From the WTA President:
The elevation of the Peaks Resort hotel and the Telluride Conference center at Mountain Village is approximately 9,500 feet (almost 3,000M). The top of the ski mountain (Revelation Bowl) at Telluride is 12,570 ft (3,832M). These are the highest elevations to date for the WTA. The sudden ascent that most of us will be making to this altitude and the strenuous activity that we expect to pursue puts us at significant risk for several forms of high altitude sickness including acute mountain sickness (AMS), high altitude pulmonary edema (HAPE), and high-altitude cerebral edema (HACE). There appears to be a fairly wide degree of variability in terms of susceptibility to these conditions, and pre-existing medical conditions may compound the potential problem. AMS is by far the most common on these, with a reported incidence of ~9% at 2,850M (9,348 ft), ~13% at 3,000M (9,840 ft), and 34% at 3,650M (11,972 ft). These notes are not meant to be prescriptive nor are they a substitute for consultation with your physician, particularly if you have pre-existing medical conditions.

The following management may help alleviate or prevent acute high altitude illness is susceptible individuals making sudden ascents to altitudes > 8,000 feet.

Gradual acclimatization:
Probably the best and the overall safest approach, but not always the most practical, is a more gradual ascent. For susceptible individuals, consider arriving a day early and taking it very easy, or spending the first night at a lower elevation. Try and avoid vigorous activity for at least 24 hours, particularly if you are susceptible to AMS or develop symptoms. Consider also skiing lower on the mountain during the first day or two (up from the town or Mountain Village to St. Sophia station at 10, 535).

Hydration, analgesics, and rest:
The majority of headaches that occur below 11,000-12,000 feet are related to simple AMS and not HACE. Most are treatable with hydration and simple OTC analgesics. A common mistake at higher altitudes is to consider feeling poorly or headaches “normal” rather than (correctly) diagnosis AMS. A common result is to continue vigorous activity with further ascent to even higher altitudes. [Classification: EJ -error in judgment, preventable]. If you develop nausea, vomiting. loss of appetite, fatigue/weakness, dizziness, periodic breathing or difficulty sleeping, consider AMS, and think long and hard about continuing vigorous activity or further ascending up the mountain.

Acetazolamide (Diamox):
This carbonic anhydrase inhibitor has been shown to be effective and preventing and treating AMS, likely facilitating acclimatization. It is effective in ameliorating the annoying symptoms of ‘periodic’ breathing (gasping for breath while trying to sleep) at altitude. Acetazolamide may be effective in preventing HAPE also. The optimal dose is uncertain. 250 mg bid or 500 mg sustained-release Q-day is the most effective, but side effects of paresthesias (‘buzzing’ sensation in fingers, toes) and nausea may make it less attractive. Beer, soda and even sparkling water will predictably taste pretty foul at this dose, and it is a diuretic with the expected GU effects (including while skiing). Consider 125 mg. bid for starters. Dosing should start 24-48 hours ahead of the ascent to altitude, and be maintained for 3-5 days. There are no rebound effects with abrupt discontinuation. Allergy to sulfa drugs is a contraindication to Diamox.

Dexamethasone:
A potent glucocorticoid, ‘dex’ has long been used primarily for the treatment of HACE, but may also have some efficacy in treating more severe AMS-associated headaches (which may represent a continuum of HACE). HAPE may partially respond to dex also, but good data is lacking. Dex does not facilitate acclimatization and may mask other symptoms. There are rebound effects with abrupt discontinuation. Treatment dosing is 4mg p.o. Q6hr. and immediate descent to a lower altitude for HACE symptoms. Prophylactic dosing (not well evaluated) is 2-4 mg. p.o. Qday.

Nifedipine:
The calcium channel blocker appears to be effective in preventing and treating HAPE during high altitude ascents by blunting the rise in PA pressure associated with hypoxia and reflex vasoconstriction. Dosing for rx. and prophylaxis is 10mg. p.o. Q12 hrs. and immediate descent to a lower altitude for HAPE sx.

More information on any of these treatments may be found through the web, or by consulting with a expert in high altitude medicine. The goal is to minimize any discomfort or incapacity that the higher altitudes at Telluride this year may create. It’s a great venue and a great mountain – I hope than no one loses the opportunity to fully enjoy it!