On Altitude

I want to take a brief moment to discuss altitude before these next few blog entries.
I read somewhere that if you took someone from sea level and placed them on top of Everest, they would pass into a coma within minutes. I do not have a citation for this, but I believe it.

The higher you go, the more stress your body is under, and you can feel it. The air thins and it feels like you can never get enough oxygen. Every breath hits a wall that can go no further. Going up the stairs leaves the fittest person winded. You are constantly dehydrated, even when you’re drinking four to six liters of water a day. Even if you weren’t drinking enough water to float away on, the altitude makes you have to pee all the damn time. They recommend loading up on the salt and sugar like you do when you have diarrhea to prevent dehydration – above 3,000 meters, at least one liter of ORS/Gatorade/tang a day. If you actually get diarrhea at altitude, the dehydration happens faster. If you get sick, or hurt yourself, it takes forever to heal unless you descend. Sleep is restless, if you can manage it at all. Even if you aren’t hiking four to eight hours a day, you burn an obscene amount of calories just adjusting to the altitude. The higher you get, the less appetite you have, which compounds the problem of huge calorie consumption. I would often notice that my energy was empty and feed myself, but more out of obligation to my body than because I was hungry.

Every time you ascend, you can feel the pressure – usually akin to sinus pressure, or like your ears want to pop. The first ascent to a new altitude beyond 3,000 meters is laborious. You have a hard time catching your breath and you spend a lot of energy fighting a headache.
And that’s just the normal stuff.

The stuff you have to worry about is scary because of the very thin line between normal adjustment to altitude and You Need To Descend Now. Normal adjustment can rapidly turn into AMS (acute mountain sickness). Its mild form is basically all of that stuff I just described. It’s more severe form includes: severe headache, vomiting, walking like a drunk, increased tiredness, and shortness of breath at rest. The best treatment is to descend. If you ignore these symptoms (or don’t manage to pay close enough attention to your body’s changes and that very thin line between normal and not), there are two other big things to worry about: HACE and HAPE.

I don’t remember what they stand for exactly, but HACE is fluid on the brain and HAPE is fluid in the lungs. HACE’s symptoms include severe headache with vomiting, unsteady stumbling gait, confusion, coma, and death. HAPE is breathlessness at rest, a ought, and heavy fatigue. Both HACE and HAPE result in emergency evacuations on a regular basis because either symptoms are ignored or they’re so damned hard to distinguish from just being stupidly high above sea level that they weren’t addressed in time.

Fitness means nothing to any of these conditions. Fitness means nothing at altitude, really. I’m in pretty decent shape and I’m flashing back to being the fat kid at summer camp all over again (I’m in good company though, almost every one is wheezing). But the thing that scares me the most is that the line between “normal adjustment” and “you need to descend or you might slip into a coma” is so very hard to distinguish. And where you define that line is, dangerously, linked to where you are on your trek. Are you at base camp? Descend for a night. Are you less than halfway up to Thorung La? Go back to base camp.

Are you more than halfway to Thorung La pass?

You soldier on, and hope it doesn’t get worse because the places a helicopter can land are limited.

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