To the Himalayas!

Other than mentioning that I've got a prescription for Acetazolamide (Diamox), a carbonic anyhdrase inhibitor that helps with altitude sickness, I haven't written much about working at high altitudes. I am not a doctor. Even if I was, I'd still make this disclaimer: whatever I write here is by no means sound medical advice. Ask your doc about altitude sickness and talk to experienced trekkers before you go summit Mount Everest with no supplemental oxygen. Come on. This is the Internet. You don't really trust what I'm writing, do you? This blog could just be the result of a room full of monkeys and type-writers. In fact, I think it is. Let's see what they have to say.

Altitude sickness is a result of the low oxygen content of the air at locations above about 2500m above sea level, or more accurately, failure to instantly adapt to this change. Because there is less oxygen to breath, there is less available to diffuse across the lung capillaries into the bloodstream, and thus less oxygen carried by each red blood cell. Your tissues have a demand for oxygen, which is obviously a lot higher when you exert yourself. One often does walk or climb whilst at the top of a mountain, so this increased oxygen demand must be met. To do that, we breath more rapidly, resulting in respiratory acidosis and consequently, feeling like crap. Acetazolamide can be used to prevent this by forcing the kidney to excrete more bicarbonate and to get the CO2 buffering system back into homeostasis.  Not only are you breathing quickly, but parts of you body (that shouldn't normally ) start to fill with fluid (= edema), muscles are sore and weak, feelings of dizziness can be overwhelming, and nausea may set in. Only when it gets extreme – to the point of cerebral edema - will there be confusion, hallucinations, coma, and eventually death.

To avoid getting altitude sickness, "the experts" recommend:

• increasing fluid intake
• decreasing salt intake
• reducing physical activity
• takingprophylactic medication (the Acetazolamide [Diamox]) that I mentioned above
• if you are into alternative medicines, ask your doctor if Coca leaves would help you
• taking your time to acclimatize slowly is a good idea, wherever possible
• if you are feeling terrible, even on the medications, make sure you alert the other members of your party

Once you do spend some time, your body's compensatory mechanisms will help you operate well in the high altitude environment. Your body will produce more blood cells to carry oxygen, you will take deeper breaths instinctively, Also, be wary of sun damage, as there is less atmosphere between you and the sun:

• wear sunscreen, SPF 15+
• use UVA/UVB 100% rated sunglasses
• wear long-sleeved clothing and a hat with a wide brim

It may be very cold up there, and many injuries can result from not arriving prepared for the climate. I need to do some more research on the expected temperatures for Leh and higher regions for July, but it won't hurt to use some common sense:

• dress appropriately: wear layers
• don't forget about your ears, fingers, and toes: find a good wind-proof hat, gloves, and warm socks/ properly fitted boots
• avoid wet clothing
• keep moving but monitor yourself for signs of

For more info, see the extremely thorough High Altitude Medicine Guide, Health Canada's exhaustive report on High Altitude Illnesses, or this BMJ article on Altitude Illness. I

I'll actually not be able to take all of my own advice. The Himalayan Health Exchange (HHE) group will be flying from Delhi to Leh, which is at least at 10 000 ft, and this is by no means a slow acclimatization. Granted, we are given time to adapt, but I'll not think twice about taking my prophylactic medications!

And as an aside . . .
Should I be worried? The BBC reports that living at a high altitude speeds up aging! Well, let's see. I'll be starting at age 21 and in the mountains for at least 6 weeks. If I'm 93 when I return, that'll be another bit of evidence-based medicine solved.