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14er newbie - frequent urination while hiking, AMS??

FAQ and threads for those just starting to hike the Colorado 14ers.
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Re: 14er newbie - frequent urination while hiking, AMS??

Postby Dancesatmoonrise » Fri Sep 21, 2012 10:05 pm

MountainMedic wrote:I love Medscape - good find. It would be awesome to do a study like that. I'm bored shitless stuck down here convalescing, so let me know if you want help trying to set this up. I've been away from academic research for a year or so now, but would love to help. Oh, and BenfromtheEast is currently finishing up a master's in biostats...


The biggest problem we'd have is sufficient numbers for statistical significance. However, to my knowledge, the study hasn't been done, so it would be worthwhile.

Can't imagine any greater repository of sojourners to high altitude than this site. Not only would it provide the greatest number of participants, but it would "give back" to the participants as well if it pans out as successful. The risk is nil, the potential reward great. It would be good to get faculty from Denver Health EM Residency on board - makes it easier to get published. Also would help with study design. I put the idea on the back burner a couple years ago, but if you're interested, maybe we could do the study. It would be fun, and interesting to see the outcome.

I'll be busy with winter 14ers this upcoming season - and as far as study participants, we'd probably do better in the warm season anyway. We could kick it around this winter and maybe come up with something to implement by summer.

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Re: 14er newbie - frequent urination while hiking, AMS??

Postby madbuck » Fri Sep 21, 2012 10:24 pm

Dancesatmoonrise wrote:The biggest problem we'd have is sufficient numbers for statistical significance. However, to my knowledge, the study hasn't been done, so it would be worthwhile.


Yes, I glanced at one of the papers from the trial when this came up earlier -- the study results are significant (p < 0.05).

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Re: 14er newbie - frequent urination while hiking, AMS??

Postby DArcyS » Sat Sep 22, 2012 1:43 am

One other point. Most people are in a slight state of dehydration because they don't drink enough water. If you're one of them, don't think you can become properly hydrated by forcing water the morning of your hike. It won't work because the body can only absorb water at a certain rate. What it can't absorb will pass through as urine.

I remember doing a bike ride where I became dehydrated. When I got home, I forced water, and within the hour my urine was clear, but I knew I was still dehydrated.

If you're new to this game and your body hasn't gained that "long-term acclimization," think about hydration a day or two before your hike.

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Re: 14er newbie - frequent urination while hiking, AMS??

Postby MountainMedic » Sat Sep 22, 2012 9:55 am

madbuck wrote:
Dancesatmoonrise wrote:The biggest problem we'd have is sufficient numbers for statistical significance. However, to my knowledge, the study hasn't been done, so it would be worthwhile.


Yes, I glanced at one of the papers from the trial when this came up earlier -- the study results are significant (p < 0.05).


Haven't read the paper yet, but you can pull significant p-values out your ass if you're good at juking the stats. I remember running post hocs for my thesis and getting a p of 0.14 with one test and 0.04 with another. You can also find excuses to remove subjects from the study, which is a common practice in clinical trials easily "justified" by small factors.

On the other hand, lots of authors will simply report their findings in a misleading manner. Say you ran a study like the ones we're discussing, and of the placebo group, 10% got AMS, while only 5% who took ibuprofen had symptoms. You might have to dig around for these figures, while authors report "ibuprofen results in a 50% decrease in AMS." Completely misleading.

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Re: 14er newbie - frequent urination while hiking, AMS??

Postby madbuck » Sat Sep 22, 2012 10:47 am

MountainMedic wrote:Haven't read the paper yet, but you can pull significant p-values out your ass if you're good at juking the stats.


Neither of these generalities are valid scientific criticisms of specific studies.

To be clear, this group had a few papers in the last 2 years. The first one compared ibuprofen to Ace (with a placebo control group) and compared the severity of high-altitude headaches (HAH):
http://www.sciencedirect.com/science/article/pii/S1080603210002073

I read this paper and am satisfied with the protocol and conclusions, enough to reject the null hypothesis that "Ibuprofen is virtually worthless...and really does next to nothing."

The more recent paper, with a smaller cohort, compared ibuprofen to placebo in symptoms of AMS:
http://www.sciencedirect.com/science/article/pii/S019606441200090X

I am satisfied that ibuprofen may reduce AMS symptoms, but further questions remain: is there a mechanism for alleviating some of the other symptoms of AMS? Or (just a hypothesis here), does reducing the headache alone allow someone to descend more rapidly, remember/able to drink and eat more, etc. so that the severity of other symptoms are reduced?

Note that ibuprofen hasn't been shown to be as effective as Ace in reducing *all* AMS symptoms -- but better than a placebo.

In short, it appears to be useful for some people for treating high-altitude headaches especially.

