TRAVEL AT HIGH ALTITUDE

Planning the trip of a lifetime, a holiday with a difference, skiing in the high mountains or a expedition?

This booklet is written to help you understand some of the ways your body may change as it has to cope with high altitude and the ‘thin air’. It is full of information, tips and stories to help you enjoy your trip and stay healthy. Most importantly, it also covers the serious altitude illnesses which still kill those unaware of the risks.

This booklet is recommended by: Association of British Mountain Guides (BMG) British Mountaineering Council (BMC) International Mountaineering and Climbing Federation (UIAA) ii TRAVEL AT HIGH ALTITUDE TRAVEL AT HIGH ALTITUDE 44 ABOUT THIS BOOK PERSONAL DETAILS

NAME: You may wish to add a photograph of yourself to this page. DATE OF BIRTH: NEXT OF KIN CONTACT DETAILS:

MEDICATIONS:

ALLERGIES: This book has been written by Research into high altitude people who like being in the illness is not easy to do, not SIGNIFICANT mountains, who have a particular comprehensive and far from MEDICAL interest in medicine and what can complete. PROBLEMS happen to people at high altitude. Anyone travelling to high areas is e.g. diabetes, high Its contents should be treated as a advised to seek medical advice blood pressure guideline only, based on current before going and also, where TREATMENT knowledge. possible, if they become ill at INFORMATION : altitude.

First published: 2007 This edition: 2008 The authors and the publisher have made every effort to ensure that information is accurate and as up-to-date as possible. However, they are unable to accept responsibility for any loss, injury or inconvenience sustained by any person, caused by errors or omissions or as a result of the advice and information given in this book. INSURANCE All rights reserved. We encourage non-commercial use of this material as long as acknowledgement is made to the copyright holder. © Medex 2007, 2008 DETAILS: ISBN 0-901100-76-5

This book may be downloaded free from the website; www.medex.org.uk 43 TRAVEL AT HIGH ALTITUDE TRAVEL AT HIGH ALTITUDE iii DAILY AMS SCORES CONTENTS

Day 1 Preface 22 The Joints / Muscles 14 13 12 11 10 9 8 7 6 5 4 3 2 1

2 Finding out about High 23 The Extremities

H Altitude 24 The Eyes eadache, eadache, Alt Alt

3 What is High Altitude? 25 The Mouth / Teeth 4 Where in the World is High? 26 The Ears / Nose H H

G 5 27 The Reproductive Bits uts, uts, G 6 North & South America 28 Sleep Morning Morning F F F

atigue, atigue, 7 Africa 29 Children at Altitude D 8 Asia 30 Porters S D Score AMS 9 Australasia 31 What to do in an izziness, izziness, T 10 Antarctica Emergency H 11 Acclimatisation 32 Incident Record Card S G 12 The Effects of Altitude 33 Pills & Potions leeping, leeping, Evening Evening F 13 Acute Mountain Sickness 35 Oxygen

D D 15 The Brain 36 Pre-existing Conditions

T OTAL Score 0=Fine to 3=Worst to3=Worst 0=Fine Score OTAL S 16 HACE 39 Healthy Environment

17 The Lungs 40 Recommended Reading T

18 HAPE 41 Useful Websites 19 The Heart / Blood 42 Credits 20 The Stomach / Bowels 43 Daily AMS Score Card 21 The Kidney / Bladder 44 Personal Details

Notes Notes

1 TRAVEL AT HIGH ALTITUDE TRAVEL AT HIGH ALTITUDE 42 PREFACE CREDITS

In 1991 some doctors interested that travelling at altitude can have Medex would like to thank the following for their written contributions: Damien Bailey The Joints / Muscles Mark Howarth The Eyes, Healthy Environment in mountain medicine saw a young, on your body and aims to help you Denzil Broadhurst Finding out about High Altitude, Olly Kemp The Lungs fit climber die on the Mera La. The to understand why you may not feel What is High Altitude, Where in Juliette Levement The Lungs, Sleep the World is High?, Europe, Mandy Jones Sleep doctor with him knew little about the well or get ill. It suggests ways to North & South America, Africa, Ian Manovel Pills & Potions risks of severe altitude mountain avoid illness and suggests what Asia, Acclimatisation, The Alex Martin-Bates Pre-Existing Conditions Effects of Altitude, Acute Dan Morris The Eyes sickness. you should do if you get an altitude Mountain Sickness Stephan Sanders Children at High Altitude The tragedy inspired the doctors related illness. Our own Mike Brookes What to do in an Emergency Eli Silber The Brain Keith Burgess Sleep Chris Smith Europe, HAPE, HACE, Porters, to study altitude illness and share experiences and real cases have Simon Currin Preface Healthy Environment this information with others. The been used as examples. Gerald Dubowitz The Heart / Blood, Sleep Jill Sutclife Healthy Environment David Geddes The Mouth / Teeth Henriette Van Ruiten The Extremities organisation ‘Medical Expeditions’ The deaths on the Mera La were Sandra Green The Joints / Muscles Catharine Wilson Africa, Australasia, Antarctica, was born with this as its mission. caused by going to high altitude, David Hillebrandt HAPE, HACE, The Stomach / Acute Mountain Sickness, The Bowels, The Kidney / Bladder, Lungs Ten years later, again high on but both could have been avoided The Reproductive Bits Jeremy Windsor The Ears / Nose, Oxygen the Mera La, Medical Expeditions’ had simple rules been followed. Medex would like to thank the following for their case studies: members saw an elderly Japanese Medical Expeditions is teaching Jim Duff, Gill Macquarie, Martin Rhodes, Ronnie Robb, Jacky Smith lady slip into a coma and die, doctors about high altitude illness Medex would like to thank the following for their photographs: having been left behind by her and wants others to learn about it Bruce Bricknell Page 33 Chris Smith Front cover, Page II, 5, 11, friends. Another life was lost. too. Denzil Broadhurst Page 17, 23 15, 19, 21, 22, 28, 30, 31, 39 Simon Currin Page III, 9, 10, Back cover Jacky Smith Page 29 Despite all the research and This Diana Depla Page 24 Catharine Wilson Page 42 education there is still much that book is Gerald Dubowitz Page 12, 14, 20, 26, 41 Jeremy Windsor Page 35 Rachel Hamilton Page 6 needs to be done to save such our best David Hillebrandt Page 25, 27 lives. attempt Annabel Nickol Page 7 Gill Macquarie Page 4, 40 Since the early 1990s members at Nick Mason Page 2 of Medical Expeditions have, along helping Ronnie Robb Page 13 Stephan Sanders Page 1, 3, with others, been busy studying everyone Dorje Sherpa Page 8 mountain medicine. to stay Medex would also like to thank: They have done their best to healthy All those who commented on the booklet drafts improve the knowledge of doctors travelling The UIAA for their supporting grant responsible for, or advising, people at Editors: General: Denzil Broadhurst, Chris Smith travelling at altitude. altitude. Medical: Simon Currin, David Hillebrandt, Jim Milledge, Paul Richards This book looks at the effects 41 TRAVEL AT HIGH ALTITUDE TRAVEL AT HIGH ALTITUDE 2 USEFUL WEBSITES FINDING OUT ABOUT HIGH ALTITUDE

