November 30, 2011

What about altitude sickness? Should I worry?

We all know that worrying will get you nowhere, and knowledge is power…so let’s get down to what you need to know.

High altitude pulmonary edema (HAPE), high altitude cerebral edema (HACE) and acute mountain sickness (AMS) are three distinctly identified types of acute altitude illness, although they are actually on spectrum, with some grey area between them. AMS and HACE are more closely related than HAPE, but prevention and treatment is similar.

If you follow mountaineering at all, then you’ve surely heard terrible tales about HAPE and HACE.  If you seen the film ‘Vertical Limit’ you know that all high altitude climbers are dexamethasone crazed maniacs.  I know it’s hard to believe, but Hollywood’s representation of high altitude climbing, and altitude illness is not entirely accurate.  In reality AMS is much more common, and more benign than HACE or HAPE, when treated properly. Symptoms of AMS include headache, nausea, fatigue, difficulty sleeping, dizziness.

The best way to approach altitude illness, like any illness, is to prevent getting it in the first place.  Gradual ascent is a great way to give your body a chance to naturally adjust to higher altitudes. The altitude where you sleep is the most important piece of the puzzle, so the ‘climb high, sleep low’ strategy is an excellent, time tested plan of action.

Being in good shape for your climb will help out as well, so that extra time on the stair climber, bicycle, running up and down the stadium with a pack on during your lunch hour will pay off…keep it up.  The stronger you are, the less stressed your body will be.  I’ve never climbed with anyone who didn’t summit because they were too strong!

Rest and hydration also play a role. You want to be well hydrated, but not overhydrated. Just make sure that you’re drinking a reasonable amount of water, with some electrolyte replacement.

Even with excellent training, nutrition and hydration some people are just more prone to feel the effects of altitude.  In general, younger folks are more likely to have symptoms than older folks (another upside to aging!).  The first time I climbed Rainier I was 17, and I felt terrible…I ascended fast, I didn’t drink much water, and I hadn’t trained for it.  I just ‘bulldogged’ my way up. The summit was awesome, but I could have played my cards better.

The best way to treat any type of altitude illness is to descend. With mild to moderate AMS symptoms it’s OK to stay where you are until symptoms resolve, but you should never move up the mountain when you have significant symptoms. When in doubt, hang out! And consult an expert.  Acetazolamide (diamox) is the most commonly used medication for prevention and treatment of altitude illness (there are quite a few).  If you’ve had significant symptoms at altitude before, or think that you will, talk to your doctor and come up with a plan.

Emily Johnston

Don’t waste your energy worrying about altitude sickness…learn about it, prevent it, get in shape, then pick a mountain and go for it!  See you on top.

Emily Johnston

Emily Johnston is one of our lead guides at IMG. When not guiding mountains, she is a whitewater guide, pro patroller at Crystal Mountain Ski Area, and oh yes, an ER doc.