Altitude Sickness:
Altitude Sickness, often known as Actute
Mountain Sickness (AMS) is particularly
an important medical consideration while
trekking in Nepal. Altitude Sickness
means the effect of altitude in those
who ascend too rapidly to elevations
above 3,000 meters. The initial symptoms
of AMS are as following:
* Nausea, vomitting
* Loss of appetite
* Insomnia/ sleeplessness
* Persistent headache
* Dizzines, light headedness, confusion
* Disorientation, drunken gait
* Weakness, fatigue, lassitude, heavy
legs
* Slight swelling of hands and face
* Breathlessness and breathing
irregularity
* Reduced urine output
These symptoms are to be taken very
seriously. In case of appearance of any
of the above Symptoms any further ascent
should be reconsidered; otherwise more
serious problems may occur which can
even cause death sometimes within a few
hours. The only cure for the Altitude
Sickness is to descend to a lower
elevation immediately. Acclimatization
by ascending to no more than 300 to 500
meters per say above 3,000 meters and
the proper amount of rest are the best
methods for preventions of AMS.
Literatures and pamphlets published by
the Himalayan Rescue Association consist
of detailed informations of AMS. The
Central Immigration Office and all
trekking agencies in Kathmandu
distribute these pamphlets free of cost.
Since they also give information on the
list of suggested supplies for trekking
it is a compulsory item for every
trekker's medical kit.
ALTITUDE SICKNESS
Himalayan Rescue Association (HRA)
provides effective information to
trekkers on prevention and treatment of
Acute Mountain Sickness (AMS).
Informations are relevantly given below:
CAUSE/FACTOR OF ALTITUDE SICKNESS:
a. Less Oxygen
b. Low Pressure, i.e. Barometric
Pressure
c. Rapid Ascent
d. Possible Dehydration
e. Hypothermia
TYPES OF ALTITUDE SICKNESS:
1. AMS: Acute Mountain Sickness
2. HAPE: High Altitude Pulmonary Edema
3. HACE: High Altitude Cerebral Edema
SYMPTOMS
I. ACUTE MOUNTAIN SICKNESS
Mid symptom feels like a hangover/not
feeling well:
1. Headache
2. Fatigue/ Tiredness
3. Nausea
4. Shortness of Breath
5. Loss of Appetite
6. Disturbance in sleep
7. Dizziness
II. HIGH ALTITUDE PULMONARY EDEMA
(Water in the Lungs):
1. Increasing shortness of breath even
at rest.
2. Severe Cough- Dry/ Productive.
3. Very tired unusual fatigue while
walking.
4. High pulse rate, i.e. 110.
5. Blueness of face, lip, fingernails-
that means the inability of transporting
Oxygen into the blood.
III. HIGH ALTITUDE CEREBRAL EDEMA
(Water in the Head): Severe symptoms of
Altitude Sickness
1. Severe Headache.
2. Vomitting.
3. Walking like an intoxicated (Ataxia).
4. Mental confusion/Altered mental
status.
5. Irritable- Does not want to be
bothered by other people.
6. Unconsciousness or Coma.
Test: Tandem walking test, Heel to toe
step. Fall off from the line.
DECISION MAKING:
1. Find out the mean problem i.e. at
altitude. Assume all problems are
Altitude Sickness unless proven
otherwise.
2. If it is altitude problems with mild
symptoms, stay at the same altitude
until the symptoms are completely gone.
An example- Take an Aspirin tablet, try
to go up but listen to your body. If
symptoms are worsening please do
descend.
PREVENTION:
1. Acclimatization- After a 1,000m.
ascent, stay one more night for
acclimatization.
2. Do not make RAPID ASCENT; don't go
too fast too high.
3. No alcohol, sleeping pills and
smoking.
4. Drink more fluid 3-4 liters a day-
clean water, hoiled and filtered, or
treated tea/coffee/soup/juice, etc.
5. Do not carry heavy packs, 10-12
kilograms is okay.
6. Climb higher, always sleep lower.
7. Over 3,000m... 300 meters ascent a
day.
8. Never travel alone.
TREATMENT:
1. DESCENT is the best remedy; please do
not wait for the Helicopter.
2. Medicines:
a)Oxygen
b)Diamox- for AMS 125 mg. Before dinner,
for sleeping problem if feeling
suffocated.
c)Nafedipine for HAPE.
d)Steroids/Dexmethasone for HANCE
3. Hyperbolic Bag- GAMMOW BAG FOUR
GOLDEN RULES:
1. Awareness of ALTITUDE ILLNESS
2. If you have mild symptoms, do not
proceed higher. Take Aspirin tablets.
3. If you have worsening symptoms, GO
DOWN IMMEDIATELY.
4. Do not leave your team member behind
unattended, either the trekker or the
guide or the porter.
THREE IMPORTANT THINGS TO PERFORM:
1. Go up slowly.
2. Drink plenty of fluids (at least 3
liters per day).
3. Before your trip, go and visit HRA to
refresh your knowledge about Altitude
Sickness so that it can help yourself
and others as well.
LIST OF CLOTHING EQUIPMENTS & PERSONAL
EFFECTS:
* Lightweight walking boots. If a new
pair is being bought. "walk them in" to
avoid blisters. Also bring spare laces.
* A pair of track shoes. To wear in the
camp at night or when the boot is wet.
* Warm jacket. Fiberfill or down should
be adequate. This is especially
necessary during winter from December to
February.
* A rainproof jacket with hood or a
puncho. Fetch the one that is guaranteed
waterproof.
* Woolen shirts and thick sweaters.
During winter months, December through
February, these items are highly
essential. Thick sweater can be
purchased in Kathmandu City.
* A pair of light weight/heavy weight
trousers. Jeans are unsuitable to wear
on treks. Cheap loose cotton pants are
available in Kathmandu. Heavy weight
trousers are useful higher up in the
mountains in the morning and at night.
* Windproof/waterproof trousers.
Necessity on all treks going above
10,000ft.
* Thermal underwear. These are excellent
to sleep in at night. In the winter
months thermal under wears are quite
invaluable.
* A tracksuit. Useful for wearing in
camp and in the teni.
* 1-2 pairs of loose fitting long
short/skirts.
* 2-4 cotton T-shirts.
* A lightweight long sleeved-shirt is
particularly suitable for avoiding the
sun-burn.
* A woolen hat to wear in the morning
and at night. During winter it is an
essential item.
* A sun-hat and ensure it has a wide
brim to cover the face and neck.
* A pair of gloves. Leather with lining
and woolen are best.
* 1 pair of sandals to wear in the
cities and in camps.
* 2 pair of thin and 2 pairs of thick
woolen socks.
* Underwear: normal quantity and
swimming costumes, hankies.
EQUIPMENTS:
* Duffle bag or kit bag to carry to gear
while trekking.
* Daypack. This is a small rucksack to
carry personal requirements for the day
e.g. toilet items, camera, films, towel,
soap, a pair of boots, etc.
* Water bottle.
* A pair of snow glasses and sunglasses.
* 2-4 large plastic bags to separate
clean clothes from dirty ones; 6-10
smaller plastic bags to dispose garbage.
* Wallet and/or money- belt with
compartment for coins.
* Toiletries with large and small
towels. Toilet paper can be bought in
Kathmandu and some villages in the
mountains.
* Small headlamp and/or flashlight with
spare batteries and bulbs, candlesticks
and lighter to burn toilet paper.
* A pair of snow gaiters essential
during winter and all treks going over
at other times.
* An umbrella (optional) which is quite
useful to ward of the dogs, suitable as
a walking stick, to use as a sunshade
and useful when the rain falls.
* Reading materials, camera and film,
game items (optional), note book, rubber
band, pen and pencil, envelopes, a
diary, a calender, a Swiss knife, a pair
of binoculars (optional), A small pillow
or head rest (optional), therma rest
(optional), an inflatable sleeping mat,
trekking map, adequate quantities of
passport size photographs.
* Personal medical supplies.
MONEY MATTER
* Nepal has modern banking facilities
and some of the International Banks have
their own offices in Kathmandu. Almost
all foreign currencies along with credit
cards such as American Express, Visa
Card and Master Card, etc. are accepted
in Nepal.
* All visitors are required to exchange
their money through the bank or
authorized agencies. In Kathmandu banks
with money exchange counters are found
everywhere and most hotels also have
exchange counters. These facilities to
change money are quicker and more
convenient. It is necessary to ask for
receipts when money is changed. On the
return journey, if one is left with
Nepalese rupees they can re-exchange
against these receipts to any foreign
currency at the Trivuban International
Airport, Kathmandu. Remember to retain
Rs.700 for airport taxation when
departing Nepal by air.
* It is generally not possible to change
foreign currency/travelers cheques
(except in Namche Bazaar, Jomsom,
Salleri, Okhaldhunga, Pokhara, etc.) in
the mountains. One must therefore change
required money in Kathmandu before the
trek starts. When cashing money for the
trek always ask for small denominations
(ones, twos, fives, twenties,
twenty-fives and some in fifties and
hundreds- never in five hundreds and
thousands). Be careful of torn
banknotes; the people in the village may
not accept them.
SOME USEFUL SUGGESTIONS:
* During your trekking sojourn in the
hills and the mountains of Nepal you
should be aware and remember that you
are travelling back in time and into
wilderness not usually frequented by
many foreigners, away from normal
policing. Although the people of the
hills of Nepal are exceptionally
hospitable, honest and friendly by any
standards, the possibilities of some
trekkers encountering bad elements who
take advantage of aliens cannot be
eliminated. It would be wise to exercise
the following basic rules as regards
security and safety during your
trekking.
* Trekking organized through a
recognized Trekking Agent ensures
comfort and convenience, safety and
security and greatly affords the unique
experience. This approach to trekking
not only prevents you from any
unforeseen hazards and accidents but
also provides educational information
regarding experiences on the mountains,
people and life in rural Nepal
* All foreign nationals are required by
law to pay their hotel, travel and
trekking agent's bills in convertible
foreign currency recognized by the State
Bank of Nepal (Nepal Rashtra Bank).
Exchange your money through authorized
banks/ money changers only. Insist on a
receipt when exchanging your money and
retain all exchange receipts with you
till the end of your journey in the
Nepalese Kingdom.
* Littering mars the purity of
environment. Avoid the use of
on-biodegradable items as much as
possible. Your attempts to burn oddments
and carry out the unburnable ones will
be a great help in the efforts to
conserve the environment.
* Avoid dispute with local people, most
particularly when you are alone. Avoid
drunkards and lunatics.
* Do not encourage beggars by giving
them money or other articles.
* Be most economical with all fuel.
Avoid hot showers which use firewood and
discourage campfires. Avoid lodges using
firewood and insist on use of Kerosene
for cooking to Trekking Agents.
* We strongly recommend that you take
out a personal travel insurance to cover
against illness, accidents, loss and
theft of items and materials, travel
alteration and deviations, rescues and
evacuation.
* It is recommended not to travel alone
in the remote areas while traveling in
Nepal particularly in the case of
females. If you do not have a fellow
trekkers as companion, you should engage
a guide/porter except through a third
party who has responsibility for the
person engaged. All the information
including fees and tariffs mentioned in
this Guide Book Are valid at the time of
printing. Therefore, they are subject to
change without prior notice. |
