Prevention of Altitude Illness for Two Day Mountain Climbs

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almost to Muir

Altitude sickness develops when the rate of ascent into higher altitudes outpaces the body’s ability to adjust to those altitudes. Acclimatization is critical for anyone climbing above 8,000 feet but those doing only a two day climb typically don’t have enough time to gradually work their way up the mountain to higher and higher altitudes to adjust. This could make them vulnerable to acute mountain sickness (AMS) which may develop at altitudes as low as 6500 feet.

Physiologically as you ascend higher into the atmosphere there is lower atmospheric air pressure pushing the air molecules together, so oxygen molecules become few and far between. The available amount of oxygen to sustain mental alertness and exercise performance decreases with altitude.  Since the number of molecules (of both oxygen and nitrogen) per given volume, drops as altitude increases, you have to move larger volumes of air to get sufficient amounts.

Symptoms of mild to moderate acute mountain sickness may include headache plus at least one of the following:

  • Sleep disturbance
  • Dizziness or light-headedness
  • Fatigue
  • Nausea or vomiting
  • Rapid pulse (heart rate)
  • Shortness of breath with exertion
  • GI symptoms (loss of appetite, nausea, vomiting),

Prevention of altitude illnesses will increase your chances of enjoying your experience.  These tips may help reduce your susceptibility to the effects of being at altitude:

If possible, spend a night at an intermediate altitude before coming to above 9000 feet to sleep.

Your symptoms will depend on how hard you exert yourself. So prepare yourself well by following a mountaineering training program for 6 months before your climb.

Your goal is to be in the best possible physical condition you can. Although physical fitness enables greater exertion at altitude, it does not protect against any form of altitude disease.

Don’t over pack your backpack. Plan very well so that you have what you need but nothing redundant or extraneous. Extra weight means you will have to exert yourself more.

The week before your climb, take extra good care of yourself by eating well, hydrating with at least half your body weight in ounces of water and getting extra sleep. Don’t drink alcohol the week before.

Ascend slowly. Utilize the rest step which preserves energy while helping you maintain a steady pace.

Limit strenuous activity on the first day at altitude.

One of the goals of acclimatization is to increase ventilation (breathing) to compensate for lower oxygen volume in the air. Take slow deliberate deep breaths, use pressure breathing techniques. During your rest step, exhale forcefully through pursed lips, emptying your lungs in one big “whoosh” as if you were trying to blow out a giant candle.

Synchronize your breathing with each movement. Inhale deeply as you step up; exhale fully into the rest step.

Drink an extra liter to liter and a half of water when coming to altitude.

Avoid tobacco, alcohol and other depressant drugs including, barbiturates, tranquillizers, sleeping pills and opiates.

Your guides are experienced in identifying altitude sickness and knowing what to do so let them know how you are feeling.

If you begin to show symptoms of moderate altitude sickness, don’t go higher until symptoms decrease. If symptoms increase, descend.

Eat enough food and drink enough water while on your climb. It is recommended that you drink from four to five liters of fluid per day. Also, eat a high calorie diet (> 70% of your calories) while at altitude, even if your appetite is reduced. Take a variety of your favorite foods that will be appealing to you. Do a trial run of these foods in the month before your big climb so you know if these foods work well for you.

Hydration is critical. Breathing large volumes of dry air at altitude increases water loss. Drinking four to five liters of water a day is usually good but keep an eye on your urine; make sure your urine is clear and copious. If you routinely take a diuretic, tell your doctor you are doing a climb and see if they want you to continue or if you can discontinue for a few days.

Keep your temperature regulated. Wearing warm clothes is important as it allows you to conserve energy that would otherwise be spent on maintaining your body temperature. But don’t allow yourself to get too warm. Learn how to properly layer your clothes so they wick moisture away from you.

Acetazolamide (Diamox) is a medication sometimes used to speed acclimatization. Talk with your mountain guide service ahead of time and your doctor to see if Acetazolamide prophylaxis is right for you. Consider medical prophylaxis if you have had a history of prior AMS.

