Mt Whitney Zone Forums General Discussion 1912 Alternative to Diamox

The Colorado Mountain Club is celebrating its 100th year. They have been writing up events that happened in 1912 and I found a news item from the Rocky Mt News issue of June 23rd.

PARIS: "The director of the Pasteur Institute announces that altitude sickness can be cured by small injections of oxygen"

I suggest you check with your Dr or one of ours on this WZ site before you rush out and try this as Diamox might work better for you. In fact, I am not sure how you would do this and where you would inject the oxygen.

I've been using a small canister of O2 for the last few years on summit hikes of Whitney and Shasta. They are available over the internet. A canister fits in your palm with or without a small mask, weighs just a few ounces, and provides dozens of deep breathes of highly concentrated oxygen. When you're struggling at high elevation, each breath provides a short but very nice boost in energy and mental clarity. The extra O2 has made the trips much more enjoyable. Before using a canister, I always used to get a headache.

These are especially great for quick trips when there just isn't enough time to acclimate. I bring a second canister if I'm base camping overnight above 10,000 ft.

I plan to try diamox sometime in the future to make a comparison, but O2 is natural and it solves the problem directly by providing exactly what the body is missing.

Note: if you decide to try this, plan ahead because they only ship via ground transpo which can take a week. They can't ship them by air transport, and you can't bring it on a plane.

Could you please provide a link? IMWTK.

This is the company I've been using for a few years. There are others out there.

https://www.betterthanair.com/

Wow, really interesting post! I have a lot of trouble at altitude, so I wonder if this will help me?

I managed to find this at Target for a very reasonable price:

http://www.target.com/p/Oxygen-Plus-O-Stick-Canister-3-pk-Natural/-/A-10949809

This product should work as well as the heavier but higher pressure canister sold by betterthanair since they're both 90% O2. I've used this style canister in Japan - they sell them at rest stations on the way up Mt Fuji where you can also get your traditional wooden hiking stick burn-stamped for good luck. They even sell these in convenience stores in Tokyo, although I don't notice any benefit at low elevation. I also used 2 large cans of this type successfully on a Mt Shasta summit.

This type of can is thin, similar to a can of air freshener or hair spray. Consequently, they are filled at lower pressure than the thick cannister sold at betterthanair. The lower pressure means they need to be bigger and they usually hold less volume of compressed O2. In order to make sense of this, you need to compare the total volume of compressed oxygen that you're getting. I didn't see that spec on the Target web page for these cans. For comparison, the O2Go-XL canister provides 18L of 90% oxygen, which is just enough for a day on the upper mountain. Remember, these are intermittent breaths of air when you're feeling low, not a constant supply. You'll probably want to bring all three cans if you go with the Target brand.

I'm sure you'll notice a significant benefit at high elevation. Hopefully it's enough to overcome the troubles you've had in the past. Good luck! Let us know how it goes.

Concentrated oxygen is NOT natural. Tell me where to find the "Oxygen Trees" from which they are picked?

It is a drug, and like all drugs, has potential issues, although I'm not specifically talking against it here.

There are situations in which high concentration Oxygen can be lethal, or cause blindness, although neither situation would apply to this activity.

However, when people talk about drugs as "natural", it always make me cautious, and you should be too.

Ironically, O2 does in fact come from trees and plants as the end product of photosynthesis. No prescription needed. No list of potential side effects to discuss with your doctor.

Of course concentrating and compressing the gas to 90% oxygen is a human process, but the substance O2 is perfectly natural. The end result is higher oxygen levels in your system, which is a direct solution to hypoxia due to elevation.

Oxygen is MAGIC!

This story from Shreve's Daily Coyote. I've linked the photo from her site. Do go read the story there.

"He saw the dire state she was in and then we both watched, transfixed, as the calf started coming to life before our very eyes. I held the non-rebreather mask over her little nose and she seemed to drink in the oxygen ~ her eyes opened and stayed open and her breathing began to slow and deepen until it was just half the rate it had been (and the rate it should be). She started moving her legs. If I pulled the mask away she would lift her head to follow it. Amazing!

After fifteen minutes, she was trying to stand up on her own. The oxygen had done good work. We lifted her to her feet and she stood, wobbly but strong, and took a few steps. It was time to take her to her mother for another boost of life force ~ mother's milk."

Ken - thanks for the insight, that's a good point you bring up.

I'm curious, given your concern over how the product is being represented, what is your opinion on using a product like this as an alternative to Diamox?