This booklet has been put interest in adventure and in together by two linked adventure medicine. Medex has run organisations with an interest in successful expeditions to Everest in high altitude travel and high altitude 1994, in 1998 and medicine. Hongu in 2003. To find out more about what we Medical Expeditions’ aims are: do, or to join us, please take a look • To investigate all aspects of at our website. altitude related Illness. • To educate mountaineers and trekkers and their doctors about the nature and avoidance of altitude related illness. British Mountaineering Council (BMC) www.thebmc.co.uk/medicine Established in 1992, it has Certec www.certec.eu.com acquired an internationally Epilepsy action website www.epilepsy.org.uk/info/sportsandleisure/index respected reputation for its Foreign & Commonwealth Office travel advice www.fco.gov.uk/travel research and educational work. Frostbite www.christopherimray.co.uk/highaltitudemedicine/frostbite.htm Medical Expeditions specialises Gamow Bag www.chinookmed.com in researching on relatively large General travel information www.fitfortravel.nhs.uk International Porter Protection Group (IPPG) www.ippg.net/guidelines/index.html sample groups over a long period International Society for Mountain Medicine (ISMM) of time. A typical expedition is www.ismmed.org/np_altitude_tutorial.htm comprised of 75 members exposed Kathmandu Environmental Education Project (KEEP) www.keepnepal.org to altitude for 6 weeks. MEDEX www.medex.org.uk - has a full list of UK doctors holding the UIAA Diploma of Mountain Medicine Medex is a club which organises Mountains for Active Diabetics (MAD) www.mountain-mad.org adventurous expeditions worldwide Oxygen (constant flow system) www.topout.co.uk and www.poisk-ltd.ru and supports the work of Medical Oxygen (demand flow system) www.summitoxygen.com Portable Altitude Chamber (PAC) www.treksafe.com.au Expeditions. It provides a link Union Internationale des Associations d’Alpinisme (UIAA) www.uiaa.ch/index.aspx between those who have an 3 TRAVEL AT HIGH ALTITUDE TRAVEL AT HIGH ALTITUDE 40 WHAT IS HIGH ALTITUDE? RECOMMENDED READING

Good question! In will be less oxygen for your body. The High Altitude Medicine Handbook , by Drs Pollard & Murdoch this book, we are Oxygen is needed to give you the talking about energy to move, but is also needed Bugs, Bites, and Bowels , by Dr Wilson-Howarth going from close simply to keep your body alive - for Altitude Illness: Prevention & Treatment , by Dr Stephen Bezruchka to sea level to your brain and digestion to work, for anywhere above healing cuts, and all those normal Pocket First Aid and Wilderness Medicine , by Drs Jim Duff and Peter 2,000m. things your body does without you Gormley Our bodies are knowing about it. used to working at As your body gets less oxygen it home. When we adapts. You breathe faster and go higher they need to adapt. deeper. It makes more red cells to Altitude starts to have an effect carry more oxygen in the blood. around 1,500 - 2,000m. The body Changes take time to happen. If starts to behave slightly differently you go Everest 9,000m as it tries to make up for the change slowly you Death 8,850m zone in oxygen levels. Go up too fast to should stay 8,000m about 2,500m and altitude illnesses healthy. Go

7,000m are common. up too fast Extreme Given enough time to adapt, and you altitude Kilimanjaro 6,000m most people can adjust to altitudes risk 5,985m between 5,000m (Everest base suffering Very 5,000m camp) and 5,500m. Above 5,500m from high Inca Trail altitude 4,198m few people can adjust any more. altitude 4,000m Health and ability then get worse. related

So what’s different about travel illnesses, 3,000m High at altitude? The main difference is such as altitude 2,000m that as you go higher the air Acute Ben Nevis pressure gets lower (the air gets Mountain 1,344m 1,000m ‘thinner’), and this means for any Sickness Sea Level single breath that you take there (AMS). 0m

39 TRAVEL AT HIGH ALTITUDE TRAVEL AT HIGH ALTITUDE 4 HEALTHY ENVIRONMENT WHERE IN THE WORLD IS HIGH?

The Food is hard to grow: environment at • Buy food where it is plentiful. high altitude is • Take care if buying food in more fragile remote areas - people may be than at low selling you their winter rations. altitudes. As a Wood is precious: result, natural • Ensure you take all the fuel you processes are need with you - for everyone. incredibly slow • Actively discourage staff from and any collecting and burning wood. damage can • Support tree planting schemes. be more long Waste is a huge problem: lasting. • Don’t buy bottled water - empty At home water, fuel, food supply bottles have nowhere to go. and sewage disposal are rarely a • Carry out everything you carry in. concern for us. At high altitude we Take packaging off at home. There are many places in the world where you can go to high need to be responsible. What we • Dispose of batteries back home. altitude. do will affect the local people and • Be aware of what is happening to others who visit the area after us. all your group’s waste and stop You can choose to, by going Be aware that some hosts are bad practices. on a trekking or climbing holiday. It may come as more of a now stretching their precious • Use deep, well placed pit surprise when using high ski resources to the limit to provide latrines. Bury deep or spread poo runs, driving or cycling over high ‘modern’ facilities to make guests (or carry it), it can take years to passes or even flying into towns ‘happy’. break down. and cities which are high. Water is scarce: • Plan sanitary wear disposal. Each high altitude area has its • Do nothing that will pollute rivers. Flora and Fauna are adapted to a own problems. Before travelling • Avoid hot / cold showers - a bowl fragile life at high altitude: you should find out more about of water will do. • Don’t uproot plants. where you are going. • Use an earth toilet, not a flush • Avoid damaging thin soils. toilet. • Protect all wildlife. 5 TRAVEL AT HIGH ALTITUDE TRAVEL AT HIGH ALTITUDE 38

LUNG CONDITIONS

EUROPE Before you go: • Know that even mild breathlessness at home can seriously affect you at altitude. • Ensure you are up to date with travel vaccinations and consider flu vaccine. Ask someone to name the high Climbing trips in the Alps or in • Build up training, starting at lower altitudes and lower levels of exertion. mountain ranges of the world and parts of Eastern Europe can also they will most likely name the put you at risk of altitude related At altitude: and the . Most illness - especially when sleeping in • Gain height gradually without rushing. people don’t know that the the mountain huts. • Prevent problems - reduce activity, take medication and descend if needed. mountains of Europe are high ASTHMA enough to cause people to Some people get worse as cold and exercise trigger attacks. Most improve due to an increase in the body’s own steroids and reduced airborne allergens. suffer from high altitude illnesses. In fact many holiday Before you go: makers and novice climbers in • Do not go unless your asthma is stable. the Alps will often know little or • Ensure you are up to date with travel vaccinations and consider flu vaccine. nothing about high altitude • Include spare inhalers / spacers and steroids. illness. High altitude • Know triggers for your asthma and try to avoid these on your trip. headaches on tourist trips are • Build up training, starting at lower altitudes and lower levels of exertion. possible, and some people will At altitude: suffer from other problems too. • Carry all your inhalers at all times. In the Alps it is easy for • Prevent problems by reducing activity, taking medication and descend if needed. people to get to high altitude • Avoid anti-inflammatory drugs (like aspirin and ibuprofen). really quickly and easily using EPILEPSY cable cars, mountain railways Before you go: and ski lifts. Many of the • Make sure your epilepsy is stable. Aim to be seizure free for at least 6 months. mountain passes have high • Be aware of issues regarding driving, belaying, etc and make sure your companions are aware of the problems. points that are over 2,000m. • Ensure any Malaria medication doesn’t interfere with your own medication. At altitude: A family of four took the mountain railway from Grindelwald (1,034m) to the • Avoid illness - it may affect your medication. Jungfraujoch, walked up to the hut at 3,650m and had a picnic. After about 4 • Know your epilepsy trigger factors (e.g. alcohol, tiredness) and avoid them. hours at altitude, the 11 year old complained bitterly of a headache. The family • Epileptic medications can affect sleep and change coordination. These descended on foot and then by train. The boy was sick on the descent. On symptoms can also be caused by altitude illness, if in doubt descend. reaching the valley he swiftly recovered. His symptoms were caused by Acute • Remember fits in some places could be life threatening, and you may be drowsy Mountain Sickness (AMS) which the family had never heard of. after fits and need rest . 37 TRAVEL AT HIGH ALTITUDE TRAVEL AT HIGH ALTITUDE 6

