Altitude Sickness

Altitude sickness, if not taken seriously, could have severe health consequences. You need to get yourself acclimatized to the altitude in order to avoid altitude sickness.

Ramesh Adhikari and his client James McFadden from Ireland were trekking around the Annapurna Circuit. As McFadden was short on time, he asked Adhikari if his trek could start from upper-Manang located at 3550mm. Not wanting to let him down, Adhikari said it was fine and the duo got a jeep from Besi Sahar to Manang and stared their trek first to Tilicho Lake after which they would climb up the Throng La. 

On the third day of the trek at Tlicho base camp, both Adhikari and McFadden started to feel dizzy. A heavy breathing McFadden collapsed while having his dinner while Adhikari started having nausea. The locals quickly rushed both Adhikari and McFadden back to upper-Manang where both were attended by a doctor. “They were suffering from altitude sickness,” shares Dr Dinesh Gurung, who was stationed at a health post in Manang.  He adds that if the duo had not been rushed back to Manang on time, both would have died. 

What is high altitude sickness?
Emergency physician and Head of Department of Emergency Medicine at Nepal Mediciti Hospital Dr Sanjay Karki says that altitude sickness is a group of symptoms that can strike anyone who walks or climbs to a higher elevation.”These can occur if you reach an altitude quicker than your body adapts. These can happen to anyone because at that altitude the oxygen level is lower, which causes Hypoxia,” adds Dr Karki. He added that if the body isn’t given time to adjust to the change in pressure, people will keep on suffering from this.

Types
So what are the types of altitude sickness? Dr Karki shares that there are three. 

“The first one is Acute Mountain Sickness (AMS) which is the most common. It is the mildest form which happens to a lot of people trekking in Nepal,” shares Dr Karki. 
The second type according to him is High Altitude Pulmonary Edema (HAPE). “This one is a bit more dangerous. This is when the person builds up fluid in his lungs. This can be very dangerous and even life threatening.”

The third one he shares is High Altitude Cerebral Edema (HACE) which is the most severe form of altitude sickness and happens when there’s fluid in the brain. “If you don’t get medical attention right away, there are chances that you won’t survive.”
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Symptoms
Symptoms for AMS include headache, dizziness, nausea, vomiting, fatigue, insomnia, and heavy breathing. 

“These symptoms usually come on within 12 to 24 hours of reaching a higher elevation and then get better within a day or two as your body adjusts to the change in altitude.

The symptoms for HAPE and HACE are different from those of AMS. “Those who have HAPE and HACE will be confused most of the time. They will be also be unable to walk and will short of breath even when resting,” adds Dr Karki. 

Who Gets It?
According to Himalayan Medic Rajesh Lama, anyone can develop altitude sickness, no matter how fit, young, or healthy one is. 

“It depends on how fit you are. But it mostly happens to are unfit. Which is why I keep telling people to climb altitudes slowly,” adds Lama.  

Subin Pradhan, who had been to higher altitude than the Everest Base Camp, suffered from both HAPE and HACE while trekking in the region. Pradhan, who is also a photographer, started to get dizzy while he was at Lobuche on his way back from Gorek Shep.  Initially he felt he was just tired, but after measuring his oxygen at a lodge in Lobuche, it was clear that Pradhan was suffering from mountain sickness. 

“My oxygen level was 45,” recalls Pradhan. “I don’t remember much of what happened after that but when I woke up I was in Kathmandu. Doctors said I was airlifted to Kathmandu after I showed symptoms of both HAPE and HACE. I only got out of the hospital after nearly two week out of which I spent three days in a ventilator and a week in the ICU.”

He shares that he never felt he would be getting AMS but has now realised that it can affect anyone. 

Lama further adds that the risk of getting altitude sickness also depends on where you live and the altitude there, your age (young people are more likely to get it), and whether you’ve had altitude sickness before.

How to avoid
All doctors and rescuers share that the only way to stop this is to climb altitudes slowly. Dr Karki shares that having altitude medicines is also recommended. 

Tour operator Deepak Adhikari shares that they have asked everyone going to Mukninath to take medicines before going there. “We’ve asked all pilgrims, especially those who come from India and lower parts of Nepal to take medicines. If you don’t, you create the risk of AMS which will affect you in a negative way,” adds Adhikari.

Dr Karki further adds that another way to negate altitude sickness is to drop down around 500 metres. “Dropping down altitude helps a lot. That’s one way it can be controlled. That doesn’t guarantee you will get better, but it will help a lot. But when you do come down, you need to go see a doctor as soon as possible,” adds Dr Karki.  

Acclimatising is the best way
Experts say that the best way you can lower the chance of getting altitude sickness is through acclimatization. “That means you let your body slowly get used to the changes in air pressure as you travel to higher elevations,” adds Lama. He adds that one needs to go up gradually. He recommends sleeping and spending as much time above 3000 metres as possible. “A couple of day sleep above 3500 m is recommended but most don’t do that,” adds Lama who wants Nepalis who trek to be careful. “People get on their bikes and go up to upper-Manang or fly on a helicopter straight to Dingboche then start their trek. These are the one who are prone to AMS. I want to tell them not to do that. You might be fine the first time but your body will not adapt to altitude the same way it does the first time.”