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.