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The Summit      Preparations       Memo      What you must Know     Altitude Sickness

Altitude Sickness

The briefing will contain a detailed section on altitude sickness and other medical issues ...

A general mountain rule is that you should not generally ascend more than 300 meters per day and for each 1000 meters that you do ascend you should take a rest day. The way Kilimanjaro is climbed contravenes both of these rules. This is what makes this mountain difficult and potentially dangerous. It is important that all climbers read and understand the contents of this section.

In climbing terminology, mountain altitudes are divided into three zones ... high, very high and extreme. As you can see below, this climb involves extreme altitudes and is therefore a serious and potentially dangerous undertaking ...

AMS : Acute Mountain Sickness : During the trek it is likely that more than 75% of climbers will experience at least some form of mild altitude sickness. This is caused by the failure of the body to adapt quickly enough to the reduced level of oxygen in the air at an increased altitude. There are many different symptoms but the most common are headaches, light headedness, nausea, loss of appetite, tingling in the extremities (toes, fingers) and a mild swelling of the face, ankles and fingers. These symptoms in a mild form are not serious and will normally disappear within 48 hours, the result of poor circulation or a small leakages of fluids within the body.

HAPE : High Altitude Pulmonary Oedema : "water in the lungs" : This more serious sickness has very clear symptoms ... breathlessness at rest, very high pulse, crackling sound in the chest leading to coughing of fluid (sputum). This condition is rapidly fatal unless the casualty experiences immediate descent. There are no drugs to cure and no possibility of re-ascent on this trip.

HACE : High Altitude Cerebral Oedema : "swelling in the brain" : Again there are clear symptoms ... a COMBINATION of two or more of the following : Very severe headache, severe loss of balance, mental confusion, repeated nausea. This condition is rapidly fatal unless the casualty experiences immediate descent. There are no drugs to cure and no possibility of re-ascent on this trip.

Climbers should not be scared by all this talk, but it is essential that they understand that if they push on or stay at same altitude with HAPE or HACE they will die. People do. Even serious cases of altitude sickness can only be treated by immediate descent. Our Western leaders and local guides are all experienced in dealing with the problems of altitude. It may be necessary for you to descend to a lower altitude until you recover or even to abandon the climb in the interests of safety. The decision of the Western leader or the Senior guide in such situations will be final.

The following three steps are a guide to achieving acclimatization:

Water : A fluid intake of 4 - 5 liters per day is recommended. Fluid intake improves circulation and most other bodily functions, but does not increase fluid leakage from the body. Thirst should not be an indicator of proper fluid intake, if your urine is clear then you are drinking enough.

Slow Walk : Pace is a critical factor on all routes. Unless there is a very steep uphill section your breathing rate should be the same as if you were walking down the street. If you cannot hold a conversation you are walking too fast. Breathing through the nose for the first 2 days of the climb will limit the pace. Walk "softly" allowing your knees to gently cushion each pace. "Pole pole" < go slowly > is the phrase that will echo around your head as it is repeated to you by the guides.

Walk high sleep low : If you have enough energy and are not feeling the affects of altitude, then you might take an afternoon stroll further up the mountain before descending to sleep. Almost all routes offer an extra day for acclimatization. Taking this day increases your chances of getting to the top by 30% and increases you chances of actually getting some enjoyment out of the experience by much more than that. We do not offer climbs which do not include this extra day.

Prevention of altitude sickness with drugs : Diamox

Diamox is a drug which can be taken to assist the body by improving the efficiency with which oxygen can be absorbed from the thin air. There is no disputing the efficacy of the drug. There is however a big debate as to whether and how Diamox should be used.

There are three ways to use Diamox on the mountain ...

The first way is to use it as a preventive throughout the trip starting from the day before the climb. The conventional argument against doing this is that it conceals the symptoms of body underperformance, thus increasing the chances of a failure if one does occur being catastrophic.

The second way is to "listen to your body" until day 3 (6 day climbs) or day 4 (7 day climbs) and then, if you are not demonstrating any severe symptoms, to take Diamox as directed above to boost your performance at higher camps. The argument against is the same as previous.

The third way is to only use Diamox as a treatment for altitude illness. This is reasonable, but severe symptoms can only be treated by removal from altitude.

We carry enough Diamox in our medical boxes for the second and third options. This should not be taken as an indication of our advocating this course of action. The choice is yours and we suggest that you consult your doctor and do some background reading on the subject if you remain unsure.

We estimate that of American climbers, perhaps as high as 75% take Diamox in some form during the climb. Of non-American climbers this number probably drops to 25% or below.

Here are some notes on the subject of Diamox :

"Diamox 750 mg is the proven medical dosage. That is not to say that a lesser dosage will not work, but that for the manufacturers need this dosage to prove its efficacy 100%. Our practical "recommendation" is 500 mg. It seems to work. More importantly you don't need to pee ALL the time (only most of the time) with this dosage. Quite a lot of clients are still recommended only 125mg or 250mg by their doctors."

"As far as we can see and from what the medical literature says, Diamox does not actually disguise serious symptoms of altitude sickness, as is the conventional counter argument to taking the drug. The consideration of whether or not to take it is more to do with the climber's individual attitude towards taking drugs as preventatives. If you never have been to altitude, the you do not know how your body is going to react. Do you want to take drugs for something that might not even make you sick? This is where the cultural difference comes into play ... Americans are in general more generous in their drug consumption than Europeans, so tend to be more willing to take Diamox just to be sure."

"We do not use Diamox as treatment if the climber is going to descend, but we may recommend it to climbers who are still going up. If our guides suggest that you take Diamox, then you may well wish to take them up on it."

"Last more general comment. Doctors back home might have very little idea about Diamox, therefore the advice that climbers gets varies enormously. If you really want to get the full information, then ask your doctor to refer you to a specialist."

Other health issues and notes

Aspirin and Paracetamol are highly recommended for headaches because they also thin the blood, so improving circulation & oxygen delivery to the body.

Strong painkillers are not recommended as they can suppress respiration.

One high altitude problem which is not altitude illness is Cheynes Stokes Breathing, which involves waking up in night gasping for breath. Climbers should not panic about this, it is simply because slow breathing at rest is not able to pull in enough oxygen from the thin air. A period of panting should restore the climber to normality.

Another issue is frostbite. The summit ascent is the only real time that climbers may be at risk from the affects of severe cold. If you have two good pairs of gloves and a couple of chemical hand warmers, then you should have no problem. It is essential however that you make your guides aware of particularly cold hands and feet. We have had only one serious occurrence of frostbite, which occurred when the climber in question told his climbing colleagues that he had cold hands, but did not tell to the guides. As a result he lost three nails and parts of two fingers, all of which should have grown back. This serves as a sanguine reminder of how you should communicate and rely upon your guides.

Ladies please note that altitude may affect the menstrual cycle, so bring appropriate materials.

Contact lenses must be removed at night to allow eyes to absorb oxygen from the atmosphere. The rarefied conditions of altitude reduce oxygen levels and in extreme cases a Corneal Oedema can develop.


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