Altitude Sickness Question

[719BR]

try this. 1 tablet of ginko biloba in the morning and one in the afternoon beginnig three days before your hike. on the morning of take another ginkgo PLUS a 500 mg tablet of ibuprofen. take another ibuprofen on the summit. and one when you reach the car.

with all due respect to the dr, ginko biloba has not proven to be an effective ams treatment at this point. at least not in the situation we are talking about, that is, specifically, taking it prior to and/or while hiking. ginko biloba - and especially acetazolamide/diamox - lose efficacy at exertion.

this means, in general, if you are going to suddenly arrive at altitude and kick back for a day or two while your body catches up, diamox is useful. if you are going to arrive at altitude and immediately start hiking, it's not. the jury is still out on ginko biloba (in regards to losing efficacy during exertion), but right now it doesn't look hopeful.

[719BR]

About Ibuprofen: Speaking as a nurse, I really would not recommend taking it during the climb. 1. You run a risk of major stomach pains if not taken with enough food. 2. Increased risk of bleeding: you fall, you already can bleed, internally or externally. Adding a medicine which accentuates bleeding will not likely be a good idea. 3. I have no idea how this would even help with altitude sickness

i am hoping you typed without thinking, because if you're really a nurse, that's not only wrong, but frightening. the whole point of ibuprofen is that it does not thin the blood. you are not at risk of internal or external bleeding if you fall while on ibuprofen, unless you have OD'd, which requires such a massive amount of ibuprofen that it doesn't even merit discussion. additionally, at the amount suggested (cumulative 1800 mgs spread over 12 hours), being mixed with food (you eat when you hike, right?), it's not an issue that should be remotely worrisome. i already covered the "how", but basically it helps stop fluid transfer across the blood-brain barrier, which helps with the headache.

[719BR]

And yes, ibuprofen has been shown in multiple studies to reduce the incidence of AMS if taken prophylactically. I'm not sure if it would've helped the OP based on the info given, but it certainly could help others coming to altitude from sea level.

Here's a Stanford article link outlining the research: https://med.stanford.edu/news/all-news/ ... -find.html" onclick="window.open(this.href);return false;
The original study is published in the Annals of Emergency Medicine if anyone wants to drop $35 to check it out.

as it turns out, i spent the last ten years or so working closely with clinical research (i work at an academic medical center), and as a hobby (which is nicer than saying obsession) i started reading AMS studies (i've gone through about 200 and am actually writing my own paper on the efficacy of diamox). i happen to have a copy of the referenced standford paper, and if anyone wants it, PM me and i can send it to you.

[HannahBearCO]

[Rainier_Wolfcastle]

To anybody early in their 14er quest, I have some general advice. Don't worry too much about minor difficulties you experience. If you read others advice and tweak your approach, you'll figure what works best for you. There is no formula that works for everybody! If you are dizzy, maybe rest steps with deep breaths, maybe sleeping at the trailhead before the climb, maybe need more electrolytes, maybe hydration, maybe your pack is too heavy, maybe your pace is too fast, maybe lack of training, maybe that ginko stuff,etc. Try what sounds reasonable to you and through testing and experience you will find more comfort. Same goes for foot problems, hunger issues, headaches, swollen fingers, bad knees, sore back or shoulders, insufficient speed, nausea, layering, navigating, twisting ankles, loose rock/rock fall...I've had it all and am still learning after hundreds of climbs. Above all, stay safe and conservative and you'll get there.

[AprilForever]

About Ibuprofen: Speaking as a nurse, I really would not recommend taking it during the climb. 1. You run a risk of major stomach pains if not taken with enough food. 2. Increased risk of bleeding: you fall, you already can bleed, internally or externally. Adding a medicine which accentuates bleeding will not likely be a good idea. 3. I have no idea how this would even help with altitude sickness

i am hoping you typed without thinking, because if you're really a nurse, that's not only wrong, but frightening. the whole point of ibuprofen is that it does not thin the blood. you are not at risk of internal or external bleeding if you fall while on ibuprofen, unless you have OD'd, which requires such a massive amount of ibuprofen that it doesn't even merit discussion. additionally, at the amount suggested (cumulative 1800 mgs spread over 12 hours), being mixed with food (you eat when you hike, right?), it's not an issue that should be remotely worrisome. i already covered the "how", but basically it helps stop fluid transfer across the blood-brain barrier, which helps with the headache.

