Nepali Times

Mountain warning

DHANVANTARI by BUDDHA BASNYAT, MDLife Times, Dhanvantari

Life Times | From Issue #522 (October 1-7, 2010)

The trekking season is upon us, and it would be wise to remind ourselves of the warning signs of altitude sickness. Consider acute mountain sickness (AMS) to be a red flag. As you trek at about 2,500 m or higher you may suffer from hangover symptoms, headache and nausea. But if you descend a few hundred meters, you may feel these symptoms subside. With AMS, it is likely that you will get better if you don't go any higher, or descend right away.

Peer pressure, an overriding ego, or wanting of their money's worth from the trek can make people with AMS go in denial of their weak condition. Dangerous complications ensue when they push themselves and try to ascend higher. Water collection in the brain (high altitude cerebral edema, HACE) or in the lungs (high altitude pulmonary edema, HAPE) occur, as water seeps out of the blood vessels in these organs due to lack of oxygen brought upon by the inability to acclimatise properly. Symptoms of HAPE and HACE thus mandate immediate descent (by foot, yak, horse, a porter's back, or a helicopter).

Preventive aspects of "Lekh Lagne" (altitude sickness in Nepali) include the practice of listening to one's body. The sea level rule of "when the going gets tough, the tough get going" clearly does not apply at high altitudes, and strong and silent 'John Wayne attitude' would be life-threatening indeed. So don't rush up the mountain. Drink adequate fluids (about 3 liters per day), do not sleep higher than 300 to 500 m from the previous night's altitude, take a rest day every third day of your trek, practice the "climb high sleep low" technique, and take 250mg of diamox (acetazolamide), if you don't have sulpha allergy, two times a day if necessary.

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Comments (Archive)

  • Siddhartha Yadav

    Thank you Dr. Basnyat for this useful article. Certainly, following your simple guidelines can help many trekkers avoid expensive helicopter rescues (as shown in the pic) for dangerous consequences of altitude sickness.

  • Anonymous

    I appreciate Dr. Basnet for providing practical 'tips' on quick diagnosis and management of the altitude sickness based on western Allopathic medicine. Hopefully, the average educated 'layperson' from the urban centers, who can read and write English, can understand the material; even though, the writing contains sophisticated medical jargon such as 'cerebral,' 'pulmonary,' or even 'oedema', terms mostly derived from Latin and Greek. My quest is -- How Dhanvantari would have tackled the problem in his (her?) own days? (In the Oriental literature, the epic of Mahabharata clearly speaks of "mahatma" Youdhisteer setting out for the high Himalayas (metaphor for heaven!) after the battle of Kuruchettra was over. Similarly, the Ramayana mentions of Hanumana, the monkey God, flying in search of "sanjeevani butee" and fetching the entire mountain top on his palmtop to save the life of the fallen hero, Laxmana, brother of God Rama. For ages high mountains have been the reference points of reverence and inspiration for the inhabitanats of the Arayavarta.) The narrative "lekh lagne" is a common vernacular among people residing in the upper hills and mountains of Nepal. I wonder if daktersahebh has done any research on the indigenous knowledge and practice (e.g. use of herbs) regarding the healing of mountain sickness among the native mountain people. Wouldn't Dhanvantari be interested in the study of ethno-medicine and local practice?