Swathi: Hello everyone, I am Swathi. In the
previous episode we had discussed about Acute Mountain Sickness. We had Arjun Majumdar, the founder
of Indiahikes with us. He told us exactly why AMS is caused, what are the symptoms and
what you shouuld do at the very first sign of any symptom. So, today he is back with
us and he is going to tell us how to treat AMS and also how we can prevent it and protect
ourselves. But before we get into that I would like to ask Arjun a bunch of questions that I received after the previous episodes. Hi Arjun, Welcome back to the show.
Arjun: Thank you for having me in your show again
Swathi: So, Arjun,I got a few questions from trekkers after the previous episode. Lets
just clarify those first. Well, the first thing was, a guy told me that he is very
fit, so his probability of getting AMS is much lower, I mean, is that true? if you are
fit that you are less likely to be hit by AMS? Arjun: Unfortunately no, Swathi, this is again
a misconception which lot of people have. You need to be fit to do a trek but being
fit has got nothing to do with altitude sickness. Whether you are fit or unfit you are equally
likely to get altitude sickness. Being fit doesn’t reduce your chances of getting altitude sickness. On the contrary, there’s again..it has got really nothing to do with fitness but the more fit
trekkers can be more prone to altitude sickness and this is something which will surprise
people. That’s because the more fit trekkers are generally faster and because they are
climbing through the mountain faster you are reaching your higher camp lot quicker than
others so your chances of getting altitude sickness increases if you are fit. So, this
is a little bit of an ironical situation, but that doesn’t mean that I am saying don’t
come prepared for a trek, you must, but understand that fitness has got nothing to do with altitude
sickness. Fit or unfit, you are equally likely. Swathi: So, what about age? does that have
anything to do with AMS? If you are older are you more likely to be hit by AMS? Is that
true? Arjun: Again, this is a bit of a myth. People
assume that those who are above the age of 45,50, they are more likely to get altitude
sickness because of their age, it’s not true. Swathi: Thank you for busting these myths,
because even I had no clue about these things. So, let’s dive straight into the treatment part
of it. I remember in the previous episode you had told us that at the first sign of
any kind of symptoms, headache, dizziness, fatigue, you had told us to alert somebody
about it. Now, lets say I have alerted somebody about my symptoms, so what is the next step?
Arjun: See, this alertness is the first big thing. It depends on exactly where you are.
You have been climbing and then you start feeling a bit of a headache coming on. Though
in previous episode I had told you that you can get altitude sickness even without headache coming on or any of the symptoms, but in most situation, 80% of the situation you will almost have a headache coming along with some of the other symptoms like feeling a little nauseated
or dizziness or plain simple headache. Now what happens is when you are climbing up in the mountain you are also tiring yourself, you are doing a heavy exercise, and doing
this exercise is making you lose fluid from your body. So in all probabilities you could be dehydrated, you need to find a water source soon as soon as possible, or if you have with your buddies. You have to borrow some water, at least 1 litre of water and immediately start on something which we call the triple one test. Wherever you are. Your camp could be one hour away, your camp could be 3 hours away, wherever it is if you have started getting the early
onset and you can recognize that look, I am feeling a little funny, whatever is the
funny, don’t try to treat it with something else but let’s start eliminating that you don’t have altitude sickness and it is just plain and simple dehydration. Start the triple one
test, it’s a very simple thing, from your medical kit take out one tablet of disprin,
take one litre of water, and wait for an hour. Now, if the symptoms are very mild you can actually start walking and wait for an hour but I would advise that probably this is the time to take
a break on your trek, rest and wait for an hour, and see if your headache has totally,
absolutely disappeared. Now, if your headache has totally, absolutely disappeared then it
was a simple case of dehydration ,go ahead to the next camp,drink more water ,you are
absolutely ok. Now, if your headache hasn’t totally,absolutely disappeared and still you
have mild traces of headache because disprin will work on your headache , you may have
mild symptoms of headache, then there is really no option, you need to start moving down and not going upto your camp. Swathi: So, after the triple one test if you
still have symptoms you start descent Arjun: You start descending and you call of
the trek. Swathi: Is there anything else that I can
do , in terms of medication? Arjun: See, there is another issue here. It
also depends on which part of the trek you are in. Suppose, this issues or symptoms have come onto you at 11000 feet, 10,000 feet, then lot can be managed, because descending is generally
very easy, you can come down to 7-8000 feet, say, in a couple of hours. What happens when
you are at 14000 feet or 14 and a half thousand feet and you are maybe 2 days away or 3 days
away from the nearest help.Then things can become little tricky,and what I would advise
everyone to do is carry a couple of medication with them. And there are two of them which
I would like to talk about, One is Diamox, which is the brand name of Acetazolamide,
and another is Dexamethasone, which we popularly on the trekking circle call it Dex. These are
readily available medications and you must always carry it with you.
