[Mount Cleverest]

I am travelling to Leh via Manali in three days time, just want to make sure that I carry the right stuff with me in case AMS strikes me or anyone in the group. I am aware of the qualities of water as a anti AMS measure. Anyone aware of what else could help..medicines? food?

Edited by john.sw, 14 June 2006 - 02:30 PM.

[ploma]

Hello MC

When I plan my trip to Leh two years ago I was told that garlic helps avoiding AMS. I Can't remeber where the information came from but anyway garlic never hurts (only smells a lot :ninja:). So I carried some garlic pills and some days before the trip I started tataking one pill a day (till some days after my arrival in Leh)… I presume you can also eat raw garlic instead but I was travelling with my girlfriend so…

At the end I didn't have any problem with AMS and everything went well during the Manali - Leh journey (in my case 2 days in a Tata Sumo), even when sleeping in Sarchu I didn't get any headache… but how knows if it was the garlic or just luck?

Good luck and enjoy this great journey, it's one of the greatest experiences I've done in my life.

uribaba

[Mount Cleverest]

Ploma,
Thanks!

I am not very friendly with Garlic so not too sure I will use it..in your case I suspect it may have been your girlfriend who kept your mind away from all thoughts and troubles of AMS rather then anything else  

How about Diamox? I have heard that 250 MG of Diamox a day helps beat AMS..has anyone tried it ever?

[dani]

check out the wikipedia article about diamox: http://en.wikipedia.org/wiki/Diamox

I guess in your situation diamox would not help much, if symptoms appear you'd need time for acclimatisation anyway. You could take it preventively, but I'd not do that, just read about the side effects...

[Mount Cleverest]

Dani,
Thanks for the link. I did read about the side effects of Diamox and was thinking on the lines suggested by you. I think I will just stick to some good old water therapy. Will carry a LARGE jar of water and target to finish it..

[AndreasW]

Hi MC,

you live in Delhi? - Visit SEGAL'S PHARMACY, 279, Khucha Ghasi Ram, Near Fatehpuri, Chandni Chowk, DELHI an buy some pills Coca 6c. Take the first days 5 pills two times/day (morning + evening), drink a lot of water/tea and attend all other precautions too...

That's all what I do every year! - It is helpful and without side effects...

Good luck and have fun!

AndreasW

[70s-80s overlander]

[quote] Anyone aware of what else could help..medicines?

For acute mountain sickness ["altitude sickness"], the US military uses both "Diamox"/acetazolamide [ 125mg (1/2 of a 250mg tab) 3-4 times per day -- or one 500mg time-release tab per day] as well as many of the meds classed as "PDEs" -- "phosphodiesterase inhibitors" [eg, "Trental"/ pentoxifylline 400mg 3 times per day -- or, don't laugh: "Viagra"/ sildenafil 40/50mg (pill size depends on the country where sold) once a day per day].  

Personally, I'd vote for Pentox as it is the most versatile -- enhances pulmonary and cerebral blood flow while having immune-enhancing plus anti-inflammatory effects. Once a person gets acutely ill with altitude sickness, it frequently is Pentox that will be given to protect the lungs and brain. [Pentox also was used to treat patients during last year's SARS outbreak, and is being looked into for probable use with avian flu patients. In double-dose, it is also being used to treat many recalcitrant skin lesions by enhancing peripheral blood flow. ?Should I bother to mention that it has mild viagra-like effects?]

[sakurablue]

That's a very informative post above.  

As for myself I have not taken diamox but a week before I trek I  start on Gingko Biloba and Rhodolia Rosea (Tibetan herb and adaptogen).  Symptoms set in for me at around 11,500ft (nausea , headache and appetitie loss) and I have to take it easy at that height for a couple of days.  Trick is also to ascend gradually.  For instance flying into Lukla (9,500ft approx) then stay 2 nights at not more than this altitude.  Third day ascend slowly and so on.  

Sherpas recommend eating garlic soup and drinking lots of water.  I'm fine around day 4.

My trekking partner takes Diamox and swears by it.  He has no probs with it but I have met climbers who have had bad side effects.  It all depends on the metabolism of those who take it.

Also keep your head warm , also at night - wear a hat in bed. That's what I had to do..... hmmm...

[Mount Cleverest]

Sakura,
Talking of Lukla, you have been to the Everest BC or higher as well?

[vistet]

dani, on Jun 14 2006, 02:11 PM, said:

You could take it preventively, but I'd not do that, just read about the side effects...

I  would suggest that in this situation you have to compare two worst case scenarios : advanced AMS vs the side effects of Diamox. This is obviously something you should discuss with a doc who knows your medical history ( for example : have you had sulfa medication with/without reactions ? ) but what we can bring in are some questions & experience in to this discussion.

