I’m going to Peru next week and the more I read up on altitude sickness, the less I want to go. I’ve been a flatlander my whole life and while I’ve travelled around the world, I’ve managed to avoid mountainous areas up 'til now.
The itinerary starts off easy enough where I follow the cost and then head up to Arequipa which is at about 7500 ft (2300 meters). The next stop is Colca Canyon which can get up to 15911 feet at the Pass of Patapampa. Then on to Puno and Lake Titicaca at 12421 feet and Cusco at about 11200 feet.
I talked to my doctor*, another flatlander, and asked him about Diamox. He said that he’s not familiar with that as much and suggested that I take a prescription of prednisone instead for the altitude sickness.
So I did, I got it filled, but as I’m reading other forums about Peru, I only see Diamox Diamox Diamox and no one has really mentioned prednisone.
I guess my question is, should I be getting this worked up about something that might not even happen? I’ve read warnings about HAPE and HACE and the warning signs if it gets severe, but I’m wondering more about if anyone else has tried prednisone for altitude sickness or if I should go quick get a second opinion.
*My real doctor retired and this was a new doctor who knew nothing about my health history, of which, there wasn’t really any 'cept for strep throat.
I am going to Nepal and my Dr. is going to give me Diamox, he has been to Nepal many times so he also has a lot of experience. I have not decided whether to use Diamox before I go or only if I have problems.
Prednisone will raise blood sugar so be careful about using it.
I have no experience with Diamox, but I do have experience with altitude sickness, in Peru even! You are following most of our itinerary (Lima, down the coast to Pisco, to Colca Canyon, then to Arequipa, on to Cusco, then hiking through the Salkantay Pass to MP). I was fine the entire way until we got to the pass in Salkantay at ~15,000 feet. I was fine in Colca Canyon as we were only at that altitude for a short time on your way to the canyon(we pulled over and took pictures, the air did feel thin and we felt like walking/running was MUCH harder, but that’s it), and I’d expect the same scenario for you. I was also fine in Cusco where we spent two days. It was when I started exerting myself at altitude during the trek that I got sick.
I was in a group of 15 people and I was the only one to get sick. I think you have a good chance of being fine, and considering where you will be (Cusco, where you can visit a pharmacy if needed) or how long you will be there (just passing through the Colca Canyon), you will likely be fine without Diamox. I didn’t take anything, just drank coca tea, chewed on coca leaves and stayed hydrated. As we made our way down the next day (the sickness hit the evening before - in retrospect, I really should have headed down instead of going to sleep!), I started to feel progressively better and by that evening I was fine.
Do you have a travel clinic in the area? The doctor there should be familiar with different altitude-sickness drugs and how each one is useful. Before I went to Peru, my travel clinic did recommend Diamox but as it was a sulfa drug (which I am allergic to) I didn’t get any.
From what I remember from what the travel clinic briefed me, Diamox aids in respiration and thus can help you acclimatize faster - when taken prior to entry into the high-altitude zone and during it may be effective at preventing altitude sickness. I was told steroids (of which it appears Prednisone is) do NOT help you acclimatize to the higher altitude, rather they just temporarily prevent the really serious symptoms from doing significant damage to your body. Thus if you end up having to take the Prednisone you will still have to get down to below 2400m (or lower) ASAP.
Don’t be too off-put by this, but when I was in Peru my friend got HAPE - we had flown directly to Cusco (3300m) and stayed there for three days, expecting to be able to acclimatize there. He seemed to be OK for the first two days but was barely able to stay awake on the third. Unfortunately none of us had brought Diamox, and coca tea did not seem to improve his condition. On the fourth day, we were to start our hike (we were doing the Salkantay trek which had the first campsite at 4400m), but by the time we got to the starting point of the hike (3600m) he was grey in the face and had to be put on oxygen. They sent him back to Cusco and due to the lack of cell-phone reception we didn’t find out his status for 4 days - it turned out that he had to be hospitalized and put in a hyperbaric chamber!
In our hiking group of 10, in addition to our friend who had serious symptoms, two of us (myself included) had mild-moderate symptoms including headache and nausea. After our friend got sent back to town I was concerned about sleeping at 4400m, but it turned out after that night it was smooth sailing for me.
