Altitude Sickness

One of the prime risk associated with the high-altitude tours, trips, or treks around the world is altitude sickness which is also generally known as the Acute Mountain Sickness/AMS.

This condition arises when our bodies struggle to adjust to the reduced level of oxygen and lower atmospheric pressure found at high elevations. Generally, the symptoms start to appear within hours of reaching the mountains or highlands or high plateaus or after an overnight stay.

In severe or chronic cases, altitude sickness can lead to fluid leakage from blood vessels which can cause the accumulation of these fluids in the lungs and brain known as pulmonary and cerebral edema, respectively.

Usually, the altitude sickness is uncommon below 2500 m and nearly 75% of unacclimatized travelers at 3,000 m and above start to experience its effects.

The risk increases more with the rapid speedy ascent. Not only mountaineers but also common tourists and trekkers living in lowlands arriving in high-altitude cities or villages like Lhasa in Tibet, Lukla in Nepal, or Paro in Bhutan are also susceptible to altitude sickness.

At what elevation does acute mountain sickness (AMS) generally occur?

Generally, most people start to notice the occurrence of AMS at around 2500 m. However, it can vary based on how well you acclimatize, your overall health, and your specific risk factors.

Since everyone reacts differently, it is quite difficult to say exactly at which altitude the AMS begins to appear. Some may even start to feel its effects at 2000 meters.

Risk Factors of Altitude Sickness

Although we cannot precisely say who suffers from altitude sickness the most but the people at the highest risk for altitude sickness are those who:

• Reside at a very low altitude area or at sea level
• Have a history of suffering from AMS
• ascend to higher elevation too fast
• Have pre-existing conditions of lung, nervous system, heart, and kidney
• Suffering from anemia, chronic obstructive pulmonary disease, and pregnant women

Most Common Symptoms of AMS

Usually, the symptoms of AMS start to arise within 5 to 24 hours after reaching an elevation over 2500 m which can present as:

• An overall feeling of discomfort
• Extreme tiredness
• Reduced appetite
• Headaches
• Sensations of dizziness and vertigo
• Difficulty breathing
• Sleep disturbances
• Increased heart rate

Please note that you may feel these discomforts more at night and become much more intense with the rising altitude. At the moderate elevation of 2500 to 3000 m, only the minor symptoms will occur such as sleep trouble, appetite loss, breathlessness and fatigue which soon disappears within few hours to a day.

Is Altitude Sickness Dangerous?

Altitude sickness if timely recognized and treated can only cause slight discomforts. However, if left ignored, and continues to climb rapidly, then AMS can lead to some serious conditions that can be fatal sometimes such as:

HAPE (High Altitude Pulmonary Edema)

It is the fluid collection in the lungs that occurs due to low atmospheric conditions in high-altitude places. It can be life-threatening if left untreated and can be recognized through the following symptoms:

• Blue discoloration of lips, nails, hands, feet, and skin called the Cyanosis
• Trouble breathing even when resting
• A sensation of tightness in the chest
• Chronic cough with blood-stained sputum
• Extreme fatigue and weakness

HACE (High Altitude Cerebral Edema)

It is a swelling of the brain occurring due to less supply of oxygen common in high altitudes. Its symptoms include:

• Headaches
• Weakness
• General feeling of unwellness
• Loss of coordination
• Confusion and psychotic symptoms
• Hallucinations

Both these conditions can be treated with prompt transfer to a lower altitude, oxygen administration, and hospitalization.

Prevention of AMS

If you wish to have a completely enjoyable experience during your trip and tour, then you should take adequate measures to prevent the occurrence of AMS which can be done in the following ways:

• Gradually ascend after 2500 m over several days maintaining a slow pace throughout the journey
• Follow the rule of climbing high and sleeping low
• Following the acclimatization schedule as planned in the travel program and not ignoring the acclimating trips and walks
• Take enough rest, especially at night
• Staying well-hydrated
• Avoidance of smoking and alcohol
• No strenuous activities
• A light diet rich in carbohydrate and low in fat

Treatment of Altitude Sickness

If the symptoms of AMS manifest, it should be treated in the following ways:

• Stop the climb and take a break, rest where you are
• Do not continue the journey for 1 to 2 days and wait for the symptoms to disappear
• Take the medication for headache
• Increase water or fluid intake, consume ginger lemon honey tea, and add garlic to your diet
• Do not do any physical activity and prioritize rest
• In case of no improvement, descend to a lower elevation by at least 500 m
• Team members be vigilant and attentive to the condition of the member suffering from AMS

Medicine to be used for Altitude Sickness

The most effective medicine for AMS is Diamox (acetazolamide) which is a diuretic drug and available readily in Kathmandu. But we do suggest you consult and take it only after his prescription as this drug is contraindicated in a few health conditions and may also cause a few side effects such as:

• Nausea and vomiting
• Headache
• Diarrhea
• Acidity
• Tingling sensation

Diamox can be taken one or two days before the start of the trip or the climb to high altitude. Please remember, it is a diuretic medicine so you need to consume as much water as you can and urinate frequently.

