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Some Acclimatizing
Required for New Heights
(Altitude Sickness)

By Dr. Peter W. Kujtan, B.Sc., M.D., Ph.D.

Article printed on page 31 in the October 6, 2010 issue of
The Mississauga News under the feature: Health & Beauty, Medicine Matters.

Climbing at High Altitude Google image from http://graphics8.nytimes.com/images/2008/10/20/health/climbing_480.jpg Skiing at the Rockies Google image from http://www.onlythebesttravel.com/images/100_1822.jpg

Many readers are planning adventures and vacations that involve destinations at high altitude, and don't realize the importance of planning and acclimatizing to their destination. It is a lesson I learned first hand in the South American Andes. It is called altitude sickness.

Similar effects can be felt in the Canadian Rockies, where skiing can quickly get you up to the 10,000 foot elevation. It is a condition to be aware of for any traveller planning to visit destinations above 7,000 feet.

Acute mountain sickness should be suspected if, within a few hours after your arrival at a new elevation, you begin to experience a headache, accompanied by intestinal symptoms such as nausea or vomiting, fatigue, dizziness and difficulty sleeping. There is no good test to diagnose altitude sickness, and it is often attributed to things like asthma, migraine, hang-over, dehydration and food-poisoning. It relies on good old-fashioned clinical gumption.

Almost half the people arriving at a destination above 10,000 feet will begin to feel the effects. It is worse, if you are under 50 years of age and tend to live near sea-level (like Mississauga, for example). Strangely, intensive training cannot prevent it and things like heart disease, pregnancy and diabetes don't make it any worse. The problem with missing the diagnosis is that it can progress to High-Altitude Cerebral Edema. As your brain swells, symptoms such as having trouble walking, concentrating and stupor will develop. As your brain swells, it can herniate out of the base of the skull and prove fatal. A similar entity called High Altitude Pulmonary Edema (HAPE) can develop concurrently, where your lungs begin to fill with fluid, making it harder to breathe.

Acclimatization is the process of preventing altitude sickness by ascending in stages. For example, if you live in Toronto (elevation: 76 m or 249 ft above sea level) and decide to visit the highest freshwater lake in the world called Lake Titicaca (situated at 3,812 meters or 12,500 feet above sea level in the Andes), it is worth making the journey by rising to the 7,000-foot level for a few days first.

This allows the needed time for your lungs, kidneys and heart to make crucial adjustments. Some hotels in cities of the Peruvian Andes actually provide their guests with supplemental oxygen to facilitate the transition and as a treatment for minor altitude ailments. As a rule of thumb, every day that you spend at the intermediate altitude allows you to quickly ascend another 1000 feet up to a maximal altitude of 14,000 feet.

The first rule of treatment is to avoid making things worse by continuing to climb, or better yet, start to descend. Administering oxygen is very helpful. We often give a medication called Diamox (acetazolamide) which is a mild diuretic that can also decrease the production of brain fluid, and helps prevent symptoms of altitude illness. As we climb, there is less air pressure pushing against our body, and so things tend to swell slightly. It's like loosening the belt buckle once the Thanksgiving turkey is finished.

The other commonly used drug is a steroid called Dexamethasone. Medical advancements are rising to new heights all the time, and even Silendafil, more commonly known as Viagra, is finding a new niche in altitude medicine. In the Andes, one quickly discovers how to effectively chew on cocoa leaves to combat mountain fatigue. It is a historical remedy, bitter tasting, but seems to work.

It is wise to check your travel destinations with regard to altitude and plan accordingly.

Related resources:

Altitude sickness from Wikipedia, the free encyclopedia. "Altitude sickness, also known as acute mountain sickness (AMS), altitude illness, or soroche, is a pathological condition that is caused by acute exposure to low air pressure (usually outdoors at high altitudes)."
Altitude Sickness from Merck. "Altitude sickness (AS) includes several related syndromes caused by decreased O2 availability at high altitudes. Acute mountain sickness (AMS), the mildest form, is headache plus one or more systemic manifestations. High-altitude cerebral edema (HACE) is encephalopathy in people with AMS. High-altitude pulmonary edema (HAPE) . . ."
Acute mountain sickness from MedlinePlus. "Acute mountain sickness is an illness that can affect mountain climbers, hikers, skiers, or travelers at high altitude (typically above 8,000 feet or 2,400 meters)."
Altitude Sickness from Medpedia. "Altitude sickness, also known as acute mountain sickness (AMS), altitude illness, hypobaropathy, or soroche, is a pathological condition that is caused by acute exposure to low air pressure (usually outdoors at high altitudes)."
Altitude Illness - Cerebral Syndromes by N Stuart Harris, MD, eMedicine WebMD.
Outdoor Action Guide to High Altitude: Acclimatization and Illnesses by Rick Curtis.
Altitude Sickness from MD Travel Health. "Altitude sickness may develop in travelers who ascend rapidly to altitudes greater than 2500 m."
Why Altitude Can Make You Sick & What to Do About It from Weill Cornell Medical College.
Altitude Illness from CDC Travellers' Health, Centers for Disease Control and Prevention.
Altitude or Mountain Sickness - High Altitude Trekking & Climbing from the Travel Doctor.
Altitude Sickness by Peter Hackett, M.D. "Acute mountain sickness is better prevented than treated."
Head Massage - 5 Simple Exercises to Reduce Headaches. Video, 3:39 min. Demonstration of exercises by Beijing doctor (in Mandarin Chinese) to help reduce headaches / migraines. View video to copy movements:
    • 1. Rub head from front to back with both hands as if combing hair, 20 times .
    • 2. Rub over both ears top to bottom, 20 times.
    • 3. Massage forehead and temporal area, 20 times.
    • 4. Locate grooves at base of skull in neck region, massage with thumbs, 20 times.
    • 5. Relax hands and lightly tap all over head for 1 minute.

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