Swathi: Ok, so, should I consult somebody before taking a Diamox or how much should I take if I am going to pop it in by myself? Arjun: Let me now tell you the typical situation
that would be happening in the mountains. You have, say, come to camp.Its around 1’o
clock in the afternoon, you feel you have a mild headache coming on,you are not feeling
too good, that’s when I would suggest start the triple one test. This must take care of
the headache bit. If it doesn’t then for sure that you have been hit by altitude sickness.If
you have been hit by altitude sickness the next course of action is to now take a tablet of Diamox. Diamox helps you to acclimatize faster. Its a drug which is readily available
everywhere .Take a tablet of Diamox , what its going to do is it works by taking the bicarbonate
out of your body through your urine, it acidifies your blood, when your blood is acidified your human body tendency is to hyperventilate, that is take in more breath and when you are
taking in more breath you are taking in more oxygen, So ,basically what its doing is it
is making you take in more oxygen, its making you acclimatize faster. So, take tablet of
Diamaox, within 2-3 hours you should start feeling better. Now, if this has happened
at one in the afternoon or 2 in the afternoon , you are still around 5 or 6 in the evening
when you should actually start feeling better. And in all probabilities if the case has been
very mild than Diamox would have taken care of it, you would have acclimatized and you
will start feeling better by 6 in the evening. Swathi: Arjun, I have heard that there are
some side effects of Diamox like frequent urination and things, so what exactly are
the side effects of Diamox? Arjun: Diamox does have a few side effects
Swathi and the most common one is that you are going to feel a little bit of tingling
sensation in your finger tips, maybe on your lips , sometimes a little of water is going
to taste funny because of the same sensation. But outside that there is really nothing much to worry about
Diamox,and these are very acceptable side effects and really there is nothing much.
About the urination, Diamox does make you urinate and that’s a good thing because
anyway you are going to be hydrating yourself with or without Diamox you got to be drinking
plenty of water and you got to be urinating more.
Swathi: And can anyone take Diamox? I mean it’s a sulfa based drug, so can anybody
take it, like diabetic people, who can and who cannot take Diamox?
Arjun: See, its widely recommended, that you consult your physician before you take Diamox because it is sulfa based drug and those who are sulfa allergic must not take Diamox but
then I am going to share my experience with you. Of all the sulfa based drugs, Diamox is the least harmful, or it has the least effect on sulfas. Even if you are sulfa allergy
and you take Diamox, really , nothing that serious is going to happen because here, when
you are hit by altitude sickness the case is lot more serious, it’s a question of
whether you are going ahead with the trek or you are not going and which part of the
mountain , maybe at 14000 feet or you know all these things, so I would weigh the two
options and I would go with the option of taking Diamox rather than not because that
can save your life. Swathi: Arjun, you have mentioned that when
you are at 14000 feet and if you are showing signs of AMS, the best thing to do is take
a Diamox and start descending , what if you don’t have enough time to come to a ,you
know, around 6000 feet in one day, is there a next level of medication?
Arjun: If after 2-3 hours of taking Diamox all the symptoms are gone then you can a actually
go ahead and finish the trek and have nothing else happening to you, now I come back to
the other situation that you are talking about, what happens if even after 3 hours I am still finding myself feeling uneasy. Uneasy in the stomach or I am feeling heaviness in my chest or I
am finding breathlessness coming on , that’s when you need to go on to part two of the
medication that I talked about. As I mentioned earlier. Now suppose even after taking Diamox you still find that you know you have these symptoms coming on and it is only going to
increase because it is not going to decrease, take it for sure, that these symptoms are
not going to decrease, in such a case Dexamethasone is going to give you time to descend.So, immediately
depending on how severe it is , right from one mg to 4 mg, depending on how severe the
issue is you can take Dexamethasone and it will give you upto 4-6 hours to get out of
there as soon as possible. So, you must descend, there is no question of not descending but
it will buy you that time to descend after that situation and you will be absolutely
ok. Swathi: So, does AMS always go away after descending?
Arjun: AMS almost will always go away once you have started descending but you know what,
again here, I would like to mention that lot of people misunderstand in descending, they
think descending to the next camp, I don’t mean that , when I mean descend you really
have got to descend down to 7-8000 feet, that’s when you will actually start recovering. Now,
suppose you are at 14000 feet and have descended to 11000 feet , I am not very sure that’s going to help you, though you will start feeling a lot lot lot better, but it may not recover
you because I am not very sure at which altitude you were affected first.It could be that you
had been affected first at 11000 feet , gone up at 14, started feeling onset of altitude sickness, now you are back at 11, you may still get worse.Though from 14000 feet to 11000 feet you will start
feeling better but I would always advice you to descend as much as possible , well below 9 or 8000 feet, that’s when you are actually safe.
Swathi: So, descending is like a sure shot medication for AMS.
Arjun: Yes, its always Swathi: Now, do you think it is wise to go
back up if I have descended, I feel better the next day, I am feeling fine. Do you
think its wise to go back on the trek? Arjun:Yeah, absolutely. If you have descended
at about 7-8000 feet and you have taken a day’s rest , you are feeling absolutely
fine , by all means go up because now you are better acclimatized actually so go up now.Most trekkers don’t have that kind of a schedule to go up,because they are on a tight schedule but
if you do have the time, by all means, go up ,in fact you will do a better trek this
time. But again, if you do fell funny, come down.
