Sea sickness, chair lift

AllyG wrote:
Ise,
Do you give diamox to everyone before they start climbing (like sea-sick pills) or only when they become ill?

I do seem to be affected by the altitude more than other people - maybe this is because I have such a large brain? :wink:

I found an interesting article about this on travel doctor. I'm pretty sure they injected me with dexamethasone when I had concussion (from falling off my horse). Have you used one of the Gamow bags?

http://www.traveldoctor.co.uk/altitude.htm

Ally

Diamox works best when you start taking it at around 3000m the day before you start climbing. You can start taking it when symptoms occur as well but the primary use is to aid acclimatization. Bear in mind I'm taking about very high (3500 m – 5500 m) and extreme altitude (5500m+) , skiers are only at high altitude (1500 m – 3500 m)

We do carry Dexamethasone in oral form primarily for HACE treatment and Nifedipine for HAPE. Dexamethasone is a powerful and versatile drug so carrying it makes a lot of sense as you can use it for other conditions, in fact Nifedipine is useful for other conditions as well.

Gamow bags are a form of hyperbaric chamber or Portable Altitude Chamber (PAC), I've never needed to use one either personally or for someone else but one of the companies I've led for provides us with access to them in certain locations.

(edited for clarity)

AllyG wrote:

caron-a wrote:sued, I've been given different advice by two doctors. My youngest gets extremely bad nose bleeds (usually on the slopes as well as at home), one doc told me to let it bleed and another told us to push the nose to the bone on the bleeding side about half way/two thirds up (you can feel where the nose starts to open up). I prefer the latter, it stops it within minutes. He has had it quarterised but it still happens.

So, apart from said nose bleeds, he was very ill after travelling up the funicular in Tignes to the Grande Motte (plied him with water for half an hour and came back down), he's come back from two trips with a chest infection (a two week stint of bronchitis this time) and I have to stand still for a couple of minutes at the top of every lift to wait for the nausea to subside.

why on earth do we do it :shock:

Caron-a,
that sounds really awful! I used to get lots of nose bleeds when I was a child, but they always stopped if I just put pressure on the end of my nose with toilet paper. Your poor son! I used to hate getting nose bleeds.
Is your nausea with lifts because of the altitude problem, or because you're frightened of lifts? I'm a bit confused.

Ally

He deals with them really well now, just holds his nose with a tissue and waits patiently. It used to be horrendous when we let it bleed, he would get very upset as he was very young then. He'd also get very pale and ended up having to take a liquid iron supplement which was the most vile thing I've ever tasted. Thank goodness for the second doctor.

I've always assumed my nausea was me acclimatising as it'd go in a couple of minutes. I suppose it could be motion sickness, I do suffer from it a little.

andymol2 wrote:Kids are more prone to being affected by altitude this may be a gross over-simplification the higher the more the brain swells. Children tend to have less free space inside the skull for the brain to swell into compared to adults who's brains tend to shrink a little with age, alcohol etc.

That makes sense and explains why I get nosebleeds, as clearly my brain is massive.

I was referring to altitude sickness in kids. (Rather than brain size & nose bleeds)

Kids get more nosebleeds for lots of reasons - usually minor nasal infections such as colds and digital trauma. Some kids are just prone to them from superficial capillaries just inside the nose.

The best way for dealing with a nose bleed is to pinch the lower fleshy part of the nose for 10 minutes. Mostly the bleeding comes from the septum (unless you've got a coke habit & destroyed it).
This is the only bit you can appy pressure to - squeeze higher up and all you do is press on the bony bits but apply no pressure to the blood vessels.

I recall one lecture I went to given by a mountaineering neurosurgeon who got voluteers to have pressure transducers inserted in their heads and monitired the effect of altitude on pressure within the skull and compared the findings to the amount of "free space" on CT scans of their heads befor the Himalayan trip. The pressure generally rose most/ most rapidly in those with least space who were the younger ones.
They didn't do the research on children (I guess it would be unethical to get minors to have transducers inserted into their heads) but kids are thought to "go off" more rapidly with head injuries than adults because they have less space to swell into so I guess the same could be applied to altitude sickess.

These days I try and minimise the risk of HACE by drinking lots of wine whilst at sea level to atrophy my brain. That and not going to altitude!

andymol2 wrote:
I recall one lecture I went to given by a mountaineering neurosurgeon who got voluteers to have pressure transducers inserted in their heads and monitired the effect of altitude on pressure within the skull and compared the findings to the amount of "free space" on CT scans of their heads befor the Himalayan trip. The pressure generally rose most/ most rapidly in those with least space who were the younger ones.
They didn't do the research on children (I guess it would be unethical to get minors to have transducers inserted into their heads) but kids are thought to "go off" more rapidly with head injuries than adults because they have less space to swell into so I guess the same could be applied to altitude sickess.

The medical advisor for the company I was in the Himalayas for was suggesting the company could look into research into this, they have around 4000 young people on expeditions each year, mostly from the UK but from North America, the Middle East and Austrailia, around half or more (I think) are over 3000m so it would be a good sample. The caveat being diamox is routinely used though. However, I know to date that there's been no serious incident regarding altitude. The group I was with had 15 teenagers and there was one female who failed to acclimatize, she was one of 4 or 5 who immediately had problems at 3500m. While the others recovered to a level consistent with the group she just didn't but her problems were more chronic lethargy (hard to spot in teenagers sometimes) than anything else. But that was more a failure to acclimatize than real AMS.

I know the Swiss study in 2008 had 50 Swiss children going up the Jungfraujoch, that's a journey that always make me nauseous anyway. And the findings there were

CONCLUSION: After rapid ascent to high altitude, the prevalence of acute mountain sickness in children and adolescents was relatively low; the clinical manifestations were benign and resolved rapidly. These findings suggest that, for the majority of healthy nonacclimatized children and adolescents, travel to 3500 m is safe and pharmacologic prophylaxis for acute mountain sickness is not needed.

That's "PMID: 19117853 (medline)", as your occupation is GP I'm guessing you may have access to the full paper. Presumably by prophylaxis they primarily mean diamox which seems reasonable, we're routinely using it but 3500m is a staging post for 10 or 15 days at 5000-6000m which is a different ballgame.

I really don't think this is an issue for skiers, they're only poking their head above 3000m rarely, it's probably useful to recognize some nausea, headaches, coordination problems or lethargy might be related to altitude if you've just stepped out of the funicular at Tignes but otherwise I'd strongly argue skiers suffering from the altitude at 2000-3000m simply aren't and there's something else more mundane wrong.

I'm hoping the wine thing works if you live higher than sea level otherwise I've been wasting my time :D

andymol2 wrote:Kids get more nosebleeds for lots of reasons - usually minor nasal infections such as colds and digital trauma. Some kids are just prone to them from superficial capillaries just inside the nose.

Andymol2,
I thought you must be a GP - digital trauma indeed :D
I believe it's more commonly known as kids picking their noses :lol:

My Mum used to be a GP (before she retired) and she always told us to squash the end of our noses with toilet paper, and it seemed to work fine, one just has to wait a few minutes for the bleeding to stop before carefully removing the toilet paper.

Ally

Digital trauma sounds nicer than pug-picker!

:shock:

Mind you, in this day and age, digital trauma is just as likely to mean the little brats have whacked each other with their laptops :wink: