The Basics of Altitude: A Primer on AMS, HACE, & HAPE, Part III

N-SIT-S-0041: Mount Everest (center) and Nuptse (right) from the summit of Kala Pattar, Khumbu Valley, Nepal. Members of Nepal's cabinet will meet on December 4th in Gorak Shep in an effort to raise awareness about the effects of climate change on the delicate Himalayan environment. The move is quite similar to the underwater meeting held by the Maldives' cabinet a few weeks ago.

While the cause is worthy, it's more than a bit concerning to think of Nepal's ministers hopping in a helicopter from Kathmandu (about 4,600 feet) and flying – with a brief pit-stop in Lukla for a medical checkup – to 17,000 foot Gorak Shep. Even though the meeting is supposed to be brief, clouds come in quickly in the Khumbu, and helicopters there can only operate in VFR, and thus are grounded when the weather comes in. Thus, even though a short meeting is planned, the weather might make other plans…and the potential for AMS, HACE, and HAPE increases dramatically. 

So, that brings us to the final part of this series on altitude sickness: how do we avoid – or at least reduce the chances of – getting AMS, HACE, and HAPE in the first place?DSC_0029-0406-1: The 2002 Ford "No Boundaries" Everest Expedition Team climbs over Memorial Hill outside of Lobuche, Khumbu Valley, Nepal. Ama Dablam dominates the skyline behind, while Scott Fischer's memorial chorten sits in front.

As a high altitude physician once said to me, the first thing to do is choose your  parents. This is because medicine is now discovering that much of high altitude physiology, of who does well and who does not do well at altitude, may depend on your genetic makeup.

Unfortunately, no matter how much we want to, none of us can choose our parents! So, we've got to take some other steps when traveling to high altitude to reduce the chances of getting sick.

  • Rule #1: Plan. This is pretty basic, but important. The altitude rule of thumb is to ascend no more than 1,000 feet per day to allow your body time to properly acclimate.

    So, set your schedule accordingly, especially if your itinerary involves altitudes higher than you've been before. If you must go up more than 1,000 feet in a day, try to fit in a day of rest and acclimatization. And, of course, monitor yourself and your teammates for any signs and symptoms.

  • Rule #2: Hydrate. Water pretty much helps with everything, altitude included. And, keep in mind that at high altitude, the air is drier, resulting in increased fluid loss. So, drink up…and keep it to water or other non-alcoholic and decaffeinated beverages!
  • Rule #3: Know Your Body. This is perhaps the most important rule. While I, as a guide, can watch my clients for signs of trouble, only they can truly know and understand what their body is telling them. Likewise, your teammates can only know so much about you and your body. So: know your body, listen to it, trust what it is telling you.

    If you have a headache at altitude, take an aspirin. But, remember that the headache is your body telling you something important: it's not getting enough oxygen. It may be dehydrated. So, take the aspirin, kill the pain, but remember to breathe and drink.

  • Rule #4: Let your body do the work. In today's world, we tend to want to pop a pill and let chemistry solve our problems for us rather than letting our bodies do the work. Often, this can be counterproductive.

    I can't tell you how many times I've had clients on a trip who, on the advice of a physician, are popping Diamox prophylactically without ever having tried to let their bodies adjust to altitude first. As a result, many have suffered the side effects of Diamox (tingling in the extremities, antsyness, dehydration, etc.) without ever knowing if they could have gone to altitude without chemical help.

    So, my rule here is let your body try. Give it the benefit of the doubt. Breathe a lot. Take it slow. Monitor for any signs and symptoms and treat accordingly. And, finally, take Diamox when and if needed, but give your body a fighting chance first!

  • Rule #5: Be flexible and relax. Altitude, like mountain weather, is a fickle thing. I've climbed with people who have done fine on big mountains and then suddenly got sick at an altitude they had been to before. Simply put, you never know. There seems to be little rhyme or reason to altitude sickness.

    So, be flexible. Rest if needed. Build extra days into your itinerary. If you get stopped by a storm, don't rush upward to make up days as soon as the sun comes out. Take your time, relax, make sound, safe, smart decisions…and enjoy the hills!

And, if you want to learn more about altitude and oxygen, be sure to stop on by the American Mountaineering Museum and see our new exhibit, Thin Air!

Jake Norton is an Everest climber, guide, photographer, writer, and motivational speaker from Colorado.

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