High-al­ti­tude seeker? Prep the right way

Oxy­gen-re­lated sick­ness at great heights avoid­able

Baltimore Sun Sunday - - FRONT PAGE -

When I told friends I was go­ing to Ti­bet last spring, al­most ev­ery­one asked, “What are you do­ing to pre­vent al­ti­tude sick­ness?”

Not nearly enough, it turned out, given the headaches, in­som­nia and oc­ca­sional woozi­ness I ex­pe­ri­enced dur­ing four days in Lhasa. The Ti­betan cap­i­tal rises from the Hi­malayan Plateau to 11,978 feet above sea level — more than twice the el­e­va­tion of Den­ver.

Al­ready badly jet-lagged af­ter de­plan­ing in Lhasa, I sud­denly faced one-third less breath­able oxy­gen than in the low-ly­ing cities I’d just left: Bei­jing, Los An­ge­les and Wash­ing­ton, D.C., where I live. Even our not-so-rig­or­ous Ti­betan so­journ — which in­volved some walk­ing, mul­ti­ple bus rides and the oc­ca­sional long or steep climb to a palace or monastery — played havoc with my head, heart and lungs.

Road Scholar, our Bos­ton-based tour op­er­a­tor, had ad­vised us to in­crease our pre-trip aer­o­bic ex­er­cise and deep breath­ing for sev­eral months to im­prove stamina, and in­sisted that we con­sult doc­tors to learn about al­ti­tude sick­ness risks and reme­dies. But be­cause we had flown straight from sea level in Bei­jing to more than 2 miles up in Lhasa with­out giv­ing our bod­ies time to ac­cli­mate, some of us were shocked by how aw­ful we felt.

Al­ti­tude sick­ness, put sim­ply, is the body’s re­ac­tion to de­creased oxy­gen lev­els. We lose 3 per­cent of in­haled oxy­gen mol­e­cules for ev­ery 1,000 ver­ti­cal feet trav­eled, ac­cord­ing to al­ti­tude re­searchers. To com­pen­sate for the lack, trav­el­ers in­hale more fre­quently and can feel out of breath. With ad­di­tional symp­toms in­clud­ing headache, nau­sea, vom­it­ing, dizzi­ness and fa­tigue, al­ti­tude sick­ness can mimic a re­ally bad hang­over.

There are three types of al­ti­tude-in­duced ill­ness. For­tu­nately, only the mildest type struck some in our 11-mem­ber group: acute moun­tain sick­ness (AMS), com­monly called al­ti­tude sick­ness. Two re­lated and po­ten­tially fa­tal ail­ments can oc­cur when lower air pres­sure and higher al­ti­tudes cause cap­il­lar­ies to leak: high al­ti­tude pul­monary edema (HAPE), a buildup of flu­ids in the lungs, and high al­ti­tude cere­bral edema (HACE), a buildup of fluid in the brain. In ex­treme cases, AMS can be­come HAPE or HACE, or the ill­nesses can de­velop on their own with­out be­ing pre­ceded by the milder one.

If you’re plan­ning a high-al­ti­tude ad­ven­ture, a bit of pre­ven­tion could save your va­ca­tion — if not your life. Dis­com­fort can set in as low as 3,000 feet for those with lung dis­ease; for oth­ers, prob­lems won’t ap­pear un­til around 8,000 feet. For con­text, Mount Ever­est, the world’s tallest peak, rises to 29,029 feet; Alaska’s De­nali, the high­est U.S. peak, hits 20,310 feet; and Mount Kil­i­man­jaro in Tan­za­nia stops at 19,341 feet.

The best strat­egy, as Road Scholar noted, is to ac­cli­mate the body at lower el­e­va­tions be­fore head­ing sky­ward. An­other way to side­step AMS is to “climb up and sleep down” at less stren­u­ous lower al­ti­tudes. This means head­ing to higher ground from your ho­tel or base camp but spend­ing the night at the start­ing point or an­other less-el­e­vated site where there is greater oxy­gen den­sity.

