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ALTITUDE SICKNESS

Altitude illnesses result from insufficient oxygen in the blood due to decreased barometric pressure at high altitudes. Persons with well-controlled blood pressure and heart problems and normal pregnancies seem to do just fine at high altitudes but must exercise some caution.

Hypoxia
Hypoxia is a pathological condition in which the body as a whole (generalised hypoxia) or region of the body (tissue hypoxia) is deprived of adequate oxygen supply. Hypoxia in which there is complete deprivation of oxygen supply, is referred to as anoxia.

In the case of altitude sickness (AMS), hypoxia develops gradually, the symptoms include headaches, fatigue, shortness of breath, a feeling of euphoria and nausea. In severe hypoxia, or hypoxia of very rapid onset, changes in levels of consciousness, seizures, coma and death occur. Severe hypoxia induces a blue discolouration of the skin, called cyanosis (haemoglobin is a darker red when it is not bound to oxygen (deoxy-haemoglobin), as opposed to the rich red colour that it has when bound to oxygen (oxy-haemoglobin), and when seen through the skin it has an increased tendency to reflect blue light back to the eye). In cases where the oxygen is displaced by another molecule, such as carbon monoxide, the skin may be 'cherry red' instead of cyanotic

Generalised hypoxia occurs in healthy people when they ascend to high altitude, where it causes altitude sickness and the potentially fatal complications of altitude sickness, High Altitude Pulmonary Oedema (HAPE) and High Altitude Cerebral Oedema (HACE).

The 3 factors that determine whether you acclimatize well or become ill are
1.    The Altitude
2.    The rate of ascent to that altitude, and
3.    Your individual susceptibility to altitude illness. Men and women are equally susceptible to acute mountain sickness and children are somewhat more susceptible. Older people seem to do just fine at such altitudes.
What is difficult for young and fit persons to understand is that superior physical conditioning grants absolutely no immunity from altitude illness.

SIGNS AND SYMPTOMS OF ACUTE MOUNTAIN SICKNESS

MILD/MODERATE Acute Mountain Sickness (AMS)
Headache
Nausea and possible vomiting
Loss of appetite
Mild lassitude, fatigue or weakness at rest
Insomnia
Unusual shortness of breath on exercise

Treatment
Do not ascend till symptoms go away
Maintain adequate hydration
Light Exercise
Acetazolamide (Diamox)
Pain medication for headaches
If symptoms do not go down, descend!
Monitor health

SEVERE Acute Mountain Sickness
Ataxia is a sure sign when severe AMS sets in
Shortness of breath at rest
Pale skin
Extreme fatigue
Increased Heart and Respiratory Rate at rest
Gurgling sound in lungs (Early Severe AMS)
Productive Cough (Late Severe AMS)
Severe Headaches not relieved by medication
Seizures
Disorientation, irritation, combative attitude, unconsciousness

Treatment
Descend!
Oxygen and Gamow bags
Dexamethasone
Evacuation

PREVENTION of Acute Mountain Sickness

The best way of preventing altitude illness is by allowing the body adequate time to acclimatize.
The reason we build extra days at various locations on our High Altitude trips is for acclimatization. Short acclimatization walks at various locations are mandatory for preparing well for the trek. Once acclimatized at such altitude, we foresee few problems on the trail.

Acclimatization days before or on the trail are not leisure or extra days. Kindly do not request to shorten the itinerary by asking to reduce these days.

Everyone’s physiology is different and there is nothing to be ashamed of if you acclimatize more slowly than others. Altitude is the great equalizer. Persons who are out of shape and not very athletic at sea level “may” acclimatize well and surpass marathon runners who may be too incapacitated to move on the trail.

When rapid ascents cannot be avoided, medications are available that help acclimatize fast. Diamox, a sulpha drug causes the blood to be slightly acidic, which stimulates breathing. It is also a mild diuretic. It hastens the natural process of acclimatization. Other drugs that seem to have a considerable affect is Coca200 and homeopathy drug. Garlic seems to work well with many locals as a great prophylactic or as a treatment but seems unreliable. More drugs are being

Adequate hydration is also helpful in preventing altitude sickness. The body loses tremendous amounts of fluid from the lungs and the skin in the high and dry environment. You must drink enough to maintain a clear and sufficient quantity of urine output. It is recommended at high altitude, more than 70% of your diet should be carbohydrates.

It’s also best to engage in some moderate activity during acclimatization rather than just lie around. Exercise stimulates circulation and respiration and help the body adapt.