I really am a nurse, been one for 13 years. Ibuprofen does increase bleed risk, as does naproxen, and all othets of that class. Their anticoagulant effect is global, even at standard dosage. Not to argue, but... This is true. Read the drug inserts or a reputable manual concerning the pharmacokinetics and side effects. Or, read this....

http://www.ncbi.nlm.nih.gov/pubmed/18245919" onclick="window.open(this.href);return false;

Like I said, I am not trying to argue, but I'm not an idiot. Surgeons discontinue nsaids prior to surgery. Depending on the surgeon and surgery, days before even. As gar as risks vs benefits, I will always recommend the do not bleed route, especially a several days in a row regimen. A peak bagged is best done safely. If you don't mind the risk, go for it.

[719BR]

I really am a nurse, been one for 13 years. Ibuprofen does increase bleed risk, as does naproxen, and all othets of that class. Their anticoagulant effect is global, even at standard dosage. Not to argue, but... This is true. Read the drug inserts or a reputable manual concerning the pharmacokinetics and side effects. Or, read this....

http://www.ncbi.nlm.nih.gov/pubmed/18245919" onclick="window.open(this.href);return false;

Like I said, I am not trying to argue, but I'm not an idiot. Surgeons discontinue nsaids prior to surgery. Depending on the surgeon and surgery, days before even. As gar as risks vs benefits, I will always recommend the do not bleed route, especially a several days in a row regimen. A peak bagged is best done safely. If you don't mind the risk, go for it.

short version: no, i don't mind the risk of prophylactic ibuprofen usage (which ironically enough i don't even do, i just suggest it to folks who have altitude issues), because the risk is minuscule.

long version: as you said, not to argue, but... This is wrong. it is true surgeons commonly withhold all nsaids perioperatively because of bleeding concerns. this is called erring on the side of caution, however, as not all nsaids block platelet function. there are a host of recent papers that support this finding, despite the one (ten person? really?) study you posted. most recently for example was a meta-analysis of over 800 studies. i'd post them here, but i don't feel like polluting the board, so if you are curious you can PM me. but i have a feeling you won't be interested because it doesn't fit your view.

[719BR]

i'm not here to debate its efficiency. I've used it on all my climbs except for twin sisters this past April and I got AMS at 10,800 feet.

All my other hikes and climbs I've used it and I've never gotten AMS. I just summited Longs today hsing the ginko and ibprof 3 days prior and on the the day of and no AMS.

this is called anecdotal evidence and thankfully science doesn't work that way. i'm not going to get into a lengthy discussion on gb because there the jury is still out on it. i will simply say that the current science does not support your regimen.

and, simply in the interest of cutting your drug bill even further, ibuprofen three days prior is overkill. six hours prior is plenty if you are going to insist on taking it. i can think of no scientific reason why ibuprofen three days prior (or two) would be useful in terms of addressing the ams process. even the graphic you posted does not recommend that.

