I'm overwait and visiting high altitude - breathing concerns

August 28, 2021 4:06 AM

I’m overweight and the last time I went to a high altitude place I had a hard time breathing. I’m planning a trip to Boulder Co. in a month. Aside from losing weight, is there any device I can use like an inhaler to breathe easier?

I know this question is pathetic. I’m trying to lose weight. But I’m planning a trip to Boulder and then Estes Park in late November. It’s hard to lose weight.

A couple months back I visited New Mexico and was shocked to see how hard it was to breathe. I mean I could breathe fine wile still, but I’d be winded by simple things like walking up a flight of stairs.

I’m a 367 pound guy who’s 32. 6 foot 4 inches tall.

posted by ggp88 to Health & Fitness (22 answers total)

It’s not a pathetic question! All you can do is slow down. All anyone, whatever their body, can do is slow right down. Altitude is horrible, and the only thing for it is time and acclimatisation.

You should know that oxygenation of the blood, getting oxygen to the muscles and brain and the rest of the body through the lungs, isn’t really related to one’s weight, at all. It’s not at all like smoke inhalation or pollen reaction, where the lungs and breathing are physically restricted, you’re breathing the same amount of air by volume, with the same efficiency and lung-power as at home, it’s just that because there’s less pressure there’s less air—and less oxygen—in it.

In first-aid extremis the solution is medical oxygen through a mask, but that’s for emergency. Altitude sickness is one of those weird categories of feeling-bad that doctors shrug at, and sports trainers have contradictory strong opinions about. Acclimatisation might take days, or months, or years. Olympians and elite athletes and aviators all train at altitude precisely because altitude hits everyone hard, and because a sea-level marathoner or 100m sprinter might have the same trouble as you’re describing, walking up a flight of stairs.
posted by Fiasco da Gama at 5:08 AM on August 28, 2021 [10 favorites]

Increasing your fitness in the meantime (regardless of whether your weight changes!) will be beneficial, as well as just taking it slowly when you get there.

I usually see acetazolamide recommended for altitude issues at higher elevations (10k feet or more), but it might be worth asking your doctor if it would be an appropriate intervention for this trip?
posted by obfuscation at 5:17 AM on August 28, 2021 [1 favorite]

Response by poster: It just sucks… the last time I went on this trip, my friend and I hiked all over the place. We got lost on a mountain, lost the path, and just hiked straight up a 50ish degree incline for about 3/4ths of a mile just to get back on the trail (we were high lol)

I’m afraid I won’t be able to do anything. Whereas my friend is just as fit as she was on the last trip.

I’m afraid I’ll be out of breath a lot, and I’m afraid about being embarrassed about it.
posted by ggp88 at 5:21 AM on August 28, 2021

Agree with Fiasco da Gama that this is not a weight or fitness thing! I am 5'2", went to Machu Picchu a few years ago when I was in the best shape of my life (running about 15-20 miles a week, weighed about 115), and got winded walking down the street in Cuzco.

Acetazolamide can help with acclimatization, as can caffeine.
posted by basalganglia at 5:27 AM on August 28, 2021 [5 favorites]

Would it be helpful to let your friend know about your concerns in advance as a way to manage expectations? “Hey buddy, I’ve put on some weight and climbing a 14,000 footer probably isn’t possible this trip but I’m really looking forward to doing XYZ.”
posted by raccoon409 at 5:28 AM on August 28, 2021 [12 favorites]

Best answer: Hello from Southern Colorado! I live full-time at just over 6,000 elevation, which a bit above Boulder but below Estes Park. The elevation here affects lots of people, and the effects you felt in New Mexico are quite common. I often find myself a little winded for the first day or two when I visit our family cabin at 9,000 feet. It's good that you are asking these questions.

The general guidance we tell visitors is to get lots of rest, drink lots of water (more than you think you need), breathe deeply and purposefully, avoid alcohol (seriously, it makes it so much worse and it hits twice as hard). If you get headaches, take your usual tylenol etc. For me, soda and fizzy drinks seem to make things worse. Eat healthy carbs.

