Category Archives: Hiking Health

Lessons on Altitude Sickness from the Himalayan Rescue Association

Annapurna Base Camp, at over 15,000 feet

A group of us trekker are sitting in a circle in a health clinic in the town of Manang, which sits at elevation of 11,500 feet in the Nepal Himalayas. A few look drawn and tired; a young woman is complaining of headaches. Outside, a group of porters walks by, one with his head wrapped in a towel soaked in cold water. He insists he is okay.

What we are learning here, at this class for trekkers given by the Himalayan Rescue Association, may tell us otherwise.

The Himalayan Rescue Association was founded in 1973 as a collaboration among volunteer visiting doctors, Nepali health officials and doctors, and representatives from trekking companies. The founders recognized that Nepal’s trekking routes were drawing more and more tourists to the high altitudes of the Himalayas – but at a cost.

The most common trekking routes reach dangerous altitudes for inexperienced hikers: up to nearly 18,000 feet at Everest Base Camp and at the Thorong La on the Annapurna Circuit, and more than 16,000 feet on other popular routes. The first foreign visitors to these high mountains were skilled outsdoorspeople with experience at altitude. But as trekking became more and more popular among “lay people,” it became clear that many trekkers had no idea how to recognize and respond to the symptoms of altitude sickness. Some became seriously ill. Some died.

Mt Everest and Annapurna Himalayan Rescue Association Aid Stations

The first aid  station was opened in 1973 at the hill town of Pheriche in the Khumbu region, on Nepal’s Mt. Everest Trek, at an altitude of about 14,000 feet. During the trekking seasons, it was manned by volunteers who lived in yak herders’ huts and tents.

A second station was opened in 1981, in Manang, a town on the Annapurna Trek, a two-day walk from Thorong La, the 17,800-foot pass that is the Annapurna Trek’s highest point. In 2008, another aid station was opened at Thorong Phedi — the foot of Thorong La, the pass that is most dangerous on the Annapurna Circuit. At these aid stations, doctors provide education, screening, and treatment; if necessary, they also aid in rescues of afflicted trekkers.

Educating Nepal’s Trekkers About Altitude Sickness

Nepal’s High altitudes can be dangerous.

Where altitude sickness (also called acute mountain sickness) is concerned, prevention is always the best course of action. This is particularly true in Nepal, where rescue is difficult because there are no roads into the trekking areas. Air-rescue is expensive and often impossible because of weather conditions and terrain.

So the Himalayan Rescue Association program focuses on prevention. They publish a series of educational pamphlets, available in Kathmandu hotels and trekking agencies. And during the trekking season, doctors hold a daily lecture on altitude sickness at the hill-town aid stations. By screening trekkers as they come through the high hill towns, the Himalayan Rescue Association has been able to decrease the incidents of mountain sickness.

The lectures teach trekkers to recognize symptoms of altitude sickness, and stress the importance of gaining elevation slowly and taking rest days. This advice is particularly important on the Annapurna Trek, because the Thorong La reaches such high elevations, and on the Everest Trek, because today, many Everest trekkers fly to the airstrip at the high-altitude village of Lukla. They therefore forego some of the essential acclimatization that is one of the main ways to prevent altitude sickness.

Himalayan Rescue Association doctors also stress that Nepali porters and guides are also susceptible to altitude sickness. While many Sherpa people native to the Sol Khumbu region near Mt. Everest are well-acclimated to the high altitude, porters and guides from lower elevations near Pokhara or Kathmandu are often just as susceptible to altitude sickness as trekkers – but may be less likely to admit to it, since their jobs depend on their strength. Trekkers therefore, need to be alert not only to their symptoms, and those of their trekking partners, but to symptoms of porters and guides as well.

Volunteer Doctors and the Local Communities

In addition to providing preventative care for trekkers, guides, and porters, the Himalayan Rescue Association has done comprehensive research on the subject of altitude sickness. It also provides free and low-cost medical care to local villagers who live near the stations (sometimes, the staff even tries to treat sick animals brought in by villagers!). These are remote towns, far from any roads, and the health care provided by the volunteer doctors is the only western medical care available. Donations collected from trekkers are used to support the medical care given to local people.

