Altitude Sickness – What It Is, Symptoms, Treatment and Medication

What are the symptoms? How can I prevent high altitude sickness? What to do when symptoms occur? Is there any medical treatment?

What is altitude sickness?

Before we went to Morocco to climb Toubkal (4167m), I did some research on altitude sickness to get prepared for the worst case. Altitude sickness occurs when you climb too high too quickly. And anyone can get it; irrespectively of age, gender or physical condition. Mild forms of altitude sickness occur in 2,500m (8,000 feet) above sea level. The reason is that the air gets thinner and contains less oxygen. In 3000m the athmosphere’s oxygen is half of that on sea level. In 5000m it’s about a third. That means with every breath you take you breathe in less oxygen than your body actually needs. Your body couldn’t adapt to the new conditions quickly enough. More severe symptoms of altitude sickness usually occur at high altitudes above 3600m (12000 feet).

Types and symptoms of altitude sickness

There a 3 different forms:

1) Mild altitude sickness or acute mountain sickness (AMS): It can occur in high altitudes above 2500m (8000 feet). Common symptoms are similar to a hangover: headache, nausea including vomiting, exhaustion and dizziness. About 50% of people who live in lower altitude and  ascend above 3000m suffer from acute mountain sickness.

2) High altitude pulmonary edema (HAPE): High altitude pulmonary edema is a more severe type of altitude sickness. Pink, frothy fluids build up in the lungs and cause a bubbling sound in the chest, coughing up liquids and breathlessness. Additionally, heart rate and body temperature can raise and lips turn blue. The person suffering from HAPE has to descend immediately.

3) High altitude cerebral edema (HACE): High altitude cerebral edema is a build-up of fluid in the swelling brain and causes difficulties to walk in a straight line, blindness, confusion, drowsiness leading up to loss of consciousness. HACE is life-threatening and requires immediate action as well as medical attention. It’s an extremely rare condition; about 1% of people ascending to 4000m get HACE and occurs mostly when symptoms of HAPE have been ignored.

Prevention and altitude sickness treatment

The golden rule to prevent high altitude sickness: get used to the high altitude above 2600m which usually takes a few days. Example: the body needs about 7 days to acclimatise to an altitude of 5000m (16400 feet). Give your body time to adapt and don’t ascend higher than 1000m a day, but more important: don’t sleep higher than 500m (1600 feet) than the night before. Stay hydrated. Drink lots of water; no alcohol!

If you do get symptoms of mild altitude sickness, don’t go higher in the next 24-48 hours. Wait until your symptoms improve and then you can continue climbing. If they don’t improve descend by at least 500m (1600 feet).

In case of high altitude pulmonary edema and high altitude cerebral edema you need to descend immediately to a significantly lower altitude (at least 1000m) and seek medical help. Again: HAPE and HACE are life-threatening conditions and need to be taken cared of instantly. Giving additional oxygen or drugs like Nifedipine or dexamethasone may help temporarily but are no substitute for getting off the mountain.

Altitude sickness medication

1) Pain killers: A common medication among climbers and trekkers to treat symptoms of mild altitude sickness or acute mountain sickness are pain killers such as paracetamol and ibuprofen.

2) Diamox: Acetazolamide (Diamox) can reduce severe symptoms like nausea or even prevent symptoms. However, opinions about it are divided. Research has shown that it can be effective but some climbers didn’t feel a difference after taking it. Side effects of Diamox can be tingling feet and fingertips and fizzy drinks can taste funny.

3) Nifedipine: Nifedipine can be used to treat high altitude pulmonary edema: It lowers the pressure on arteries in the lungs and improves chest tightness and helps to breathe more easily. It is usually prescribed to lower high blood pressure. So be careful when standing up.

4) Oxygen: In case of HAPE and HACE, the person should be given oxygen in order to balance out the lack of oxygen. But also people with mild symptoms will feel relief.

5) Portable hyperbaric chamber: The portable hyperbaric chamber is a tent that can provides an airtight seal. It is inflated to a significant pressure above ambient atmospheric and simulates a descent of 2000m. The hyperbaric chamber has shown effective for the treatment of HACE.