It might be different for you as you are starting at a lower altitude while we were never below 3000m pretty much the whole time from when we arrived in Cusco. Also not sure whether you being a “flatlander” matters too much, in our group one guy from Washington DC had no problems while my friend and I are from Calgary (already at 1000m above sea level). Nevertheless, I would definitely try visiting a travel clinic and discuss with them the usefulness of Prednisone vs Diamox. It never hurts to be prepared.
Anyways I concur with EmAnJ, Peru is wonderful and I hope you have a good time there
their info is consistent with what I studied in the past. Acclimatization is usually the key, lots of people get mild symptoms like a headache, a few get the more severe. IIRC pulmonary edema is much lower incident than cerebral edema. they’re not quite sure what makes people vulnerable to pulmonary edema, but there is some theory that pre-existing perfusion mismatches in the lungs can set you up for it. There is also anecdotal evidence that vasodilator like viagara can help with symptoms (although it may make your headache worse).
Diamox speeds up your aclimatization, and is more for preventing symptoms, steroids are more for treating them. IIRC, part of the problem is a change, an irregularity, in your breathing pattern brought on by the change in O2 concentration, and diamox prevents that. I can dig for data if you like, but I think that sleep studies show a more regular breathing pattern on diamox. Be advised it’s also listed as a diuretic, so expect to pee a bit more, but you should keep your hydration up to help prevent mountain sickness.
The first time, following all the advice of seasoned skiiers, I got sick as a dog and puked for about 6 hours and felt like my skull was going to crack. The drive up to the mountains, I remember be insatiable hungry, like two big macs down the pie hole at a stop and two more at the next chance we get. That has never happened to me in my life except on prednisone. I have had migraine issues my whole life.
Finally fell asleep about 4am ( on the bathroom floor) popped up at 6am ready to ski like none of it happened. Drank vast quantities of water all day long - no booze at all - and didn’t pee until late that night.
Second time wasn’t nearly as bad. No puking or pulsating headache. Just feeling funky and like I could feel my blood go through my body. Weird stuff.
All of this was before the web and google. We went skiing with Jesus and Buddha.
Now that this thread has alerted me too drugs and stuff, I will not be so reticent to go out west again.
I traveled in Tibet, and didn’t get much altitude sickness. I took the train up, so I had some time to acclimate. The first few days were a little tough- you definitely want to avoid alcohol and take it easy. I’d get pretty bad headaches throughout the trip, but nothing too worrying.
I believe there is no real way to predict how the altitude will affect you. Just keep an eye on your body and have a plan for what to do if things go wrong.
I had altitude sickness in Rocky Mountain National Park, which I think is around 14,000 feet. Basically I just got a headache and started to fall asleep. The next day I went over it in a private plane which didn’t have any supplemental oxygen and I was just fine.
Based on some tales I’ve heard, which tend to involve people becoming violently ill and turning quite pale, it may be a good idea to lay off alcohol at high elevations.
As I understand it just because you’ve never had it, doesn’t mean you still can’t get it, each trip to altitude is a crap shoot. I was over high passes in Ladahk and Nepal, each time traveling slowly to altitude without ill effect. Same for climbing volcanoes in SE Asia.
When we went to Peru it was different. Flew into Lima, then on to Cuzco the next day, 2 days later we were on the Inca trail. That’s not enough time. I had all the typical symptoms, mild (brainstemish) headache, sleeplessness, loss of appetite. It was a real challenge for me to get over the highest pass, along about day 2 of a 5 day walk to Machu Picchu. Every 8 feet I was winded and had to rest, for the entire last quarter of the way up to that pass. But I did it.
Over the five days, it did get better. By the time we actually reached the ruins I was good again. I’m sure it was just a case of not taking the time to acclimate. It would honestly never occur to me to take drugs beforehand, as prevention. Such medications are a rather new development and heretofore people just took their chances and if need be, went back down.
I called up my HMO (Blue Cross/Blue Shield of MN) for a travel physician for altitude sickness and they tried to refer me to an infectious diseases doctor. I don’t think we Minnesotans travel much. So after explaining to the nurse that I didn’t expect to “catch” it as much as be affected by it, she then said to go to a general practitioner. Hakuna matata.
I made an appointment and saw a new Doctor today and he knew as much as the first doctor. But at least he had a computer with a database so we looked it all up together. As Delayed Reflex and outlierrn had mentioned, the prednisone was going to be more to fix the problem, whereas the Diamox could prevent the issue from getting worse. So he prescribed a 3 day supply of Diamox.