DIABETES

Before you go: NORTH & SOUTH AMERICA • Before booking get a specialist eye test. If you have eye damage avoid going very high. • Before booking get expert medical advice if you have poor circulation or nerve Skiing and damage. climbing in the • Establish good glucose control over preceding months. Rockies may • Get a robust glucose monitor (and spare) that will work at altitude and in the cold. put you at risk, • Find out what you will be eating. Plan your diet. and some • Take spare insulin to cover changes in requirements. people will be • Practise managing diabetes when exercising hard and in adverse conditions. affected in the • Make contact with ‘Mountains for Active Diabetics’ (MAD). towns and At altitude: cities. For • Always carry emergency glucose, glucose monitor and medication. example the • Stop insulin freezing e.g. inside pocket close to skin. town of • Avoid infection. Get help fast if you become ill. Never stop insulin. Leadville, • Remember exercise reduces and rest increases insulin need. Colorado is HEART CONDITIONS & HIGH BLOOD PRESSURE above 3,000m. Before you go: The major mountains of North should rest for the first few hours • Get your heart checked out and get advice on emergency medications for new America are in the northern then take things easy for a few onset chest pain. latitudes, where air pressure is days before trying one of the high • Have a stable and acceptable blood pressure prior to departure. lower for the same altitude than at treks such as the Inca trail. • Find out about problems with BP medicines with exercise, altitude and cold. the equator. FIFA have banned international At altitude: In the Andes it is possible to fly football matches in La Paz in • If you feel unwell, stop further ascent, consider descent. Tell your companions. or even drive into places such as Bolivia since the home team have a ALLERGIES / ANAPHYLAXIS Cusco (3,326m), or La Paz major advantage due to their Once a reaction has been treated it may recur, without warning, within the next 24 (3,600m) without any natural acclimatisation to the lack of hours. Aim to get to medical care as soon as possible. acclimatisation en route. You oxygen. Before you go: • Get adrenaline, antihistamines and steroids. A businessman hoping to clinch a multimillion dollar contract flew to La Paz At altitude: (3,600m) in Bolivia the day before an important meeting. His company had • Carry MedicAlert bracelet / necklace with allergies on it. decided to save on the expense of sending him a few days early to enable him to • Carry auto-injector adrenaline (EpiPen) at all times and be prepared to use it. acclimatise. He felt so ill when making his presentation that he lost the contract. The next time he will make sure he gets the chance to acclimatise. 7 TRAVEL AT HIGH ALTITUDE TRAVEL AT HIGH ALTITUDE 36 AFRICA PRE-EXISTING CONDITIONS

The major problems occur on help acclimatise before tackling the People do go to high altitudes With any condition there is more Kilimanjaro, where due to the costs main summit. with pre-existing medical risk to health when travelling to being based on the number of days Some companies are starting to conditions. If you suffer from a remote locations. The key is to you are on the mountain, many offer itineraries which take account condition, you must talk to your lower this risk as far as possible. Be organised groups ascend far faster of this. It is worth spending a bit doctor about whether or not you prepared to give up part or all of than the recommended 300m per extra to stay safe and achieve your should go to high altitude and, if your trip for safety reasons. day. It is possible to spend time on goals. Find out from the trekking you do, how you should take care some of the adjacent mountains to company how many people did and of yourself. how many didn’t Before you go: reach the top • See your doctor / specialist at least 6 months before your trip. Find out about (or Gilmans the risks your condition poses for travel at high altitude. Point) on their • Make a medical plan and what, if any, support you will need. Find out what last few trips. medical help may be available. Think about what you will do if things go wrong. Ask how many • Make a contacts list for your condition for home / where you are going. days they were • Make everyone aware of your medical condition, the signs, symptoms and trekking. A safe treatment. Your illness could affect everyone in your group. • Get first aid / medical training for yourself and others if necessary. ascent should • Make a kit with your medicines. Make clear labels and instructions. Have spare take 8 to 10 supplies and split the kit between people to lower the chance of losing it all. days. • Ask your doctor to prepare an official letter, explaining your condition, treatment and contact details (translate if necessary). • Tell your travel nurse about your conditions before vaccinations, etc. • Get medical insurance that covers your condition and the risks of the trip. It can be hard, very expensive or impossible to cover what some people want. An experienced British Mountain guide with training in mountain medicine was At altitude: leading a group up Mt Kilimanjaro (5,895m). They came across a very scared • Always carry your medical information letter / MedicAlert bracelet. group with a collapsed 17-year-old boy. The guide injected dexamethasone at the same time as commencing a rapid and life saving descent. On arrival at a hut • Each day, write down medicines taken and any changes in your condition. shelter he used his satellite phone to contact a UK climbing doctor who advised • If symptoms worsen avoid further ascent, consider the possibility of altitude further descent through the night. Two days later the boy was fit and well. Had related illnesses and descend as necessary. anyone in the group known a little more about altitude illness they may have been • Be honest with everyone about changes in your medical condition. able to avoid the emergency. Sadly they all learned some lessons the hard way. • Look after your family, friends and other travellers. 35 TRAVEL AT HIGH ALTITUDE TRAVEL AT HIGH ALTITUDE 8 OXYGEN ASIA