Personal experience

I suffered from mild altitude sickness when we climbed Toubkal, North Africa’s highest mountain. We took the car to Imlil (1740m) and starting trekking from there. Our first stop was Les Mouflons (3207 meters), Toubkals refuge, where we stayed over night. Until then I was fine. Next day we were supposed to summit, climbing another 960m.  By then I had a slight headache, but I felt generally okay. Close to the summit, only 100 meter away in height, we had a snack to wait for the rest of our group members. I was eating chocolate, nuts and raisins. I thought it was a good idea to gain some energy, but it really wasn’t! 10 minutes later nausea kicked in. Oh man! My memories of that are still very vivid. I didn’t throw up, but I significantly slowed down on the way to the summit in order not to do exactly that. I felt better when we descended down to the refuge again, but still felt a little nauseous and had a bit of a headache that night. We went for another climb the next day and I was completely exhausted. But I don’t really know if that was due to the altitude sickness or the tough climb from the day before. I must say, I didn’t really enjoy suffering from altitude sickness *surprise*. It gave the whole climbing experience a bit of a bitter taste. It took me a while to forget about it and concentrate on the key moments, standing on top of the summit, looking over the entire Atlas mountains in a 360° circle, the quietness up there. I played with the idea of doing Kilimanjaro (Africa’s highest mountain), but I dropped that idea after climbing Toubkal. I read so many blog articles of people climbing Kili and literally puking their guts out on the way up. No thank you. I don’t have any ambitions to climb in high altitude unless I have enough time to adjust to the conditions.

READING TIP: If you want to read more about a real situation of high altitude sickness, read the bestseller ‘Into Thin Air: A Personal Account of the Mt. Everest Disaster.’ Here, Jon Krakauer describes the effects of HACE upon one of his fellow climbers, Dale Kruse.

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A Walk in the Woods (Film) – Review

Yesterday, we finally, finally saw Bill Bryson’s ‘A Walk in the Woods’ featured by Robert Redford and Nick Nolte.

After seeing ‘Wild’ we couldn’t wait for the next hiking film to be released. But to be honest, I didn’t read the book, so I didn’t really know what to expect. And after watching the film my feelings about it are mixed.

• It’s humorous; the jokes are very subtle sometimes. It makes you smile and even laugh a few times which created a good atmosphere in the cinema.
• The film is more about age, which doesn’t quite fit into Bryson’s context. Bryson was 44 when he walked the Appalachian Trail. Robert Redford was 78 when they filmed ‘A Walk in the Woods’. I think Redford is fantastic actor but not quite the right cast for this role. Same applies to Nick Nolte. Too old; they represent a different issue than the book.
• I have never seen anyone throwing a 20kg backpack so easily over their shoulders with one hand like Redford and Nolte.
• Unlike ‘Wild’ I didn’t come out of the theatre and wanted to start walking. (Maybe that’s a good thing. Longing for something you can’t yet follow up for several reasons is not a good feeling.)
• (If you haven’t read the book and don’t like spoilers don’t read on:) Like I said before I haven’t read the book, so I was stunned to see the film ending with Bryson giving up after half the distance, not finishing the trail. It’s unusual for a Hollywood film not having a ‘happy ending’. The concept itself can be charming but it left me a little unsatisfied.
• Also the background knowledge that they didn’t film on the Appalachian Trail most of the time is kind of a spoiler. Despite that they did have some really nice shot of Georgia and North Carolina.

Would I recommend the film to watch? Hmm… I don’t know, really. It’s nice to watch but not the greatest film ever. Should you spend your money on it? I’d say, wait until it’s on TV.

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Change

We were just about to descend from the top of Snowdon when this huge cloud came in, a forwarning of the weather change. It was fascinating to watch how it was hanging there and couldn’t get over the top. As an invisible wall tried to stop it and keep the peak in sunshine a little bit longer. The hikers give a good relation to the huge size of it.

The White Cliffs of Dover – About Castles and Fairies

29th August
20.7km – with Prasana.

This walk lies a little longer in the past, but I didn’t want to keep it from you :-).

Inspiration
Following my ‘Bored of Hiking‘ post, I followed up a suggestion of one of my blog readers and researched the White Cliffs Walking Festival in Dover that was supposed to be on the August Bank Holiday weekend. (What’s the Bank Holiday about, you wonder? We celebrate the ‘Late Summer’. UK doesn’t have an Independence Day or an International Worker’s Day, so the government had to come up with an alternative to avoid emigration due to the insufficient amount of bank holidays.)

I heard about the White Cliffs of Dover before; they were in fact on my to-do list, so I figured it was a great opportunity to take them off the list.

