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
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
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
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
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.