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The Right Attitude About Altitude

The Right Attitude About AltitudeHere in Alaska I frequently go hiking leaving from my front door which is at sea level, and before I know it I am deep in the woods or climbing a peak. Sometimes I drive a little bit to a beautiful trailhead starting at low altitude and soon I get to around 3000-7000 feet. To get to high altitude hiking here in Alaska takes a little more effort such as a long inward hike or a plane ride to be dropped off remotely beginning an expedition type of trip. In the lower 48, the story is very different. In the Rocky Mountains or the Sierras, one can start a trail that’s already at a higher elevation and even drive up to the peak of a 14,000+ footer to day hike. Driving up to the peak of a fourteener is common where roads have been built for tourism and studying astronomy such as the big mountains in Hawaii.

As one hike ( or drives) to higher altitudes, it’s important to be aware of altitude sickness. The best treatment of acute mountain sickness -AMS (altitude sickness) is knowledge and prevention and knowing the basic things to do at the first signs of symptoms. This condition occurs due to the lack of oxygen at higher altitudes resulting in a lack of oxygen circulating in the blood. Usually, when this occurs the hiker feels tired and fatigued but usually shrugs this off thinking it’s part of the exertion of the hike. On overnight trips at altitude, sleeping can become an issue. This is more likely to occur when ascending to higher altitudes too quickly and not giving the body enough adjustment time (acclimation)to function at lower levels of oxygen.
The body starts to feel these changes once you hike above 8000 feet.

There are three types of altitude sickness the most common being acute mountain sickness. The hiker will feel tired and fatigued more easily, can have a bad headache, feel nauseated and even vomit, have difficulty breathing even at rest and notice an increased heart rate. Being aware of these signs and symptoms and descending to lower altitude can help dramatically and allow the process of acclimatization to occur more smoothly at a slower pace. Ignoring these signs can lead to confusion, decreased consciousness, shortness of breath, and inability to even stand or walk. High altitude cerebral edema ( HACE) can occur if acute mountain sickness is ignored and this form of altitude sickness involves a swelling of the brain to the point of brain function essentially stopping. The hiker becomes extremely confused, irritable, drowsy and usually cannot walk. High altitude pulmonary edema (HAPE) can then occur or can occur on its own where the lungs fill up with fluid making them difficult to function normally. This results in breathlessness, coughing, and weaknesses. Both. HACE and HAPE are serious medical emergencies, descending to a lower altitude, using supplemental oxygen and seeking emergency medical care is essential as these can both result in death.

Being in top physical condition before a strenuous hike at elevation and understanding the basics of acute mountain sickness is a good start. Giving your body proper time for acclimatization, staying well hydrated, avoiding alcohol and caffeine, eating a well-balanced diet that contains carbohydrates are all good foundations to reduce the risk of altitude sickness. Being willing to stop further ascent at the first signs and symptoms of altitude sickness and descending to a lower altitude is essential but naturally hard to do because at that point your trip is essentially over as far as the climbing. Taking ibuprofen and Tylenol at first signs of AMS, taking Ginkgo Biloba prior to your trip, getting a prescription for Acetazolamide ( Diamox) from your physician and understanding thoroughly how to use these medications can help with prevention of developing acute mountain symptoms but the hiker cannot rely on the medications alone and must be mindful of how his body is reacting during the ascent. Prescription steroids like dexamethasone ( Decadron) are sometimes needed when HACE has occurred. When a person is planning to be hiking at high altitude it is imperative to meet with their physician and discuss the best options and protocols regarding medications and how to use them.

Having some basic knowledge of altitude sickness can make or break one’s trip. When hiking above 8000 to 18,000 feet about 20 -25% of hikers will experience acute mountain sickness type symptoms, when you exceed 18,000 feet in altitude 50% of people will be affected in some way. High altitude hiking is extremely beautiful and rewarding both mentally and physically. It also keeps our feet moving which is very important to us as Podiatrists. Climb high, sleep low and most of all happy trails.

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