Dover Castle
We arrived in Dover early in the morning as we wanted to squeeze in Dover Castle as well. Southeastern trains have a special 2-for-1 offer for the castle if you can show a valid train ticket from that day. BUT: make sure the castle doesn’t have any special events going on. Because then you can’t take up this 2-for-1 offer. Unluckily, that happened to us. We were fully prepared to take on this bargain to visit the castle for 9£ each, but they had to disappoint us on the entrance after we fought our way up the hill where the castle is located. Kids Day! Dammit! Alright. We went anyway. And if you’ve got kids, these events are really entertaining. And the adults can sneak a bottle of mead.

Fairies from Calais. No, FERRIES from Calais
After visiting the castle we picked up the coastal path and got to a view point from where you can watch the ferries arriving from Calais. The first thing I saw were people lined up on folding chairs and holding field glasses to observe the ferries. I was rolling my eyes over that. But then we sat down for lunch and I tell you, it’s really interesting seeing the ferries coming in, unloading, loading, all the logistics involved (we mainly talk about cars and lorries and the de-chaotisised traffic :D). In fact, if you believe it or not, I could have sat there all day to watch the port.

The cliffs
But we had to move on. So we followed the coastal path along the cliffs (which I think look most amazing from the ferry itself, rather than when walking on them. I once took the ferry from Calais to Dover, when I was still wet behind my ears. Indeed a while ago… And I still can remember the view of the cliffs you see on so many postcards and fridge magnets).

Due to the walking festival there were quite a few people on the path. Half way, we came to a very cute lighthouse, with SUCH a corny tearoom. Flowers all over the place: walls, cushions, teapots, cups. Very original.

The Highlight
Towards Deal it got quieter. Less people, more untouched nature, and half a shandy for 1 Pound. I couldn’t believe it. In London, I’m so used to paying 5.50£ for a pint, and when anything has a decent price, you’ll ask twice if the barman didn’t make a mistake…

Maybe I should think about moving to the North…

See hiking details: Instructions

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Monochromatic – In Morocco

Oh how I love these photo challenges. It’s a weekly opportunity to dive into long forgotten trips and memories.

This picture was taken on a walk through Todra Gorge in Morocco. We got up early and went on a guided tour for 2 hours. Our guide was lovely and incredibly chatty. He showed us secret corners and caves of the gorge and invited us to have tea with his friends who lived in one of the caves. Unbelievable that people actually lived there. I regret that we rushed back to our hotel to get a ride to our next destination. Apparently there are tours through the Gorge that last 8 hours and longer. You can even walk up the gorge to look down into the canyon. This is definitely a place where I want to go back and explore the place a bit more.

3 Peaks Challenge in the Chilterns – Discovering the Gluteus Maximus

Still up for fun at the 1st peak

13th September
29km – with Rhys.

I just love charity walks. Why? Because they are well organised and marshalled. You meet exceptionally friendly people and someone is cheering for you when you cross the finish line.

But from the beginning: my new hiking buddy Rhys and I signed up for the 3 Peaks Challenge in the Chilterns organised by Rennie Grove Hospice Care. And he was late. Overslept his alarm. This is the worst that can happen to a German (me). Torn between a heart collapse and a panic attack mixed with a “I-knew-it!”-feeling, I choose the English way of dealing it: lot’s of “That’s alright!” and “No worries!” and agreed to meet at starting point an hour later.

After a slap on his hand we took on the 18 miles challenge from Princes Risborough to Ivinghoe along the eastern part of the Ridgeway via Whiteleaf Cross Peak, Coombe Hill Peak and Ivinghoe Beacon (hence the “3 Peaks Challenge” :D).

We started out with quite a pace. Rhys is a fast walker. Me, too. But my legs are about half as long, so I kind of fell into a slow jog trot. Thank God, we slowed down a bit after the first third. I couldn’t have done the jog for 18 miles. On our way we passed marshalls guiding us the way, feeding us with bananas, candies and water. And you know what? Some people might find it boring to just “follow the acorn” and do a couple of turns here and there but otherwise just walk straight ahead. But I really enjoyed it. I didn’t have to follow any instructions, Rhys took over the map reading, and I was free as a bird to take in the wonderful surroundings. Or the ground, in order not to trip and fall which I like to do every now and then.

