Sure, we’ve all thought about it and some of us do it often. Getting high on your holiday trip can be pretty fun, in fact. I mean really high, above 11,500 feet (3500 m). Not everything cool is on a beach at sea-level. Ruins in the Andes, trekking in the Himalayas and chasing back country powder are a few things you have to get high, to do. These trips are all “dream vacations,” so why risk a problem with altitude sickness?
High altitude is considered to be 1500 – 3500 m (4950 – 11,500 ft) while very high altitude covers 3500 to 5500 m (11,500-18,050 ft). Anything above 5500 m falls into the extreme altitude category. Altitude sickness is not related to physical fitness and can have some deadly consequences, if not recognized and treated promptly.
Accute Mountain Sickness generally includes symptoms of headache, worse at night or during straining, nausea/vomiting and dizziness. The symptoms are often described as a “bad hangover”.
Some conditions associated with more severe forms of altitude sickness or AMS (acute mountain sickness) include HACE (high altitude cerebral edema) and HAPE (high altitude pulmonary edema). These conditions involve swelling and fluid accumulation in the respective tissues. Swelling of the brain, as seen in HACE, can present as marked stupor and confusion. HAPE, with fluid collecting in the person’s lungs, often starts as a cough followed by progressive shortness of breath.
As with most things, prevention is better than treatment. Prevention of AMS and it’s associated conditions centers around a slow, gradual ascent to altitude. This gives the body a chance to acclimatize and adjust to the physiologic demands of life at the new altitude, even if only for a few hours or days. This can be a problem for people traveling by car or plane to an area of high altitude, simply because they ascend very rapidly.
Symptoms of AMS can begins quickly, in as little as 2-3 hours after arrival to altitude, which means you can get off your plane and begin to feel bad, even before you arrive at your hotel! In an ideal world, all travelers going to higher altitude will be able to have a slow and controlled ascent, gaining no more than 600-900 m (1,980 to 2,970 ft) per day. However, this is not always practical. Anytime there is suspicion of an altitude related illness, stop ascending, immediately. If symptoms do not improve, consider a descent to lower altitude, for a few days of further acclimatization. Some expedition physicians also believe that most all medial problems, at high altitude, are to be considered AMS until proven otherwise.
There are a few medications used to combat AMS and a few good arguments, both for and against their use. The medicine that is most commonly used is called Acetazolamide. This medicine causes an acidosis, designed to combat the alkalosis caused by hyperventilation at high altitudes. Designed to be taken a few days prior to ascent, during the time at altitude and for a few days after descent, Acetazolamide is both a prophylactic medicine as well as a treatment. There is some controversy over the ideal dose to be used and I consider this article a good source of information, along with an article that favors a higher dose.
Against Acetazolamide Use:
Everything in life is a trade off and medicine is a perfect example of this. Side effects of Acetazolamide include a metallic taste, especially with soda, and frequent urination. Acetazolamide is a sulfa-based drug and allergic reactions can occur. Some studies have show than judicious exercise, on the first few days of arrival to altitude, can be effective in AMS prevention and that only 25% of travelers to resort communities at 8,000 and 12,000 feet have altitude illnesses.
For Acetazolamide Use:
A dream vacation can be ruined by many things and with 25% of travelers in an high altitude zone experiencing AMS symptoms, why risk spending your trip with a headache, or worse. Most vacation trips to high altitude zones last 7-10 days and Acetazolamide is a cheap and very effective medication for control and prevention of AMS.
Some other treatments for AMS, HACE and HAPE include dexamethasone and inhaled asthma medications like salmeterol. For the hard-core out there, Gamow bags can be used, especially on mountaineering expeditions. Ginko Biloba is also currently showing promise in AMS treatment/prevention.
As with most travel-related illnesses, prior proper preparation prevents poor performance. Understanding altitude illness and being aware of it’s symptoms can help with early recognition and treatment, thus preventing a ruined trip and health risk. To learn more about AMS check out these sites:
The International Society for Mountain Medicine
The High Altitude Medicine Guide
CDC Traveler’s Health Yellow Book: Altitude Illness
