Altitude Sickness Prevention : 2019 Update

Wilderness Medical Society has just rolled out the second update of the evidence based guidelines for prevention & treatment of AMS , HAPE & HACE. This was from the start in 2010 a gold standard document from a highly experienced expert panel . The references now lists more than a hundred sources.

Selected keypoints :

Lowest level for altitude sickness : mentioning the possibility of AMS below 2500 in the extra sensitive group . This was first mentioned in the 2014 update.

Medication : preventive use of Acetazolamide/Diamox to be “strongly considered” for moderate & high risk category. This starts with all first comers and no history of AMS going higher than 2800 meters first night . One small study in 2019 claiming to prove equal effect & equal level of side effects from half dosage ( 62 vs 125 mg x 2 ) reason for more research.

Dexamethason : prevents AMS , but does not ( as opposed to Diamox ) speed acclimatization . Risks with long time use , not to be stopped abruptly , not for children.

Ibuprofen : limited and conflicting evidence , can be taken by those who are unwilling to take acetazolamide or dexamethason.

Ginkgo boloba : conflicting evidence , Diamox considered “far superior”. Not to be used when pregnant or while taking anticoagulants.

Hypoxic tents ( basically a backwards version of Gamow bags : oxygen generator run inside a sealed tent , shunting O2 to the outside ) has a positive effect , given long enough period : nightly for weeks.

Other options : no preventive effect from coca , iron supplements , ASA/Aspirin , or high intake of water . Avoid dehydration.

Chaddar Trek & ILP/PAP : New Regulations 2018/19

Flying in last to Leh in January I met a lot of tourists heading for the Chaddar trek , with minimal awareness of AMS and rushed itineraries. Interesting medical experiment. Leh Council has apparently grown tired of the resulting high workload at the Sonam Norbu Hospital.

* from this season a check up at the hospital is recommended
before setting out , with a health declaration to be filled in first.

* from next season this check up will be mandatory on day three after arriving Leh.

* foreigners will be required to show proof of travel insurance when applying for PAP/ILP permits for Pangong Tso , Nubra etc.

High Altitude Poodle

In Sweden the word poodle is used in two ways. One way is the dog , the other is linked to when you have to give up an earlier strong position. In public. The expression came from a press conference in 2002 with a minister that had the bravery , or  at least  strategical insight , to realise that the only way out was to recant  and act humble. It was described by a journalist as a ” full poodle , all four paws in  the air , asking for forgiveness” . The expression ( ” att göra en pudel ” ) stuck.

 

In Britain today the National Health Service is in the very slow,  discreet process of making a poodle re their guidelines on fluid intake & prevention of altitude sickness.

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2008

“Minimum 4-6 liters per day”

This was the NHS  standard recommendation from the turn of the millenium – for any altitude , any activity . One group that would be  puzzled by this advice was historically  aware climbers , familiar with the new concepts that took Hillary & Tenzing to the top of Mt Everest : the fluid rations were around three liters per day.

Another group were those who had attended the altitude health lecture run by in Pheriche ( alt. 4200-ish ) on the Everest trek , by by the docs from Himalayan Rescue Association. Then and now they talked about avoiding both de- and overhydration , and a base recommendation of around three liters of fluids per day.

 

 

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2014

“Plenty of fluids”

In 2014 NHS changed course , for reasons unkown  , by going to ” drink plenty of fluids”.

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2017

“Drink enough”

Now who could argue with that ? The Scots , as in the Scottish NHS Fit for Travel site , sought a new quarrrel with the sassenach and allied with Himalayan Rescue Association etc : maintain a good intake , and avoid an excessive one.

The stakes involved , and the reason why for example the Himalayan Rescue Association and the Institute for Altitude Medicine warns against talking about fluid intake with no upper limit , is best described by one of the proponents of a high fluid intake.

Enter  Dr Stephen Bezruchka , with a short chilling remark in Altitude Illness – Prevention & Treatment” :

“Like any advice it can be overdone and people have died from drinking too much water.”

 

 

Srinagar, day 41

Thursday , August 18th : yet another ambulance arrives at SMHS  , Srinagars main hospital. Last in line to the emergency room is the ambulance driver , who has managed to complete the run with shotgun wounds in his hand from a roadblock. The frustration of the docs  in Srinagar has now reached the point where they have started to leak X-ray pics to the press , pics that are gruesome enough to make laymen pause.

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The theory behind CPRFs armament and strategy is  that their pellet shotguns  are non-lethal when aimed below the knees. In actual practice they have had a devastating effect all too often from the abdomen and up , shown on a near daily basis on the front page pictures since July 8th. Punctured lungs , abdominal bleedings and , the icon of 2016 : the permanently blinded. Last estimate was 400+ with severe eye injuries to one or both eyes.

Little reason to believe in any immediate changes for the better , with announced plans for continued strikes and protest marches over the weekend.

The tourist perspective checklist :

* flights to Srinagar : airlines offered full refunds for tickets at least up to the 16th.

* Jammu-Srinagar road is  open again, out first two weeks

* travel insurances are basically void during curfews etc – check the  official travel advisory back home.

* Srinagar-Leh road is open , see the updates at http://korta.nu/sticky

 

 

 

 

Third Highest Airport

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End of my 2015 tour in Kham , driving past worlds third highest airport serving Kangding @ 4280 meters . Looks like a interesting landing , with the four thousand meter long runway ending as a ramp . Think cutting of the top of a cone , and flipping it to extend the flat surface.

 

Kangding town  is forty  klicks away and seventeen hundred meters lower : flat real estate is scarce in these parts.