Blisters: How to Prevent and Treat Them

I admit that I’m a bit of a nutcase on this subject. New hikers worry about big-ticket dangers like bears, rattlesnakes, and lightening strikes, but for me, the prosaic truth is that far more hikes are ruined because of blisters. What starts as a tiny, innocuous hot spot that can easily be ignored can quickly turn into a blister that proves the Chinese adage: “Failure results not from the length of the journey or the height of the mountain but the pebble in one’s shoe.”

Fortunately, it’s possible to prevent blisters with a little attention and care.

Pre-Hike Preparation and Boots Choices That Help Backpackers Prevent Blisters

  • Don’t go overboard on heavy footwear. Because of the lightweight backpacking movement pioneered by long-distance hikers, today’s backpacking and hiking gear is lighter and less cumbersome than yesterday’s equipment. You may not need boots! You almost certainly don’t need the stiff all-leather support of a waffle-stomping five-pound boot. For day hikes in temperate climates, lightweight trekking shoes are perfectly adequate, and for longer trips, most backpackers choose either trekking shoes or lightweight boots made of a combination of leather and lighter-weight fabric. Both choices cause fewer blisters than heavy leather boots because they are more flexible and better ventilated.
  • Make sure shoes or boots fit. especially when buying new boots, go to an outfitter that specializes in outdoor gear. It is much more likely that the staff is properly trained to fit boots. After the purchase, wear them at home around the house to double-check the fit. Boots can usually be returned as long as they haven’t been worn outside.
  • Break in boots and shoes. New boots (and even new trekking shoes) should be broken in by taking short “training hikes.” This is especially important for people who don’t ordinarily wear hard or stiff shoes (in which case the training hike may be more a matter of breaking in feet than breaking in boots). Training walks should include at least a little bit of uphill and downhill, as boots flex differently and feel different on slopes than they do on the flats.
  • Check the fit and feel of old boots, too. The boots that felt so comfy on last year’s hike may feel stiff and hard after a year in an attic store-room, or when reintroduced to feet that haven’t hiked in a while. Old boots can be treated with boot conditioner or saddle soap, and a quick training hike to reintroduce boots to feet won’t hurt, either.

How Hikers Can Prevent Blisters on the Trail

  • Protect the trouble spots. Most hikers know from painful experience where they are likely to get blisters. Common spots are the back of the heel, and around the sides or tips of toes. Pre-treat these spots by protecting them with a Band-Aid or a piece of Moleskin.
  • Wear wicking socks. Fabrics such as polypropylene wick moisture away from the skin, which helps prevent blisters. A cushier outer sock, made of wool, fleece, or a synthetic combination provides a bit of padding. Wear both, even with lightweight trekking shoes. Avoid cotton socks, which absorb moisture and contribute to blistering.
  • Take it easy! Especially on backpacking trips, it pays to start slowly. Don’t over-do the mileage, and pack as lightly as possible. Stop every once in a while to rest, and on long breaks, wash feet in cool water and let them air out a bit.
  • Listen to complaining feet. A hot spot can be caused by a pebble, grass-seeds, bits of dirt or sand, or even a wrinkle in the sock. It is easily ignored, especially if a hiker feels pressed to keep walking by a partner who doesn’t want to stop. But stopping to treat a hot spot is the number one thing hikers can do to prevent blisters from forming – and waiting too long to treat these hot spots is the number one cause of unnecessary blisters.
  • Treat hot spots. A piece of Moleskin can protect a hot spot and prevent it from becoming a blister. If the hot spot is painful or a blister has started to form, treat it with Spenco’s Second Skin. This dressing, available in pharmacies, is a gel-like layer that acts as a protective coating. Fix it into place with athletic tape, which should be in a first aid kit. (This type of tape has the best adhesion, and stays on even when feet get damp and sweaty.)

Once a blister forms, it can take weeks to completely heal, especially if the area continues to be irritated. On backpacking trips, blisters are especially subject to infection and to being exacerbated by continued pressure. By attending to these simple preventative steps, hikers, whether on long-distance trails or short day-hikes, can avoid this common, painful – but usually preventable – problem.

Annapurna Circuit: Best Long Hikes in the World Series

I’m going to jump around the world in this series. Keep things interesting. Nepal is about as far away from where I live as you can get on this earth, and the Annapurna Circuit is one of that country’s iconic treks.

It’s a  three-week trip that circles around the Annapurna Massif, which are among the world’s highest mountains. Annapurna I is one of the world’s classic 8,000-meter climbs.

