Thursday, August 18, 2011

Odds and Ends January 2011

January was a decisive month for work. I decided to resign from my job and look for a position that had a comprehensive approach that included surgical options for patients. My expertise is in the surgical management of Parkinson's, tremor and dystonia. Now I have some time on my hands so I decided to take a wilderness first aid class to make sure I am up to date for the climb. Remote Medical International provided the course with very professional and very knowledgeable instructors. I had been trained in emergency medicine in the past so most of the course was a review of stopping exsanguation, finding occult injury and things I should have in the back country in case of an accident. The attendees did mock injuries and role play to address accidents, assessment and treatment. It was a fun day patching up bleeding limbs and broken bones. We had a large class with several medical professionals. One of the physicians talked to me about Kilimanjaro and passed along the recent altitude illness prevention paper that specifically addressed Kilimanjaro.

Kilimanjaro is known to be associated with acute mountain sickness (AMS) due to the altitude gain and rate of ascent. After reviewing Alpine Ascents itinerary, I felt we would have plenty of time to acclimatize to the high altitude where it takes more work in breathing to get in enough oxygen. The extra day built in for acclimatization should prevent problems noted with the more common five day ascent where summit success is low due to AMS. The five day ascent is cheaper so it is popular.

Diamox is used for prevention of AMS but slow ascent is as good or better. Ibuprofen has also been studied and is also a good medication used for prevention of AMS. I have used both and prefer ibuprofen as long as headache does not escalate. Diamox can cause dehydration for which you can't monitor without a way to measure urine output or blood pressure. Heart rate could be helpful at sea level to monitor for dehydration, but not at altitude. If a person is concerned about AMS, the recommended dose to prevent Diamox varies widely so it is difficult to provide guidance so it is best to decide individually what is the best strategy for prevention. Treatment of AMS is different than prevention and I find most people get these two scenarios confused.

 My travel doctor prescribed 250mg of diamox. When I got home I realized it was slow release capsules which can't be cut. For me, 250mg would be too much. There are wide opinions about the right dose of diamox, but there are research papers that include doses that are known to prevent and or treat AMS. I prefer to use a very low dose of diamox if I get a headache that doesn't respond to ibuprofen or tylenol. My plan on Kilimanjaro was to use diamox 62.5mg once a day and increase to twice a day if a headache came on and persisted above 10,000 feet. I think most people use too much too fast and get dehydrated which leads to more risk of AMS. AMS is an elusive problem on high mountains as no one knows if AMS will be a problem. AMS generally is more common in young men and most think it is because they go too fast. AMS can strike at any time in any one, no matter how many mountains climbed. All we can do is train, eat, drink, go slow and hope it doesn't strike on summit day. As anyone that has had AMS knows, if it comes, you just have to go down, you really don't have a choice as the body is in charge.

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