There are some myths that say Diamox just masks the AMS symptoms which is not true. In fact, the drug actually helps in quick adaptation to the high elevation air.

Health and Fitness

Any trekking trip in Nepal, Bhutan, or Tibet needs adequate health, and physical condition which will help you to enjoy your journey without any risks.

Regardless of the type or difficulty level of the trek, you will face a certain level of walking which is a physical activity that must be faced with the right preparation which is necessary for all – a beginner to an experienced hiker.

Here are some physical workouts and routines for you that will help you remain fit and take on any adventure you like:

• Improving Cardiovascular Endurance through aerobic exercise

Cardiovascular endurance is most important for any trekking trip be it in Nepal, Bhutan, or Tibet. If your heart health is good, you can endure several hours of long multi-day walking without any difficulties.

To improve your heart health, you should focus on aerobic routines such as rowing, swimming, cycling, and walking which put intense demands on your lungs and heart.

Schedule these activities three times a week for 45 minutes to an hour. Start slowly and gradually progress the intensity. If available, you can also incorporate the mountain trails where you can run or walk that imitate the condition of the high-altitude trek.

You should also choose to walk frequently with a lightweight in backpack so your body can get used to the long hikes with load on your back.

• Build the Muscle Strength

Along with endurance, muscle strength is also significant for tackling the hard rugged, and uneven terrain along with steep inclines of mountains and hills.

The most pressurized muscle will be your legs along with the back and core muscles. To prepare for this, you can do exercises such as step-ups, lunges, squats, push-ups, pull-ups, and planks that will help in improving your posture, and maintaining stability while trekking in the mountains.

• Try to train with real equipment of hiking

When trekking, the light backpack and hiking shoes are the integral part. So incorporate these when you are carrying out your fitness regime. Load your backpack with water bottle, clothes, or some books to weight it at least 7 to 10 kg.

This way, you will get used to the weight on your back or your shoulder that will also stabilize muscles of your back and legs.likewise, walking shoes of high quality with good cushioning and grip is also very essential.

Once you got what you need, wear it when you go for a walk which will reduce the risk of blisters and discomfort while you are actually take on the hiking trails.

• Start with the Preparatory Hike

You cannot mirror the effects of altitude in your daily workout routine so it is best that you go for shorter or multi day hikes in the mountains of your country.

If possible, make your hike to the elevation of at least 3000 m so your body can get accustomed to the oxygen deficiency in the high air thus reducing the chance of AMS when you are in the actual mountains.

• Integrate Breathing Exercises

When preparing for a high-altitude trek, learning proper breathing techniques are also essential as the air at high elevations has less oxygen that makes each breath less effective.

So integrate the breathing exercises as well which can enhance the oxygen utilization of your body. The most effective technique will be diaphragmatic breathing where you expand your abdomen, take deep breathe and then exhale slowly.

Likewise, Pilates and yoga can also help in enhancing your lung capacity and prepare you for the challenges of high-altitude conditions.

• Plan Adequate Rest

Continual exercise is also not beneficial for your body as it also needs time to rest and repair the muscles after the intense workouts. Therefore you should also focus on taking adequate rests and recover from your regular exorcise routine.

Make sure to plan at least one full rest day each week staying away from any heavy activities. Also, after each workout session, do not forget to stretch and stay hydrated.

Stretching will ease muscle tension, enhance flexibility, and help prevent soreness. You can go for a sauna, massages, or hot bath for the complete recovery of your sore muscles.

• Plan a Balanced Diet

Just like physical preparation, you should also focus on maintaining a balanced diet a few months before departing for your trek which will strengthen your health and help in the recovery process.

Integrate meat and dairy products for protein, vegetables, legumes, and whole grains for the carbohydrates and eat olive oil, nuts and avocados for the healthy fat.

Also try to take enough iron important for oxygen supply in blood, calcium for bone health and magnesium for the prevention of cramps. Do not neglect the intake of enough water and during the high physical exertion, drink electrolyte drinks.

• Improve your Mental Resilience

If physical health and diet are important, then mental resilience for any  trekking trip is more than essential. The mountains are notorious for the unexpected adverse conditions taking place at any moment such as intense snowfall, winds, or even a sense of remoteness and seclusion.

Thus, building and enhancing the mental health will help you preserve your calmness and spirits even in any conflicting situations. One of the effective exercise for building your mental health will be visualization exercise.

Try to imagine yourself in the mountains and Himalayas, their trails, slopes and terrain. You can also do meditation for staying calm during difficult times.

Schedule a few minutes of meditation everyday in the quiet room and develop the ability of peacefulness and mindfulness necessary for the mental well being during the multi day trek and trip.