Logistically, this is an easy trek to arrange. From Kathmandu, you take a bus to Besishahar. From there, it’s a two-hour drive on a rutted, pitted, washed out jeep track to Syanje, where the trail actually starts. (You can also walk it; plan for a full day). Negotiating passage on a truck or four-wheel drive vehicle is generally possible because trekkers are a big part of the economy here. The details, while not exactly controllable (ours involved a drunk driver and a vehicle that had a slight problem keeping the engine running), do seem to fall into place, at least in hindsight. It didn’t seem that way when we were stuck in a creek without the proverbial paddle, and all of the trekkers were trying to push the stalled vehicle through the boulder strewn river-bed.

The general contour of the trek is to circle the massif counterclockwise by going upriver, trekking across a plateau, and then going downriver. (That summary is kind of like saying the Empire State Building is a building somewhere in New York.) The route begins with an ascent of the Marshyangdi River valley, with  views of  Manashlu and Himal Chuli. The trek rises from rice fields and forests to scruffier subalpine vegetation, following the same pedestrian routes of travel used by villagers. There are no roads.

The trek then veers west, to the Manang Valley, a windswept, sandy, rocky, avalanche strewn landscape inhabited by Tibetan Buddists. This is part of the Tibetan plateau, and indeed, Tibet is just over the mountain range to the north. The trail then crosses the Thorong La (“La” means Pass), which at 17,800 feet is the highest point on the trail. After Thorong La, trekkers descend to the pilgrimage site of Muktinath, then continue down the Kali Ghandaki Valley, the world’s deepest gorge, with jaw-dropping views of the fierce-looking Dhaulagiri. This part of the trek can be done as a smaller subsection by flying into Jomson then trekking down-valley: With many guesthouses and restaurants, it’s come to be known as the Apple Pie Trek.

Buying last minute equipment en route.

Traditionally, trekkers stay in the small villages along the route. If you’ve booked a commercial guided expedition, you’ll probably be staying in tents pitched for you by your porters. If you’re on a private independent trek, you can carry (or hire porters to carry) tents, or you can stay in tea-houses along the way. The majority of trekkers hire porters to carry their gear. This makes the trekking easier, and porters hired independently (as opposed to pre-paid commercial expeditions) cost only about $15 – $20 US a day, depending on the trek. A guide might cost $20 – $30 a day, and he can help negotiate transport and stays at tea houses, give you cultural insights, and help with route finding and logistics on the more remote routes.

If you do book porters and guides independently, check their high altitude equipment: Many do not have adequate equipment (sunglasses, boots, warm jackets, hats), and won’t let you know until you are dependent on them, in a remote village, where some equipment may be available for sale from enterprising locals at a high prices (which you, as the employer, will be expected to pay). Also be aware that they will expect tips. Going on strike in Nepal is a time-honored porter tradition: A commercial expedition costs far more than an independently arranged one, but makes this hassle someone else’s problem.

Another concern for all trekkers in Nepal is hygiene and health. Arriving in Nepal after having spent several months in East Africa, after having spent another several months on America’s Continental Divide Trail, I thought my resistance was up to snuff. Not so: I was flattened by severe stomach trouble within a day of my arrival. Living and hygiene conditions can be, quite simply, life-threatening in Nepal, which has one of the lowest life expectancies in the world. Use every food caution you’ve ever heard of and then some, from opening your own soda bottles to using your own utensils and never eating anything raw.  Our pampered western immune systems simply aren’t tough enough for the bugs they’ll encounter here.

In the Annapurna Sanctuary

The final issue is altitude sickness. The typical schedules offered by the guidebooks and the itineraries followed by the trekking companies give plenty of time to acclimate to the high elevations. If you’re trekking on your own, don’t try to rush this part: The elevations are frankly dangerous, and to be safe, you’ve got to follow the rules.

A final alternative is to extend the 19 – 21 day circuit with another week of trekking into the Annapurna Sanctuary itself. This takes you to the all-white world of the mountaineer, and you can stay overnight at Annapurna Base Camp. If you’re coming all this way, it is absolutely worth the additional time.