There is no reliable scientific evidence for Gingko Biloba at this time but some believe that 100 mg by mouth twice daily started 3-5 days prior to ascent then continued for 2-3 days at maximum sleeping altitude is beneficial.  If you decide to try it, do a trial run first a month before to make sure you react okay with it. And always inform your doctor or pharmacist if you are taking other medications to avoid a drug interaction.

Treatment of mild AMS: Tylenol 650 mg to 1 gm by mouth every 6 hours as needed until symptoms improve or Motrin 400-600 mg by mouth every 6 hours as needed until symptoms improve.

  1. Bailey DM, Davies B, Castell LM, Collier DJ, Milledge JS, Hullin DA, Seddon PS, Young IS:Symptoms of infection and acute mountain sickness; associated metabolic sequelae and problems in differential diagnosis.
  2. High Alt Med Biol 2003, 4:319-331.
  3. Hackett P. High altitude and common medical conditions. In: Hornbein TF, Schoene RB, editors. High Altitude: an Exploration of Human Adaptation. New York: Marcel Dekker; 2001. p. 839–85.
  4. Hackett PH, Roach RC. High altitude cerebral edema. High Alt Med Biol. 2004 Summer;5(2):136–46.
  5. Hackett PH, Roach RC. High-altitude illness. N Engl J Med. 2001 Jul 12;345(2):107–14.
  6. Hackett PH, Roach RC. High-altitude medicine and physiology. In: Auerbach PS, editor. Wilderness Medicine. 6th ed. Philadelphia: Mosby Elsevier; 2012. p. 2–33.
  7. Johnson TS, Rock PB, Fulco CS, Trad LA, Spark RF, Maher JT. Prevention of acute mountain sickness by dexamethasone. N Engl J Med. 1984 Mar 15;310(11):683–6.
  8. Luks AM, McIntosh SE, Grissom CK, Auerbach PS, Rodway GW, Schoene RB, et al. Wilderness Medical Society consensus guidelines for the prevention and treatment of acute altitude illness. Wilderness Environ Med. 2010 Jun;21(2):146–55.
  9. Luks AM, Swenson ER. Medication and dosage considerations in the prophylaxis and treatment of high-altitude illness. Chest. 2008 Mar;133(3):744–55.
  10. Maggiorini M, Brunner-La Rocca HP, Peth S, Fischler M, Bohm T, Bernheim A, et al. Both tadalafil and dexamethasone may reduce the incidence of high-altitude pulmonary edema: a randomized trial. Ann Intern Med. 2006 Oct 3;145(7):497–506.
  11. Pollard A, Murdoch D. The High Altitude Medicine Handbook. 3rd ed. Abingdon, UK: Radcliffe Medical Press; 2003.
  12. Pollard AJ, Niermeyer S, Barry P, Bartsch P, Berghold F, Bishop RA, et al. Children at high altitude: an international consensus statement by an ad hoc committee of the International Society for Mountain Medicine, March 12, 2001. High Alt Med Biol. 2001 Fall;2(3):389–403.
  13. Schoene RB, Swenson ER. High Altitude. In: Mason RJ, Murray JF, Broaddus VC, Nadel JA, eds. Textbook of Respiratory Medicine. 4th ed. Philadelphia, Pa: Saunders Elsevier; 2005: chap 65.
  14. Strom BL, Schinnar R, Apter AJ, Margolis DJ, Lautenbach E, Hennessy S, et al. Absence of cross-reactivity between sulfonamide antibiotics and sulfonamide nonantibiotics. N Engl J Med. 2003 Oct 23;349(17):1628–35.
  15. van Patot MC, Leadbetter G 3rd, Keyes LE, Maakestad KM, Olson S, Hackett PH. Prophylactic low-dose acetazolamide reduces the incidence and severity of acute mountain sickness. High Alt Med Biol. 2008 Winter;9(4):289–93.
  16. Wright A, Brearey S, Imray C. High hopes at high altitudes: pharmacotherapy for acute mountain sickness and high-altitude cerebral and pulmonary oedema. Expert Opin Pharmacother. 2008;9(1):119-127.
  17. Yaron, M, Honigman, B. High- Altitude Medicine. In: Marx JA, Hockberger RS, Walls RM, et al., eds. Rosen’s Emergency Medicine: Concepts and Clinical Practice. 7th ed. Philadelphia, Pa: Mosby Elsevier; 2009: chap 42.
  18. http://wwwnc.cdc.gov/travel/yellowbook/2014/chapter-2-the-pre-travel-consultation/altitude-illness
  19. http://www.altitudemedicine.org/index.php/altitude-medicine/for-healthcare-providers
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How to Get the Whole Family into a Healthy Lifestyle

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Make healthy living a family affair and lead your family down the path of exercise and proper diet.