Avoid alcohol and sedatives. The typical symptoms of Acute Mountain sickness are exactly similar to alcohol hangover. One reason alcohol should be avoided at high altitudes is that it can blur the distinction between AMS and a hangover. Alcohol also aggravates the effects of altitude and can actually impair acclimatization and make people more ill.

 
HAPE & HACE or HAPO & HACO

High Altitude Pulmonary Edema (HAPE) - HAPE is considered to be caused by a leak in the alveolar capillary membrane. It is a non-cardiogenic form of pulmonary oedema. Some of the possible causes may include:
  • Pulmonary arterial vasoconstriction
  • Fluid retention
  • Rapid climb
  • Physical exertion at high altitude, and
  • Cold temperatures
High Altitude Pulmonary Oedema (HAPE) - Symptoms
  • Hypoxia,
  • Shortness of breath,
  • Fatigue,
  • Tachycardia,
  • Tachypnea, and
  • Central cyanosis.

High Altitude Pulmonary Oedema (HAPE) - Treatment
  • Calcium channel blockers (Nifedipine),
  • Acetazolamide (Diamox)
  • Dexamethasone (in extreme cases)
  • Corticosteroids
  • Complete Rest
  • Oxygen therapy
  • Immediate evacuation to lower altitudes, and
  • Use of a Hyperbaric Chamber – Gamow bag
     
High Altitude Pulmonary Oedema (HAPE) - Prognosis
  • If HAPE is not treated immediately, it could prove to be fatal for most patients. If the oedema fluid is drained off promptly, however, HAPE does not seem leave the patients with any long term complications.

High Altitude Pulmonary Oedema (HAPE) - Prevention
  • In order to reduce one's chances of developing HAPE, there are simple precautionary steps that one can take, including: climbing slowly, allowing one's body additional time to get used to high altitude environment, and not drinking any alcohol.
  • High altitude pulmonary oedema (HAPE) is a life-threatening form of non-cardiogenic pulmonary oedema that occurs in otherwise healthy mountaineers at altitudes above 2,500 meters (8,202 ft). Some cases have however been reported also at lower altitudes (between 1500 and 2500 m in highly vulnerable subjects), although what makes some people susceptible to HAPE is not currently known. HAPE remains the major cause of death related to high altitude exposure with a high mortality in absence of emergency treatment.

High Altitude Cerebral Oedema (or HACE) is a severe (frequently fatal) form of altitude sickness. HACE is the result of swelling of brain tissue from fluid leakage. Symptoms can include headache, loss of coordination (ataxia), weakness, and decreasing levels of consciousness including disorientation, loss of memory, hallucinations, irrational behavior and coma. It generally occurs after a week or more at high altitude, but symptoms of mild HACE can sometimes show up even after few hours at higher altitudes. Severe instances can lead to death if not treated quickly. Immediate descent is a necessary life-saving measure (2,000 - 4,000 feet). There are some medications (e.g. dexamethasone) that may be prescribed for treatment in the field, but these require proper medical training in their use. Anyone suffering from HACE must be evacuated to a medical facility for proper follow-up treatment. A Gamow bag can sometimes be used to stabilize the sufferer before transport or descending.

 
OTHER ALTITUDE RELATED AILMENTS

Common Cold
Take every care that you do not get common cold when you hit the trail you will need all your lung capacity to breathe in maximum amount of air and any blockage could be an irritant.

Hypothermia
Sudden change in temperature and exposure to severe cold especially while crossing a high, cold windy pass may cause hypothermia. It occurs when the body is unable to contain body heat and one feels extremely exhausted, cold, confused and unable to co-ordinate limbs.
Immediate treatment is to be undertaken to avoid further deterioration in the condition. Remove the patient to a shelter, remove wet clothes and get the patient into a sleeping bag. Hot liquids, like coffee, should be given to drink. Alcohol should be avoided.

Chill Blains
A painful swelling of the hand, feet or ear by excessive exposure to cold and by poor circulation. These can result from intermittent exposure to high humidity and low temperature without causing the tissue to freeze. Keep the affected limb wrapped in warm clothing or in a sleeping bag.

