Imagine trekking up a mountain, experiencing the beauty and wonder of nature, and the exhilaration that comes with climbing it. It takes months of preparation and training for your mind and body to be able to handle such a feat, and you’re doing it—until you feel a headache coming on, followed by nausea.
Already exhausted, now, suddenly, you’re confused. You feel sick, almost drunk. What do you do?
According to American Family Physician, a clinical journal of the American Academy of Family Physicians, acute mountain sickness (AMS) is common in people traveling to altitudes above 8,000 feet and tends to hit around 25 percent of travelers to Colorado ski areas, 50 percent of those visiting the Himalayas and nearly 85 percent of people flying directly to the Mount Everest area.
A SPECTRUM OF SEVERITY
Also referred to as “mountain sickness,” altitude illness happens when a person’s body doesn’t have enough time to adapt to the lower air pressure and oxygen of a higher altitude. The Cleveland Clinic, a nonprofit academic medical center, defines this sickness as “a group of general symptoms that are brought on by climbing or walking to a higher and higher altitude (elevation) too quickly.”
Altitude sickness exists on a spectrum of severity, says Dr. Humberto Choi, who specializes in pulmonary medicine and critical care for the Cleveland Clinic.
“The mild symptoms can be easily confused with being drunk or feeling a viral illness, because you just have a headache and feel very tired; but it is actually the altitude,” he explains.
According to the clinic’s website, the symptoms (which can also include dizziness, loss of appetite and sleep problems) tend to start within 12 to 24 hours of arriving at a high altitude and lessen within a couple of days as the person gets used to it.
“When they have mild to moderate (symptoms), most, if not all, will recover just fine,” Dr. Choi says, “but they do have to stop their trip, slow down or descend. Descent … is recommended, especially if they aren’t getting better.”
When symptoms intensify to moderate altitude sickness and include weakness and shortness of breath, people won’t be relieved by over-the-counter medicines and could deteriorate over time. The person suffering might have difficulty walking, loss of coordination, severe headache and vomiting, and tightness or congestion in the chest.
Severe altitude sickness, according to Cleveland Clinic’s website, comes with symptoms that include “shortness of breath at rest, inability to walk, confusion and fluid buildup in the lungs and/or brain. Other symptoms may include a cough and gray, pale or bluish skin tone.”
“Severe altitude sickness can worsen to a coma and become deadly. Descent and treatment should begin immediately,” says Dr. Choi.
Nevertheless, according to American Family Physician, mild cases of altitude sickness are much more common than the more serious illnesses of high-altitude cerebral and pulmonary edema.
A CASE IN POINT
When Kathy Burt started climbing Mount Kilimanjaro in September 2014, she knew altitude sickness was a risk, because she had felt ill while climbing a volcano in the past. She and her adult daughter, Amy Logan, chose the nine-day route for climbing Kilimanjaro, in part because they thought it would make it easier to acclimate to the altitude.
Given training on safety by climb-organizing program Peak Planet, Burt and Logan knew the dangers of altitude illness. “We had lectures about altitude sickness, and the recurring theme was ‘It’s not worth your life,’” Burt says.
The two women took Diamox, a prescription altitude illness medication, as soon as they started the climb. After making it to base camp, located at an altitude of several thousand feet, the women and their group were briefed by their guides about what to expect the next day. Then, they ate dinner and went to sleep early.
“When I woke up, I knew I had a problem,” Burt recalls. “I was very nauseated and kind of light headed.”
Although Burt considered turning back, she thought she should at least try to push on, so she got dressed and went to the food tent (although she had no appetite). About 15 minutes after she started climbing with the group, however, Burt found it extremely difficult to pull herself up.
“There was one point on a rock face when I remember putting my foot on a rock, trying to pull myself up and feeling like I was absolutely exhausted,” she says. “My whole body was heavy, and I literally had no strength. I could barely hold myself up to a 3-foot reach, so I sat down on the rock face.”
In addition to extreme fatigue and nausea, Burt also experienced dizziness and a “brain fog,” she says.
The lead guide came to check on Burt. She remembers him looking into her eyes with a flashlight and asking her what her name was. “I couldn’t come up with my name,” she says.