And don't overdo it. It's super common for people in travel forums to be like, "Hey we live in Nashville and my buddies and I are coming out to bag some fourteeners for a bachelor weekend, which ones are the best?" And then everyone on the forum is like, Bro, just no, go find some hot springs and hang out there, you'll love it, trust us.

Oh! You just updated. Okay, so hey: I used to work summers on top of Pikes Peak, which is 14,110 feet, and for a while I did the hiring for the top. I can't tell you how many new hires would take the staff transport up, struggle take a breath, wobble a bit from dizziness, hop back in the van again and head straight back down. One of these turnarounds was a dear friend who was literally training for a triathlon at the time. Meanwhile, my bookworm friend did fine up there. We'd have thousands of tourists up there and some were fine, some weren't. You just never know. It really does affect people differently.

Please have a heart-to-heart with your companion and be sure you're on the same page about your comfort level for this trip. Colorado is gorgeous, but it turns out I hate difficult hikes, which quite honestly suck all the fun out of the awesome beauty that's here. It's glorious to sit nestled among the mountains and towns and meander a bit. It's TOTALLY OKAY for you to grab your sketchbook or try out a coffee shop while your friend hoists herself up an incline. The important thing is to enjoy the trip, and if that means doing some separate activities, that's a really agreeable way to approach this.
posted by mochapickle at 5:42 AM on August 28, 2021 [29 favorites]

I do not do well with elevation changes and tend to feel altitude sickness way before other people do. This might have to do with my asthma.

Suggestions, take it as slow as you can. If you can, slowly increasing your elevation can assist with your body adjusting. If you are having trouble at a specific elevation, spending a day at a bit of a lower elevation can help (but not all the way down!), and then heading back up.

I ended up getting a little bit of oxygen once. I think an urgent care doc took pity on me because I was feeling so panicked and short of breath and I hadn't relaxed in days. He told me to go visit a town about 2000 feet from the one I was in and come back the next day. But overall I did acclimate. It's going to depend on how long you are there.
posted by AlexiaSky at 7:02 AM on August 28, 2021 [1 favorite]

I just returned from a week-long trip in ~10,000 ft spots in Colorado. I agree with all of the above. The other thing I would mention is that our whole family seemed to get much more acclimated after a day or two. So, if the first day or two is rough, don't assume that it will not improve - it did for us. One other thing: the first night I woke up with a bad headache, and I get headaches very rarely, so have whatever headache remedy you use handy.
posted by Mid at 7:04 AM on August 28, 2021 [1 favorite]

Denver resident here. There are cans of oxygen, they give a few breaths, but incredibly expensive for the temporary boost you get.

Hydration, drink less alcohol, and rest up the first day or two you are here are the best advice for anybody coming from lower altitude.
posted by nickggully at 7:48 AM on August 28, 2021

Denver resident here also, reasonably fit and acclimated, but lately I've been struggling with terrible sleep when we go into the mountains and sleep at 9500+ feet of elevation. This article does a decent job explaining why (disordered breathing is your body's natural response to compensate), and it shows up on my Garmin watch as huge spikes in heart rate along with breathing irregularities. I haven't found a great solution to this, but it has made me think harder about the elevation of wherever I'll be sleeping the night before an active day at a higher than usual elevation level, because hiking at altitude after a night of shitty sleep is terrible. I'm also going to try not having any alcohol on night 1 at a higher elevation moving forward. Long story short: descending to lower elevation for sleep might help you feel better here.
posted by deludingmyself at 8:18 AM on August 28, 2021 [2 favorites]

Ugh, I haaate altitude. It's like a hangover but without the fun part the day before. Anyway, fitness, schmitness. It seems to hit everybody differently regardless of BMI or whatever. Anectada source: we were in the High Uintas with a bunch of high school kids, all young and strong. My mom was pushing 70 and did fine. I, recently turned 30 or so, had hangover misery. Some of the kids were leaping about like gazelles; some were in their tents moaning and puking. Did not seem to be any correlation between their bodyweight and their level of misery. Your friend's just lucky. Definitely don't drink anything; Christ, I can't even imagine.
posted by Don Pepino at 8:43 AM on August 28, 2021 [1 favorite]

Best answer: It's not pathetic, you're anxious about being ashamed (or shamed, by somebody else) and that is understandable. But there is also not a ton you can do at this point except pre-set expectations with your friend and don't push it (because, among other things, you do NOT want to have to go anywhere near an ER under current circumstances). Go slow on inclines, and set that expectation with your friend. It's much easier to just get it out and say it up front instead of waiting the whole time for them to say something well-meaning but embarrassing.

