Avoiding Altitude Woes: What To Bring On Your Next Ski Trip

skierThere are few things that bum out a ski trip more than altitude issues. Even if your symptoms are just in the form of Acute Mountain Sickness (AMS) – headache, fatigue, dizziness, insomnia or nausea – it’s often enough to make you wish you’d stayed at home.

I live in Colorado, and have resided in a couple of high-altitude ski towns in the past. Since our ski season just kicked off, for the purposes of this post I’m only focusing on AMS, rather than more serious forms of altitude sickness.

Predisposition to AMS is subjective. Age, physiology, genetics, and physical fitness may or may not play a role. If, however, you’ve got congestive heart failure, a nice alpine getaway may not be the best thing. Conversely, if you’re not in the habit of drinking lots of water at elevation, you’re going to feel like hell, regardless of how fit you are.

The higher the elevation, the harder your body has to work, because air pressure is lower (i.e. there’s less oxygen, which is also why it’s dehydrating). The body responds by producing more red blood cells to increase circulation. The short answer is, high elevations stress the body.

To ensure your next visit to the mountains is free of altitude-related woes, follow these tips:

  • Hydrate – with water, not soda or other sugary beverages – then hydrate some more. Amounts vary depending upon your gender, activity level and weight; 2.5 liters a day is considered a rough daily estimate necessary for good health at sea level. If you’re seriously shredding the pow, then a sports drink with electrolytes at day’s end is also a good idea.
  • If you have health concerns, acclimate slowly, if possible. Try to spend a night at a lower elevation before heading to your destination. Example: Fly into Denver (5,280 feet), before heading to Aspen (7,890 feet).
  • Go easy the first 48 hours, as you acclimatize.
  • Since you’re burning and expending more calories, be sure to eat small, regular meals or snacks when you’re out there tearing it up on the slopes.
  • Reduce (I know better than to say “avoid”) consumption of alcohol. At altitude, one drink has double the impact. This makes for a cheap date, but it can do a number on your head and body. Pace yourself, and drink a glass of water in between each alcoholic beverage. You’re welcome.
  • Take Diamox, ibuprofen, or aspirin, which will eliminate many of your symptoms such as headache, sluggishness, or dizziness. When I attended culinary school in Vail, one of our classrooms was located at 11,000 feet. Our first week of school, most of us were nodding off due to the altitude, and aspirin was far more effective than caffeine.
  • If you’re having trouble sleeping, you can try an OTC, or avail yourself of the local hot tub or a warm bath before bed (remember to hydrate afterward!). If you already have insomnia issues, be sure to bring your prescription or regular OTC with you.
  • Slather on the sunscreen. Not only is the sun far stronger at elevation, but its reflection off the snow can reduce your skin and eyes to cinders. Know what else a potent sunburn does? Speeds dehydration. As well as photoaging and skin cancer, but that’s a topic for another article.
  • Don’t get cocky. I live at 5360 feet, and sometimes, even I forget to follow my own advice – a certain crushing hangover in Vail two weeks ago comes to mind. Just because you live at altitude doesn’t mean you’re used to higher altitude. You’ll be better conditioned, yes. But you still need to hydrate regularly, and for the love of god, go easy on the bourbon rocks.

For more detailed information on altitude sickness, including extreme elevations, click here.

Wishing you a safe, happy snow season!

[Photo credits: skier, Flickr user laszlo-photo; tea, Flickr user Kitty Terwolbeck]

Getting High on Your Holiday

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