Nepal is not an easy destination: The entirely different culture, the hygienic problems, the sometimes limited food choices, the Sanskrit alphabet, the unfamiliar religious customs which foreigners should respect but may not understand…. all of this leads to a feeling of what the French call depayse: being out of one’s element. But the dramatic beauty of the highest mountains of earth is worth every possible traveler’s travail. Among the highlights were the views of 7,000 and 8,000 meter peaks, the climb to nearly 18,000 feet, the stark whiteness to the Annapurna Sanctuary, the emerald green of the rice fields, the rhododendron forests in bloom, the sky-piercing point of Machapuchare, and the sheer power of the raging rivers that drain the snowmelt and the remnants of avalanches. All of which, added together, put this trek securely among the top hikes in the world.

 

Hiking in the Inferno: Tricks to Keep You Cool and Safe

It’s HOT this week. I live in generally cool New England, on a mountain, no less, and I’m wishing I had AC this week. (Most houses here don’t have it because we usually don’t need it.)

In mid-July, the bulk of the Appalachian Trail thru-hikers are by now somewhere in the mid-Atlantic or southern New England regions, and you can’t ask for a worse place to be when the thermometer edges into triple digits.

I know because when I thru-hiked the AT, a heat wave with the palpable force of a tsunami hit just as we arrived in New York. The air shimmered, the humidity rose to sauna-like levels, and when we crossed highways, we could feel soft melting tar burning through the soles of our hiking shoes. The heat didn’t break until northern Massachusetts.

It seemed like a giant dinosaur had gobbled up everyone else on the trail for that couple of weeks. We didn’t pass any other hikers, and no one passed us. And we couldn’t even find respite in the usual places: When I scrambled down to a lake in Fahnstock State Park, I plunged into water that was full of mud and vegetation and as warm as a hot-tub. The other hikers — the smart ones — had abandoned ship and headed for the beach.

So I’m going to offer that up as your first strategy: STOP! Hiking is supposed to be fun, not life-threatening. (And hiking in heat CAN  be life-threatening: Every year, it seems, I read a newspaper article about some hiker — usually a middle-aged male, too stubborn to stop) dying of a heart attack on a hot day on a steep hill. Seriously. I know a lot of people reading this are super-fit thru-hikers, but even if you’re super-fit, why endure the misery?

But if you choose to stay on the trail, here are a few tips to keep you, if not comfortable, then perhaps a little less uncomfortable.

1) Drink water regularly. Keep water bottles full, and don’t push on past water sources.

2) As important as water: Food! Eat little bits of snacks, especially GORP and energy bars and grain-filled snacks even if you don’t feel hungry (which you probably won’t, because who wants to eat when it’s a million degrees outside?) Anything with a little salt and sugar will help replace electrolytes you lose while sweating and will help prevent a dangerous condition called hyponatremia, which results from an electrolyte imbalance. I don’t want to go all Chicken-Little on you with life-threatening dangers, but hyponatremia is nasty (if you don’t believe me, talk to rangers and nurses at Grand Canyon National Park about it).

3) Take cooling off breaks whenever possible: This includes sitting in spots of shade and, even better, immersing yourself in cold water whenever possible. Assuming, that is, you can find any.

4) SLOW it down! Set a slow climbing pace, and adjust your daily mileage if necessary.

5) Use hot weather fabrics. We have the technology, damn it! Start with nothing cotton — not even your socks. Cotton absorbs moisture, leading to discomfort, blisters (on your feet) and rashes under pack belts). Wicking fabrics like lightweight Capelene will bring the sweat away from your skin slowly — just what you need to stay as cool as possible. Gentlemen: wear shirts. Going shirtless can lead to sunburn, dehydration, and heat stroke.

6) Wear a light colored hat. It keeps the sun off your head (important for everyone, but especially for bald people and those with dark hair). Hats help keep bugs away, too.

7) Sunglasses may help some people with the perception of being cooler. I can’t promise anything here; this tip comes from my own experience, and YMMV. But try it and see if it works for you.

8) Neckties filled with small water-absorbing crystals can help keep you cool. Soak the tie in cold water and sweat it around you neck. Kafta’s Kool Ties (R), one of the original manufacturers in this field, has received positive feedback from the U.S. Military about the product and its effectiveness in hot weather. Hot weather ties are available on-line or at outdoor retailers such as REI.

9) Make like a rattlesnake: Experiment with napping during the heat of the day, assuming you can find a nice shady shelter somewhere; then hike your big miles early in the morning and into the cooler evening hours.

