DISCLAIMER : The basis of this article comes from knowledge I gained through research and also through my own experience on these trips. I am not a doctor and so do not take the content of this article as a sole source of health related information. Use it as a guide for your own research and for consultation with medical specialist. If unsure, always consult your doctor.
I put together this document based on my four previous trips in Himalayas. I am certainly not expert but I learned a thing or two which can be helpful to people who come to Himalayas for the first time and want to leave with great experience and memories. Although the target destination is Nepali Himalayan region, many of the topics covered here can be applied to other high altitude destination.
Acute Mountain Sickness
You might wonder what has health to do with photography. Actually a lot. You get sick, you won't take any photographs or just enjoy the trip for that matter. As simple as that. When it comes to Himalayas, the most obvious concern is AMS or Acute Mountain Sickness. It occurs during prolonged exposure to higher altitudes with low oxygen pressure. It manifests itself with series non specific symptoms. In most severe cases they occur in two forms. HAPE (high altitude pulmonary edema) and HACE (high altitude cerebral edema). As a consequence of being in high altitude, the brain is swelling (HACE) or lungs are being filled with water (HAPE) and if untreated, it can cause death. However, if you follow some easy steps and watch for warning signs, you can maximize your chances avoiding it all together. It is important to note, that every person is different and will react to exposure to high altitude differently. Even the most seasoned mountaineers can get sick.
Some of the notable AMS symptoms are:
- Headache (the most common)
- Lack of appetite
- Gasping for air
- Inability to sleep
- Peripheral edema (swelling of hands for example)
Almost everyone is going to experience one or more of these main symptoms. Red flag should be raised when they get worse and no precautions is taken. In that case things are going to get inevitably worse and potentially really serious. If you have strong persistent cough, fever, permanent shortness of breath, strong headache that does not respond to medication, gradual loss of consciousness. retina hemorrage, unsteady gait then you are in trouble and you have to take necessary steps to ease the symptoms. The only real remedy is to go down to lower altitudes. Immediately. You should never let thing go this far though. Watch for the early signs and act while symptoms are not severe.
How to avoid severe AMS?
As I said before, everybody is different. Some people will be more sensitive to altitude than others. There are few simple things you can follow to minimize the chance of getting AMS.
First, and most important thing is to go up slowly. Take your time. Enjoy the environment. Take photographs. Let your body adapt naturally. Rushing up to higher altitudes quickly, is certain receipt for trouble. It is safer to gain no more than 500-600 m of altitude in a single day. That does not mean you cannot climb up higher than that during the day but you should always come down to altitude which not higher than above mentioned number from your starting point.
Drink regularly. Dehydration is dangerous, especially in the mountains and high altitudes. It is very important to keep yourself hydrated. Whenever possible, have hot drink. Hot or warm water, tea will do. Water bottle should be a part of your travel kit. While aluminium bottles are more durable, I found plastic bottles are more practical. Thermos bottles are also very good especially in extreme cold where water. Water in traditional bottles might freeze over night.
Eat. Some people loose appetite in higher altitudes but still, it is a good idea to force a bite or two down your throat. The heart has to work much harder to supply the oxygen to blood cells In high altitude with thin air. This burns far more calories than on sea level. Add to that physical work of trekking or climbing and you are set for the most effective weight loss program ever. Energy levels get depleted rather quickly and it is important to replenish on every possible occasion.
Include day or two for rest and acclimatization. This is very important and almost everybody will need this. Even if you are not sick and feel just fine it is a good idea to rest a day just for prevention and strengthen your body. Number of acclimatization days throughout the trip will depend on difficulty, length, altitude and also your physical fitness.
Monitor your body. Watch for any signs that might give away coming AMS. If you feel sick you need to stop your ascent immediately. Eat, drink, rest and give body a time to acclimatize. If the symptoms persevere the next day or if they get even worse you need to go down to lower altitudes. This is a must.
Note about AMS related medication
There are few products such as Diamox that prevent or ease the symptoms of AMS but I never used any and I would not recommend it for a simple reason. Medication like that just "hides" the symptoms but does not prevent it from happening. After taking medication you might feel better and you continue your ascent. But when the influence of the medication wears of, the symptoms reappear and are usually more severe. It is much better idea to monitor your body and go down when you feel sick. Without any medication it is far easier to gauge the seriousness of any symptoms. This is what I have always done.
Other health related issues
AMS is one and most important medical condition to watch for but there are others. Obvious ones are injuries of any sort, food poisoning, diarrhea, snow blindness etc. You should be already familiar how to prevent these but occasionally they happen. Always drink water from safe source, either bottled water or boiled water. Food should be heat treated. Medication for food poisoning and diarrhea is good to have at hand. Wear sunglasses. If you walk on snowy surfaces the glare can be really damaging for your eyes. For peak climbing have sunglasses that wrap around your face completely not letting any glare to reach your eyes from the sides.Burned retina is damaging for your eyesight and is also really painful. As for physical injuries, keep in mind that healing process is slow in altitude. So better be careful. Small emergency kit should be part of your equipment. You might need it in more remote places.
Due to remoteness and lack or road access this happens usually by utilising helicopter. You should avoid this whenever you can. First of all if they need to send a helicopter for you, things are usually very serious. Second, it is very expensive. One hour of flight can cost you thousands of dollars. If you are not insured, it can cost you your lifetime savings. I have seen it countless times that helicopter evacuation was needed. Usually these news spread among trekkers fast. More often than not it is AMS but it can be broken leg or arm that prevent the trekker to come down safely and helicopter is the only option.
Absolutely vital part of your trip expenses should be your insurance. Make sure it covers emergency evacuation (see above). Some trekking agencies actually require you to be insured and often it is your responsibility to find suitable insurance. It gets little bit more specific when looking for insurance for adventurous activities like trekking and climbing. Many policies have limit on altitude. Some policies are ok with trekking but any activity involving specialized gear such as ropes, harness, ice ax, is not insured. For example for my peak climbing I was insured for 5000m altitude. Anything happened above that altitude and I was on my own. This was a calculated risk from my side. For a regular treks this kind of insurance should be sufficient.
This concludes my Himalayan adventure series. I hope the articles were helpful and if you have further questions and comment please let me know. If you missed previous two posts I include links to part 1 that is all about travel tips and part 2 that discusses photography on your trip.