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acute mountain sickness

When our next destination is situated at high altitude, we have to take into account the fact that our body will go through a phase of adaptation and that what we call « Acute Mountain Sickness » (AMS) could manifest itself rather violently at first. When Claudiaexpat was living in Latin America, where many cities are at high altitude, she came into contact with some expats who had lived at more than 3,000 meters. She tells us what you can expect and how to minimize the inconvience caused by altitude sickness.

 

Brief introduction to AMS
Chiara in La Paz
Ana José in La Paz
Claudiaexpat in Cusco
Small lexicon on AMS

At high altitudes the barometric pressure diminishes, which means a lowering of the oxygen pressure in the air. The amount of oxygen available to the human body is reduced, and causes a phenomenon called hypoxia. The higher you climb, the more you become hypoxic. In other words, at high altitude you do not « oxigenate », and therefore your physical performance is reduced.

The body reacts to this phenomenon by increasing the heartbeat and breathing rate, in order to increase the intake of oxygen that feeds every cell of our body when we breathe.

However, these mechanisms of compensation may be insufficient, and it is at this point that a series of problems, grouped under the name of Acute Mountain Sickness, can show up. These can get worse as the altitude gets higher, especially when ascending rapidly. In most cases AMS can be easily treated, but sometimes it can cause a pulmonary or cerebral edema, and lead to death.

If you travel to high altitudes you must therefore be careful not to dismiss any symptoms your body might show that can be related to altitude, even if you think it can be explained otherwise.

Peter Hackett is a doctor who took part in the Medical Expedition on Mount Everest in 1981. A climber himself, he studied Acute Mountain Sickness extensively and published many works on the subject. He classified the symptoms of Acute Mountain Sickness with a scoring system that distinguishes among mild, moderate or severe cases :

– Migraine (1 point)
– Nausea or loss of appetite (1 point)
– Insomnia (1 point)
– Dizziness (1 point)
– Aspirin-resistant migraine (2 points)
– Vomiting (2 points)
– Dyspnea (3 points)
– Unusual or acute fatigue (3 points)
– Decreased volume of urine (3 points)

A total score between 1 and 3 points corresponds to a light Acute Mountain Sicknessthat can be treated with proper medication.

A score between 4 and 6 points corresponds to a moderate Acute Mountain Sickness that can be treated with proper medication and by immediately stopping the climb.

A score higher than 6 corresponds to severe Acute Mountain Sickness that requires immediate descent to lower altitudes.

It would be ideal to give the body time to acclimatize, and then gradually climb to higher altitudes. Since this is not always possible, you have to be very careful about the symptoms your body manifests, and take immediate action in case a descent is needed.

One of the most common tips for those who move to high altitude locations is to do everything very slowly during the first few days. Never force the body into physical efforts it cannot deal with: at high altitudes even running up a steep staircase represents a significant challenge.

Chiara in La Paz

Arriving in La Paz can honestly be pretty upsetting. The journey from Europe is very tiring, as it takes between 18 and 24 hours. International arrivals are usually at 6 am, which at 4,200 meters above sea level (where the airport is located) means intense cold even in summer, and a sense of alienation due to the thinness of the air and the extraordinary intensity of the light at sunrise.

You are generally caught by the first symptoms of « soroche » (Acute Mountain Sickness) as soon as you arrive : tachycardia, muscle weakness, shortness of breath with minimal efforts, dizziness, nausea, and even vomiting.

In order to protect yourself, all you need is to be aware of the symptoms and know what to do: sleep as much as possible on the plane, move very slowly until you reach the city (which can be at between 3,200 and 3,600 meters, depending on the neighborhood), don’t exert yourself, rest a lot during the first few days, eat lightly, drink lots of water and absolutely no alcohol. If you wish, don’t hesitate to drink mate de coca (the very best cure against altitude sickness !) and give your body time to acclimatize. In just 2 or 3 days you’ll feel normal again, and after 15 days you’ll be perfecly hiperglobulinical (you will have naturally increased the number of red blood cells, hemoglobin and oxygen receptives) and you won’t have any major problems.

The natives, however, apply the formula of the triple ban : comer poquito, beber matecito y… dormir solito! (eat little, drink mate and sleep alone).

The French usually take a drug based on acetazolamide, which is typically prescribed for epilepsy, but has empirically given excellent results against altitude sickness (I personally limited myself to drink mate, but most of the French can confirm…).

When you leave La Paz for a lower altitude location (or to return to Europe), you feel in great shape : the hyperglobulinemia gives you extraordinary energy, and you are really perky and tireless! However, after a few days you have to take into account a day or two of discomfort and extreme fatigue.

Anyway, during long stays you can live a more or less normal life, doing sports, walking, running and working (or giving birth !) almost normally. I say almost because you do get more tired then you would at sea level, going up stairs is harder and you feel intense efforts much more – and you also sleep badly while hypoxia makes digestion difficult.