But aside from taking normal elevation precautions when you're there as others have advised, one thing you can do that will help as much as anything can in a month is walk for half an hour or more a day, every day. A month really is enough time to improve your general stamina and condition your lungs enough to at least give you a little improvement in performance. Make sure to hydrate well in the days before your trip, as well.
posted by Lyn Never at 8:52 AM on August 28, 2021 [5 favorites]

For general safety, I wouldn't hike somewhere I've never been while high (or drunk). Especially a steep trail in the mountains, where being disoriented can result in serious injury or death. Keep the pot for when you're chilling in camp or taking in the scenery.

Altitude can suck and the best solution is acclimatization. General guidelines (for Switzerland where everything is at some altitude, like Colorado) for getting used to the change.
posted by fiercekitten at 9:29 AM on August 28, 2021 [1 favorite]

Best answer: Ive spent a lot of time going from sea level to 10000+ feet. I am prone to altitude sickness, so this is what I suggest:

Start taking iron supplements two weeks before your trip. Low iron levels make acclimation very difficult.

Get a prescription of Diamox (Acetazolamide), which is specifically for altitude sickness. I would also ask for an albuterol inhaler.

Do not drink for at least the first several days. Keep it super moderate afterward, especially if you're over 8000 feet.

Pace yourself! It's ok to go slow or skip a tough hike. Have fun :)
posted by ananci at 9:37 AM on August 28, 2021 [1 favorite]

Best answer: Before I went to Tibet, my doctor told me it was often impossible to predict who would suffer most from altitude problems and who wouldn't. In fact I (a fat person) had no real problems in Tibet, and neither did most of the elderly people in the group. But some of my younger, fitter peers basically never left their hotel rooms because they felt so bad. Not much later I went to a comparative lower-elevation place in the US and had a very bad time. So you just never know.

To me, your weight sounds kind of secondary to your physical concerns, which is that you're less in the habit of strenuous exercise right now than you were before + the fact that anyone (ANYONE!!!) can find themselves unexpectedly slammed by high-altitude exertion. If your friend is really a friend, they'll understand completely if you gather up your courage and just say, "Hey, I don't think I'm as ready for extreme hiking as we were that other time, and I'm worried about the altitude because I had a bad time in NM recently. Can we take it easy the first couple of days/I might have to rest more than usual or take easier routes/not get high when we hike/[whatever]?"

If they respond negatively, they're a shitty person and don't deserve to be your friend.

Last time I needed to say something like this to a much fitter friend, they laughed in relief and said they'd tweaked their ankle two days ago, and had been worrying they wouldn't be able to keep up. Seriously, anyone can experience a drop in their endurance or fitness at any time, and decent people should be ready to accommodate that.

Final note: I hear a lot of self-shaming in your question and phrasing, and in my experience those feelings make everything more difficult, including getting back to whatever level of activity you would like to achieve. So long-term, it might not be a bad idea to work with a therapist to help you be kinder to yourself.

I hope you have a great time on your trip. (Even if it's different from last time, it can still be fun!)
posted by kutsushita nyanko at 9:41 AM on August 28, 2021 [9 favorites]

I visited Evergreen, CO, 1.5 mi above sea level, from Portland, ME, sea level. I was in okay shape, but just walking up a flight of steps winded me. I improved steadily during my visit, bodies acclimate. It's not about weight, it's a little about cardio-vascular condition, mostly about not being acclimated to air with a lower saturation of oxygen. On Amazon or maybe an airport shop, you can buy a small canister of supplemental oxygen to give yourself a boost when you really need it. Note: I did not research the quality at all, the link is an example.

