UKH

I am planning a small group trip to the Dolomites. The group have all been there before, but one woman really struggles with altitude and has got quite unwell on Marmolada (3340m) despite it being towards the end of the fortnight. We had access to a pulse oximeter and found her readings were over 10% lower than everyone else’s at altitude. This has happened quite a few times.

She is worried about spoiling her upcoming holiday or restricting the rest of us. I am not sure whether she would benefit from seeing an altitude doctor privately, or alternatively would the money be better spent on sending her up to an alpine hut on her own for one night at some point in the trip (the rest of the group insist on their creature comforts down in the valley). Any thoughts?

In reply to Gone:

You might find this paper useful:

https://www.princeton.edu/~oa/safety/altitude.html

You might try the section "Prevention of Altitude Illnesses"

Good luck and hope you have a good trip

In reply to Gone:

Diamox (Acetazolamide) is also an option, mentioned in the above link. Worth trying the other things listed in the above link as well of course but Diamox might be a good back-up and certainly better than not going. Also, not drinking enough water I see often to be a contributing factor to altitude sickness with people unfamiliar with altitude.

In reply to Gone: has she been checked for iron deficiency? That doesn't help.  Is she physically fit (though be careful there as being  overtrained, orclose to it also won't help)

 

In reply to Gone:

You could try dropping hints along those lines and the problem might disappear. 

 

In reply to Gone:

Seems a very low altitude to be suffering any effects, but physiology can do strange things at times.

If you get desperate, I've got a few Diamox tablets left over from a trip to Nepal last year. I am looking forward to using it to tease some Dutch friends about needing it to get up Snowdon next month

In reply to Gone:

You don't say how you spent the holiday. Did you do a lot of peaks, walking each one from the valley up? If so, you should all have become very fit and acclimatised, and I'd say there's cause for concern. Or did you just do a few with the help of cable cars?

One night in a hut doesn't sound like the solution for your friend; make it 2 or 3 for all of you at around 2000m with a couple of lower summits before going significally above 3000m. You experience the mountains completely differently, the food and accommodation are mostly fine, many huts have showers ... using altitude drugs in the Dolomites is honestly ridiculous, let your body get acclimatised the natural way and the problem should vanish.

In reply to wbo:

Definitely worth checking. You can be anaemic without being aware of it and it can have a significant effect on altitude. 

 

 

 

In reply to Dogwatch:

Thanks for all the replies and suggestions so far.

- She can’t be anaemic as she is a regular blood donor.

- Fitness not a huge factor, as on one trip where she struggled she was unfit, but on another occasion she had recently done two weeks army reserve officer training so was in good shape. She drinks plenty of water.

- Trips are mostly about via Ferratas at altitude. An average day would take the cable car to the start where possible but still lots of exertion and altitude gain.

- She has committed to going on the trip, and knows that with her physiology she may get accused of being an East Anglian flatlander and checked for webbed feet

In reply to Gone:

"- She can’t be anaemic as she is a regular blood donor."

Right after giving blood one will be hugely anaemic  for many months.  You need more blood, not less to deal well with high altitude.  Don't donate blood within a year of high altitude trips especially if there are already problems.  The process of acclimatization involves an increase in red blood cells as the body responds to oxygen stress.  Giving blood decreases red blood cells.  She should totally stop giving blood until she resolves her issues with anaemia, whether she is going climbing or not.

Practice pranayama or breath holding to oxygen stress the body.  The body will respond by building up the blood.  Slowly inhale, hold breath; slowly exhale, hold breath. Repeat.

Keep well hydrated. Chris Bonington would stop during the day to brew up on his Himalayan climbs to keep hydrated.