Frost Bite
Frostbite is the medical condition whereby damage is caused to skin and other tissues due to extreme cold. At or below 0º C (32ºF), blood vessels close to the skin start to narrow (constrict). This helps to preserve core body temperature. In extreme cold or when the body is exposed to cold for long periods, this protective strategy can reduce blood flow in some areas of the body to dangerously low levels. The areas where this occurs will freeze over. The combination of cold temperature and poor blood flow can cause severe tissue injury by freezing the tissue. Frostbite is most likely to happen in body parts farthest from the heart, and those with a lot of surface area exposed to cold. The initial stages of frostbite are sometimes called "frostnip". Mountains or high altitudes with snow are most dangerous to cause frostbite. If frostbite is not treated immediately then the damage and the frostbite become permanent. Nerve damage will occur because oxygen doesn't get to the areas. Frostbitten areas will turn discolored, purplish at first, and soon turn black. After a while nerve damage becomes so great that feeling is lost in the frostbitten areas. Blisters will also occur. If feeling is lost in the damaged area, checking it for cuts and breaks in the skin is vital. Infected open skin can lead to gangrene and amputation may be needed.
To treat frostbite, move the victim to a warm location and seek medical help. Soak frostbitten areas in warm (not hot) water, or, if in wilderness, warm by contact with the skin of a non-frostbitten person. Continue until the victim has regained sensation and movement in the afflicted region; this often follows great pain as the nerves thaw. Never rub, slap or shake the stricken region as ice crystals in the frostbitten skin will damage surrounding tissue. Follow the treatment with a period of constant warmth: refreezing following thawing exacerbates the damage.
Factors that contribute to frostbite include extreme cold, wet clothes, wind chill, and poor circulation. This can be caused by tight clothing or boots, cramped positions, fatigue, certain medications, smoking, alcohol use, or diseases that affect the blood vessels, such as diabetes.
If caught in a severe snowstorm, one should find shelter early or increase physical activity to maintain body warmth.
People susceptible to frostbite should wear woolen socks/gloves/caps in extreme cold. For frostbite in the feet, keeping feet in warm saline water will provide relief. Diabetes can also sometimes lead to frostbite, so diabetics should take precautions as to avoid trips to ice-cold places.

Immersion Foot

When a person’s foot is exposed to wet and cool conditions for long but not freezing conditions, it leads to immersion foot. Usually the feet will get pale, get a tingling sensation or may lack pulse. This injury seems to affect the nerves and the muscles due to reduced supply of oxygen than to the blood vessels. Immersion foot can bet treated by gradually re-warming the feet in a warm water bath.

Heat Exhaustion
Prolonged exertion on a hot day can cause heat exhaustion. It happens due to reduction in water and salt in the body rather than increased body temperature. Lots of water is lost due to excessive sweating. The symptoms are dizziness, headache, vomiting and loss of appetite. Transfer the patient to cool environment and increase intake of salt and fluids.

Heat Stroke
This is caused from exposure to high temperature over a considerable period. Heat exhaustion can lead to heat stroke. Usually it set sin suddenly without warnings except reduction in sweating. The body temperature rises over 41 degrees C. The body must be cooled as rapidly as possible. Total immersion in cold water may be undertaken or the victim can be covered with cold towels. Stop cooling when the temperature comes down to about 39 Degrees C.

Snow Blindness
Snow blindness is a burn of the cornea caused by excessive exposure to UV light. It is entirely preventable by wearing adequate glasses or goggles that filter 90% of UV-B radiation and reduce exposure from sides too.

UV light penetration increases by 5% for every 1000 Feet gain in altitude, hence there is 75% more UV penetration at 15000 feet than there is at sea level. Even on cloudy days the exposure is enough to cause damage.

Snow blindness is extremely painful and can last for 48 hours or more. If snow blindness occurs, patch the eyes to prevent extreme irritation caused by the eyelids moving across the injured cornea. Cold compression should be applied and pain pills administered.


THERE WILL BE MORE TO READ ABOUT ALTITUDE SICKNESS WHILE WE GET THERE, AND IT’S IMPORTANT FOR EVERYONE TO KNOW AND LEARN MORE.

PLEASE REPORT ANY SYMPTOMS OR SIGNS OF ALTITUDE SICKNESS
SO THAT THINGS DO NOT GET OUT OF HAND!

Sources
1. www.wikipedia.org
2. “Trekking in Pakistan and India” by Hugh Swift
3. “Mountaineering – The freedom of the Hills” - The Mountaineers

For detailed study of Altitude Sickness kindly refer:

1.    http://www.ismmed.org/np_altitude_tutorial.htm#AMS
2.    http://www.emedicinehealth.com/mountain_sickness/article_em.htm

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