2nd the fact that you have no need to feel shame about this. Bonus: when you get home, you'll feel great because you'll have acclimated a bit; you might be able to leverage that into exercising to improve your cardio-vascular health. I did that, exercising more when I returned and enjoying feeling great. Colorado is gorgeous, have a good time.
posted by theora55 at 9:58 AM on August 28, 2021

I was basically in your situation, but with 5-6 weeks instead of 4. You're not going to lose all the weight in time but you can increase your fitness a bit. Try to get in 2-3 miles of walking at least per day and at least one HIIT workout (there are lots on YouTube). Take one rest day a week. If you can, do a hike every weekend--you can search on AllTrails for elevation change and total distance (as well as how far the trail is from you). Get some hills in, both with walking and hiking.

If this was long term, you'd want to add weights and more rest days. But this is short term, so you want to blow your spot up. You'd be surprised how quickly you can build up your cardio when you're detrained. It won't make the hiking easy, but it will make things easier. The last 4 or so days before your trip back off, maybe just the walking.

Obviously with all of these be reasonable and don't injure yourself. Listen to your body. You might want to focus on not-jumping HIIT ("low impact" and "no jumping" are good search terms).

Also I recognize this is unconventional. However it worked really well for me, by the end of it I could tell my cardio had improved.
posted by Anonymous at 10:46 AM on August 28, 2021

Bronkaid or equivalent(there's another one I can't remember offhand) inhaler OTC at most pharmacies. I have zero clue how this would interact with you, your weight or possible health issues, so be sure to do your own research and talk to the pharmacist if you go this route. I'm in the middle of a backpacking trip and not in cell service range long so I can't do any digging right now to see if this would be a good option for you, but the pharmacist would be able to tell you. It's cheap, and I suspect as long as you don't have any heart issues might help a bit.

Altitude affects everyone not acclimated! I second the advice to drink a lot and take lots of breaks. If you have sleep problems, use all your tricks to get the best sleep possible. It makes a helluva difference. Have fun!
posted by liminal_shadows at 10:55 AM on August 28, 2021

IANAMD, but I would be cautious about taking iron supplements; that advice may be much more appropriate for women, but men in the United States typically do not have iron deficiency.
posted by coberh at 10:15 PM on August 28, 2021

I used live in the mountains and take flatlanders for hikes up the Selkirk Mountains with the scouts. Our rule was to limit a single day ascent to less then 1000 feet. You can just buy oxygen for hiking. There is a greymarket for it if you skip going through the US medical establishment. I have been out of the mountains for years and would strongly consider that option as a backup, just in case.
posted by zenon at 7:01 AM on August 29, 2021

One rather expensive and cumbersome option is a small oxygen tank in a sling attached to a nasal cannula. People doing heavy physical work at high altitude (e.g., building telescopes) often use them and say it makes a huge difference. I don't know if you'd want to pay for the oxygen needed to use it for days, but it might help a lot with the steep and high parts, or if you can't sleep.

(If there are other altitude sickness symptoms, I've seen diamox work wonders on someone who was already beginning to experience pretty severe symptoms, allowing them to continue a trip that would have been aborted otherwise. There are possible serious side effects. Having someone else drive you to lower altitude is the safer choice.)
posted by eotvos at 10:42 AM on August 29, 2021

Your weight isn't the issue. I agree with others that anyone can get altitude sickness. But also, to the extent that you want to be able to do fun, challenging activities, the best way to prepare for that is to work on your fitness, rather than focusing on your weight. I'd suggest climbing stairs, both because it sounds like the most readily available analogue for hiking through hills, and also because it's really, really hard. Like, there are professional runners who get winded climbing stairs. So if you practice on that, you're more likely to be able to handle other challenges that might come at you on your trip. But I also agree that talking in advance with your friend might help your anxiety. You're definitely not the only person who is less fit than they were when they were a lot younger, especially after this past 18 months of lockdowns and isolation. If your friend is really a friend, she'll work with you to find fun activities you can do together that you feel comfortable and safe with, and you'll be able to say stop when you need to stop, or rest, or find a less hilly path, or whatever.
posted by decathecting at 12:11 PM on September 1, 2021