Runs on trail and tar­mac, kite and wake ac­tion, bikepack­ing and more.

Action Asia - - CONTENTS - By Steve White

THE WORLD EX­PE­DI­TIONS LODGE AT De­boche in Nepal’s Khumbu re­gion was packed. Sat down one wall were the 12 of us, five days into the High Passes trek. The seats op­po­site were fill­ing fast with a bois­ter­ous party of Aus­tralian women in the last days of the same trek in re­verse. All can­cer sur­vivors, they were brim­ming with life, talk­ing loudly and laugh­ing of­ten. One of our group, a fel­low Aussie, fell into the fa­mil­iar Khumbu con­ver­sa­tion: where are you headed, how long are you out? And that old chest­nut – were we tak­ing Di­amox for the al­ti­tude? Heather Hawkins, leader of their group, told us they had all taken it from the start on med­i­cal ad­vice. That stirred de­bate. None of our party had been told that and at that point only a cou­ple were us­ing Di­amox, though as the days went on, oth­ers would join them. But just what is the best ap­proach?

The ef­fects of al­ti­tude can be dan­ger­ous, but al­le­vi­at­ing and treat­ing them is sim­ple and well un­der­stood.

Most peo­ple feel some ef­fect as al­ti­tude in­creases. Climb­ing be­yond 3,000 me­tres, es­pe­cially if mov­ing quickly, in­ten­si­fies the ef­fects and can bring on acute moun­tain sick­ness (AMS). The first sign is usu­ally a nag­ging headache, fol­lowed by fa­tigue, dizzi­ness and loss of ap­petite. Nau­sea and vom­it­ing may oc­cur too. AMS is eas­ily treat­able and needn’t pro­voke alarm, as­sum­ing you are fol­low­ing a rea­son­able ac­cli­ma­ti­sa­tion sched­ule. Peter Hack­ett is Di­rec­tor of the In­sti­tute for Al­ti­tude Medicine in Ridg­way, Colorado. He rec­om­mends a min­i­mum of nine days to walk from Lukla to Ever­est Base Camp, for in­stance, a sched­ule that al­lows for rest, or ac­cli­ma­ti­sa­tion days – a chance for the body to catch up with the de­mands be­ing placed on it. One way t o c h e c k h o w we l l y o u a r e ac­cli­ma­tis­ing is to use an oxime­ter to check the oxy­gen sat­u­ra­tion of your blood – not as ac­cu­rate as tak­ing a blood sam­ple, but far eas­ier. “Med­i­ca­tions are not of­ten nec­es­sary,” says Hack­ett, “but if de­sired, Di­amox is the drug of choice, 125mg twice a day start­ing at around Nam­che Bazaar [3,440 me­tres]. Ibupro­fen is an­other choice for pre­ven­tion. For an Ever­est climber, meds are OK for the way in to base­camp, but be­fore go­ing on the moun­tain, they need ex­cel­lent ac­cli­ma­ti­sa­tion, with­out drugs.” “For per­sons pre­dis­posed to AMS for var­i­ous rea­sons, or who get AMS re­li­ably when they go to al­ti­tude, or those with­out ad­e­quate time for ac­cli­ma­ti­sa­tion, Di­amox started at the be­gin­ning of the trip may be a good idea.” On its web­site, Hong Kong’s Travel Health Ser­vice sug­gests sim­ply that ac­eta­zo­lamide (typ­i­cally mar­keted un­der the name Di­amox), “. . . is taken one day be­fore as­cent and con­tin­ued for sev­eral days at al­ti­tude.” The dosage they pre­scribe fol­lows stan­dard UK prac­tice: one 250mg tablet a day. The most com­monly no­ticed side-ef­fects of Di­amox are a mild di­uretic ef­fect and some tin­gling in ex­trem­i­ties. Oc­ca­sion­ally there are headaches and fa­tigue. None of these are a ma­jor con­cern though and al­ler­gic re­ac­tions are rare. On the other hand, AMS left un­treated can es­ca­late to far more se­ri­ous high-al­ti­tude cere­bral edema (HACE). “AMS can pro­ceed to HACE,“says Hack­ett, “al­though for­tu­nately, that is rare. AMS does not pro­ceed to HAPE [high-al­ti­tude pul­monary edema]. Al­though they can oc­cur to­gether, AMS/ HACE and HAPE are sep­a­rate – one af­fects the brain, the other the lungs. AMS is the com­mon hang­over feel­ing, with­out con­fu­sion or loss of bal­ance. HACE is di­ag­nosed on the ba­sis of men­tal changes and loss of bal­ance.” If symp­toms of AMS don’t mel­low with Di­amox, the pa­tient can be taken to a lower al­ti­tude, or dex­am­etha­sone – of­ten short­ened to ‘dex’ – can be ad­min­is­tered. “Dex treats AMS very well, but does not boost ac­cli­ma­ti­sa­tion, says Hack­ett. “Di­amox works for AMS – not as well as dex – but it speeds ac­cli­ma­ti­sa­tion. So if the per­son is not go­ing down, the combo makes sense. The dex is stopped af­ter a day or two, the Di­amox may be con­tin­ued as long as they are as­cend­ing.” The re­sponse to AMS/HACE with treat­ment can be dra­matic – some­times al­most too dra­matic. “I have had many pa­tients who are un­con­scious in the Khumbu, and wake up dur­ing the flight to low al­ti­tude, and then don’t want to pay for the he­li­copter be­cause they thought it wasn’t nec­es­sary!” says Hack­ett. “Amaz­ing how such se­vere ill­ness can re­verse so quickly. With med­i­ca­tions, the most dra­matic re­sults are with dex­am­etha­sone. I have seen cere­bral edema turned around in four hours, with the pa­tients want­ing to quickly go higher! Oxy­gen can also re­sult in a rapid re­cov­ery.”

Newspapers in English

Newspapers from China

© PressReader. All rights reserved.