The lack of oxygen causes many ‘bag’, known as a Portable Altitude The most popular areas for high Hotel Everest View (3,860m) high altitude illnesses, the only real Chamber, Certec or ‘Gamow Bag’. altitude trekking and climbing are in suffered AMS. way to fix the problem is to get The bag is ‘pumped up’ to increase this part of the world. A gradual ascent to the Tibetan more oxygen. This can be done the pressure inside - so the oxygen From Nepal, Pakistan or India it plateau is impossible, so AMS simply and sensibly by breathed is like that 2,000m lower. is usually possible to make a symptoms must be carefully DESCENDING, or if this is The person should stay inside for 1 gradual ascent into the mountains - monitored and exercise kept to a impossible there are two ways to hour but may need several hours. ideally avoiding the highest landing minimum until acclimatised. get more oxygen at altitude. Lifting the head end may help with strips. 84% of people flying in to the (1) From an oxygen bottle breathing. Although these bags can Oxygen cylinders can be fitted with be a life-saver, there are problems: a face mask. The person needing • Hard to talk to the person inside. oxygen simply puts on the mask • An unconscious person needs and breathes in the oxygen, mixed someone inside to monitor them. with some of the surrounding air. If • They can using a ‘constant flow’ kit (oxygen damage the flowing all the time) at 2 litres per eardrums. minute, a bottle containing 300litres • The air will last 2 to 3 hours. If using a inside needs ‘demand flow’ kit (oxygen flows only changing. when breathing in), the same bottle • Recovery is may last 6 to 9 hours. often short- (2) Inside a pressure bag lived. Those suffering from AMS, HAPE While cycling from Lhasa to Everest Base Camp, a group had crossed two or HACE can be placed inside a 5,000m passes in 8 days. On day 9, at 4,150m, one member of the team woke up feeling dizzy and nauseous, was shivering and unable to walk straight. By midday, A couple decided to climb Kilimanjaro (5,895m) by the Marangu route. After two with no improvement, the group decided to go down. This was over a 5,150m days trekking they reached the Horombo Hut (3,760m). Within two hours the pass. The casualty turned blue, was hardly breathing, ‘rattling’ and frothing at the husband began to feel breathless. During the night he began to cough up pink mouth. Once over the pass, her condition improved. The group stayed at 4,100m frothy spit and became unconscious. He had HAPE and was placed inside a that night and the local doctor wrongly diagnosed high blood pressure. Luckily ‘Gamow Bag’ for 4 hours. He came round and was able to descend with porters’ they met a climbing doctor with drugs to treat altitude illness. They dropped to help. In hospital he made a complete recovery. 2,400m by truck the next day and finally on to Kathmandu for medical attention. 9 TRAVEL AT HIGH ALTITUDE TRAVEL AT HIGH ALTITUDE 34

AUSTRALASIA Problem Drug Dose AMS Paracetamol 500mg tablet, 2 tablets 4 times a day Headache and / or ibuprofen 400mg tablet, 1 tablet 3 times a day New Zealand has many peaks African peaks it is worth trying to AMS Metoclopramide 10mg tablet up to 3 times a day over 3,000m but very few reported ascend more slowly and Nausea or Prochlorperazine 1 to 2x5mg tablets up to 3 times a day incidences of altitude illness acclimatising if possible. The requiring evacuation, though difficult tracks, lack of reliable AMS Acetazolamide Half a 250mg tablet 2 times a day, Prevention started 24hrs before ascent frostbite is common on Mount maps, muddy wet seasons, limited Cook. medical care and risk of tropical HACE Oxygen gas Breathed continuously - cylinder or ’s highest point Mount illness can turn what looks like an pressure bag Kosciuszko (2,200m) is an easy easy weekend into a nightmare. Dexamethasone 8 - 16mg a day in divided doses, for up walk so is unlikely to cause altitude - Mt Kinabalu 4,101m - Corticosteroid to 5 days problems but it is still possible. can be climbed rapidly, resulting in Acetazolamide 250mg tablet, 1 tablet 3 times a day / a high incidence of AMS. HAPE Oxygen gas Breathed continuously - cylinder or have a number of pressure bag mountains over Nifedipine 20mg MR tablet 2 times a day 3,000m, the Acetazolamide 250mg tablet, 1 tablet 3 times a day highest being Diarrhoea Ciprofloxacin 750mg 2 times a day Puncak Jaya or Azithromycin Capsules taken daily for 3 days (Carstensz Pyramid) at Loperamide 2mg capsules taken up to 8 times 4.884m. Many Dehydration Electrolyte rehydration in 200ml of boiled and cooled water tourists report solution AMS symptoms Infections Amoxycillin 250mg 3 times a day for at least 5 days spoiling their trip and / or Metronidazole 200mg 4 times a day or as and some recommended by doctor trekkers have Cough Pholcodine Linctus 10ml up to 4 times a day died. As with the Sore Throat Lozenges with anaesthetic i.e. Benzocaine In 1982 two climbers were stormbound for two weeks on the summit of Mount Dry chapped Lip balm & sunscreen with at least SPF 15 - skin section Cook. When the weather improved, and they were rescued, both had suffered lips and skin Moisturiser cream frostbite to their feet due to the combination of cold and altitude. Both men had Blocked Pseudoephedrine 60mg 3 times a day their feet amputated. They have each returned since then to summit the mountain, nose or Xylometazoline Nasal spray with one of them also summiting Everest. Cold sores Aciclovir 5% cream - 5 times a day for 5 days 33 TRAVEL AT HIGH ALTITUDE TRAVEL AT HIGH ALTITUDE 10 PILLS & POTIONS ANTARCTICA

No trip to high altitude should Always carry a letter from your leave without certain medicines. doctor about your medicines to Some are prescription only and avoid legal problems. should only be taken on the advice of a doctor. Some of them can save your life while others will ease some symptoms, leaving you to enjoy the trip. Opposite is a brief list of drugs used at altitude. Use it to help you decide what to take, but remember Antarctica is the coldest, highest, companies are offering climbing medical advice changes so windiest, driest and iciest packages. It is worth remembering check before you go. on earth with an average altitude of that pressure is lower in the Polar 2,300m. The highest point is Mount Regions. Low pressure weather Before you go: At altitude: Vinson at 4,892m. The ice can systems can also lower the • Take this list to your doctor and use • Make sure you have your reach a depth of 4,700m in places. pressure further. As a result it to discuss what to take and how medicines and doctor’s letter. Most people visit Antarctica as reduced oxygen levels and AMS to administer it. • Carry medicines labelled with the • Buy medicines at home. Your doses in quick to open, zip-lok part of organised expeditions or will develop at lower altitudes than chemist should stock all except bags. Keep them in two or more work projects and have training in elsewhere. oxygen. Medicines may be cheaper places in case you lose some. altitude conditions and guides. Extreme cold makes altitude abroad but may be fake. • Always wash tablets down with However with the continent opening related problems even worse. • Confirm any allergies. water - they will work better. up to independent travel some I was stung on the shoulder with a needle-like pain. Three minutes later I started A fit 66-year-old tourist flew from the Patriot Hills camp at 887m to the Pole at to feel itchy. After another minute I fell into someone's arms as the 'lights went 2,800m. She hurried the 300m to the flags to take photos then needed help to out'. The team shouted for our medical barrel. Oxygen, adrenalin, antihistamine climb the 30 steps into the NSF research base. She was short of breath and had a and a drip were all given in a matter of minutes. An hour later I started to recover. headache. She was treated with oxygen, fluids and simple painkillers. Later that Next day I was able to carry on with the trip. I owe my life to the quick actions of day she was able to walk back to the plane and made a full recovery at Patriot our group’s doctor. I now always carry an EpiPen in case I get stung again. Hills the following day. 11 TRAVEL AT HIGH ALTITUDE TRAVEL AT HIGH ALTITUDE 32 ACCLIMATISATION INCIDENT RECORD CARD