I personally have a tough time at altitude, but have never taken Diamox. I've day hiked Whitney without any kind of drug or supplemental oxygen, but I did experience some bad nausea and toward the end I started getting light headed and a bad headache. I'm considering bringing one of these small canisters along on my trip on the High Sierra Trail this year - to serve as peace of mind in case I do experience bad symptoms, but try to avoid using if possible.

Thoughts?

I'm pretty reluctant to go along with the idea that a small canister of Oxygen would make much difference for someone experiencing AMS symptoms such as nausea and headache.

It could very well help you feel better, but how long is that increased oxygen going to stay in your system ... a minute or two? And then you are back to dealing with the effects of the high altitude again.

There is quite a bit of evidence that Diamox can help people. But I've not seen much on supplemental oxygen making a significant difference.

some responses:

take a deep breath. Just one. How much of that little 18L canister could potentially be used up? The flow of O2 only supplements the inspired air rather than being a full replacement, but still the question is how much is that 18 L worth? Total lung capacity in males is about 6 L. There are other useful lung measurements with a smaller number, but all of them suggest that 18 L is not much.

Rapid changes DO occur when one inspires extra oxygen. Pulmonary artery pressures drop, hypoxic dusky lips and other tissues pink up, color vision improves, and mental function improves. AMS headache is in part due to the hypoxia-induced increased cerebral blood flow, and all of these can begin to normalize in a few minutes.

But note that severe hypoxia is what is being described above. Most AMS cases do not have anywhere near that degree of hypoxia, unless they are at heights much greater than Whitney, or complicated by HAPE or HACE. Does simple AMS or just exercise-fatigue respond to a few whiffs of canned O2? We have had a few anecdotal reports here on this forum.

There doesn't seem to be any research on these small canisters of oxygen, which are relatively new and have not caught on yet. However, supplemental oxygen is a recommended therapy for moderate AMS and here's an indicator of how much might be effective. This is from the Institute for Altitude Medicine at Telluride:

"Treatment of Acute Mountain Sickness

Supplemental oxygen 2 liters per minute in medical setting until symptoms improved. AMS headache typically resolves within 10-15 minutes of supplemental oxygen."

One small canister contains 9 minutes at 2 liters per minute, which is right at the minimum amount that typically resolves an AMS headache. If you're getting this same amount spread out over the course of the hike, it stands to reason that it would be significant at preventing the headache in the first place, which is what I find. I don't feel a need for constant use. With one of these in my pocket I can keep catching my breath very deeply every 5-10 minutes. Works for me and that's all I care.

I still plan to try Diamox on my next overnight trip to Shasta in June. I do not sleep well above 10,000 and the canister doesn't work as well because I have to wake up to use it and then fall back asleep. Diamox looks to be very beneficial for improving sleep at elevation, but from what I've read from Ken and others, the typical recommended dosages seem to be too high. With both of these working for me, I'm looking forward to a good night's rest and plenty of air all day. Clearly there is no magic bullet, so why not use all the tools available to make it a great experience.

Thanks for that from Telluride. This helps give some more useful information on the subject. The equivalent flow rate and response of headache sounds legitimate, but of course are both of limited time duration. I do not have personal experience with canisters , nor seen others use it, but have my knowledge based in traditional O2 usage.

I wonder how long it will take to find the optimal use for canisters? I do have concerns about what seems to be this: taken intermittently with a few canisters, the hiker's headache improves, they go higher and higher, or they sleep at an altitude higher than tolerable, and so by not truly acclimatizing they either (A) get over the hump (which some AMS cases do), or more typically they risk exacerbation with even worse complications if the treatment allows them this extra tool to get into more trouble. This is exactly what one risks using dexamethasone which covers up the AMS only to have it worse as one ascends rather than the preferred recommendation that altitude specialist Peter Hackett famously said was, "descent, descent, descent."

One could modify the above rule by saying that on a moderate altitude mountain and a single day push (such as Whitney) one might get away with it, and as you say, it works for you. Part of my experience has been seeing, treating, and evacuating cases of AMS, HAPE, HACE, and altitude death, so makes me slower to jump on the canister bandwagon yet.

Here is an interesting quote:
Be thou not by whom the new is tried,
nor the last to lay the old aside.

