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The Pros and Cons of Diamox

Thanks to Bob Holdsworth for this take on Diamox and the Mountain…

One of my concerns for the climb up Kilimanjaro was my ability to manage the altitude necessary to make the summit, and equally important, to enjoy the experience. Also, the threat of severe AMS lurked in the background to completely derail my attempt to summit or worse to miss my next birthday.

Past Experience

During previous hikes over 10,000 feet (3000m), I had struggled. Headaches, loss of appetite, and general fatigue were always present during trips to the Sierra Nevada. I recall experiencing shortness of breath just walking around camp at 12,000. When I was younger, better physical conditioning helped me push through the physical problems and get to the top (usually 13,000 to 14,000 feet). But Kilimanjaro is 19,341 feet (5895m)! Plus now that I am, let’s just say more mature (over 50), I was really concerned.

I know that in my earlier mountain trips, I did not drink enough water. Compounding this was usually no time to acclimatize because of the requirement to finish hikes over a weekend. Drinking adequate water (4 to 5 liters per day) will be easy to do this time and our extended trek across the western flank of Kilimanjaro will provide for acclimatization. However, my doubts still lingered.

Diamox: How & Why…

For this trip, I decided to take Diamox (Acetazolamide) to speed up the acclimatization process. Because of the reduced oxygen at altitude, breathing harder and faster allows your body to get more oxygen in the system as it produces more red blood cells. The increase in carbon dioxide exhaled at the same time makes the blood more alkaline. The kidneys get involved to excrete the excess alkaline to balance things out. Diamox helps the kidneys by speeding up the process. My local doctor prescribed 250 mg daily starting 2 days before the hike. I had read a number of articles that recommended anywhere from 125 mg to 500 mg per day, so this seemed reasonable.

Side Effects

The side effects described were numbness or tingling in the fingers and toes plus more frequent urination. There was also a big caution about not taking any sedatives once you started the medication. All of the side effects go away when you stop. This seemed manageable especially compared to not making it to the top.

I started taking the Diamox at the hotel in Moshi the night before we left for Kilimanjaro. I wanted to have a bathroom ready to see just how frequent, frequent is. Three Tuskers that night at dinner added more liquid than normal, but frequent turned out to be every other hour! Manageable in the hotel, but no more Tuskers until the end of the trip.

The first three days of the hike we climbed from 6890 feet (2100m) to 12,600 feet (3840m) over a relatively gradual incline and 22 km. I did not have any difficulty. The tingling side effect in my fingers and toes was no different than if you slept on your arm and felt mild numbness. It lasted for 20 to 30 minutes. I maintained my water intake which created two excursions per night out of the tent. This was not a problem because after midnight the skies cleared and I was able to view the splendor of every star in the sky and the Milky Way stretched across the heavens. A great side benefit even at the expense of a temporary chill from getting out of the sleeping bag.

The Result

The first test was Day 4 when we hiked from Shira Hut to Barranco Camp via the Lava Tower at 15,230 feet (4642m). We would ultimately sleep that night at 13,000 feet, but 15,000 feet was the highest I had ever hiked. It turned out to be no problem at all. Walking slowly (Swahili – poley poley), plenty of water, a good workout program prior to the trip, and the Diamox combined to make this day’s hike a great experience. I was not winded, no headache, and plenty of energy. The landscape was phenomenal and I was able to fully enjoy and appreciate it.

This was a major confidence booster for me. Over the next two days, we hiked up to Barufu Huts Camp at 15,358 feet (4681m). This was the last camp before our summit attempt that night at midnight. After 6 days and almost 40 kilometers of walking, the excitement and anticipation provided plenty of adrenaline. I was raring to go and felt great.

The Summit

When the last cheers of “Happy New Year” started to subside, we left Barafu Camp for the summit. Pitch black with your headlamp only illuminating the next three feet, we trudged steadily up the next 4,000 feet over the next 7 hours. We pass multiple groups huddled over fallen comrades and we lose one of our own to the altitude (Note – later in the day, she recovered and made it to the top). The ingredients of training, pace, hydration, and modern medicine combined to deliver me to the peak at 6:45AM. An unbelievable feeling of accomplishment and satisfaction wash over me as I get my picture taken at Uhuru Peak 5895m, Africa’s highest point, the world’s tallest freestanding mountain.

Could I have made it without Diamox? I don’t know. I wanted to give myself every advantage possible so I trained hard, took care of my body during the trip, followed directions (poley poley), and used available medicine whether it was Imodium or Diamox to aid my ascent. What I do know is that I made it and that is good enough for me.