Don't breath carbon monoxide from your cooking stove:

http://zenstoves.net/COHazard.htm

In the mid 70's Off Belay magazine had an article on carbon monoxide production by camp stoves. They all put out considerable amounts. Very dangerous. As the flame contacts the cold pan combustion becomes incomplete and CO is formed. The lower the pot the greater the CO production. By raising the heigth of the pot so little flame contacts the pot CO production is reduced dramatically with only 5-10% loss of efficiency. This is a problem stove manufacturers and gear retailers have not addressed responsibly.

http://www.bushwalking.org.au/FAQ/FAQ_Monoxide.htm

"While backpacking in New Hampshire's White Mountains last winter, four members of our party of 12 complained of dizziness and nausea after supper. The symptoms were the same as as those associated with altitude sickness, but we were camped at only 3400 feet. All four men felt fine the next morning, and the incident passed without explanation. Several months later we found a small winter-stove and cook-kit combination at a low price at a local hardware store. We bought a stove and decided to try it out by cooking lunch in an office at work. After 30 minutes, we noticed we felt dizzy and were experiencing mild headaches. We smelled combustion odors and decided to test for carbon monoxide. Our suspicions were confirmed when we found carbon monoxide levels of more than 100 parts per million (ppm) near the stove. We recalled the complaints of the four men during our winter trip. Unlike the rest of the group, they had cooked supper inside their tent because of severe winds and a low temperature. We decided their discomfort probably had resulted from exposure to a high level of carbon monoxide produced by their mountain stove."

Cold Research Division, US Army Research Institute of Environmental Medicine, Natick, Massachusetts.

"Carbon monoxide (CO) poisoning is a common problem encountered in a wide variety of settings, including both suicide attempts and accidental exposures. Fatal CO exposure occurred in two young, healthy mountain climbers who succumbed to fumes generated by a small cook stove in the enclosed space of their tent at 14,200 feet on Mount McKinley. There is the potential for confusing mild to moderate CO poisoning with the signs and symptoms of altitude illness.

One Norwegian study (see Thomassen below) exposed 7 healthy young nonsmoking male subjects to 2 hours of melting snow with an Optimus 111 stove in three different tents at a campsite 200m (650') above sea level . They all ended up with COHb levels of greater than 20%. At that low elevation the subjects were already experiencing signs of CO poisoning from their burning stove and were subject to the possible long term neurologic damage and potentially deadly CO levels. Exposure to similar levels of CO at greater elevations is a sure invitation to a very dreary death."

http://www.spiritburner.com/

Here's a good article from Backpacker Magazine:

http://www.spiritburner.com/fusion/showtopic.php?tid/123/

excerpt:

"Since both altitude and carbon monoxide reduce the oxygen saturation of the blood, their effects are approximately additive. Suppose our winter mountaineers cook in their tent at an elevation of 5,000 feet, instead. The HbO2 saturation in their blood would be 95% (the normal amount at 5,000 feet) minus the 5% reduction caused by the stove, or 90%. They would experience drowsiness, lassitude and mental fatigue,
At 10,000 feet the mountaineers’ HbO2 levels would be 85% saturation. Headache, nausea and euphoria could ensue, and they could be in some danger.
At altitudes higher than 10,000 feet, exposure to levels of CO becomes very dangerous. At altitudes of 17,000 feet, the mountaineers could vomit and collapse.
These effects represent what typical mountaineers might experience under the conditions indicated. But they might vary considerably from one individual to another depending on physical condition, acclimatization to altitude and amount of exercise."

A simple experiment to test ventilation is to light a stick of incense next to the stove. The amount of incense you can smell will give a good idea of ventilation efficiency.

Carbon monoxide (CO) is so extremely poisonous that one needs to totally isolate the stove from the living area. An enclosed vestibule or separate chamber in the snow cave or just put the stove outside. Also a chimney system could take care of the problem and made out of aluminum foil and nylon could be very light weight.

In reply to Gone:

Not clear why Diamox / acetazolamide would help with that. Since Diamox acts mainly on the problem of Low CO2 at altitudes, not Low O2.