The guide reminded Burt that her life was more important than reaching the summit. “I knew I couldn’t make it,” she says. So Burt began the descent.
“About halfway down to the next camp, I suddenly felt human again,” Burt says. “I felt strong and healthy; I was able to have conversations and laugh. I was about 2,000 feet down. So, from around 14,000 to 12,000 feet, by the time I got to the next camp, I felt alive again.”
Once Logan realized her mother had to turn back, she became worried. “I started to feel nauseated,” she says. “I think it was just totally mental fear, and I was exhausted, too. I was freezing.”
She pushed on, knowing she had hours to go, but about 10 minutes later, Logan felt overwhelmed and nauseated. When Logan tried to take her next step, she fell down. She was already behind the rest of the group. Her guide flashed a light into her eyes and questioned her—similarly to how her mother had been questioned—but he determined she could continue.
“I just relied heavily on the guides. They told me I had the option, and I trusted them fully. If I weren’t with them, I would have gone down,” she says.
Logan eventually made it to the top. And, despite the trip not going as planned, Burt says it was an amazing experience.
“I think you cannot overestimate the importance of having professionals with you in this kind of adventure,” she says. “To have a guide with us who was knowledgeable about the mountain and altitude sickness, calorie intake, nutrition, water and hydrating was important. I was able to trust my guide. I really believe that when he made that call for me, he did save my life.”
MODERATEWeakness Shortness of breath Mobility problems Severe headache Vomiting
SEVEREShortness of breath at rest Loss of coordination Inability to walk Confusion Fluid buildup in lungs or brain Cough Bluish skin color Coma
ADVICE FROM A CLIMB SPECIALIST
William Parker, Kilimanjaro climb specialist for Peak Planet, explains a few things climbers can do to acclimate to the altitude and prevent the sickness.
“Being hydrated and well fed is very important,” he says, noting that climbers should drink 4 or 5 liters per day, as well as eat—even when they aren’t hungry. “Because everyone acclimatizes at a different rate, guides deliberately set a very slow pace so that all climbers will have time to adapt to the thin air. Our guides also lead acclimatization hikes, taking climbers to higher elevations during the day and sleeping at a lower elevation at night. This approach, called ‘climb high, sleep low,’ is known to help adaptation.”
When deciding whether a climber should head down because of acute mountain sickness, Parker says guides looks for the common symptoms, which include headache, lightheadedness, fatigue, sleeplessness, loss of appetite and nausea.
“But they also look for changes in a climber’s behavior, such as food and water intake, walking pace, gait, balance, manner of speaking and energy level. It is pretty apparent when someone is suffering from altitude sickness, because they will have symptoms and show a change in behavior.”
As Burt mentioned, deciding when a climber should turn back could be the difference between life and death.
“Our guides will assess the situation by evaluating the condition of the climber, the rate of deterioration and the current and future elevations,” Parker says. “If the guides determine that the climber’s condition will likely
migrate into moderate or severe AMS, they will bring the climber down. Client safety is our number-one priority.”
When climbers are at a high altitude on a mountain and are stuck because of the weather or another reason, rescue workers might bring oxygen or portable hyperbaric chambers to treat mountain sickness. But you shouldn’t count on that.
“Ascent is one of the major risk factors so, if you can, slow down and let your body get adjusted and adapted to a lower pressure of oxygen,” Dr. Choi advises. “The other thing they have to keep in mind is keeping well hydrated and avoiding alcohol. Very intense extreme exertion can also cause symptoms, but one major thing is that if they know they have had problems with altitude in the past, they should probably see a doctor, because there are ways to prevent that with some medications.”
Choi also warns that people who live near sea level should note that they might be at risk when they travel to higher-altitude destinations, because their bodies aren’t used to it.
“It’s not only … about the altitude but also how fast you get to that altitude. That’s probably the major contributor to altitude sickness,” he says, pointing out that this can also happen to people who are flying or are traveling by car.
“If you know you’ve had a problem in the past, you probably will again,” Choi adds. “Planning a slow ascent is probably the best advice, because this is something you can control.”