Dr Vidya Jeevan,
A few days ago I decided to break the monotony of life inspired by the other wilderness travellers in my circle of friends and went on backpacking.
Although I have been a frequent traveller from much before, this was my first ever expedition to “the Himalayas” (Tarsar & Marsar, Kashmir).
The team consisted majorly of doctors from different specialities, business entrepreneurs and advocates etc. This was organized by “Mr Tiger Solanki’ and ‘Pahadi Adventures’.
We were given a “standard exercise regimen” before going on the trek, and all of us had promptly followed the same.
The trek was uneventful for me (medically) although “I had developed high grade fever with chills and rigors “on day-3. It subsided with medications and didn’t recur fortunately. This form of sickness is called “acute mountain sickness”. The other symptoms under this syndrome include nausea, tightness in the head, loss of appetite, sleep disturbance and blood in the sputum and nasal secretions, etc. I had experienced similar such symptoms during a previous trip (Ladakh). And I learnt that, I am prone for “acute mountain sickness” and should be better prepared with prophylactic medications from next expedition onwards.
However, this was not the case with one of the fellow trekker. When we were at around 12,500 ft height he developed “acute pulmonary oedema” and had to descend immediately.
Progression of symptoms of “acute pulmonary oedema” ….
Day 1 –He was leading the gang carrying a backpack weighing around 8 kgs with ease.
Day-2-Continued with same enthusiasm even when it was pouring heavily.
However, started feeling cold (extreme degree) and developed cough by night.
Day-3 (12,500ft)-Started feeling extremely weak, cough persisted, and kept pushing himself but had to use a porter to cover the last kilometre to reach the campsite.
Day 3(at the camp site)- started feeling giddiness, extreme difficulty even to get up.
Intensivist (another trekker) from the group on evaluation noticed pink frothy sputum and altered breath sounds (crepitations) and declared that he had developed “acute pulmonary odema”.
The organizer trained to deal with such situations and the doctors in the group made a collective decision, that the trekker had to start “descent” immediately. The doctor and the organizer had to walk along with the porter for around 7 hours to shift the ‘trekker’ to reach the primary care hospital (10.00pm).
Day4- admitted at Army hospital-ICU, Srinagar.
Day 6-Recovered completely.
High altitudes (because of decreased air pressure) expose travellers to altitude sickness. Rapid ascent increases the stress of reduced oxygen levels.
The three different forms of altitude sickness include; acute mountain sickness, high altitude cerebral oedema and high altitude pulmonary oedema.
Acute mountain sickness (AMS) is the most common form-it affects around 25-30% of the travellers at 3000m if they have not followed proper measures of acclimatization.
Persons with pre-existing disorders like anaemia, chronic obstructive pulmonary diseases, and previous history of mountain sickness are more prone for altitude sickness. However, it can affect perfectly healthy individuals as well.
AMS can be addressed by treating the symptoms accordingly, descending slightly and then resuming climbing. If one continues to climb with symptoms, one may develop confusion, disorientation and lapse into coma.
High altitude pulmonary oedema can occur by itself or in association with ‘AMS”.
Management includes immediate descent and oxygen.
High altitude cerebral oedema is a severe form of AMS and the symptoms include drowsiness, confusion and ataxia (Poor balance while walking, change in speech and difficulty swallowing). The management here again includes, immediate descent, otherwise it may lead to death within 24 hours of developing ataxia.
Trip measures to follow;
- Gradual ascent (Avoid reaching more than 9000 ft on the day 1 itself).
- The optimal rate of ascent should be no more than 500 m per day at levels greater than 2500m.
- Avoid consumption of alcohol and exercise during first 48 hrs until acclimatized.
- In presence of one of the modifiable risk factors (mentioned elsewhere), consulting a doctor before the trek-avoid self medication.
- Hydrate well.
- Avoid strenuous exercise for the first 24 hours.
- Consume light and balanced diet.
It is highly recommended to consult a trained doctor before attempting such expeditions to rule out any contraindications and always better to go with experienced trek organizations.
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