. Maybe it's just a cya statement? saying "don't use this, we do, but we're geeks in a lab with little connection to real time human problems"

I don’t think there’s rigid diagnostic criteria. Full fledged cerebral edema doesn’t even have hard & fast diagnostic criteria even though docs will do a CT scan, blood panel, and a neurological exam. It’s partially informed by underlying issues, like whether a patient has been at altitude or gotten a TBI or been diagnosed with one of the infections that cause brain swell. I reckon a CT scan could detect for AMS, but it’s a lot of effort & money for something that’s generally non-fatal (assuming it hasn’t progressed to HACE and the patient is conscious, and is clear/coherent/coordinated as usual).

I get the sense mild to moderate altitude issues are a lot like mild to moderate dehydration. Uncomfortable, but not life threatening, and most people are self-diagnosing based on their symptoms & the steps they took that made them feel better. It made me curious who bothers to fund the research - wilderness medicine & defense grants (guessing that the latter likely has deeper pockets).
 

Monique

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To some extent, I think flying is a factor that messes me up. I've driven from sea level to over 9'000 and backcountry skied in a span of 5 hours. It's comical how slow I am, but I don't get headachy or anything else.

I get pretty dehydrated on plane flights - I wonder if that's a factor for you.

It is a strange experience, because I don't realize I have no appetite, so I will order food and when it arrives discover I can't eat it.

Appetite is definitely an issue. I have trouble mustering an appetite for anything but junk food at the lodge, and when I helped out a trail crew at high altitude, we were told to bring lots of highly tempting snacks, because we wouldn't be hungry. And actually, I often don't feel hungry at altitude, but then am ravenous as I hike (or whatever) down.

Possibly related: airplane food is spiced differently than normal food. It needs to be saltier and whatnot to taste right.
 

James

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The Boeing 787 and Airbus A350 can maintain somewhat higher relative humidities and higher cabin pressures. Nearer 6,000ft then 7-8,000ft because of the use of a composite fuselage. Relative humidities can vary from < 10% to 55%, but at altitude It can be less than 20% the whole time.
Carbon Dioxide levels are also higher than normal in commercial aircraft.

The 787 also has larger windows because of the stiffer composite shell and I assume the Airbus does too.

The new Boeing 777X will also have cabin altitude more near 6,000ft even though it's made if aluminum. Don't know about humidity.

--------------------
IMG_6630.jpg


"Air quality and relative humidity in commercial aircrafts:
An experimental investigation on short-haul domestic flights "
https://core.ac.uk/download/pdf/53284046.pdf
-------------------


-----------------
Boeing is making a major change to its planes that could end jet lag as we know it

In a study conducted by Oklahoma State University with the help of Boeing, researchers wrote:

"Some passengers on long commercial flights experience discomfort characterized by symptoms similar to those of acute mountain sickness. The symptoms are often attributed to factors such as jet lag, prolonged sitting, dehydration, or contamination of cabin air. However, because barometric pressures in aircraft cabins are similar to those at the terrestrial altitudes at which acute mountain sickness occurs, it is possible that some of the symptoms are related to the decreased partial pressure of oxygen and are manifestations of acute mountain sickness."
---------------------
https://www.businessinsider.com/boeing-787-dreamliner-777x-cabin-pressure-jetlag-2016-9
 

JoeSchmoe

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Does anyone else have the Central Sleep Apnea issue while sleeping at altitude where the body goes into "Cheyne-Stokes breathing"? I usually get this problem by day 3 of being at altitude, and it continues until I return to altitude. Interestingly, days 1-2 are usually okay, with only minor problems while I'm awake.

I've gone nights without any meaningful sleep because of this.

I was reading a study where Diamox eliminated the problem in most of the participants (I think it was better than 80%).

Has anyone else had success with Diamox for this? For me, I'm hesitant to book any future trips to CO because it's so much of an annoyance... though some friends are interested in going back.
 

Kneale Brownson

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Never had that that I know of for the 30-odd years I visited somewhere in the mountains from Michigan, but using Diamox helped a lot with headaches and general sleeplessness after my first couple trips.
 

Ron

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I used diamox years back when I still lived in NJ and was skiing in chile At over 9500. It worked pretty well but does have some side effects. of course you will need to see dr about its use.

FWIW. Steamboat is on 6700 downtown.
 
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TS
Tricia

Tricia

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Funny...
When we were staying at a ski house with 7 people last winter, 3 of our house mates had c-pap machines.
Not sure how that relates to sleep apnea but...
 

Kneale Brownson

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Were they c-pap or oxygen concentrators?

There's a big difference
 

palikona

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Random question but can canned oxygen help with the affects of high altitude (either skiing or hiking)? Or are they BS?
 

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