To my non-expert ear, repeated low O2 saturation sounds kind of serious.

Time to see a medical doctor who knows something about altitude sicknesses and altitude acclimatization.

Perhaps she has a special kind of anemia that's not getting detected by the normal blood-donor process?

Ken

 

In reply to kenr:I think it's a bit more simple than that.  I used to go to altitude for athletics training at least once a year, and you take 3 weeks to be anything like normal at 2000m so if you've got a depressed level before you go you'll still be stuffed a few weeks later, so cut out the blood transfusions for some months before going and get haemocrit checked. 

I've raced 10km at 3000m - quite tough.  I remember sport climbing with my wife at 3000m-ish - she was not very happy after only a couple weeks

 

In reply to wbo:

I don't think that for most of us "having trouble with altitude" means that we do not have as fast a time running a 10 km race as "normal" at sea-level.

For most of us the "altitude troubles" include like feeling nauseous, lethargic, headaches, especially when trying to sleep at night.

And I think for most of us it takes a lot less than two weeks for those kinds of "troubles" to go away. That's what most of us (who are not nationally competitive endurance athletes) mean by "acclimatization".

Ken

In reply to Gneiss: "Right after giving blood one will be hugely anaemic  for many months.  You need more blood, not less to deal well with high altitude.  Don't donate blood within a year of high altitude trips especially if there are already problems."

Blood donation does not cause anaemia. Typically, blood donation will cause a drop of 10g/l, which is unlikely to have a significant effect on aerobic capacity. In the UK, the haemoglobin on the pre-donation test needs to be at 125g/l for women and 135g/l for men.

https://www.blood.co.uk/the-donation-process/further-information/haemoglobi...

Perhaps regular blood donation, which stimulates erythropoiesis, may actually be good training for adaptation to altitude?

In reply to gneiss:

While it is true that oxygen deprivation stimulates production of EPO + hemoglobin + red blood cells, I've never seen any credible that that particular _protocol_ works very well.

Athletes who are serious about using (WADA-legal) methods to increase their hemoglobin or red blood cell count use more clever oxygen-deprivation  protocols that include some special equipment.

Ken

 

In reply to Gone:

3,300m is already fairly high and it’s entirely normal to feel it at that altitude if not acclimatised. Some will feel it more than others and some are lucky enough not to feel it at all. You have to know your body and that takes many trips to figure out. Even then, sometimes it’s seemingly random and you feel better / worse than expected.

There are many variables:

How many times you already been up to X altitude on the trip.

How high have you slept.

Length of time spent at altitude.

Effort expended at altitude.

Weather, hydration, food intake.

Walk up or take the lift.

As an example, I can arrive in Cham, go up the Midi the day after, do a rock route all at 3,500 a 3,800m and as long as I get the last lift down, I’m generally fine. But if I miss the last lift, it’s a very miserable night - can’t eat, heavy breathing and generally feeling crap.

 

 

In reply to Gone:

a couple of thoughts that might help your friend if she is struggling:

1) acclimatisation is best done without exertion. Acclimatising is itself a strain on the body.  High exertion during  day before predicts altititude problems that night and the next day. This is one of the strongest findings in altitude research. Go hard on day 1 and you will get sick on night 1 or day 2. On a short holiday trip people are keen to get stuff done, so might go quite hard early on , and , especially if not very fit, exert themselves quite hard without having really intended to. Your friend could try going up high as gently as possible (no more than 6 out of 10 effort wise) early in the trip, lifts being an obvious way to get this done. If walking up don’t exceed conversational pace, this can feel ridiculously slow early in the trip. 

2) and so fitness makes a difference (as high fitness reduces risk of over exertion). No point in doing any high intensity training , but a gradually increasing weekly number of hours of uphill walking or gentle running. Conversational/nose breathing  pace. Not all done at the weekend, best spread over three or more sessions per week. 

3) the body seems to get the hang of acclimatising over several trips. Your friend might just find it easier this time. 