When the body slowly adapts to slowest to Fill out as much of the incident For each casualty: lower oxygen levels the process is acclimatise - record card as you can before called acclimatisation. and the leaving the scene. It contains Name: Different people acclimatise at timetable valuable information for different speeds, so no rule works should be emergency staff and may help Date of birth: for everyone, but there are good made to further treatment of the casualties. guidelines. keep them Allergies: For your group: Over 3,000m go up slowly, healthy. A sleeping no more than 300m higher rest day Medication: Exact location: at the end of each day. Going scheduled higher during the day is ok as long after every 2 Previous medical problems: Type of incident: as you go down to sleep ( “walk high to 3 days (what happened) - sleep low” ). If you go up higher will also help. Time of last meal / drink: and can’t descend - take a rest day Driving or flying to high altitude Hazards in area: to allow your body time to ‘catch means more people will suffer from What happened: up’. AMS. Access to the area: This may seem very slow, and It is really sensible to find out (how to get to you) some people will comfortably be about the height of your planned Injuries: able to go up much faster, but in a route before you travel. Better still, Number of casualties: group someone will always be the make a drawing to show the height

that you will sleep Treatment given: Equipment needed: at each night. If

you don’t know - ask. There’s no better way to spot the days which are likely to cause altitude illness. Time: Date:

Name of recorder: Signature: 31 TRAVEL AT HIGH ALTITUDE TRAVEL AT HIGH ALTITUDE 12 WHAT TO DO IN AN EMERGENCY THE EFFECTS OF ALTITUDE

••• The fact you are reading this • Treat casualties as best you can. Most people going high have to Oedema - HAPE) can happen and section suggests that you are Prioritise care based on how bad deal with altitude related illnesses. these can kill you very quickly. planning ahead or that each injury is. Basic first aid is Dealt with correctly, they are What people don’t know about is something has gone badly OK. Simple splinting and kind unlikely to be a major problem. that you’ll need to pee more, your wrong. Whatever the case, the words can go a long way. Dealt with incorrectly they can be balance may become unsteady, most important thing is not to • Make evacuation plans - local panic. The following points are transport, carry or helicopter. disastrous - spoiling the trip for the your eyesight could change and aimed at helping you to deal with • Keep everyone warm and safe person who is ill and those with your nails will grow differently. an emergency. until help arrives - it could be them. We hope the following pages will • Make sure everyone is safe - minutes, hours or days. Being honest about how you feel tell you about some of the things yourself, any casualties, the rest each day can make a difference, you may experience and how best of the group. If one person has and knowing what’s happening to to deal with them. Some are mainly hypothermia, the chances are you could save your life. about comfort, but some can lead others may have it too. Move to Some very strange to long term damage to health or somewhere safe if you have to. death. Finding out about what your Do not become another casualty. things can happen to • Have one person in charge. your body when you body is doing as it goes higher is • Collect the information you need. go high! fascinating and can become part of Use ‘ETHANE’ as a guide. Most people who have the fun of travel! In fact, when you been to altitude can think how clever your body is at Exact location. tell you about having dealing with such big changes, you Type of incident. Helicopter Landing Zone headaches, being out of breath, may even want to know more! Hazards to rescuers. • Find firm, level ground (or even sleeping badly and not feeling Access to the incident. slope below 10º), about 100 paces in diameter. hungry. These are symptoms of Number of injured / ill. • Clear loose objects & people from AMS. AMS is uncomfortable, Equipment required. the area. not life threatening. If the AMS • Communicate. The sooner you • Mark with ‘H' using stones, or use symptoms become severe and flashing torch or brightly coloured you keep going higher - fluid in call for help, the better. Radios clothing to attract attention. and telephones may not work in the brain (High Altitude Cerebral • 1 person stand outside zone, back the mountains. Give your to wind making Y shape with arms. Oedema - HACE) or fluid in the location first (so they know where • Do not go to helicopter until told to lungs (High Altitude Pulmonary the problem is). Be accurate. by the crew. 13 TRAVEL AT HIGH ALTITUDE TRAVEL AT HIGH ALTITUDE 30 ACUTE MOUNTAIN SICKNESS (AMS) PORTERS

The common symptoms for AMS equally important. If you (or your travel company) The International Porter are: Hiding illness or pushing are hiring porters to help with your Protection Group (IPPG) have set • Headache. someone on could be fatal. holiday, you are responsible for clear standards which all parties • Nausea (feeling sick). Some people just seem to them. You must consider their should aim to achieve. These • Vomiting (being sick). acclimatise slowly, and need to health and safety – it is as include the provision of: • Fatigue (feeling tired). take things more gently. important as your own. • Adequate clothing and footwear. • Poor appetite (not hungry). If you are unfit, it doesn’t mean Porters who have trekking jobs • Adequate shelter, food and drink. • Dizziness. you are more likely to suffer, but don’t always live at high altitude all • Medical care and life insurance. • Sleep disturbance. overdoing it might be risky. If you the time. They can suffer from • Care on descent if ill. A simple scorecard is shown on are unused to exercise, feeling tired altitude illnesses in the same way • Appropriate sized load to carry. the next page, and on Medex while trekking is not surprising. that visitors do. In the past ill expeditions everyone keeps a Similarly if you are sleeping in a porters were seen as ‘useless ’, Questions to ask companies (or check of their scores twice a day. tent every night and are not used to ‘paid off’ and sent home. Many died yourself) It’s good if everyone logs how it, your sleep may be poor. The going down alone. 1. Does the company you are thinking they feel while travelling (copy the food may also be very different. of trekking with follow IPPG's five guidelines on porter safety? sheet in the back of this booklet) - The most important thing is: are 2. What is their policy on equipment and is honest with others in the the symptoms getting better or and health care for porters? group. Everyone can help make worse? 3. What do they do to ensure the decisions - to go up, to have a rest If you think you are getting worse trekking staff are properly trained to day, or to go down. As a group, - walk down (at least 500 to 1,000m look after porters' welfare? everyone’s health and happiness is lower for sleeping). Give your body 4. What is their policy on training and extra time to acclimatise. Don’t monitoring porter care by its local leave this decision until it’s too late. ground operator? 5. Do they ask about treatment of porters in their post trek Before you go: questionnaire to clients? • Learn about the symptoms of AMS. • If you plan to use Diamox - learn all about the side effects and try one at Kulbahadur, a 33 year old porter was left by the trail when he was too ill to carry home to find out how you feel. his load in the Everest National Park. Later he was found unconscious by another • Check you are not allergic to trekking group, eventually losing his feet to frostbite. He never knew the name of Diamox (a sulphonamide). the company or the nationality of the trekkers he was carrying a load for. 29 TRAVEL AT HIGH ALTITUDE TRAVEL AT HIGH ALTITUDE 14

