Among many things which we do for fun, traveling is one. But traveling to high altitude is not always safe because we never know what lies amidst the cloudy peaks; it can be the exotic beauty of the high mountains or altitude illness that may claim your life. The above-mentioned scenario depicts the trauma of a woman who developed high altitude illness symptoms while ascending to Gosainkunda, which lies at an elevation of 4380 meters, during Janaipurnima festival last year. As a medical student I was helping in the health camp to treat high altitude illness during the festival when thousands of pilgrims flock to Gosainkunda.
Of the 584 patients who arrived at our camp, 33 percent were diagnosed with altitude illness including severe High Altitude Pulmonary Oedema (HAPE) and High Altitude Cerebral Oedema (HACE). HAPE and HACE are fatal lung and brain complications respectively, resulting from altitude illness. They require immediate interventions ranging from extra supply of oxygen to steroid injections and an immediate shift to lower altitude.
High altitude and its beauty allure any intrepid trekker to Nepal and many of them come back again and again. But some of them also have memories of near fatal incidents they were rescued from. Others even lost their lives. So it’s always wise to be prepared for bad times while traveling to high altitudes.
A trip to or near the high mountains can be a lifetime experience, but it requires understandings of the basic principles of high altitude physiology. Anywhere above 2000 meters from the sea level is considered as high altitude. Our bodies are used to working at home altitude. So when we go higher up, the human body needs to adapt to the new atmosphere. Altitude starts to affect from around 1500-2000 meters. The body starts to behave slightly differently as it tries to make up for low supply of oxygen. If one ascends too fast to an altitude of 2500 meters, they will be at risk of suffering from altitude illness.
Given enough time to acclimatize, most people can adjust to altitudes ranging from 5000m and 5,500m but only a lucky few can go beyond that. Even if the body gets less oxygen at high altitudes, it can adapt through acclimatization. The only thing is we start breathing faster and deeper, making more red cells to carry more oxygen in the blood. But these changes take considerable time to happen.
Different people have different capacity to acclimatize. So you should mind your own pace while trekking in high altitude. Prophylactic acetazolamide (Diamox) tablets may help to quicken the acclimatization process if we need to ascend fast but this is not always recommended. Rather ‘walk high and sleep low’ is a dictum for better acclimatization. This means we ascend to a higher altitude during the day and rest and sleep at a lower altitude during the night.
Death might be lurking behind the beauty of high mountains and cloudy peaks. So trekkers should have basic knowledge about high altitude illness and equip themselves to face it.
With rapid ascent people show a variety of symptoms. Acute Mountain Sickness (AMS), the commonest of all the altitude illnesses and what we call ‘lek lagnu’ in Nepali makes people experience headache, nausea, poor appetite and fatigue. Just like a morning hangover following overnight boozing!
If you notice such symptoms, stop ascending any higher and take a rest at the same altitude. If these symptoms go away after a day’s rest, then you can proceed further up; but if you get worse, descend to a lower altitude until you start feeling better. Meanwhile you can take Diamox and drink plenty of liquid, but refrain from drinking alcohol.
HAPE is another variety of altitude illness. It is a condition resulting from accumulation of fluid in the lungs that impairs oxygenation of blood with symptoms such as suffocation, tiredness even during rest, coughing of frothy and blood mixed sputum.
...a 24 years old man from Kathmandu who ascended in a day ( which otherwise should have taken at least 3 days for better acclimatization) from Dhunche ( 1900m) to Gosainkunda ( 4380m) came to the health camp with severe breathlessness, fatigue and headache. His oxygen saturation was only fifty percent(less than ninety at Kathmandu needs hospitalization). There were basal crepitations (crackling sounds heard in the chest due to filling of the lungs with water/fluid) in both lungs. With high dose of oxygen, nifedipine and acetazolamide tablets for HAPE his oxygen saturation improved to 80 percent. He felt significantly better and was advised to descend with supplemental oxygen. He learned it the hard way not to ascend too fast……...
Similarly, HACE is another variety of high altitude illness resulting from the swelling of brain cells due to fluid accumulation. It causes severe headache and people become clumsy, act strangely and may even suffer from a non-stop vomiting. They may be confused, or have a reduced level of consciousness, and lose balance.
You can conduct a simple test to find out if someone is affected by HACE. Ask the person to walk on a straight line and if he walks like a drunken person, be assured he is suffering from HACE (provided he has not taken alcohol).
...a 54 years old lady from Nuwakot who ascended to Gosainkunda in a day and a half, had severe headache, anorexia, nausea, slurred speech and decreased responsiveness. Her oxygen saturation was 80 percent. She could not walk on a straight line; neither could she touch her nose with her finger with her eyes closed.
She was diagnosed to be suffering from HACE and was treated with oxygen supply, acetazolamide tablets and Dexamethasone injection. She was counseled to descend but she refused. She was taken care the whole night. She improved next morning but needed help to descend.
These conditions could have turned fatal had there not been medical intervention. But medical facilities at high altitudes are rare in Nepal, so descent is always the best option for AMS, HACE or HAPE suspects.
Most of those trekking to Gosainkunda were completely ignorant of altitude illness and its fatal consequences. Some even believe that they have the blessings of Lord Shiva who will get rid of the illness if they continue the ascent. Altitude illness is yet to catch the attention of the government. It should at least make an effort to educate people about altitude illness to prevent deaths due to altitude illness.
The media should also give space to such issues, especially during the peak trekking seasons and during Janaipurnima festival in Gosainkunda, when thousands of pilgrims—children and elderly alike—risk their lives seeking Lord Shiva´s blessings.
(Writer is a final year MBBS Student at Tribhuvan University Teaching Hospital Maharajgunj, Kathmandu).
themaniraj@gmail.com
Related story
Nepal hotel holds record for highest altitude hotel in world, M...