The finish line in sight – far, far away

After 11 miles, we increasingly started to meet extraordinarily supporting people. Marshalls. “You’re almost there!” (still 7 miles to go), “Only 4 more miles!” (when it was 6), “The rest is just a little up and down!” (when in fact the steepest and biggest, final peak was waiting). And I was hungry. I was craving for sugar. Bananas. By mile 17 I felt reminded of the Minions when Steward, Kevin and Bob were trapped in a boat far, far away from any civilisation or food and Kevin and Bob turn slowly into BANANAAAs. Well, I didn’t jump on the marshalls and licked their cheeks but I was close to. And imagine my delight when I heard that chocolate is waiting at the finish line. Forget about “you’re almost there” and “only a few more yards”. CHOCOLATE is the motivator! The pain in my knees was forgotten; I felt like 17 again, being on cloud nine.

The biggest reward

At the top of Ivinghoe Beacon, a few lovely volunteers were waiting for us and cheered for and congratulated us with a medal on finishing the 18 miles. I have to say, it did make a difference. Not the medal. But that someone was waiting and cheering for us. It enhanced the feeling of accomplishment. I remember the Shine event in London organised by Cancer Research. And despite the fact that it was my first marathon walk, I didn’t have any feeling of achievement when I crossed the finish line at 8am in the morning after walking through the entire night. No choir of angels singing for me, nobody cheering. I was just glad that it was over.

At this point I want to say thank you to every volunteer and marshall who guided us the way, had a little chat with us, encouraged us with little white lies, water, candies and BANANAAAs! Also many thanks to Arriva Buses, who took us back to the starting point (I wouldn’t have wanted to walk the whole thing back again), and the lovely, lovely bus driver who gave us a ride closer to the train station. (Thanks to him we made our train back home in time).

The aftermath of the day?
– Sore muscles. I discovered that I do have muscles in my bum! That’s a good thing!
– The question, why I was so whiny during the last 5 miles or so. Wasn’t so bad after all! Although my knees are still a little … unstable…
– The question, what’s the next challenge… Maybe we’re growing a little bigger now. Scafell, Snowdon, Ben Nevis…

What Rennie Grove says about the day: 3 Peaks Challenge in the Chilterns

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Connected in the German Alps

Sign posts in the German Alps

You think the German and Austrian Alps are grand, and they certainly are, but it’s kind of impossible to get lost. You can find a map of the area near every start of a trail and every cable car station. You pick your trail and sign posts on the way will guide you along the way, whenever there is a turn. They also estimate the walking time to your destination. It helps you incredibly with the judgement of your performance, if you’re on time or if you’re late, or how far the next hut is away. I love it. It gives your more opportunities to take in the surroundings instead of looking constantly on a map or instructions!
Germany and Austria are even working in collaboration to standardise the sign posting across the German and Austria borders to ensure the hikers’ safety and guidance.

Today Was a Good Day – Summiting Toubkal (Morocco)

It’s not a secret that I like hiking and climbing.
Last year I did my first winter climb summiting Toubkal in Morocco, the highest peak in North Africa. Big challenge for a first timer. Especially when you have to fight against altitude sickness. But it was a great day! Physically challenging and at the top rewarding with amazing views over the entire Atlas Mountains up to the borders of the Sahara. Would I do it again? (Well, the memories of the altitude sickness did fade.) Hell, yeah, I would!

Parkland Walk – About the Poison and Antidote of London

Disused platforms of Crouch End Station

22 August
10km – with Prasana.

London stinks sometimes. Especially in the last few weeks. It feels like every person I meet wants to screw me over for their own benefit. Call me naive, but I highly value honesty and genuineness. Apart from the fact that it takes you some serious guts to live this way, you don’t get far with it in this city. And even if you try you need to watch yourself with every human encounter, especially when it’s all about business.

That’s why I flee into the wild on weekends, getting away from smelly, competitive London.

Look at the upper corner of the vault.

On the other hand, it’s time to become aware of the sweet side of London. That is why we went for a walk in London last weekend. I remembered a walk on disused railway tracks. So I did some research and found the Parkland Walk in North London. It reaches from Finsbury Park to Alexandra Palace and follows the disused railway line that used to connect the two places between 1873 and 1957. The locals use the Parkland Walk for dog walking, jogging or teaching their kid how to cycle on a bicycle. It was a rather peaceful atmosphere, and quite soothing after last week’s bitter taste.  London does actually have a sweet side as long as no people are involved.

For more information, history and maps visit their website: http://www.parkland-walk.org.uk/.

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Newest Acquirement – Getting Serious

I’m getting serious about this big plan I’ve got: getting lost and have fun. 🙂