[AprilForever]

I really am a nurse, been one for 13 years. Ibuprofen does increase bleed risk, as does naproxen, and all othets of that class. Their anticoagulant effect is global, even at standard dosage. Not to argue, but... This is true. Read the drug inserts or a reputable manual concerning the pharmacokinetics and side effects. Or, read this....

http://www.ncbi.nlm.nih.gov/pubmed/18245919" onclick="window.open(this.href);return false;

Like I said, I am not trying to argue, but I'm not an idiot. Surgeons discontinue nsaids prior to surgery. Depending on the surgeon and surgery, days before even. As gar as risks vs benefits, I will always recommend the do not bleed route, especially a several days in a row regimen. A peak bagged is best done safely. If you don't mind the risk, go for it.

short version: no, i don't mind the risk of prophylactic ibuprofen usage (which ironically enough i don't even do, i just suggest it to folks who have altitude issues), because the risk is minuscule.

long version: as you said, not to argue, but... This is wrong. it is true surgeons commonly withhold all nsaids perioperatively because of bleeding concerns. this is called erring on the side of caution, however, as not all nsaids block platelet function. there are a host of recent papers that support this finding, despite the one (ten person? really?) study you posted. most recently for example was a meta-analysis of over 800 studies. i'd post them here, but i don't feel like polluting the board, so if you are curious you can PM me. but i have a feeling you won't be interested because it doesn't fit your view.

Research is great, all well, and fine. But, i take it you are into some kind of research? I worked inpatient 13 years now in hospital settings. I have a bachelors of science in nursing. And, patients who are on ibuprofen bleed more. I bleed more when on it also.
Please feel free to pm me your research. I don't understand why you think i wouldn't want it. I like research, even if i think it is wrong. But, personal attacks are not required to get your point across. Both your posts have been very dismissive, and frankly, demeaning. I will look at your research. But, you do realize there is a whole lot more to coagulation than platelet aggregation, i am sure. Research how ibuprofen works, you will see for yourself.

Also, if you don't use it, why argue?

[Urban Snowshoer]

Yesterday I attempted Grays Peak. Right before the switchbacks I had to stop every minute to catch my breath. My legs felt fine, I had been drinking fluids the whole way up, no headache or nausea but some dizziness (no loss of balance though) I could not understand what was wrong...others seemed to be moving the same pace as I. On a time restraint, I had to desend. I am wondering if I was suffering from preliminary altitude sickness or perhaps was not physically fit enough? Would altitude pills solve that problem? Thoughts are appreciated. Thanks!

As other posters have probably said, it could have been any number of things, including having a bad day. I'd guess many (if not most) of the users of the site have, at some point or another, had a climb when it just wasn't meant to be.


With respect to physical fitness level, there is little (if any) correlation between your fitness level and your susceptibility to altitude sickness.

I'm not sure which pills you're referring to when you say "altitude pills" but Diamox isn't a magic bullet--it basically works by speeding up the acclimatization process but doesn't guarantee immunity from altitude sickness. It is also not without side effects.

[HannahBearCO]

[martinleroux]

i'm not going to get into a lengthy discussion on gb because there the jury is still out on it. i will simply say that the current science does not support your regimen.

Dr. Hackett wouldnt have published that if there wasnt something to it... It works for me, and I'll continue using it.

There have been several studies on Ginkgo biloba extract (GBE) and AMS, but with conflicting results. Here are a couple. Peter Hackett was a co-author for both of these.

Leadbetter et al (2009), "Ginkgo biloba does - and does not - prevent acute mountain sickness", http://www.ncbi.nlm.nih.gov/pubmed/19364166

"Two randomized, double-blind, placebo-controlled cohort studies were conducted... Ginkgo biloba reduced the incidence and severity of AMS compared to placebo in the first but not the second study... The primary difference between the 2 studies was the source of GBE... The source and composition of GBE products may determine the effectiveness of GBE for prophylaxis of AMS".

Tissot van Patot et al (2009), "Ginkgo biloba for Prevention of Acute Mountain Sickness: Does It Work?", http://www.ncbi.nlm.nih.gov/pubmed/19278351

"We review the current literature regarding the prophylactic use of Ginkgo biloba extract (GBE) in acute mountain sickness (AMS)... Overall, the literature suggests that due to the complexity of GBE the standardization of the product is inadequate, which likely explains the disparate clinical results. The variability in commercially available GBE products makes it impossible to determine whether GBE is truly effective for preventing or ameliorating AMS".