For one thing , I´ve seen the second worst case scenario with AMS ; it was - and should be -  a frightening experience. Parestesia - which I got the one time I felt it was necessary to take Diamox- or even temporary  decreased field of vision are lesser evils than advanced AMS.

Talking this over with a doc you`ll probably will get a response that is somewhat similar to what you will get if you ask for something to beat the bends when diving : don´t get it , i.e. use safe ascent rates. Get at least one extra day in Manali, or better in Keylong, or you may land yourself in trouble.

"70-80`s overlander" said:

For acute mountain sickness ["altitude sickness"], the US military uses both "Diamox"/acetazolamide [ 125mg (1/2 of a 250mg tab) 3-4 times per day -- or one 500mg time-release tab per day]

Please note that these  are the dosages for treating manifest AMS , preventive medication is half of these. Anyone starting with a slow release form are stuck with whatever reactions this may give for a longer time , caution would dictate to start with a lower test dose, normal release.

I had high hopes for gingko myself , used it last time and felt great . When I came back I read the abstracts  on the large studies that have been made, which disproves the effect of gingko.  In retrospect I could see that I had another ascent pattern as well.  

The ISSMMED page is a good source on prevention & medication.

[sakurablue]

Cleverest, I haven't been as far as EBC.  Before I visited the Khumbu I imagined I'd never be able to get that far, but now I know that of course I can and I hope I will one day.

Vistet - somewhere in my office I have references for very positive reviews of gingko.  I'll try and find them. I downloaded them from an Everest medical website.

[vistet]

My guess this would be the first pilot study, made on Denali with around 40 subjects. Even Dr Dietz, who launched this study says today :

Quote

Ginkgo initially appeared to be a promising new drug for the prevention of altitude illness, but much more data has now been accumulated in multiple well-designed studies, and there is no demonstrable benefit to taking Ginkgo. Ginkgo is no better than placebo for prevention of AMS, and Ginkgo plus acetazolamide (Diamox) is no better than acetazolamide alone.

I´ve read the abstract for one of these studies, which used something like 600 subjects, if I remember it right, and after that all my expectations died away.

[Serena]

AMS is my biggest concern about my trip in Ladakh and after reading this post I don't feel much better......

I don't like medicines and I don't want to take anywithout severe symptoms.
Hope that everything will go fine...

[sakurablue]

Serena, try not to be apprehensive.  You might feel fine.  Are you flying into Leh or taking the road up from Manali.  The road journey would be better for acclimatization but then you have to weigh up the risk of accidents although the scenery would be great!  Always hard choices in life!  If you fly in then set aside 3/4 days to take it easy in Leh in case you feel unwell.  
I would recommend that you try Gingko and Rhodolia Rosea - I do well on them.  Having trained for 3 years as a nutritionist doing biochemistry, I have learned to be wary of the results of trials.  You have to make your own mind.  If you do want to take supplements then start one week before.

[jyotirmoy]

I totally agree with the advice given by sakurablue. Gradual acclimatization is the best thing. I have heard of people becoming unwell after flying in to Leh. I myself had a very unpleasant time when I flew to Bagdogra & then to Gangtok & almost immediately to Nathu La.

[Serena]

I will fly in and return by road..... someone told me that the way down is better.......
I can find Ginko in herbalist's shop?

MC, where are you now?

[vistet]

sakurablue, on Jun 17 2006, 10:51 AM, said:

The road journey would be better for acclimatization

This line  of this reasoning baffles me every time I hear it. How can travelling between 2000-5000+ (in the same or two days) be seen  as as slow acclimatisation, often by the same people who stress that you have to acclimatise for days after arriving in Leh at 3500 ? Look at the altitude profile : within hours after leaving Manali you are above Leh`s altitude and climbing, after the descent to Keylong you are for a short spell at Leh`s altitude and after that you spend most of the time between 4000-5000+.  Now try to find any responsible travel agent agreeing to put somebody on a jeep to the Khardung La and Nubra the day after flying in to Leh ...
Or compare this to what climbers and doctors say on ascent rates :

Quote

The key to avoiding AMS is a gradual ascent that gives your body time to acclimatize. People acclimatize at different rates, so no absolute statements are possible, but in general, the following recommendations will keep most people from getting AMS:
   - If possible, you should spend at least one night at an intermediate elevation below 3000 meters.
   - At altitudes above 3000 meters (10,000 feet), your sleeping elevation should not increase more than 300-500 meters (1000-1500 feet) per night.
   - Every 1000 meters (3000 feet) you should spend a second night at the same elevation.

