Medication Training

No matter how fit you are – do not under estimate altitude sickness

To climb the 7 summits in 1 year requires extreme fitness, full dedication and determination, and an optimum preparation. All things we are able to control. But there are a few factors that we are not capable of to control, and which can cause the 7 summits – 1 year project to fail. It requires a certain amount of luck that the weather will cooperate with us, to name one. We don’t want the guys to get sick by eating contaminated food or drinking unclean water. But the toughest enemy we will need to deal with is probably altitude sickness. A tricky bastard we need to take very serious. To leave nothing for a surprise we need to know more about it. So let’s have a closer look at it.

Why and when it happens

When you go to higher altitude the pressure of the air that surrounds you drops and there is less oxygen available. Your body will need time to adjust to the change in pressure. Any time you go above 8,000 feet, you can be at risk for altitude sickness. Age, sex or physical fitness have no bearing on your likelihood of getting altitude sickness. Just because you haven’t had it before doesn’t mean you won’t develop it in another expedition.
Symptoms of altitude sickness usually develop between 6-24 hours after reaching altitudes above 8,000 feet and can occur in different stages, all with different symptoms. Let’s start with the easier one;

Acute Mountain Sickness (AMS)

Its is the mildest form and it’s very common. This sickness affects close to half of all people who begin near to sea level and climb to 14,000 feet of elevation without scheduling enough rest time. It starts off with relatively mild symptoms, but if left untreated, it gets severe and could form into worse.
The symptoms can feel like a bad hangover. AMS is uncomfortable but not life treathening.
Symptoms of acute mountain sickness can include: 

  • Headache that is not relieved by over-the-counter pain medicine 
  • Nausea or vomiting 
  • Dizziness or lightheadedness 
  • Weakness or fatigue 
  • Difficulty sleeping 
  • Loss of appetite

Treating AMS:

No rocket science there. For very mild symptoms, a delay before further climbing may be enough to allow symptoms to go away. Nevertheless, all symptoms that develop at high altitude should be taken very seriously, since some altitude problems can develop into fatal illnesses such as HACE and HAPE. This becomes more serious, let’s look at the first one, HACE..

High Altitude Cerebral Edema (HACE)

This is considered by many experts to be an extreme form of acute mountain sickness. It usually develops after symptoms of AMS. A good thing to keep in mind is that the symptoms of this more severe altitude disease may not be noticed immediately because the illness can begin during the night. Because this low-oxygen injury affects the brain and thought process, a person with high-altitude cerebral edema may not understand that symptoms have become more severe until a traveling companion notices unusual behavior. 
Symptoms may include: 

  • Worsening headache and vomiting 
  • Walking with a staggering gait 
  • Confusion, forgetting things, misjudge risks
  • Exhaustion 
  • Visual hallucinations (seeing things that are not real) 
  • Changes in the ability to think 
  • Changes in normal behavior such as saying irrational things, or act euphoric without any reason(Some people start to undress because they think they feel hot while it’s actually -30 °C and risk to freeze to death)
  • Coma (in advanced cases)

Treating HACE:

Early detection is the key here! It isn’t very hard to detect HACE because the headache is really bad. Easy, normal activities such as zipping up your tent becomes the toughest thing you can think of. There are only three cures: Descent, descent and descent!!!
The only way out of HACE is to descend and lose as much altitude as soon as possible.
To help you do that, it’s smart to take a 500 mg dose of Diamox and around 4mg of Dex. This combination will stop your brain from swelling, giving you a window of a few hours to get yourself out of that altitude. 
Start your descent immediately. Try to get to an altitude around 8,000 feet as soon as you can.  
If you still cannot reach lower altitudes after six hours, you need to repeat the same dose and continue your descent, than don’t stop until you have reached around 8,000 ft. 
Once you have reached a lower altitude, you can lower your dosage of Dex to 2 mg, followed by 1 mg every 6 hours. Dex needs to be weaned away and cannot be stopped immediately. It’s life threatening and you need to seek medical attention right away!

And then there is also HAPE..

High Altitude Pulmonary Edema (HAPE)

This is the lung’s reaction to the altitude.
In contrast to HACE, You can miss the symptoms of HAPE if you’re not paying attention. There are two things you should be able to catch; cough and breathlessness. If you have HAPE, you’ll cough a very dry cough every now and then. Next, notice how you walk around the campsite. If your movements are laborious or your breathing heavy, it is a big warning shoutout. You may even notice yourself breathing heavy while sitting. Anything will tire you. There is always a feeling of fatigue. These are the initial stages of HAPE. It is during these stages that you must recognize HAPE and start treatment immediately. HAPE escalates very quickly into an advanced state and the following, dangerous and life threatening symptoms will occur;

  • Chest tightness or fullness 
  • Extreme fatigue 
  • Inability to catch your breath, even when resting 
  • Blue or gray lips and fingernails 
  • Coughing, which may produce pink frothy fluid 
  • Fever (temperature is above normal but is less than 101° Fahrenheit / 38,5°C) 
  • Noises when breathing, such as rattling or gurgling sounds

Treating HAPE:
To treat HAPE, you need Diamox and Nifedipine. (I’m writing this assuming that you may not have canned oxygen with you. Supplementary oxygen can also work wonders while having HAPE.)
When you have identified HAPE, take 500 mg of Diamox immediately (even if you have taken Diamox few hours earlier).  
Follow it up with 20 mg of Nifedipine. After this you should be able to breathe easier. 
Nifedipine eases out the pressure around your lungs, giving it some space to breathe.
With these two tablets in your system, start descending. You should try to lose as much altitude as possible over the next three hours. 
If you cannot reach around 8,000 ft even after six hours, repeat the dose of 500 mg Diamox and 20 mg Nifedipine and continue descending.
You’ll be tired, but it’s a matter of life and death. You need! to be at a lower altitude. 

The last one I like to point out is snow blindness

Arc Eye (Snow Blindness)

This is a painful eye condition caused by overexposure to ultraviolet (UV) light. When too much UV light hits the transparent outer layer of your eyes, called the cornea, it essentially gives your cornea a sunburn.
Snow blindness symptoms can be disorienting. They include:

  • Pain in your eyes
  • Headache
  • Blurred vision
  • Temporary loss of vision

Severe cold temperatures and dryness can also play a part, making snow blindness more common in higher elevations. But snow blindness is easily treatable, and your eyes will heal quickly once you remove yourself from the UV rays and rest your eyes.

Preventing altitude sickness

The best way to prevent altitude sickness is to travel to altitudes above 3,000m slowly.
It usually takes a few days for the body to get used to a change in altitude. You should also:

  • Avoid flying directly to areas of high altitude
  • If possible take 2-3 days to get used to high altitudes before going above 3,000m 
  • Avoid climbing more than 300-500m a day 
  • Have a rest day every 600-900m you go up, or every 3-4 days 
  • Make sure you’re drinking enough water 
  • Avoid alcohol 
  • Avoid strenuous exercise for the first 24 hours 
  • Eat a light but high calorie diet 
  • Avoid smoking 
  • Ask your doctor for advise on medication 

Do it yourself!

If you’re trekking always keep your trek leader or buddy informed of your symptoms.
Verbal communication of your symptoms is always most useful and effective. 
If you’re trekking solo or with a group of friends, then it’s imperative that all of you have this knowledge of treating altitude sickness. Make sure you are well informed before setting off.  If you like to have more information on mountain sickness, feel free to ask your questions in the comments below or send me an email with your schedule to; [email protected]

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