Thursday, November 21, 2013

High Altitude Sickness

High Altitude Sickness

Trekking in Nepal is one of the most sought after activities for foreign visitors who love to visit this Himalayan country which houses some of the world's highest peaks and Mount Everest the highest in the world. The unbroken high terrain beauty is the attraction to break one from the monotony of modern life. With all its mesmerizing effects, trekking in high altitude can have some repercussion, known by some as High Altitude Sickness (AMS). Here in this post, we at Green Trekking Lotus will highlight you about it.

This sickness goes by many different terms in various places as they are known as Acute Mountain Sickness, Altitude Illness, Hypobaropathy, "the Altitude Bends" or Soroche, is a pathological effect of high terrain lands when humans are exposed to low levels of oxygen found there. This high terrain is lands above 2,400 metres above sea levels. The symptoms would be a collection unspecified illnesses like flu, carbon monoxide poisoning or when you had too much to drink the previous night.

It does not mean all could be affected by it, but those who are should not progress on, but get treatment as soon as possible. Going further can only result in acute mountain sickness to become Pulmonary Edema (HAPE) or High Altitude Cerebral Edema (HACE), which can prove fatal eventually. Monge's disease which is also called Chronic Mountain Sickness  is a different issue as it may occur after being exposed for a long time to this high altitude.

What causes high altitude sickness? Basically, understanding the earth's atmosphere would gives us an understanding of it. Oxygen which is a necessity for the survival of all animals and for its release of energy from the body to do its activities is in a constant level with other gases of the atmosphere which is 21% till an altitude of 21,000 metres above sea level. Much higher than the highest place on our planet - Mount Everest. So this cannot be the cause of AMS. It is as the atmosphere goes higher from sea level the density of the atmospheric level decreases and so does the level of oxygen. This gives us less oxygen with the other neutral gases, causing various symptoms if our body is not used to that density of oxygen intake.

If we are people living at a comfortable level of air density and as we ascend quickly the body needs the same level of oxygen that we are used to and when it gets less because of the density, the body begins to function differently.

The best remedy is to stop completely and get used to that level of air density for a few days which is known as acclimatization which is a kind of adaption to the air density level.

Different altitudes have different forms of this sickness. They can be differentiated on the basis of their altitude such as High Altitude, Very High Altitude and Extreme Altitude. High Altitude is the level between 1,500 to 3,500 metres above sea level and due to rapid ascend in this region, High Altitude sickness is more prevalent. In the next one, is the severe form of the sickness and the last but extreme form can result in death and also here you would find no settlement and few people dare to venture forth due to it.

High Altitude Sickness cannot be diagnosed by one symptom as it is different in different people. One thing for sure is that any healthy person could show the symptom above 2,000 metre within a period of 6 to 10 hours after ascend and would usually reduce after 1 to 2 days. The common symptoms would include headache, fatigue, stomach illness, dizziness and not being able to get sleep. In this case exertion just makes it worse.

There are either primary symptoms and severe symptoms. The primary symptoms are lack of appetite, nausea or vomiting, fatigue or weakness, dizziness or lightheadedness, Insomnia, pins and needles, shortness of breath upon exertion, nose-bleeding, persistent rapid pulse, drowsiness, excessive flatulence, general malaise, and peripheral edema (swelling of hands, feet and face). The severe symptoms which can be broken into two categories, and life-threatening, are  Pulmonary edema (fluid in the lungs). The symptoms of which are symptoms similar to bronchitis, persistent dry cough, fever and shortness of breath even while resting.

Cerebral edema  (swelling of the brain) are headache which does not respond to analgesics, unsteady gait, gradual loss of consciousness, increased nausea and retinal hemorrhage.

The question which might arise is how to prevent AMS? While trekking in Nepal, it is best to ascend slowly and not to ski or hike in the first 24 hours. It is also best to avoid alcohol as it has a tendency of dehydrating the body and if you have also fallen into the trap of the sickness, alcohol will further exacerbates things.

The next thing one should acclimatize to the altitude to allow the body to adjust to the level of oxygen in the air. This is making periodic stops for a day or two on your hike. Besides this, there are medical treatments.

The drug, Acetazolamide (Diamox) can be of some help for people to sleep make sleep possible, if they have to make quick ascends and is only good if started early in time but Everest Base Camp centre warns against it use. On the other hand, the Centre for Disease Control and Prevention says a dose of 125mg should be taken every 12 hours. CDC suggests that Dexamethasone be used to treat AMS and HACE when going down, while Nifedipine could help in HAPE. There is another drug which might help in altitude sickness called Sumatriptan.

There is also a promising new drug in the making called myo-inositol-trispyrophosphate that is said to help in the increase of oxygen let out by hemoglobin. As with all drugs it is advised against their use. Using of oxygen tents and bottle mask can make a tremendous difference.

Finally, while on a trek in Nepal, it is advisable to adhere to your guide as they know the terrain and the effect of things going wrong. They are the best help as is natural of any such person; he only believes in your welfare. This actually makes all the difference between you and Altitude Mountain Sickness.

Happy trekking in the versatile and pulchritude country of Nepal.  

Steven William Pitts

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