It makes it easier if everyone is on the same page as far as lifestyle is concerned. It is difficult for one to eat healthy if two or three others have fast food and junk around.

Families doing exercise and healthy eating together are going to be more supportive… doing things, having common goals for a family is very important. It helps bring the family together whatever those goals are.

Top tips for fine-tuning your entire family’s well-being.

  1. Set modest, simple health goals. Take baby steps so your cooking slowly evolves from fattening to fit. Incorporate fruits and fat-free snacks into children’s diets. Also start slow with light exercise such as walking for a few minutes, a couple of times a week and gradually increase the frequency and duration.
  1. Reinforce healthy behavior. Don’t get discouraged… even if your family won’t eat every morsel of the healthy meal you’ve made. Be pleased with even the smallest progress.
  2. Focus on motivation. Encourage your children to be more like their favorite sports idol. All professional athletes have fitness trainers and registered dietitians because optimal exercise and nutrition helps performance.
  3. Go public. Commit to a walkathon or another event involving a large group of people. Such events are great motivators because they get you to train.
  4. Associate health with favorite activities. Your husband loves golf and your daughter loves cheerleading? Use these loves to get them to exercise. Knowing that exercise will help them to excel at their favorite activities is a great way to get them motivated.
  5. Exert influence, not control. Don’t force exercise and healthy eating down the throats of your loved ones. They will be more inclined to change their lifestyle if they think it’s their idea.
  6. Lead by example. Be a role model. If you make healthy lifestyle changes, your family is likely to follow suit.
  7. Make it easy for your family to be healthy. Don’t obstruct attempts to be healthy. If your kids want to play soccer with the neighbors, let them. Disguise exercise by suggesting you and your children walk down the street to see what the neighbors have done to their house.
  8. Do activities together. The family that walks together, talks together. Plan activities that will spawn healthy bodies AND healthy relationships.
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Post Rehab Exercise Programs

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First Aid Station 2

Post-rehab exercise programs meet the needs of clients who do not feel comfortable or knowledgeable enough to exercise on their own, given their medical condition and history.

If you have had an injury, you may not know how to proceed with post-injury exercise. It is crucial that you consult with someone who knows how do transition you from injury recovery to the gym with a program that is going to help you and not cause further harm. The ultimate goal is to achieve physical fitness, continued recovery without further or continued harm through carefully developed, customized personal training.

Do not try to create your own program.  Post-rehab is a key component to keeping your body healthy and without it, it is possible to regress.

A 56 year old male former football player client was referred to me with a history of three knee surgeries, shoulder impingement, degenerative disk disease and a herniated disk.

Included in his self-designed current program were several exercises that were high risk exercises for any person without injury and especially contraindicated and harmful for someone who has injuries.

Here are the contraindicated ones that I am removing from his program and my explanation of why.

The Pec Dec Machine is high risk for those with shoulder problems since many machines take the joint to an extreme range of external rotation and horizontal abduction, placing the joint in a vulnerable position.

The Overhead Shoulder Press is controversial due to the vulnerable position of shoulder and increased risk of injury.

The DB Fly is considered high risk because of the risk of extreme, uncontrolled end range of motion in the eccentric phase), leading to shoulder joint injury.

The Triceps Dip is risky because the front of the shoulder is placed at risk due to the starting position of the upper arm.

The Leg Extension Machine creates constant ACL tension and it places undue stress on the kneecap, so people with ligament injuries should avoid this exercise. There is an increased risk of lateral patellar deviation, no hamstring activity and increased joint stress in regards to shear forces.

The Sitting Ab Crunch Machine limits you to one restricted movement, specifically one that may cause lower back issues, including herniated discs in your spine.

I am removing these harmful exercises and replacing them with safe, more effective exercises.

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