AMS Scorecard Total CHILDREN AT ALTITUDE None 0 Mild 1 Headache Moderate 2 Children have the same altitude or Severe / incapacitating 3 problems at high altitude as adults, descend until Good appetite 0 but it is more difficult to tell when they are better. Poor appetite, nausea 1 Guts / Stomach they are having these problems. It Older children Moderate nausea or vomiting 2 is essential to climb slowly to allow can describe the Severe / incapacitating 3 children time to acclimatise. symptoms of Not tired or weak 0 Mild fatigue / weakness 1 Young children can’t tell you AMS, which are Fatigue / Weakness how they feel. The carer should be the same as for Moderate 2 Severe / incapacitating 3 guided by the child’s fussiness, adults. Assume None 0 eating, sleeping and playing. If symptoms are Mild 1 Dizziness / Light-headedness these are worse than usual the caused by Moderate 2 child should be assumed to have altitude and stay Severe / incapacitating 3 altitude illness and stay at the same at the same As well as usual 0 altitude or Not as well as usual 1 Difficulty sleeping Before you go: descend until Woke many times, poor night 2 • Discuss plans with your doctor at they are better. Could not sleep at all 3 least 3 months before leaving. • Think about: clothing, clean water At altitude: At altitude: supply, strange food, sunscreen, • Treatment for children with altitude • If you have a headache and a total sunglasses, preventing boredom illness is the same as for adults, but of 3 or more for the others, do not and realistic goals. children weighing below 40kg need go any higher. • Consider how you would get help if smaller doses of medicines and prefer syrups. • If you have a headache, and a total your child became seriously ill and of 3 or more for the others, have got who would look after them if you • Carry a card with children’s weight, no better or got worse - go down. became ill. drugs and doses on. • Be sure this is a sensible holiday for • Remember descent is the best Diamox The drug acetazolamide (trade name Diamox) can be used to reduce the the children. treatment. effects of AMS, useful where big height gains are unavoidable. It also helps periodic breathing (see page 28). It works by speeding up acclimatisation, but 4 year old Tommy was taken to Colorado’s Arapahoe Basin ski resort at 3,290m. does not mask the symptoms of AMS. You can still get AMS, HAPE and HACE He had enjoyed staying with friends lower in the valley, but was very unsettled while taking it. Some people are allergic to Diamox. There are side effects, e.g. tingling, during the first night at the resort. The next day he was miserable and refused especially of hands, feet and face. Some people find this unpleasant, but it is not meals. After he was sick he was taken to the resort doctor who diagnosed AMS harmful and will go away when you stop taking the drug. It also makes you pee and recommended descent. In the valley he was back to normal 6 hours later. even more. 15 TRAVEL AT HIGH ALTITUDE TRAVEL AT HIGH ALTITUDE 28 THE BRAIN SLEEP

The brain is affected by altitude Mood changes - on a ‘trip of a Disturbed sleep during the first Altitude may increase the because it needs a good supply of lifetime’ there will be good days and few nights at altitude is common number of times you need to pee, oxygen and may swell causing bad days. Bad days can trigger and normal. You may be slow in so you lose more sleep. pressure. disappointment and depression. Be getting to sleep, wake up a lot and Many changes are because you High Altitude Cerebral Oedema prepared for mood swings! feel that you have not slept well, or breathe more. In some people this (HACE) is AMS / HACE - see other pages. feel less refreshed. may cause ‘periodic breathing’ at caused by Stroke - developing sight or Poor sleep may be related to night, where rapid breathing is brain swelling speech problems and / or a weak how well your followed by periods when breathing and can kill arm, leg or face are signs of a body is briefly stops, sometimes causing very quickly if stroke. (Some migraine sufferers adjusting. As you to wake up. This is common not treated. have similar effects during an you over 2,800m, and almost everyone Some people ‘aura’). acclimatise gets it over 5,000m. Apart from feel no effects. Before you go: sleep usually worrying your tent mate, it does not Others may • Learn the signs of HACE & stroke. improves. appear to be harmful and gets suffer any (or all) of the following: • Prepare medical supplies. People with better with acclimatisation. Headaches - very common at • Consider expectations / fears and AMS may Snoring may be made worse by altitude, especially if you suffer who will support you on bad days. also sleep badly, suggesting poor dry, dusty air but night-time headaches or migraine at home. acclimatisation. blockage of the airway at sea level At altitude: Loss of balance - co-ordination Other things such as cold, (‘obstructive sleep apnoea’) does • Headache (AMS) avoid triggers - and balance may be affected. Older dehydration, exhaustion, alcohol - someone snoring, or an not appear to get worse with people and those who are treat with painkillers. uncomfortable bed or tent may also altitude. acclimatised feel less effect. • Stroke - treat with ½ a 300mg be a problem. At altitude: ‘Clumsiness’ and bad judgements aspirin & descend. See a doctor. Before you go: • Expect to need more sleep. increase the risk of accidents. • Be honest about how you feel. • Invest in your sleep comfort - a good quality sleeping bag and mat. • Consider avoiding caffeine and alcohol later in the day. I set off at the back, with a sore head, coughing. My cough and head got worse. A • Bring ear plugs to aid sleep. • If your sleep does not improve after ‘drag’ feeling began in my mouth. When I met the others, I plucked up the courage • If being treated for obstructive sleep to ask if ‘my speech was slurred’. The shock hit me. I had heard myself mumble a few nights do not go higher - apnoea, check with a specialist consider going down to allow incoherently. They looked horrified, my words just dribbled out, I couldn’t use my sleep doctor. acclimatisation. left arm, no power, my left hand tingled, the left of my face was paralysed and my head sore. I was done for!!! Expert medical care and rapid descent saved my life. I slept so badly! My tent mate must have got up every hour in the night to pee! 27 TRAVEL AT HIGH ALTITUDE TRAVEL AT HIGH ALTITUDE 16 THE REPRODUCTIVE BITS HACE

Ladies - acclimatisation taking the combined contraceptive The main signs: Can they: increases the body’s iron-rich red pill at altitude. In reality this risk is • Severe headache. • Touch nose with index finger with blood cells. If you suffer from heavy low in a fit, active, non smoking • Become clumsy. eyes closed? Repeat rapidly. Walk heel to toe in a straight line? periods discuss iron supplements lady unless staying above 4,500m • Act differently - unhelpful, violent, • with your doctor before travelling. for over a week. Many women use lazy. • Stand upright, with eyes shut and • May have bad, non-stop vomiting. arms folded? When travelling, periods can be ‘the pill’ for period control. • Do simple mental maths? difficult and disposing of sanitary Progesterone is safe at any • Blurred vision. • See, hear, feel, smell odd things. If not able to do or have difficulty doing wear a problem. Periods can be altitude and is available as the ‘mini any of the above, suspect HACE. • Confused. controlled, maybe by a change in pill’. In an injection, implant HACE can develop very quickly with contraception. This needs planning. contraception or Intra Uterine • Reduced consciousness. no other problems or can follow AMS There may be an increased risk System (Mirena) it may also and HAPE. of blood clots in the legs when prevent periods. Ladies and gents - barrier What to do: methods such as condoms don’t • Stay with the person at all times - do not leave them on their own. give full protection against disease. • Descend now - not later or in the morning. Abstention always works. Dispose • Sit them upright and keep warm. of condoms properly as they take • Give oxygen via cylinder or pressure bag if you have it. many years to rot. • Give dexamethasone if you have it. A child’s organs are being • Give acetazolomide if you have it. formed in the first three months in ••• If really unable to descend - prolonged use of a pressure bag may be needed. the womb. It is probably best to Consequence if ignored: avoid high altitude during this time. Loss of consciousness - confusion, drowsiness. Reduced breathing. DEATH. Before you go: • Plan contraception and period In serious cases death can occur within as little as an hour of symptoms control 6 months before travelling. being noticed.

