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Altitude Sickness


High-Altitude Problems

Mt Kilimanjaro is one of the world’s most climbable high altitude mountains in the world. You won’t need technical mountaineering skills, but you should keep in your mind that climbing Mt Kilimanjaro is about mental and physical preparedness. Being physically prepared for the trek should begin as early as possible. As your fitness level increases, your mental confidence will also increase. The combination will make a world of difference to your enjoyment of the climb and your sense of achievement.

The main concern when climbing Kilimanjaro is altitude sickness. This condition is an acid-alkali imbalance in the blood and body fluids which affects climbers indiscriminately. Whatever your level of fitness, it may not reduce your chances of getting some degree of altitude sickness because almost everyone does - mild headache, nausea, tiredness, loss of appetite are common symptoms.

For your safety you should definitely not be climbing at altitude against your doctor’s advice. You should not climb at altitude if you have sickle cell disease, recurrent pneumothorax (burst lung), pregnant (above 3,500m), a respiratory problem, sore throat, cold, cough, increased temperature or a nose bleed. People who have had laser surgery for short sight may experience vision changes (over 4,500m).

There are no hard and fast rules about who will be affected by these illnesses. Some Himalayan experts who have been climbing for years can experience altitude sickness; meanwhile, inexperienced climbers going high for the first time might feel fine all the way to the top of Kilimanjaro.

The major illnesses are outlined below, but these are such serious issues  you should research these ailments further on your own.

Acute Mountain Sickness (AMS)
The most common altitude-related problem is acute mountain sickness (AMS). Like other altitude illnesses, AMS is caused by ascending to high elevations too quickly for the body to adjust. AMS can occur at any altitude but is most likely in the first 1,000 meters (3,280 feet) of elevation gain during a climb. Generally, its symptoms begin to occur at 2,500 meters (8,000 feet). Those who live at low elevations, fly to East Africa, and get straight on a mountain are especially vulnerable.

Symptoms of AMS include headache, breathlessness at rest, nausea, vomiting, dizziness, a rasping cough, insomnia, and a loss of appetite. To quote Dr. Charles Houston, a leading researcher on altitude-related sicknesses, “AMS is much like a bad hangover, and like a hangover usually subsides in a day or two.”

A normal but unpleasant occurrence at altitude is Cheyne-Stokes breathing, also called periodic breathing, which causes a dozing-off climber to suddenly awake gasping for air. This occurs regularly above 2,700 meters (9,000 feet) and can be extremely frustrating but isn’t dangerous (whereas such breathing is very abnormal if due to something other than being at altitude, such as a head injury).
AMS is easily cured by descending to a lower altitude and resting for a day or two. Generally, after this period of rest, a climb can be resumed.

It is also important to remember that not everything that feels like AMS is AMS. There are many bugs in East Africa, including a simple stomach bug, that can cause similar symptoms.

In recent years, some climbers and trekkers have begun using Ginkgo biloba leaf extract for the prevention of AMS. Some studies—formal and informal—have suggested it reduces incidents of AMS. Classified as a dietary supplement, and one of the most popular on earth, ginkgo is believed to function in several ways—notably as a bloodflow enhancer in microcapilleries—explaining how it might help against AMS. While formal testing in mountain settings might be limited, the fact that it’s an innocuous herbal remedy means there is little argument against trying it, if you think it might help you. Remember, the evidence—informal or otherwise—that it can prevent or lessens the affects of HAPE or HACE is limited.

High-Altitude Cerebral Edema (HACE)
High-altitude cerebral edema (HACE) is the most serious altitude-related illness and is caused by a lack of oxygen. The large and small arteries of the brain dilate so they can carry more blood and more oxygen, causing the brain to swell.

One of the obvious results of this swelling, or cerebral edema, is a tremen­dous headache. Other symptoms are confusion, hallucination, an inability to control emotions, and a staggering walk. The staggering walk is often one of the most definitive ways of identifying a HACE victim. Ask the victim to walk heel to toe along a straight line; if the victim has a problem with that they are in trouble and need to descend.

As with HAPE, it is imperative to get the victim to a lower elevation as quickly as possible. Carry the person if you must! Don’t wait for helicopters. The victim must descend until fully well and with absolutely no residual loss of coordination (ataxia).