This norm means that the Srinagar-Leh route is close to ideal, when using Kargil as half way point(2500), that the second best option is flying in, and that the Manali-Leh road requires one day extra in Manali and one stop in Keylong or Jispa, another in an intermediate location betwen Jispa and Sarchu .. which basically doesn`t exist. Minimum.  

The point of all this is not paint a dramatic picture, just saying that an extra stop in Manali and Keylong will give you a lot better chance of actually enjoying one of the most dramatic and beatiful roads on the planet.

And if you are concerned , fly in.

Quote

Having trained for 3 years as a nutritionist doing biochemistry, I have learned to be wary of the results of trials. You have to make your own mind.

So basically you say that you feel certain that large studies , involving hundred of subjects , are not valid , based on personal experience ... or what ?

Edited by vistet, 17 June 2006 - 07:02 PM.

[sakurablue]

I'm not saying all trials are suspect. I have no idea about validity of trials.  It's important to look at exactly who (or which company) instigated any trial.  For instance if Monsanto did a trial on gingko and found it useless, no matter how many people took part, I would question this result, Monsanto being against natural products (for business reasons) yet I believe they own the Solgar supplement company.  

I only said I am WARY of trials and make up yr own mind.  I didn't say I was certain about anything.  So there! :-)

[volga_volga]

dear experts, can you please express your opinion on my case

I am flying to Lhasa (3300m) in a couple of weeks' time. This is my second time in Tibet (incl 5000 mtr passes) and in the first time I have not had any serious AMS symptoms EXCEPT my migraine came twice in the 10 days period that I was there whereas I normally have it every other month, or less frequently, at the sea level.

(I suspect my migraine is linked to my being at high altitude as I had the same (two attacks in two weeks) when I was in the Karakorum mountains a couple of years ago. To date, no doctor has ever found the cause of my migraine attacks.)

the first time I was in Lhasa it took me about 24 hours to acclimatise. Now I am thinking what shall be my medicine strategy this time.

I see options are: diamox, Gingko, Rhodolia Rosea, or do nothing.

I have been taking 120 mg 24% standardised extract Gingko Biloba as health supplement for many months. What kind of dose would you suggest for acclimatisation/AMS?

I have taken Rhodolia Rosea while in Lhasa last time, but didn't see much effect (although I don't know what I would have felt like if I didn't take it).

this time I have got hold of acetazolamide 250 mg - shall I try taking it to accelrate acclimatisation? shall I avoid taking it unless I have AMS symptoms? pls let me know what you think... sure you are not doctors and i'll have to make my own decisions but I trust your expertise is better then mine... vistet?

thanks

v-v

[vistet]

If gingko works out for you as a health supplement , by all means continue. As a cure or preventive measure against AMS , it´s  off the books. I had high hopes for this as well and used it last time but reading the large studies published afterwards leaves no doubt in my mind: no effect.

I talk over all my plans with a doc each trip , and make a point also to mention  the non-prescription or non-traditional medication I plan to use (last trip it was gingko ) to  get a chance to avoid unwanted interaction effects.

Dehydration could be a factor for migraine ( I checked this with a doctor here ) and it can occur during acclimatisation , both from the lack of appetite/mild nausea and  the high diuresis as the body concentrates the blood. My own rule of thumb is to push a liter of fluid if  I get a headache while ascending to cure this basic hangover headache, but more importantly to keep track of the color of my urine so that it doesn´t start to get concentrated.

Diamox, which has a proven effect to  speed acclimatisation, also works as a diuretic so you´ll need to up the fluid intake if using it. There are a few factors ( previous experience with sulfa drugs the most important) that should be talked over with your doc , but flying in to Lhasa or Leh is a common indication for using it.
Common dosage is 125(-250) mg twice a day ,depending on body weight, for prophylaxis, starting 24hrs before ascent. The ISSMMED site has a good rundown of the pro and cons of Diamox, written by proffessionals. My unproffessional advice would be to talk it over with your doc , take a test dose at home and start  in prophylactic dose.
On the speculative side Diamox corrects an imbalance in the acidity levels in the blood and since the mechanisms of migraine are largely shrouded in mystery, the more factors that fall in to the normal range the better.

Hypoxia would be the factor has the the greatest chance to influence you , but it´s a fact of life at high altitudes. Apart from being aware of sensible ascent rates, and slowing down until our bodies have had a chance to adjust , there is little we can do to boost the respiratory system. There is good evidence that garlic has a benificial effect on respiration, but the chances of getting too little garlic in India or Tibet seems low...

The last environmental factor (entering the wildly speculative side) that is dramatically different is light and  radiation. If you can see a difference in the frequency of migraine attacks between Russia and Asia, or between winter and summer it might be a good idea to get the best polarising sunglasses you can find.

Edited by vistet, 22 August 2006 - 06:13 AM.