After a successful trek to the summit of Kilimanjaro (5,895m) a traveller celebrated Remember it is possible to have AMS, HACE and HAPE at the same time. with a tour of the east African coast and game parks. He avoided malaria but returned home HIV positive. DESCEND DESCEND DESCEND DESCEND 17 TRAVEL AT HIGH ALTITUDE TRAVEL AT HIGH ALTITUDE 26 THE LUNGS THE EARS / NOSE

Because the air is thinner at high Fluid may collect in the lungs As you ascend to altitude, Failure to warm and moisten air altitude there is less oxygen causing a problem known as ‘High problems with ears and noses when breathing in leads to a sore available so breathing gets deeper Altitude Pulmonary increase. Sunburn and skin throat, persistent cough or in the and quicker to compensate. This Oedema’ (HAPE). Symptoms damage to the ears and nose is a worst cases, damage to the areas ‘acclimatisation’ helps you cope include severe breathlessness at painful problem. of the lung essential for the normal with the altitude better. Being more rest and frothy bloodstained spit Changes in the inner ear trigger passage of oxygen. short of breath for the same may be coughed up. People who the symptoms of dizziness and exercise as at sea level is normal. have had HAPE are likely to get it light-headedness commonly Other changes occur in the again, often at the same altitude. found in AMS. blood, which you will be less aware This is a serious (potentially life- One of the commonest of, allowing the blood to carry more threatening) condition and should problems at high altitude is a oxygen to where it is needed. not be ignored. blocked nose. Although this People often seems to be a minor hardship develop a dry Before you go: when life threatening cough at altitude. • Exercise regularly, preferably the conditions seem just around It is not entirely type planned at altitude; don’t be the corner, a blocked nose short of breath due to unfitness! clear why this upsets the normal warming happens, but At altitude: and humidifying process that is At altitude: whilst irritating, it • Walk slowly. essential to keep the lungs healthy. • Dizziness could be a sign of AMS. is not usually • Take plenty of rests. • Wear a wide brimmed hat and use sunblock on ears, nose and insides serious. • It’s not a competition! Some people Before you go: of nostrils. adapt better than others. Occasionally • Ensure gloves have a soft, • Use or improvise a nose guard on more serious • Do not ignore signs of HAPE. Seek absorbent patch over the thumb - sunglasses. medical help if possible and if in great for wiping your nose! problems can occur with breathing. doubt DESCEND! • Blow your nose regularly. • Pack tissues and wipes, high factor • Use a barrier cream (eg Vaseline) An experienced trekker on a medical research expedition arrived at 5,200m to find sun-block and barrier cream. to protect dried, cracked skin. her blood oxygen had dropped below what would normally keep her alive. Her lungs were filling with water, she became dizzy and had difficulty breathing at A climber with a cold was suffering from a runny nose and spent 2 days climbing night. Descent was impossible without crossing a high pass. She was given Ramtang on and snowfields. The reflected sunlight badly burned the acetazolamide tablets 500mg followed by 250mg three times a day. After 24 hours underside of his nose as the sun-block had been washed off. It took almost a and a lot of peeing, her blood oxygen had risen to the normal level. week to recover fully. 25 TRAVEL AT HIGH ALTITUDE TRAVEL AT HIGH ALTITUDE 18 THE MOUTH / TEETH HAPE

Your mouth and throat will get Visit the dentist before you travel. The main signs: What to check for: dry when you breathe through your Painful teeth for days (or weeks) • Trouble breathing. • Has there been recent ascent? mouth. Drink lots and use cough could ruin your trip. • Tired & weary. • Does it take a long time to get lozenges. All problems with teeth can be • Coughing. breath back after exercise? The sun can burn your lower lip prevented. Poor hygiene can trigger • Froth and later blood in spit. • Are they breathless when resting? badly. Using a zinc sun screen will the wisdom teeth problems which • Lips, tongue, nails become blue. • Is the breathing rate increasing? help to protect it. younger people often get. The cold HAPE can develop in 1-2 hours or • Can ‘wet’ / crackling sound be over several days and even when heard in chest? Put ear to back air at altitude will upset un-treated below shoulder blades. broken fillings and cavities. descending. Too much sugar may make a decayed cavity so painful that it What to do: needs root treatment or extraction • Stay with the person at all times - do not leave them on their own. which is, in most cases, impossible • Descend now - not later or in the morning. on an expedition. • Sit upright and keep warm. Most teeth and gum infections • Give oxygen via cylinder or pressure bag if you have it. can be helped for a short time with • Give nifedipine if you have it. Amoxycillin and Metronidazole. You • Give acetazolomide if you have it. can also take ibuprofen to cut down ••• If really unable to descend - prolonged use of a pressure bag may be needed. swelling.

Before you go: At altitude: Consequence if ignored: • Dental check with x-rays at least 6 • Drink lots to moisten mouth, lips Breathing stops. weeks before you travel. and throat. DEATH. • Buy zinc cream for lips. • Protect lips with zinc cream. In serious cases death can occur within as little as an hour of symptoms • Buy a chap stick. • Take antibiotics and ibuprofen for being noticed. • Buy cough lozenges. dental swellings and severe pain.

In one month at Namche Bazaar dental clinic the author of this page treated climbers from seven expeditions whose summit hopes on Everest, Lhotse, Remember it is possible to have AMS, HACE and HAPE at the same time. Nuptse, Ama Dablam and Pumori were ended by serious dental symptoms. None had dental checks before leaving home. DESCEND DESCEND DESCEND DESCEND 19 TRAVEL AT HIGH ALTITUDE TRAVEL AT HIGH ALTITUDE 24 THE HEART / BLOOD THE EYES

