Testing a New Drug for Mountain Sickness

In the medical news this week was a study showing that altitude sickness can be prevented with ordinary ibuprofen. This is interesting for geologists and anyone else who goes to high places. It was particularly so for me, because I served in that research study.

Altitude sickness—a syndrome formally called acute mountain sickness—affects about a quarter of people who ascend from sea level to elevations above 2500 meters, or 8250 feet. The main symptoms are headache, fatigue, nausea, loss of appetite and trouble sleeping. For most victims it goes away in a day or two, but some cases are severe enough to be disabling, and if untreated the brain may sometimes start swelling inside the skull to the point of death.

The best treatment for acute mountain sickness is to move to a lower elevation until the symptoms stop. But that isn't always possible—bad weather may pin you down, for instance. Some people, like search-and-rescue teams or soldiers, simply must carry on. Others, like ski parties or expeditions, are very reluctant to get off schedule. There are prescription drugs for preventing acute mountain sickness, but they have side effects that can be as severe as the condition they're treating. Plus, they need to be taken a day ahead of time—not good for, say, a fire-fighting crew.

So a team of doctors, most of them at Stanford, designed a double-blinded study to test over-the-counter ibuprofen as a preventative. They sent groups of ordinary folks on a two-day summer exercise in the White Mountains, where Stanford maintains high-altitude research facilities. They sent out a call for volunteers. Sounded good to me. I arranged two more nights on the road and made a nice field trip through eastern California out of it.

The study employed 86 people on four separate weekends in the summer of 2010. My group assembled August 20 in Bishop, at the Owens Valley Laboratory, part of the University of California's White Mountain Research Station, and spent the night there at 1240 m (4100 ft). We got up early the next morning.

After breakfast we took our first doses (ibuprofen or placebo, no one knew which), underwent examinations and filled out questionnaires. Among other things, we had our eyeballs ultrasounded.

Then we drove into the White Mountains and stopped for lunch at the bristlecone pine forest, where I'd never been before. The big snag on the left might be thousands of years old.

Here, at least, it was clear how the range got its name: large areas of dolomite marble. One idea for why bristlecones reach incredible ages here is simply that only dolomite can resist erosion for that long. I thought it was beautiful stuff.

From here, too, the view east over Nevada was immense; range after parallel range marching off to the horizon. Geologists know this as the Basin and Range province, a zone where the crust has stretched westward to one-and-a-half times its original width. The White Mountains, with their southern sister the Inyo Mountains, are the westernmost and highest of these ranges.

Next we parked at a gate at 3545 m (11,630 ft), took another dose, then hiked almost three miles with our backpacks of clothes and bedding to UC's Barcroft Station at 3800 m (12,470 ft).

I had never hiked at such an altitude before. Walking on level ground was OK, but whenever the path turned uphill my heart and lungs went into overtime and my legs turned to lead. When I couldn't push any more, though, I could pause for just a minute or two and feel fine again. That was uncanny. When the going was good, being there felt at times like floating in the sky.

We left our packs at Barcroft Station and then made one last steep climb to Mount Barcroft's summit, 3975 m (13040 ft). It felt so good to stop, and the view was fantastic. This is looking due west. . .

. . . and this is White Mountain Peak, to the north.

That evening one of the researchers delivered a thorough lecture on acute mountain sickness and other medical issues of high altitudes. It was a peek into the world of adventurers who braved altitudes twice as high as ours, pushing the limits of human capability.

Most of us experienced some of the symptoms of acute mountain sickness, no matter which pills we had taken. We played pool and socialized until bedtime. That's when I noticed how hard it was to sleep; part of it was physiological and part of it was an inability to tolerate snoring.

But I took advantage of the sleepless night by arising before dawn. That was how I managed to witness a rare green flash as the sun first peeked over the Nevada ranges. After that was all downhill: breakfast, a final dose, and a last round of examinations. Then we were free to go. Some of us had plans to tackle White Mountain Peak; mine were to visit the volcanic wonders of Long Valley, at a much more manageable elevation.

And that was it for me until the first paper from the study came out this week in Annals of Emergency Medicine. Ibuprofen, it turned out, works roughly as well as other medicines but is much cheaper to get and easier to take. It won't stop all the symptoms, but it makes a notable difference and may save you from a very bad time. Remember it the next time you hit the high country.