4) colds and bugs massively interfere with acclimatising. Might have been the problem last time? Even good acclimatisers get felled by a simple cold . 

5) whilst the evidence on this is still developing, it seems likely that anxiety increases risk of altitude problems. Your friend might benefit from focusing on anxiety reduction, calming breathing exercises, muscular relaxation. meditation / mindfulness/ music etc. Just taking a couple of minutes out to calm self every hour or so might help. 

6) think of a stint of acclimatising like a burst of heavy exercise. It needs to be recovered from to do any good. Stress the system by going high (gently) then rest it at lower altitude. 

 

In reply to Malcolm Bass:

i might well be overthinking this, but have just read your (Syv K’s) response to Dogwatch saying that the trip is mostly via ferratas (VFs) Not knowing your friend this is just a guess, but doing VFs might in itself be exciting/stressful/exerting (I am guessing this because there aren’t many in the UK to practice on). Any of those features would count against good optimal acclimatisation. The nervous system needs to be focussed on acclimatising not on being stimulated by VFs, technical climbing, working hard or anything else! . So it may well be better for her to focus her first few days on low exertion acclimatising, then resting, and not on VFs. Or maybe go out early to get this done. 

You also mention in that reply that on one trip she must have been in good shape because she has recently done a 2 week army reserve training. That would not guarantee the sort of fitness needed, especially if done on an inadequate base of endurance training. If very close to the trip it might even have made her more susceptible (due to inadequate recovery) to altitude. The sort of fitness needed would have to come from a gradual build up of aerobic (nose breathing/conversational level) endurance over some months not a boot camp. The Scott/House book Training for the New Alpinism covers all this stuff. 

These might seem like over the top solutions, but there are few short cuts with altitude. 

My personal health and fitness goal is to get my body clock back into a normal sleep rhythm so I can stop over analysising at first light! I promise to let it drop now.......

 

In reply to Gone:

Honestly mate ... every evening in a hotel in the valley ... either you want a mountain holiday, or you don't. Can't have the best of both worlds. Get her acclimatised properly, 3300m is no big deal.

In reply to Andrew Hannan:

There are genetic factors which mean that some people don't acclimatise as well as others. For such people 3300m would be a big deal.

In reply to Gone:

Army reserve officer training for two weeks doesn't make you fit or prove that you are. Many horrendously unfit people complete it as the only real physical requirements are to run 1.5miles in 12mins (women) and march 8 miles in two hours carrying 15kg over mildly undulating terrain. Neither of these tests are at a level above absolute punter with a little determination.

I'd suggest listening to her breathing, is she controlling it while exercising. Many people breathe uncontrollably particularly if they are not used to endurance exercise, this limits their ability to absorb oxygen in the lungs. Slower circular breathing needs to be taught to many people.

Remember also that many people take camelbacks to drink from these days. They require sucking which if you are breathing heavily or at altitude is harder therefore people neglect to drink from them as the effort to do so increases. For someone who isn't used to endurance exercise this will compound any problems.

In reply to gneiss:

I have noticed you've copied and pasted this post a number of times. It's a good read. Are you the person behind zenstoves?

In reply to Stefan Jacobsen:

No, zenstoves isn't my site but I am a fan.   Here's a good article  on the deeper toxicity of carbon monoxide, CO :

https://www.sciencedaily.com/releases/1997/09/970927111303.htm

 

In reply to gneiss:

Interesting study. The NO mechanism was new to me.

In reply to Gone:

Crikey. I can't help thinking perhaps you and your friend are overthinking this one. Strenuous and stressful exercise in the Alps ISN'T pain and discomfort free - that's partly the point.

I'm no expert but I don't think it's unreasonable to suffer some nausea and headaches at 'altitude' when climbing in the Alps, that's just the way it is. At a guess, the intensity of those symptoms will vary depending on how much fun she's having...