Travelling to altitude can have to the blood thickening, making the The high level of UV light at vision at altitude but this resolves several effects on your heart. The circulation sluggish. With this in altitude can burn the eyes (snow on descent. Don’t get laser lower oxygen in the air and mind, you should make sure you blindness), like ‘arc eye’ which treatment just before you travel - exercise you are doing can make drink plenty. If you have a known welders get - it feels like sand in the think ahead. your heart beat faster. This is not heart problem (such as an irregular eyes. Rest, padding the eyes, Tiny bleeds at the back of the normally a problem but if you have heart beat, high blood pressure, a lubricant drops and painkillers will eye can occur (retinal a heart condition (eg angina) it can heart attack or angina) or have had help. Good sunglasses or goggles haemorrhages), put extra strain on your heart. Your surgery on your heart you should are needed on glaciers even when which can affect blood pressure may go up a small talk to your doctor to make sure it’s cloudy - UV gets through patches of vision. amount at altitude, but this effect is that what you are planning is not clouds. Choose glasses designed Usually these are not normally going to put undue strain on your for the mountains and not for not dangerous and noticed. heart. If you take medicines, make fashion. Prescription sunglasses will disappear after One of the sure you take plenty with you. and goggles can be made. a few weeks. effects of altitude If you are healthy then travel to Contact lenses can be used, but Descend if you lose is for you to altitude will not put any more strain very strict hygiene is a must, which vision in either eye produce more on your heart than rigorous is difficult at altitude. Daily at altitude. red blood cells exercise at sea level. disposable lenses are fine but must (so you can carry People with inherited sickle cell be removed at night. Laser At altitude: more oxygen). problems are at risk and refractive surgery can blur your • Wear your goggles when it is bright. This can should avoid going to altitude. • If you lose your goggles improvise Before you go: using cardboard with thin slits to sometimes lead At altitude: • Get glacier goggles / glasses. look through. Before you go: • Walk slowly, don’t race. • Sort out contact lenses and • Make sure staff have goggles and • Get as fit as possible. • Take plenty of rests. cleaning fluid. wear them. • Try the level of exercise out at • Drink plenty of fluids. • If you need glasses, get spares. • Maintain hygiene if using contacts. home before you try it at altitude. • If you have any problems, stay at • Make sure you have all your that altitude, don’t go higher. A 29 year old man used daily disposable soft contact lenses on . He medications / prescriptions. • If problems persist then descend. didn’t change his lenses for four days, and on summit day wore sunglasses, not goggles. At 8,600m his vision became blurred. At the summit he couldn’t see the On a Medex trip, my BP was recorded at 168/118 one day. The group doctor said view or navigate. He was helped down by two Sherpas. He had snow blindness this was common on ascending but usually sorted itself out as you acclimatise. He and a bacterial infection. A doctor peeled the contact lenses from his eyes, but the advised that my rest day was to be taken very easily, even though I felt fine. scarring has left his vision permanently reduced. It could have cost his life. 23 TRAVEL AT HIGH ALTITUDE TRAVEL AT HIGH ALTITUDE 20 THE EXTREMITIES THE STOMACH / BOWELS

At high altitude you are at more die. This is You may lose your appetite at If you have indigestion or piles at risk from burning and freezing. High very altitude and AMS may make you home, see your doctor well before levels of UV radiation at altitude serious feel sick. Changing food may affect travelling. Piles can be a misery at can easily cause sunburn. Low and may appetite or cause the runs. altitude. With indigestion, avoid temperatures and low oxygen make lead to Many altitude trips are in areas indigestion causing painkillers. it easier for your skin to develop amputation where water and sanitation are frostbite, especially in people who of fingers poor, so the risk of the runs is already have poor circulation (such and toes. higher. Prevention is better than as in Raynaud’s disease). Body parts most at risk of cure. Bottled water and water filters Frostbite can happen to any sunburn and cold injuries are those can be unreliable. Iodine is the body part in freezing temperatures ‘sticking out’ - lips, toes, nose, chin, best, unless you have thyroid and / or high winds. Early signs of fingers, ears - so they will need disease or are pregnant. frostbite are white, numb and hard extra protection. If you do get the runs keep skin. Re-warming is very painful Swelling around the hands, face hydrated by drinking plenty of and the skin may go red, itchy, and ankles at altitude is common. purified water or rehydration blotchy and swollen. If freezing This is not serious, but it may be solution. Traveller’s diarrhoea is goes on, blisters may develop and worth checking for other problems. likely to be caused by bacteria so finally the skin can go black and antibiotics may be needed. Milky drinks, curd or yoghurt may At altitude: sooth the problem. Before you go: • Keep hands and feet dry, change Before you go: Rotting toilet paper and piles of • Get suncreen (SPF 15-30). wet gloves / socks quickly. • Plan how to get clean water so you poo ruin places. Don’t just leave it! are not afraid to drink plenty. • Get total sun block. • Wear properly fitted kit. • Apply sunscreen / block regularly. • Take rehydration sachets and / or • Get warm gloves, socks, hat, boots know how to make up your own. At altitude: - be sure they fit properly. • Cover up from sun, cold and wind. • Find out about traveller’s diarrhoea • Drink plenty. and how to treat it. • Take your favourite snacks to eat During an avalanche in the Himalayas, nine people were killed and several others • Have a group plan for disposal of when you’re off the food. were injured. The injured were air-lifted out to hospital. The porters involved were toilet paper ‘in the field’. • Always wash your hands. left behind to find their own way down, carrying the equipment of their clients. Some of the porters never made it back, but died from the cold. The clothing they When high on a Patagonian glacier a climber had to demand a sudden stop to had was not good enough for the conditions, but they dare not open the bags drop his salopettes whilst roped due to traveller’s diarrhoea. On a bivouac that they were carrying. They died beside bags containing warm mountain clothing. evening he took some antibiotics and was able to continue the next day. 21 TRAVEL AT HIGH ALTITUDE TRAVEL AT HIGH ALTITUDE 22 THE KIDNEY / BLADDER THE JOINTS / MUSCLES

As you acclimatise, your body after drinking Most people who go on of joint pain just because the will naturally make more urine. This two litres of adventure holidays feel new aches person is at high altitude. is a good sign but may mean you fluid you or pains with the extra exercise. The knee joints and leg muscles need to pee more during the day may have a Getting fit are usually the problem areas! and night. urine before you Support bandages or braces can be Exercise in the dry air and heat infection go is useful. However, it is best to try and of altitude can cause dehydration needing important, improve your muscle strength so which can be made worse by antibiotic whether that supports are not needed. traveller’s diarrhoea. Thirst, treatment. skiing, Using two trekking poles when headache and tiredness are often Older men walking, walking can reduce the load on the signs of dehydration. These can be naturally horse knee joints, especially if there are prevented by drinking several litres develop riding or lots of down-hills where the strain of safe fluid per day. Peeing at least enlargement cycling so on the knees is greatest. This could four times a day with a good of their that you be helpful if you already have a volume of clear urine shows that prostate glands which can increase can enjoy joint problem. Reducing your weight enough fluid is going in at the top frequency and urgency in passing your trip. (if you are overweight) or that of end. urine at sea level. This can lead to There has been no research your backpack helps. Frequent painful peeing of small painful retention of urine. If in doubt done that has shown a higher risk volumes (cystitis) can be a sign of get checked by your doctor well dehydration. If it does not settle before you travel. Before you go: At altitude: • Get fit with any form of exercise that • If your joints or muscles start to is practical and increases your hurt, slow down, lighten the load, Before you go: heart-rate. and / or consider a rest day. • Buy a good pee bottle for night use. At altitude: • Try and include at least a full day’s • If you normally have joint pains, • Ladies consider a Shewee or • Keep hydrated. suitable exercise each week for the make sure you take your regular similar. • Keep hydrated! month prior to departure. painkillers with you. The temperature can be colder - • Ladies may find a skirt easier for Keep hydrated! • If you are going to use trekking • discreet peeing. • poles, get used to them before you make sure you have enough layers leave. to stay warm. A normally fit trekker felt exhausted with a headache at the end of an easy day at increasing altitude. She was worried she was developing AMS but made a rapid After 6 hours riding on the first day, my knees were killing me. I knew I should recovery after drinking two litres of purified water flavoured with lemon juice. have ridden more than 3 times before we went. I suffered over the next few days!