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Travelers are drawn to high altitude places in ever increasing number- Nepal alone now receives more than one hundred thousand trekkers from around the world every year. It can be easy to under-estimate the dangers of altitude illness; deaths from these conditions are all the more tragic because they are entirely preventable.
Mountain climbers, serious trekkers, romantics sauntering through the foothills of the Himalayas, native porters, skiers in North America and Europe, pilgrims to high altitude shrines, diplomats posted to La Paz or Lhasa, miners in South America, and Everest marathon runners have something in common: they are all exposed to the effects of high altitude, and may be at risk from a potentially fatal but eminently preventable problem: Acute Mountain Sickness, commonly referred to just as AMS.
AMS
consists of headache plus any one of the following symptoms in different degrees: nausea tiredness, sleeplessness or dizziness, occurring at altitudes of around 8000 ft or higher where pathophysiological changes due to lack of oxygen may manifest. Another term, "altitude illness', is also widely used - an umbrella term that includes the benign acute mountain sickness and its two life-threatening complications, water accumulation in the brain (high altitude cerebral edema,
HACE) or high altitude pulmonary edema (HAPE, water accumulation in the lungs). The latter two complications may follow AMS, especially when people continue to ascend in the face of increasing symptoms.
Preventing altitude illness
There is little doubt that altitude illness is one hundred percent a preventable illness. No one should die from it. For the past quarter of a century, one of the most important objectives of the Himalayan Rescue Association in Nepal has been to preach the gospel of prevention, from its aid posts in Pheriche (at around 14000ft in the Everest region) and Manang (at around 12000ft in the Annapurna region). There are four golden rules, plus some important general principles that should always be followed:
1. Understand and recognize the symptoms of AMS. Recent growth in adventure
travel has made trekking at high altitude simpler and more accessible, with the
result that more and more people who go trekking are ignorant of the basic facts
Of altitude illness.
2. Never ascend with obvious symptoms. Incredibly, people who have hired a horse or a yak to go up higher when they were too sick to walk. This
is courting disaster.
3. Descend if symptoms increase. It is amazing how striking and dramatic the relief
may be with even a couple of hundred feet of descent. People with signs of
HAPE or HACE have to descend.
4. Group members need to look out for one another (perhaps like the buddy
system in SCUBA diving). This rule gets broken with unfailing regularity every
trekking season in the Himalayas, because people are just too anxious to complete
their trek, even if one of their party members is ill. A trekker with AMS, HAPE
Or HACE will want nothing more than to be left alone, unbothered, at the same
Altitude- potentially a fatal option. There is no alternative but to bring the person
Down to a lower altitude accompanied by a friend who speaks the same language.
Avoiding of excessive exertion in the initial days
Excessive physical exertion at high altitude makes one more susceptible to AMS. It is important to take it easy at high altitude, especially in the initial days. People who are very fit for example marathon runners or those who carry very heavy backpacks seem more vulnerable to AMS than others, probably because they push themselves harder. I once looked after a trekker who felt he could not break his morning jogging sessions despite a strenuous trek day ahead, even at 4000m! The feeling of" man against nature" may be stronger in this fitter group.
Avoiding alcohol
Jim, a rock star, decided to "whoop it up" with four bottles of beer, on arrival at 3500meters in the Everest region. He felt ill with severe AMS and needed to be helicoptered out two days later. He had been warned not to drink alcohol on the trek, especially while ascending. Alcohol may dehydrate the trekker but more importantly it depresses breathing or ventilation. Sleeping pills may have a similar effect.
Maintaining adequate hydration
Adequate amounts of fluid (about 3 liters a day) are necessary in the mountains:- dehydration mimics altitude sickness and may even predispose to it. On the other hand excessive water drinking should also be avoided as this may lead to electrolyte imbalances.
Maintaining a high carbohydrate diet
A high carbohydrate diet aids ventilation and efficient use of oxygen. The good news is that - in many high altitude places - there is not much alternative: rice, potatoes and other strach-laden foodstuffs tend to be the staple, with not much else to choose from.
Conclusion
Most of the problems of high altitude are totally preventable. With careful precautions, your experience in the mountains should be safe and rewarding.
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