AMS – Why it happens (Pathophysiology)
The reason AMS occurs is because of decreased oxygen in the blood. If you can put more oxygen in the blood, AMS does not occur. In response to lower oxygen levels, the lining of the blood vessels called the endothelium releases molecules that cause dilation of blood vessels. And when these blood vessels dilate in the brain, this causes many of the symptoms of AMS. Activation of the sympathetic nervous system causes the kidneys to retain water and the end result of these changes is brain swelling. Brain swelling is actually a normal and universal response to altitude. Therefore, it is the degree of swelling that differentiates someone with AMS. This continued swelling is likely responsible for most of the mountain sickness symptoms.
Treatment of acute mountain sickness should focus on increasing blood oxygen levels. When caught early, conservative measures rapidly reverse symptoms but if left untreated, the condition can be severe or even fatal. The first step is to give oxygen to the person. Oxygen very quickly reverses the symptoms of AMS. Also remaining at the same altitude until symptoms disappear can help. This may not be an option, but it is a solution. This gives the body time to adapt to the lower oxygen levels. Adaptation can be accelerated with a prescription drug called acetazolamide (Diamox). Ibuprofen and aspirin and Tylenol are the best treatments for headache. A drug called promethazine works well for nausea and vomiting. Alcohol, sleeping pills and other respiratory depressants should be avoided to prevent dangerously low oxygen levels during sleep. If symptoms do not respond to rest and over-the-counter drugs, descent below the altitude where the symptoms began is advised. Finally, a cortico-steroid drug called dexamethasone is effective in relieving some of the symptoms and treating the nausea.
And of course going back down to sea level also cures the problem right away. But this may not be an option for many as once you’re in the rally it is difficult to leave it and come back to the bivouac.
Chinese Adaptogenic Herbs
Adaptogenic herbs can help with altitude in many ways. The Chinese have been using them for altitude adaptation for thousands of years. These herbs can help the body’s oxygen system work more efficiently at adapting to low oxygen concentration environments. These herbs will also help focus and mental energy, which are very important during the Rally. Robby Gordon’s co-driver, Kellon Walch uses Tianchi every time he races the Dakar Rally. Herbs such as Rhodiola, Gensing, Ginkgo biloba, cordyceps are Chinese herbs that have shown by research to help in AMS. If you want a ready-made packet of Chinese Adaptogenic herbs, try a company called Tianchi. (Herbworks).
Optimization of hydration
Hydration is a big deal while it altitude. It is often difficult to drink enough water and one must have a good handle on their hydration status at all times. The moment one falls behind it is very difficult to catch back up. And water is going to be a concern as many people are particular about where their water comes from. And any time a racer or crew member drinks from a local water source there is always a concern of getting gastrointestinal related illnesses such as Giardia. It is a pretty sure bet that the medical tent will be administering many IVs and efforts to help racers and crewmembers battle severe dehydration from the altitude. Also having a good salt solution like tri salts is going to be very important. If you do not already use a salt solution in your drink mix or whatever you used to hydrate with, you should consider finding one that you like and sticking with it.