One more thing: at high altitude you are always at risk of dehydration, and in La Paz the climate is really bone-dry (even the skin suffers horribly!). So you must really get into the habit of drinking often – which is not a problem since the whole city is teeming with vendors that offer drinks of all kinds (avoiding fruit juices, though, because they are made with tap water, which all over the country cannot be considered safe for drinking… despite the reassurances of Agua del Illimani, the local distributor, which incidentally is a French group…).

Ana José in La Paz

Let me begin by saying that in my opinion it is always advisable to consult a doctor before settling in a city like La Paz. Each of us can react differently to altitude, and without wanting to be overly alarming, one should know that there are cases of very serious adverse reactions. The city of La Paz lies at 3,600 meters, but El Alto airport is at 4,000 meters.

And now here’s how I lived six perfectly happy years in La Paz. I used to live in Calacoto, a neighborhood near Acchumani, where the French Bolivian school is located (these neighbourhoods lie at 3,200 meters above sea level).

Upon arrival at the airport you must remain calm, don’t rush to pass the checkpoints quickly and be patient. It often happens that someone needs oxygen upon arrival. When I came back to La Paz after giving birth to my son in France, a friend came to pick me up at the airport with an oxygen bottle. The baby had chicken pox at that time, and the pediatrician had prescribed a respiratory aid for a few days. One must be aware that the administration of oxygen should not be random: you have to be cautious and follow the doctor’s instructions.

There is often a tendency to underestimate the difficulties of adaptation to high altitudes, but these do exist and must be taken seriously.

That said, my husband, my daughter and myself never had any particular problems during the six years we spent in La Paz. Every time I came home after a holiday in Europe, I took things very calmly and did everything in slow motion to allow my body to readjust to the altitude and produce a higher number of red blood cells (it takes ten to fifteen days). Your physical performance can get really low. One gets tired very easily, I was dizzy just making a bed… I drank a lot of mate de coca (at least 4 cups a day) when I got back from a vacation, but then kept on drinking it regularly all the time (at least 2 cups a day). During the first two years I also took a diuretic, under medical prescription, to help with the lower pressure in the lungs and brain. One should also be prepared to expect digestive disorders, which can be partially mitigated by drinking anise herbal teas.

Claudiaexpat in Cusco

I want to mention my experience because my visit to Cusco coincided with the first time I suffered from Acute Mountain Sickness in my entire life. I had been to Lhasa (3,650 m.) in Tibet, in Sanaa’ (2,400 m.) in Yemen, and Quito (2,800 m.) in Ecuador without any problems, apart perhaps from a slight headache in Quito.

Upon my arrival in Cusco (3,450 m.), which I reached by bus, I immediately began to suffer from the classic symptoms of AMS : vomiting, throbbing headache, fatigue. At the hotel where I was staying they kept giving me mate de coca (tea of coca leaves) but I couldn’t keep it down. This all began at 11 :00 am, when I arrived, and lasted exactly 24 hours, leaving me quite exhausted and shaken. Towards noon the next day I could actually get up, walk (very slowly) and eat a little. There are drugs on the market that can be taken beforehand to help the body adapt to the altitude, but they should always be taken under medical prescription. In any case, the number one rule is to never underestimate the symptoms, and most importantly to immediately descend a few hundred meters if they persist. In Cusco, besides coca tea, I was also recommended some gooey candies made of coca, which actually tasted quite good.

Small lexicon on AMS

ITALIAN FRENCH ENGLISH SPANISH
Mal d’altitudine Mal aigu des montagnes Acute Mountain Sickness Mal agudo de altura/Soroche
Altitudine Altitude Altitude Altitud
Battito Cardiaco Dédit cardiaque Heartbeat Latido del corazón
Cefalea Céphalée Cephalalgia Cefalea
Difficoltà respiratoria Difficulté respiratoire Breathing difficulty Dificultad respiratoria
Disidratazione Déshydratation Dehydration Deshidratación
Diuretico Diurétique Diuretic Diurético
Edema cerebrale Œdème cérébrale Brain edema Edema cerebral
Edema polmonare Œdème pulmonaire Lung edema Edema pulmonar
Emicrania Migraine Migraine Emicrania
Emoglobina Emoglobine Hemoglobin Hemoglobina
Globuli Rossi Globules rouges Red blood cells Globulos rojos
Infusione Infusion Infusion Infusión
Insonnia Insomnie Insomnia Insomnia
Ipossia Hypoxie Hypoxia Hipoxia
Nausea Nausée Nausea Náusea
Ossigeno Oxygène Oxygen Oxígeno
Respirazione Réspiration Breathing Respiración
Urine Urines Urines Urinas

 

Claudia Landini (Claudiaexpat)
Lima, Peru
April 2006

 

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