I guess I should reiterate that I've never had a bad AMS problem in the first place - persistent headache, low of appetite (I consider that a benefit ), and difficulty sleeping. Before finding these canisters, I made it up and down 14er's with just aspirin, and I adjust pretty quickly to backpacking at high elevation. So my anecdotal experience with a canister is just one point on the graph - it does not apply to someone who has more difficulty with elevation. I seem to be marginally susceptible and a canister tips the scales just enough for me. I'm confident others would feel a benefit, but maybe not enough, and maybe someone would push themselves further up the mountain than they otherwise should. I'm not advocating, just sharing my experience.

I echo Harvey's concerns. When one is ascending and develops AMS syptoms, your body is telling you that you are not sufficiently acclimatized. Taking any kind of product that produces short term relief: Aspirin, Vicodin, Oxygen, Ginko, Dex......does not change the underlying situation in the body, it has masked it. So doing that, then proceeding to ascend would be basically ignorning the 4-alarm bells that your body has set off. As you obtain more altitude, you would be at risk of more severe consequences.

If one were in a stable scenario....at the summit, at trail camp for the night, for example...Using O's for symptom relieve would seem reasonable for mild symptoms. At the summit, it might even facilitate descent. If a person had bad symptoms, I might give O's, WHILE descending. But descent would be mandatory.

Diamox is somewhat unique in what it does: accelerate acclimatization. It is not a pain medicine, and has no magical on-the-spot properties. However, it's effects go to the underlying process--altitude incompatability--and given sufficient time to work, if you feel better, it is because you ARE better.

Ken,

I've read about recommended dosages of diamox discussed in other threads, and the timing before hiking. Maybe this would be a good place to restate things. What's the typical regiment?

[edited to avoid asking personal medical advice from a doctor]

usual these days seems to be 125-250 twice daily. Larger doses probably offers not much more benefit, but nearly guarantees side effects. Other factor is not just dose, but when to take it and how long. Various opinions suggest begin the day before ascent or start the day of, and take it for a few days or as many as five along the way at each successive rise in sleeping altitude, etc, etc. Lots of ways to do it but not all well established. Here is a protocol often quoted:
High Altitude Tutorial


Getting back to waggas post about the calf:
Did you know that (1) babies (calves, humans, and some other animals) are very hypoxic in utero and at birth, so of course O2 helps pink them up. One of the compensations is production of fetal hemoglobin (hgb F) a temporary form that has a left-shifted oxygen dissociation curve, the very same physiological effect that hyperventilation and blowing off CO2 to raise blood ph has in high altitude climbers. (2) calves and young cattle are much more sensitive to altitude than humans. They have a pulmonary artery reactivity that causes them to have pulmonary hypertension at altitudes as low as 5,000 ft. This causes Chronic Altitude Sickness (Brisket Disease). Selective breeding and medical testing for susceptible cattle is carried out in higher altitude states like Utah. They learned that hard way many years ago that bringing cattle from lower pasture states to higher ones caused them to die from Brisket Disease.

Re: Brisket disease. Interesting similarities with humans and AMS: Between different individuals, the susceptibility varies markedly.
From this source on Brisket disease (High-mountain Disease: Introduction)

Re: AMS and Diamox. The Altitude Tutorial recommends 125-250 mg twice a day. I myself have used the 125 twice a day for Mt Whitney ascents. There are some people who use less -- 62.5 mg once or twice a day.

Akichow gave some interesting information on her personal experience on her Kilimanjaro Trip report (Jan. 8-17, 2012), where she was using 62.5 mg once a day, and after experiencing more serious AMS symptoms, increased to 62.5 mg 4 times per day with good results.

Indeed,Steve, although Brisket Disease in cattle is more like Monge's Disease in humans. Both of these are chronic conditions occurring after months or years at various species-specific altitudes and manifested by two main problems (1)complications from too many red blood cells as a response to hypoxia. yes, you can make too much, and (2) Right-sided congestive heart failure (CHF) due to the extra workload of the right side of the heart pumping blood through pulmonary hypertension, itself a direct effect of hypoxia.
(note: this is different from usual left-sided CHF that humans get from coronary disease or systemic hypertension

By the way, why do llamas in South Americas and bar-headed geese in Asia survive well at high altitudes? They do not get the pulmonary hypertension effect , and, they have left-shifted oxyhemoglobin dissociation curves for their hemoglobin, and/or other metabolic advantages. There is a lot we can learn from veterinary medicine.


Wiki does not have much on Monge
http://en.wikipedia.org/wiki/Chronic_mountain_sickness

This has a bit more and other sources are searcheable.
http://www.amjmed.com/article/0002-9343%2871%2990181-1/abstract