10) This is a great time to experiment with carrying a lighter backpack. Heavy backpacks are painful in ANY weather, but even more in the high heat. And when it’s 100 degrees out, you don’t really need to be carrying that much, so check out what you can live without — then go ahead and live without it.

Good luck to everyone out there!

Hypothermia Basics for Outdoorspeople

Yes, it’s summer. And it’s broiling n many parts of the country — but not everywhere. Several feet of snow is still piled on top of High Sierra trails. And In mountains throughout the country temperatures do what they always do at high elevations: They drop 3 – 5 degrees per thousand feet.   It may seem absurd to think about hypothermia when you leave a warm valley and start sweating your way uphill. But weather changes quickly in mountains, and on an exposed ridge in a sudden storm, you can be vulnerable in minutes.

I’ve seen too many people shivering in the high country because they didn’t bring enough clothing or rain gear. And I’m sick of reading about people dying in places like the White Mountains of New Hampshire. What a tragic, preventable waste. So here are some tips to keep you safe from the so-called “killer of the unprepared.”

Prevent Hypothermia With Good Hiking Equipment, Common Sense

Unfortunately, hypothermia can progress very quickly from a simple chill to a life-threatening emergency, and it is difficult to treat in the field. The good news is that prevention is almost always possible with some forethought and good outdoors equipment, including a rain jacket (Take a full set of rain gear in high or northern mountains; in summer, a simple rain jacket is usually enough for mountains in warmer climes, such as the Blue Ridge Mountains of Virginia or dryland mountains in Arizona, New Mexico, and Southern California.  and New Mexico).

Also take an extra insulating layer and a hat. Take more clothes — including gloves — in colder, higher mountains such as the Colorado Rockies, the North Cascades, or in New England and northern New York.  Remember that in some of these ranges, it can snow any day of the year. If the water is frozen, think what the temperature can do to you!

  • In typical summer conditions, a rain jacket may be all you need to break the wind or protect you from the rain. In colder mountains, add an insulating layer.
  • Wicking clothing draws moisture away from the skin.
  • Avoid wearing cotton, because it absorbs water and loses its insulating ability when wet.
  • Heed the saying “Cold feet? Put on a hat.” Most body heat is lost through the head, so wear a hat or your rain jacket’s hood.
  • When taking breaks, sit on an insulating pad or a backpack to prevent losing body heat to the cold ground.
  • Stay dry, inside and out. This means not overexerting so much that clothes are wet from sweat.
  • Bring extra warm dry clothes, and at the end of the day, change into dry clothes immediately.
  • Pay attention to chills and put on more clothes, a hat, or terminate exposure.
  • Realize that hypothermia can strike even on a mild-day, especially if it is damp or windy.
  • Drink and eat small quantities of high-calorie foods frequently.

Recognize Symptoms of Hypothermia and Terminate Exposure Immediately

Hypothermia often goes unrecognized because outdoorspeople mistake the symptoms for just being cold and figure they can tough it out.  Shivering alone is not a sign of hypothermia — but can lead to it. Never ignore being cold!Take a brisk walk uphill, put on an extra layer, drink a hot drink. And watch for these signs:

  • The “umbles” (The hiker stumbles, mumbles, fumbles, or grumbles).
  • Shivering stops, but the victim still feels cold.
  • Fatigue, forgetfulness and irrationality.
  • Staggering, lack of coordination, falling.
  • Finally, unconsciousness. (Obviously, this is an emergency, and can be life-threatening.) 

 Hypothermia Treatment

If you suspect you or a hiking partner may be on the way to hypothermia, it is critical to terminate exposure as soon as possible. Take a side trail out. (This means having a map with you that shows possible routes back to civilization.) If you have to stay in the backcountry:

  • Put on more clothes, especially hats and gloves.
  • Change (or help the victim change into warm dry clothes).
  • Put something between the victim and the cold ground: an insulating sleeping pad, a backpack, a bag of clothing.
  • Rest behind a wind-break, in a trail shelter, on the lee side of a bush or large rock, or in a tent or trail shelter.
  • Gently warm the victim by sharing a sleeping bag, starting a fire, or making a hot drink.
  • If necessary, go (or call) for help: If the victim cannot assist in his or her own rescue by following directions and walking out, a rescue may need to be arranged.