Many high-al­ti­tude seek­ers rely on Di­amox, a pop­u­lar pre­scrip­tion drug that “stim­u­lates breath­ing and raises your oxy­gen level,” says Peter Hack­ett of Tel­luride, Colo., an emer­gency medicine physi­cian, al­ti­tude sick­ness ex­pert and ex­pe­ri­enced moun­taineer. Yes, you’ll uri­nate more of­ten, car­bon­ated drinks may taste odd and your toes and fin­gers will tin­gle, he ex­plains, but those are tem­po­rary and harm­less side ef­fects. While the body usu­ally needs two to four days to ad­just to high al­ti­tudes, “Di­amox does the same thing in about eight hours, speed­ing the nat­u­ral process,” says Hack­ett, not­ing that the drug works for 85 to 90 per­cent of peo­ple.

Nov­el­ist Rus­sell Banks has climbed moun­tains on four con­ti­nents. He says he suf­fered his lone bout of al­ti­tude sick­ness when a de­layed flight from Al­bany, N.Y., cost him a day and night of ac­cli­ma­tiz­ing at 10,000 feet in Quito, Ecuador. He and his bet­ter­ac­cli­mated pals were climb­ing Vol­can Cayambe ( just un­der 19,000 feet) in the An­des when Banks was struck by a headache and vom­it­ing. “I was not so sick that I had to go down. I had Di­amox, and I just popped those.”

Now 78, Banks has given up high-al­ti­tude ad­ven­tures, but he hap­pily of­fers this ad­vice: “Al­ways ac­cli­ma­tize, and don’t wait un­til you’re sick to start tak­ing Di­amox. Just take it, be­cause it can’t hurt you.”

There are also fa­vorite lo­cal reme­dies: yak but­ter tea in the Hi­malayas, which our Ti­betan and Nepali guides swore by, and coca leaf tea, con­tain­ing mi­nus­cule traces of the al­ka­line known as co­caine — the highly pro­cessed drug that shares its name uses the leaves — and widely served in the An­dean re­gions of South Amer­ica, which sev­eral of my fel­low trav­el­ers had sa­vored in Cusco, Peru (11,152 feet). Alas, the tea is banned in the U.S.

Many ho­tels in moun­tain­ous ar­eas pump ex­tra oxy­gen into guest rooms, es­pe­cially overnight; oth­ers pro­vide small per­sonal oxy­gen can­is­ters or por­ta­ble units in rooms. I used a ma­chine the size of a small ra­di­a­tor in Lhasa. It cost $5 per hour, ster­ile nose hose in­cluded. Dur­ing those 60 min­utes, I felt marginally bet­ter, although the headache roared back af­ter­ward be­cause the body can’t store sup­ple­men­tal oxy­gen. I could have kicked my­self dur­ing our time in Lhasa for stupidly, in­ex­pli­ca­bly choos­ing not to take the Di­amox I’d brought along.

Some­times, the cure can be mis­taken for the ail­ment. Con­ven­tional wis­dom urges high-al­ti­tude trav­el­ers to tem­po­rar­ily avoid caf­feine, a di­uretic that has­tens de­hy­dra­tion and con­stricts cap­il­lar­ies. Con­se­quently, what seems like al­ti­tude sick­ness can, in fact, be caf­feine with­drawal, which struck one group mem­ber who usu­ally downs eight to 10 cups of black tea a day.

Hack­ett, the physi­cian, em­pha­sizes that “the most im­por­tant fac­tor of whether or not you get sick is how fast you go high.” If you’re headed to Tel­luride, he sug­gests, spend the first day or two in Den­ver or Mon­trose, both at sig­nif­i­cantly lower el­e­va­tions than the ul­ti­mate des­ti­na­tion.

That lay­over, says Hack­ett, could mean the dif­fer­ence be­tween a great va­ca­tion and a nasty bout of al­ti­tude sick­ness. Or worse.

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