Altitude Sickness by Dr. Rajiv Narula
This column is being written in the beautiful Alpine City of Innsbruck, Austria, where I am attending a conference of the International Society of Travel Medicine. There are approximately 1700 attendees from 70 countries. There are various presentations ranging from jet lag to malaria to yellow fever to road safety etc. the common link is diseases or conditions that are encountered by travelers, and how best to prevent them. I will discuss the issue of altitude sickness, as it is becoming a common illness encountered by travelers who are finding themselves traveling to regions of the world, which were traveled only by a few people years ago.
Dr. Oswald Oelz a physician from Switzerland presented a talk on “High Altitude Tourism: Risks and benefits for the host countries”, Dr. Olez climbed Mount Everest several years ago, and was in Nepal recently . He showed several slides on the trek to the roof of the world. What was amazing was the number of tents that were present at base camp – perhaps 500 of them, years ago there was maybe one, these tents may have a few people in each tent. Interestingly one has to wait on line to get to the summit. What was once an opportunity reserved for the privileged few is now becoming a routine travel stop , there are several travel companies which sell packages to the top of the world! Just last week Everest was scaled by a blind person.
Planning a trip like this costs thousands of dollars and requires the participants to be physically and mentally fit to accomplish this task. David Shilm MD ran the CIWIC medical clinic at the base camp for several years until he returned to the US in 1998. According to him “Altitude sickness or Acute Mountain Sickness is a preventable illness” . AMS can occur within 1 to 6 hours of being at high altitude. The higher one goes the less oxygen there is. High altitude would be considered at heights between 5000 and 11, 500 feet , at this level there is decreased exercise performance. Very high altitude would be considered at heights between 11,500 – 18,000 ft, and extreme altitude would be considered above 18,000 feet.
Symptoms of AMS can be classified into early ones: headache, nausea, irritability, loss of appetite, insomnia, fatigue, wanting to be left alone. Most importantly, these common symptoms need to be recognized and accepted by the suffering individual and by others in his/her party. The therapy is immediate descent to safer levels. One must NEVER ascend to higher heights with any of these symptoms, as there can be a fatal outcome with in 12- 16 hours. David Shlim, recommended ascending 1000 ft per day on an average. An interesting point that he made was that if you flew a person to the peak of Mount Everest he would stay conscious for 30 to 60 seconds and would die in half an hour. Life threatening complications of AMS include HACE , or High Altitude Cerebral Edema and HAPE, High Altitude Pulmonary Edema. These can lead to coma and death within 8-24 hours after the onset of changes in mental status.
Prevention of AMS, acclimatization for 2-3 nights at 8000- 10000 ft for 2-3 nights is recommended. For maximal performance you need to spend 2-3 weeks at the same height. Although with busy schedules these days this maybe difficult to do, it would make sense to limit one’s ambitions. There are medications that one can take to help one’s body to adapt to high altitudes. One of these is Diamox, which can be used for people who have a history of AMS or are flying to places like La Paz in Bolivia, which is above 10,000 ft. Other medications are beyond the realm of this column and need to be addressed with your travel medicine specialist prior to departure. In conclusion, go out there and enjoy the world, but remember you cannot rush or be rushed. So when you have a headache or feel irritable while climbing, it is AMS, despite what anyone says. So take Tylenol and descend!