Altitude Illness

Maybe not so relevant down here at sea level in San Luis Obispo, but since I’ve had two calls in the past couple weeks from friends headed to high places, I thought I’d hit some altitude medicine high points. Back when I lived at 5000 feet in Albuquerque with a few mountains nearby, altitude was more of a topic, especially among travelers with heart or lung problems.

For starters, there’s no fixed altitude above which you may expect altitude related problems, and each person is different. Hydration status, caloric intake and fatigue are other factors to consider. Diarrhea in Cusco on your way to Maccu Picchu can add another wrinkle. Also, a 14,000 footer at the equator isn’t the same as a 14,000 footer far north or south, because our atmospheric blanket is thicker around the equator. (If Everest was as far north as Denali, its summit may still be out of reach.) In general, the more time you have to adjust the better.

The three medical acronyms you’ll hear most are “AMS”, “HACE” and “HAPE”, for acute mountain sickness, high altitude cerebral edema and high altitude pulmonary edema, respectively. Sleep disturbance at altitude and “HAFE” (high altitude flatulence expulsion) are other nuisances to expect up high. AMS and HACE are considered two ends of a brain swelling spectrum. But that’s all neither here nor there. More important than knowing acronyms is knowing red flags and solutions.

Red Flags:

• Rapid ascent
• Headache (AMS)
• Nausea/vomiting (AMS)
• Disorientation (HACE)
• Slurred speech (HACE)
• Unsteady or staggering (HACE)
• Unconscious (HACE)
• Coughing… absent an infectious cause (HAPE)
• Bloody, frothy sputum (HAPE)
• Underlying heart or lung disease
• Anemia
• Cancer

Happy Words

• “I just flew from Miami to Cusco and I’m really tired and can’t climb steps as fast as I’d like.”
• “It usually takes me 2-3 days to acclimatize. I’ll be fine.”
• “I’m not in a hurry and I don’t mind ascending slowly.”
• “I drank a bottle of wine at the summit.” (…bad idea, but drunk is a better diagnosis than HACE.)

When it comes to altitude illness, one solution solves all, DESCENT. And it doesn’t have to be far. Dropping 500-1000 feet down hill can make enormous difference. If you can’t get there yourself, you may be lucky enough to find someone with a “Gamow bag”. It’s basically a hyperbaric sleeping bag that let’s someone outside with a pump lower your effective altitude inside.

As for medicines, people commonly take a diuretic called acetazolamide (Diamox) if they expect some altitude illness. It’s much more useful when started a few days ahead of the climb, however. Also, beware that it’s not for people allergic to sulfa, it’ll cause urination and possible dehydration, and it kills the taste of anything carbonated. Persoanlly, I’m not a fan for just a quick trip up and down a 14er.

Gingko is a popular non prescription supplement to prevent AMS. Steroids like prednisone or dexamethasone are also something to bring along in your first aid kits to manage illness at the extremes of altitude. Nifedipine and surprisingly Sildenafil (Viagra) may also be helpful for HAPE. And of course oxygen if you happen to have a bottle nearby.

If you want to dig deeper, have a look here. Very much of medicine is taking the edge off of self inflicted injury. My advice from down here at sea level when you’re struggling with altitude is to just come on back down for some oxygen below tree line, where the birds are chirping. Heroes are those who know when to turn back.

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