Mountain hiking can be fun and exhilarating, but rapidly changing weather and exertion can combine in dangerous ways. Preventing hypothermia is much easier than treating it. Bring adequate gear, including the so-called “10 Essentials” Drink and eat often, don’t over-exert, recognize the symptoms of hypothermia, and terminate exposure when necessary.

Staying Safe in Deserts and Drylands

First, some definitions: Desert hiking refers to hiking where annual rainfall is less than 9 inches. Dryland hiking refers to places where annual rain is more than that, perhaps 9 -15 inches, but where water scarcity and heat are dominant influences in the environment.

In the United States, this means most of Arizona and New Mexico, much of Nevada, Utah, and southern California, and parts of Colorado, Idaho, eastern Washington, and eastern Oregon. For backpacking and hiking in both deserts and drylands, the challenges and strategies are similar. Both require planning, acclimating while on the trip, assiduous attention to water, and a good dose of common sense.

pinon juniper
Hikers can walk for many miles without seeing water, as in these pinon-juniper drylands of northern Arizona.

Hiking in places like the Grand Canyon and Sonoran Desert can be beautiful, but surviving in and (even) enjoying the desert requires acclimating and preparation.

Preparation for Desert and Dryland Hiking Vacations

  • Check out seasonal weather patterns. Trails that may be sweltering in the summer can be comfortable (or even ice- covered) in the winter. For example, the Sorth Kaibab Trail descending from the South Rim of the Grand Canyon, is frequently covered with ice in the winter at higher elevations.  Even trails at the bottom of the Grand Canyon are comfortably cool in winter.
  • Seasonal factors affect water availability. Drylands surrounded by mountains have more water after the spring snowmelt. Drylands subject to a monsoon season have more water just after seasonal rains. Guidebooks have this information, but check locally for current seasonal information, because the condition of seasonal water sources varies.
  • Get a trail map! To reliably find seasonal water sources such as springs requires a good map. 1:25,000 U.S.G.S. map, available from the U.S.G.S or local outfitters has the most detail. A G.P.S. alone is not enough. Nor is Google Maps! Maps of trails need to be detailed enough to show springs, windmills, water tanks, and buildings, all of which are potential water sources, and to note whether water sources are seasonal or perennial.
  • Realize that a cell phone may not work in a remote desert with no cell towers, so leave a hiking plan and expected time of return with family or friends. Portable satellite phones are also an option.
  • Get in shape. One of the biggest problems in desert and dryland hiking is acclimating to the heat and physical exertion. A body that is in shape will sweat less, a huge benefit in an arid environment.
  • Hiking and camping gear for deseerts should include a wide-brimmed hat, sunglasses, enough water containers, lightweight breathable clothing that covers your entire body (in case of blazing sun or sunburn), sunscreen, bug repellent, and a warm layer for cold desert nights.
  • Mark all known water sources on your map and calculate the mileage and hiking hours between them.

Hiking and Backpacking Gear and Strategies for Desert Travel and Safety

  • The heat-water relationship is paramount: The more extreme the heat, the more water required. Bring enough water (and containers to hold the water)! The amount will depend on exertion, your fitness, your metabolism, and the air temperature. Figure at least a quart per hiking hour; For more detailed recommendations, see the National Park Service recommendations for the Grand Canyon.
  • Never walk past a water source without drinking as much as possible and filling water bottles with enough water to get to the next water source.
  • Try to hike in the coolest parts of the day: Early morning and evening are best. During the heat of the day, walk slowly and take shade breaks whenever the opportunity presents itself. Try to find a comfortably steady pace and avoid over-exerting.
  • Be aware of desert fauna. Rattlesnakes are hard to spot (until they rattle). Shake out boots before putting them on in the morning, as scorpions may have decided to nest there. When rock scrambling, never put hands where you can’t see them.
  • Wear clothing that covers as much skin as practicable. Less water evaporates from covered skin than from exposed skin.
  • Eat continually to replace electrolytes lost to sweating. Light easy-to-digest snacks — GORP, crackers, cereal bars — with salts and sugars are best for hot weather hiking,

A desert environment can be both dangerous and beautiful. Following these basic strategies and staying aware will help hikers minimize the danger and enjoy the beauty

Altitude Sickness: A Basic Primer for High-Elevation Mountain Hiking

Summer is the best time of year for tackling high trails in high mountains. In June, snow starts melting, in July, trails are mostly passable, in August, mosquitoes are less of a problem. But one issue can rear its head — and potentially knock you off yours: Altitude sickness.
Also called Acute Mountain Sickness (AMS), altitude sickness is a risk on alpine adventures, particularly for people who live at low elevations.. It is easily prevented by acclimating and responding to early symptoms.

