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Information on altitude for Kilimanjaro 2007

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Information on Altitude

This topic is wide open for discussion, nobody really knows the full story behind altitude sickness, there is a large amount of documented information available on the web and through various books.
Every year people die through AMS (Acute Mountain Sickness) this should not happen, because we know enough to prevent it. The high mountains ranges of the world are now so accessible to the none mountaineer, ordinary people are now experiencing the thrill and beauty of this realm, but problems arise through lack of information of the hazards involved.
There are many ways to enter into this high mountain realm, via trekking agencies, charitable events, or as an individual, which ever way you intend experience this wide and beautiful part of the planet, you should be aware of the symptom of AMS, and my advice to you is to do your own research, even if your trip is organised, don't just pay your money and sit back, take responsibility for your own health.
I know the more you know about a subject the more you may worry, this is only natural, but because the symptoms are usually gradual, you have plenty of time to make the right decisions and take the right coarse of action.

What is Acclimatisation
Altitude illness is common in people ascending to more than 2500m, the human body is fantastic and can adapt to most temperatures, environments, and altitudes if given enough time, and thats the key factor "TIME".When our bodies are exposed to higher altitudes they start to make a series of adjustments known as acclimatisation, this serves to increase the delivery of oxygen. Different people will aclimatise at different rates, nobody is sure why this happens.
If you rise in altitude faster than your body can adjust to the changes, then you will start to experience altitude sickness, if you ignore these symptoms it will progress and you will become sick, and could if no action was taken die, luckily this does not happen very often.
At altitudes above 3000 m the speed at which you ascend should be gradual and height gain should not exceed 300m-600m per day with a rest every 3rd day (or every 1000m) this is not always adhered too!through time limits and money etc.
The height at which you sleep at is also very important, you will probably have heard the term climb high sleep low, which basically means it is okay to climb high say a 1000m if you then drop back down 500m to sleep a gain of only 500m that day. It is actually beneficial to do this as it exposes the body to higher altitudes, in preparation for the next day.

What is Acute Mountain sickness (AMS)
AMS happens when the body does not adapt to higher altitudes, iether because you did not give your body time to adjust or you just went to high to fast. Fluid starts to accumulate in between the cells in the body, and eventually collects in the most vulnerable places ie lungs and head, I will not go into the nitty gritty of it all, but eventually the lungs fill with fluid and person drowns, this is called High altitude pulmonary oedem or HAPE.
If fluid collects on the brain it is called High altitude cerebral oedema or HACE.

Symptoms of HAPE
Breathless while walking and eventually breathless at rest you develop a cough that starts to produce frothy sputum, this is serious and can be fatal if the person does not descend immediatly.
Symptoms of HACE
Headache, loss of appetite, nausea which can sometimes lead to vomiting, you become tired and your balance will be affected, at this stage if you do not descend you may slip into a coma and die.

To be honest most people should never experience the latter stages of HAPE and HACE, as the onset of AMS is gradual you will have plenty of warning, foolishly people who ignore these signs, are the ones who are irresponsible, completely oblivious to the dangers of AMS, or hide the symptoms from the trek leader, just so they won't be sent back down. It is better to be sent down, than to be carried down on a stretcher or in a bag.

Most people these days are aware of the dangers and symptoms of AMS, and on the whole, Trekking at altitude is safe and very rewarding.


Prediction and Prevention of AMS
Every body acclimatises differently, the height at which you may be affected will vary with each individual. The height at which you are okay and where you start to suffer the effects of AMS is called the acclimatisation line, and awareness of this altitude can help prevent AMS by taking the appropriate measures.

Through lack of time and money various treks that I have seen advertised actually rush there itenery and do not allow enough time for acclimatisation, be aware of this. If a trek as been designed with the appropriate acclimatisation stops and rest days, trekkers should reach there desired goals, this is not to say that you will not be affected with AMS, you will most likely experience some AMS it is inevitable, there is a saying that goes like this it is okay to get AMS but it is not okay to die from it

Most or all of the symptoms of mild AMS will disappear through rest and ascending no further, and assuming the symptoms disappear, the trek to the summit can be continued, most people who are climbing Kilimanjaro will experience mild or moderate AMS, this can be in the form of headache nausea, loss of appetite and a general feeling of being unwell.

headaches usually disappear with rest or with a couple of headache tablets, if pain does not disappear then you would have to rest and watch this condition closely.

If any of the above symptoms do not disappear and gradually get worse, you will develop severe AMS this is very dangerous, symptoms are lack of coordination and balance, mental confusion, slurred speech, gurgling, liquid sound in the lungs, persistent cough which may produce a pinky liquid, immediate evacuation down the mountain is essential, usually all symptom will disappear with no long lasting side effects.

Medications
This topic is wide open for discussion, there are various medications and herbs that are said to help to acclimatise, each country as there own theories in Peru it is coca tea, or chewing on the leaves, Nepal it was garlic soup and so on. Gingko Biloba (the plant extract), asprin and dexamethasone have all shown to have some beneficial effects, there is less evidence of there efficacy compared to prescription drug known as Diamox.

Diamox (acetazolamide) has been shown to help with acclimatisation, there are some mild side effects such as tingling at the finger tips, feet, lips, increase urinating, a few people have experienced diarrhoea, nausea, vomiting etc, full details can be found in the patient information sheet in the box.

Individuals who are allergic to sulphonamide antibiotics or have any presence of liver or kidney disease, pregnancy and low levels of sodium or potassium should not take Diamox.

Through my own experiences and the information provided by guides doctors and mountaineers from all over the world, and having tried several of the methods listed, the one I think is very helpful in the pursuit of safe high altitude trekking is Diamox, wether you need to take it is another thing, but having it to hand on the mountain, is I think beneficial, obviously this is my own oppinion and there a other views on this!.

I am no medical health practitioner but thousands of trekkers have used diamox and combined with sensible rates of assent, it has proved to be a safe and effective. I personally have used it, I experienced some of the side effects, Tingling etc but on the whole sleep was sounder and unbroken and I only felt mild symptoms of AMS.

I also belive that the amount of rest you have before you start your trek is beneficial, the pace you walk, over-exertion and dehydration are all contributing factors, the amount of fluids taken should be at least 4 to 6 litres a day.

I Hope the above helps, always do your own research, speak to your own GP and be responsible for your own actions.