High-Altitude Pulmonary Edema (HAPE)
High-altitude pulmonary edema (HAPE), an accumulation of fluid in the lungs, can come on quickly and kill a victim within a few hours. Symptoms include exhaustion, difficulty in breathing (at rest), chest pain, a gurgling noise in the chest, and a cough with bloody sputum (saliva mixed with mucus).

The best treatment (the only treatment) is to get the victim to a lower el­evation as soon as possible, even if that means carrying the person. Oxygen is often used to treat HAPE on mountaineering expeditions (in conjunction with a hyperbaric bag if available), but the best treatment is a fast and immediate descent. The victim should be kept warm or the pressure in their pulmonary vessels may increase even further, and you don’t want that. Adalat (nifedipine) is an important treatment and is used to decrease the pulmonary pressure by dilating the pulmonary blood vessels.

There are a few simple rules that you should swear by if you plan to reach the summits of any peaks in East Africa.

First, climb slowly. The expression pole-pole (“slowly, slowly” in Swahili) is well known as a climber’s mantra in East Africa. A slow ascent will always produce better results than a fast one.

Above 1,500 meters (5,000 feet), experts recommend taking a full day for every 300 meters (1,000 feet) of elevation increase. This is sometimes difficult because of time considerations. If time and budget allow, plan on spending one or two extra nights on the mountain. The extra time will help you acclimatize and increase your chances of reaching the summit.

If one member of the party shows signs of HAPE or HACE, slow down, stop, or turn back before the problem escalates.

Also, don’t let your guide rush you. Guides and porters are especially known for this on the descent, where it’s only a problem in terms of fatigue. Certainly they’re eager to get home, but occasionally they will set a pace on the ascent that is unreasonable. Set your own pace and don’t be pressured into going at a speed you can’t handle.

Second, drink a lot of water. Acclimatization is much easier for a well-hydrated body than a dehydrated body. Drink at least 4 liters per day—6 liters if you can. Avoid diuretics such as coffee and tea, as well as alcohol and rec­reational drugs.

Many climbers like to use drugs to help with acclimatization and to treat altitude-related problems when they occur. Such drugs include Diamox (acet­azolamide), Decadron (dexamethasone), Adalat (nifedipine), and others. If you decide to use any of these drugs read as much as you can about them before you go (and before you use them), talk to your physician, and understand the side effects, good and bad.

Hypothermia and Frostbite
East Africa’s mountains lack the extremely cold temperatures found in many mountain ranges of the world, but hypothermia and frostbite can still occur.

Hypothermia is a condition in which the body’s core temperature drops below normal. The victim becomes weak and often begins to shake. The obvious response is to warm the victim by providing warm liquids, high-energy foods, hot-water bottles, and even crawling into a sleeping bag with the person (both of you nude for better heat transfer).

In frostbite, soft tissue is destroyed as body fluids freeze into crystals around the cells of the tissue. In the initial stages, the skin is white and hard.

In mild frostbite, when the skin is still soft (sometimes called “frostnip”), the affected area can be rewarmed fairly easily by placing the part someplace warm—under an arm, in a sleeping bag, in the crotch, or against the bare skin of a companion (the chest is good). The rewarming process may be painful, but is usually without long-term problems.

When an appendage is seriously affected by frostbite, the best thing to do is to evacuate the victim without rewarming the frostbitten area. Rewarming a frostbit­ten area often causes more damage than the actual frostbite. Often, a victim can walk out on frostbitten feet but must be carried if the feet are rewarmed.

If your evacuation must include another night out, rewarming the frostbitten area is inevitable. Modern medical thinking now dictates that rewarming be done quickly. Use water between 38 and 41 degrees Celsius (100–105 degrees Fahrenheit) and soak the frostbitten part for 30 minutes. Do not massage the affected flesh in any way. Once the frostbitten area is warm, wrap it with a loose bandage and keep it warm until a full evacuation can be made. Refreezing of a frostbitten part will cause further damage.

The best prevention for both hypothermia and frostbite is to dress properly. Dress in wools and fleece fabrics; never wear cotton clothing! You should also keep yourself well hydrated and well fed.

Denial is a huge issue on big mountains, especially with people who are ada­mant about reaching the summit. You need to admit when there is a problem. Don’t succumb to denial just because you are weak or because you aren’t lead­ing the pack. Denial can lead to the very serious, life-threatening problems described above.