Altitude sickness is caused by the fact that the higher the elevation, the lower the air pressure; hence, the less oxygen you take in with every breath. Early symptoms include shortness of breath, even when only lightly exerting, as well as headaches and nausea. Ignoring these symptoms or continuing despite them can lead to more symptoms — dizziness, confusion, lack of coordination, and staggering — followed by full-blown AMS.  In the late stages, potentially fatal pulmonary and cerebral edemas can occur.

Danger Zones for Altitude Sickness

Hikers and climbers on adventure travel trips frequently ascend high above sea level. Examples of popular high altitude treks include trekking the Inca Trail in Peru, climbing any of East Africa’s volcanoes, trekking in Nepal and Bhutan, glacier skiing in Europe, hiking in much of Colorado, California, and Wyoming, and climbing the Pacific Northwest and Mexican volcanoes. It is also a possibility when ascending via car, train, or even ski lift.

Symptoms of Altitude Sickness

The first rule of high elevations is to “Blame it on the altitude.” This means that travelers to alpine areas above 8,000 feet should assume any maladies or irregularities they are experiencing are due to altitude. If something is wrong up high, don’t pass it off as “allergies,” “jetlag,.” or”something you ate.” It’s probably altitude related, and if it is, it needs to be dealt with.

Common early symptoms of altitude sickness are headaches and nausea. These are warnings that the body is not getting enough oxygen. With mild symptoms, sometimes all that is needed is a rest day, which gives the body a chance to acclimate. Most people can acclimate to the kinds of elevations common on alpine adventure travel vacations (10,000 to 16,000 feet; sometimes more) if given enough time. In fact, time to acclimate is the number one way to prevent altitude sickness -– and lack of time to acclimate is the number one cause of it.

Often,  simply taking a rest day is enough to solve the problem. The body adjusts and the traveler moves onwards and upwards. But if symptoms persist or increase, afflicted travelers should go downhill until they feel better.

Who is at Risk of Altitude Sickness?

The short answer is that anyone can be at risk, even people who have successfully climbed to high elevations in the past. People who live at sea level are especially vulnerable when they change altitudes too quickly, for example, when flying from sea level to a high-altitude town or ski area. In addition, people who are elderly, frail, chronically ill, or who have breathing problems are especially at risk.

It is impossible to say at precisely what elevation a trekker may feel the effects of altitude. Many factors influence travelers’ responses to altitude, including overall fitness, the length of time travelers have been at altitude, whether the travelers are adequately hydrated, and how slowly (or quickly) they have been ascending. Further confusing the picture is the fact that the same hiker may do the exact same trip twice in a row – and might respond differently each time.

The Continental Divide Trail in Colorado averages more than 11,000 feet.

Many travelers who live at sea-level feel some shortness of breath at higher elevation ski areas (around 8,000 feet), such as those in Colorado or the Alps, or while driving scenic mountain roads over high passes. Most healthy adults adjust easily to altitudes of less than 10,000 feet, although it may take a few days to get up to full speed.

Minimizing the Risk of Altitude Sickness

Above 10,000 feet, the standard recommendation is that trekkers try to gain no more than 1,000 feet of net elevation per day. Following the mountaineer’s dictum of “Climb high, sleep low,” climbers often hiker higher during the day, which helps acclimatization, then return lower to sleep.  If you fly to a high altitude town from which you plan to start your trek, take a couple of rest days to get used to the elevation. This is not always possible, in which case, take rest days en route. Time is the most effective defense against altitude sickness: It allows the body to catch up with the altitude.

The second most important defense is adequate hydration: “A happy mountaineer pees clear.” Drink even when not thirsty; in cold dry weather, hikers are often unaware of incipient dehydration

Finally, there are medical drugs. If time is a problem (as it often is on guided adventure trips), talk to a doctor about the drug Diamox, which is used as a prophylactic. Be aware that it is a preventative, not a treatment: It must be taken before any symptoms arise.

With adequate planning, plenty of time and water, and an understanding of the symptoms and danger of AMS, altitude sickness is easily preventable.