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Re: 14er newbie - frequent urination while hiking, AMS??

Postby tehchad » Sat Sep 22, 2012 12:44 pm

MountainMedic wrote:HVR in turn does stuff. Here's what I posted earlier explained by Auerbach, he's much clearer than I am and I should have merely found this passage: "Other factors influence ventilation on ascent to high altitude. As ventilation increases, hypocapnia produces alkalosis, which acts as a braking mechanism on the central respiratory center and limits a further increase in ventilation. To compensate for the alkalosis, within 24 to 48 hours of ascent the kidneys excrete bicarbonate, decreasing the pH toward normal; ventilation increases as the braking effect of the alkalosis is removed. Ven- tilation continues to increase slowly, reaching a maximum only after 4 to 7 days at the same altitude (see Figure 1-3). The plasma bicarbonate concentration continues to drop and ventilation to increase with each successive increase in altitude. Persons with lower oxygen saturation at altitude have higher serum bicarbon- ate values; whether the kidneys might be limiting acclimatization or whether this reflects poor respiratory drive is not clear.102 This process is greatly facilitated by acetazolamide (see Acetazolamide Prophylaxis, later)." He doesn't mention the urination here, but the "water follows salt" thing is pretty straightforward, and acetazolamide is often used in hospitals as a diuretic (that is, it increases urination). The most common side effects with acetazolamide are peripheral parathesias (tingling in limbs/digits) and frequent urination.


A - Don't apologize. I'm learning and that's what this site is about.

B - I'm interested in the above and more elaboration on it. Where would you send me? I only know what I've read here. I never knew that plasma DECREASED when the body was pumping out more red blood cells. This must be why cuts and things higher don't like to heal.
How long does the avg person take to make these adjustments? (Begin decreased plasma, begin producing more blood cells, finish and return to whatever "normal" might be at the new altitude, etc)

Good stuff! Keep it up! \:D/

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Re: 14er newbie - frequent urination while hiking, AMS??

Postby MountainMedic » Sat Sep 22, 2012 12:54 pm

madbuck wrote:
MountainMedic wrote:Haven't read the paper yet, but you can pull significant p-values out your ass if you're good at juking the stats.


Neither of these generalities are valid scientific criticisms of specific studies.



Nor did I at any point say they were. Lots of people have posted on this thread have reported p values; stats alone just don't mean that much to me. I think it's worth mentioning the need to be critical of scientific studies. The study you posted originally does look well done and I don't deny that ibuprofen has a proven purpose in HAH/AMS.

I'm quickly reminded why I used to post less on online forums...

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Re: 14er newbie - frequent urination while hiking, AMS??

Postby madbuck » Sat Sep 22, 2012 4:28 pm

MountainMedic wrote:Nor did I at any point say they were. Lots of people have posted on this thread have reported p values; stats alone just don't mean that much to me. I think it's worth mentioning the need to be critical of scientific studies. The study you posted originally does look well done and I don't deny that ibuprofen has a proven purpose in HAH/AMS.

I'm quickly reminded why I used to post less on online forums...


It's all silly internet forum stuff, lots of people talking around in circles, where it's hard to balance personality with quickly getting facts and information out there. Thanks for much of the meaningful discussion of physiology and medicine on this thread!

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Re: 14er newbie - frequent urination while hiking, AMS??

Postby jdorje » Sat Sep 22, 2012 10:21 pm

Did I read you right that we need to get an MRI up to the top of a fourteener? When we can't even handle a hot tub?
-Jason Dorje Short

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Re: 14er newbie - frequent urination while hiking, AMS??

Postby MountainMedic » Sun Sep 23, 2012 2:30 am

jdorje wrote:Did I read you right that we need to get an MRI up to the top of a fourteener? When we can't even handle a hot tub?


Not the top, just the base. Most rural hospitals use MRIs housed in RV-like vehicles...it would actually be very easy to bring an MRI to most THs, or to the summit of Evans or Pikes, for example.

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Re: 14er newbie - frequent urination while hiking, AMS??

Postby Duffus Kentucky Climber » Mon Sep 24, 2012 8:09 am

Two things:

It's when you are not urinating that is cause for concern.

If you are still using the terms "number 1" and "number 2", that is even more cause for concern.
It looks like the ridge is just right up there!

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Re: 14er newbie - frequent urination while hiking, AMS??

Postby onepeakatatime » Fri Jul 05, 2013 8:26 pm

I would like to respond to part of the original question - if I can remember what it was??? I normally carry a poncho with me, summer and winter. It is a simple weather protection device, but also I have used it as a quick tent for an unexpected overnighter, and as privacy when off-trail. Ooops! I guess you now know who's in the poncho a hundred feet off the trail, above tree-line on a sunny day.

Great thread, learned a lot

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