Swathi: So, Arjun, is there any way to prevent AMS completely before going on the trek?
Arjun:See, The probability of getting AMS can be reduced; I will talk about two ways.
One is the natural way and one is the not-so-natural way. The natural way is, again, which I advice
lot of trekkers and they don’t do that is that they don’t take enough rest. You got
to take rest. Now what happens generally is you are flying in from Chennai, you are flying
in from Mumbai, you are flying in from Bangalore, you are coming down to Delhi and there is
almost always an overnight train journey and then even after that you are moving on to
your base camp and the next day the trek starts. Now, this is how the schedule of most Himalayan
treks is going to be. If you can you got to take rest, probably add in a day to your itinerary.
Before you reach the base camp, maybe a nice hill station on the way or somewhere where
you can take a day’s rest. That will greatly help, your body resting is very very important,lot of people don’t take enough rest. Say, while on the trek you have reached your next camp,
you have reached an altitude of say 9000-10000 feet or 11000 feet. You have reached camp
at 1 o clock, avoid moving around too much, take rest in the afternoon, maybe take a nap,
that is really greatly greatly reduce your chances of getting altitude sickness. I am
not saying its gonna prevent it, absolutely. But it does reduce. Body taking rest is very
very important, now lot of people don’t do that, another one is of course, keeping
yourself hydrated. Now, I am very sad to see that most of our trekkers are not really well
hydrated and believe me this is really bringing in the onset of altitude sickness much faster
than what you would want , so maybe 2-3 days before the thing you must keep your body so
hydrated and its not easy considering that you are travelling all the time. This is something
that we recommend trekkers to do is to go on a preventive course of Diamox to acclimatize
faster. Now what we suggest is this, very simple. Before you start the trek, say, when
you are in Delhi, the day before, I would say the day before you reach your base camp
start on a course of Diamox .Take 125mg or half a Diamox as is available in our country.
Take half a tablet of Diamox and every twelve hour take a Diamox. So I would say if you
have a routine of taking a Diamox at 8 in the morning then take another at 8 in the
evening and following morning 8 until you finish the trek.
Swathi: Like finish, go summit climb and even after the climb you are supposed to ,..
Arjun: Even after the climb is over, because it’s a diuretic, it thins your blood , it
needs time to wean out of Diamox, being on a course of Diamox will reduce your chances
of getting altitude sickness by 80%.This is what we have seen across thousands of trekkers
across Indiahikes, and when especially you are on a tight schedule , you are on a tight
budget and you don’t get leaves very often, it’s a very wise thing to do is to be on
a preventive course of Diamox. Swathi: So, what should I do, just in case
I am hit by AMS even after a preventive course of Diamox?
Arjun: I think you have to increase the dosage of Diamox at that stage, just like how I have
said, take a Diamox tablet .Even if you are on a preventive course of Diamox and you are
feeling the onset of something funny happening with your body, take one full tablet of Diamox
and that should generally take care of the situation.
Swathi:So Arjun, there might be a lot of people I mean there has always been a debate about this
topic, you know that, I don’t want to take medication on my trek; I want to go about it the natural way. So what would you recommend for trekkers who believe that ?
Arjun: I think this is being a little foolhardy here, being on a course of Diamox is not going
to change the trek by any way. You have to put in the same effort to climb, the setting
is not going to change, you will still feel the feeling of accomplishment of doing the
trek. It is actually a very unnecessary debate, if being o a course of Diamox is increasing
the chances of making the trek successful then I think you must do it, it’s a modern
innovation that has come into the world of trekking and like so many other modern innovation
that has come into the world of trekking , you can absolutely go ahead with it and those
who still chose not to go ahead with it , go for natural acclimatization which your itinerary
allows you and hope for the best and if it helps you, great. And in all probability it
can and it must then nothing wrong with it. Swathi:Arjun, I have one last question, a
lot of trekkers ask me this, about why we tell them about AMS, why its important to
know about it because many trekkers tell me that it scares them to have information about
this and they are constantly thinking of all these symptoms when they are climbing, so
why exactly is it important to know about it?
Arjun:See, altitude sickness or AMS can be fatal, when oxygen is lower at higher up in
the mountain, at 11-14000, 1200 and you don’t really have to climb that high to get hit
by altitude sickness and if you can die ,please,..it’s better to be a little scared and worried than
rather than not know anything about it. Information is the biggest asset that you have and this
is nothing but information I am giving you Swathi: So, ignorance is not really bliss.
Arjun:Not at all, you can die in the mountains, and lot and scores of trekkers do die in the
mountain because of altitude sickness , even quite unaware that they have been hit by altitude
sickness. Swathi: Thank you so much Arjun. Well Arjun just told us about how exactly we can treat AMS and also how we can prevent it. He spoke about going about it naturally and with medication. In the next episode he will be here again to talk about HAPE and HACE. Which is High Altitude Pulmonary Edema and High Altitude Cerebral Edema. These are all very important topics that you can not ignore especially if you’re going on a high altitude trek. So if you want to know more about anything just write to me at [email protected] or you can or you can drop a comment and I’ll get back to you. Thank you for joining us.