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Altitude sickness prevention

 

grey Altitude sickness preventionIt is really hard to put into words how extreme altitude affects you but I shall try: Imagine waking at 3am inside a refrigerator with the worst hangover of your life. Inside the fridge is a treadmill. Run on this for 12 hours straight…with a plastic bag over your head.

Some of my most vivid memories were formed inside a high altitude torture chamber; climbing Island Peak (my first Himalayan mountain), trekking the Inca Trail with my parents, trekking parts of the Andes with a donkey and finally returning to Nepal to climb Manaslu, all involved various degrees of altitudinal discomfort. Don’t be put off though, I am going back this October for some more high altitude suffering with some good friends so it can’t all be bad news…right? Dealing with altitude can be seen as just a regular part of adventuring at the really good places.

So why does altitude affect the normal functions of your body?

As altitude increases, atmospheric pressure drops, this means that less oxygen is delivered to your body with every gasped breath. After some time the body responds by producing more red blood cells (to transport the limited oxygen) in a process called acclimatisation. There are also some changes in how the body manages its fluid.

grey Altitude sickness preventionGeneral rules for altitude sickness prevention are as follows:

  1. Go up slowly. When above 3000 meters try not to sleep more than 300 meters higher than the previous night and take a rest day every 3 days, or for every vertical kilometre gained.
  2. Take planned acclimatisation walks. On a rest day climb about four to five hundred metres then descend and sleep at your original altitude. This shocks your body into making more red blood cells. It is a proven method and is how climbers can survive at extreme altitudes.
  3. Remember the old adage “climb high, sleep low” Don’t sleep on top of a high pass if there is a chance to sleep lower in a valley. It is the altitude you sleep at which tends to dictate your risk of altitude issues.
  4. Drink lots of fluids. One thing that many people don’t realise is that you will pee a lot at altitude, this combined with exertion and dry air sucking moisture out of your system can lead to dehydration. Maintaining good hydration levels helps the body to acclimatise.
  5. Be honest with yourself and your trekking partners. A niggling headache or slight nausea can be your body’s warning that AMS (Acute Mountain Sickness) is just around the corner. Rest and take it easy if you are feeling poorly.
  6. Have an altitude profile to plan your trek or climb (see image below). This will help you to plan your altitude gains and to factor in rest days at clever intervals.
  7. Drugs. Some people use them, some prefer not to. Diamox (Acetazolamide) is a diuretic drug which is commonly used to treat and prevent AMS. It is generally only used if a person is going straight from sea level to around 3000 meters or if someone is planning to climb (and sleep) at more than 600 meter altitude gains per day. This drug speeds up acclimatisation but takes a day or two for the full effect so is not super helpful in cases of acute AMS. A dose of 125mg once or twice daily is commonly used to aid acclimatisation, starting 3 days before going high. Higher doses are commonly used in cases of acute AMS. More detail can be found in the footnote*.

AMS has stages, almost everyone who visits areas at high altitude will suffer some or many symptoms, I sure haveplenty of times.    The most common symptoms include: Headache, breathlessness, insomnia, nausea and loss of appetite. Keeping a close, honest track of these is very important in monitoring and managing your acclimatisation. There is a great worksheet here which helps in tracking and monitoring progress of symptoms.

If in doubt, descend and don’t push yourself too hard.

Below is the altitude profile of a climb to extreme altitude. It shows a lot of up and down done to shock the system into acclimatising as well as possible. Most treks to high altitude have available altitude profiles where you can plan rest days, acclimatisation walks and see which days to watch closely with regards AMS risk.

grey Altitude sickness prevention

(Reproduced with permission from Mal Haskins @ Speedfly8000)

 

HAPE and HACE

Many of the serious health issues that occur at altitude stem from water’s nasty habit of shifting location as we go up in the world. At sea level much of the body’s fluid spends its time helping out in our circulatory system, moving red blood cells and nutrients about and flushing away toxins. This arrangement is rather agreeable for survival. At high altitude the water can go where it’s not wanted or needed. The fluid not being where it is meant to gives rise to the symptoms many trekkers suffer at altitude. If too much moves to the brain or lung cavity it can cause serious, often fatal, conditions such as HAPE (High Altitude Pulmonary (lung) Oedema), and HACE (High Altitude Cerebral (brain) Oedema). Yes, Australians spell Oedema differently to the rest of the world, deal with it! The mechanism is similar to how ankles can swell on long haul flights but much more serious.

Don’t cancel your adventure just yet though guys, HACE and HAPE rarely occur below 8000 metres and only ever kicks in after you body has given plenty of warning signs. It can occur much lower at altitudes as low as 3000 metres but usually this is due to a rushed or non-existant acclimatisation plan.

I will not go into details here on treatment of HAPE and HACE, treatment involves rapid descent if possible, Adrenaline, Dexmethasone and oxygen given by qualified physicians.

HAFE 

HAFE is another uncomfortable part of trekking at altitude. Gasses expand at decreasing pressure, this also happens in the bowels. This expansion, combined with a trekking diet commonly high in carbohydrates can lead to High Altitude Flatulent Extravaganzas. There is no cure for HAFE. It can be managed by walking separately from the group from time to time and by leaving the tent open a bit at night.

Sun Smart 

grey Altitude sickness prevention

Recent research has confirmed a long held belief that people get sunburn more readily at high altitudes. UV-B levels, the most damaging UV band, have been proven to be around 60% higher at 2500 meters than at sea level. Higher UV-B levels combined with snow reflecting the sun’s rays can lead to sunburn in some interesting places, like under the earlobes! I once ended up with a seriously sunburnt and swollen tongue after an extended climb at altitude. It happened after gasping with my mouth open for too long. I could hardly talk let alone eat properly and it was absolute agony. This is one experience I certainly do not want to repeat. It is crucial to cover up and regularly apply a high SPF (Sun Protection Factor) sunscreen while up high.

The dry air and harsh sun can lead to cracked lips so buy, and regularly use, a high SPF lip balm as well. I have a special top with a little pocket in the sleeve near my wrist which just fits a lip balm. Remember guys, it is not seen as dorky to use lip balm above altitudes of 2500 meters.

 

 

 

Above: The author being very sun smart after suffering a sun burnt tongue.

Altitude affects everyone differently. Some unfit people will spring along without an issue while some super-athletes can struggle at the slightest elevation. One person’s response to altitude can differ from trip to trip as well. Once I was in the Andes trekking at around 4500 meters and had to spend an excruciating 24 hours in my tent, curled in a foetal position with a pounding headache, nausea and no chance of descent; yet the next time I went high I got to 7000 meters before even getting a slight headache. The main rule is to be gentle with yourself and to descend if in doubt.

So, if you are smart, plan your height day by day and don’t push yourself too hard, you can have a healthy and most importantly fun time playing in the world’s high places.

Much more detailed information on this topic can be found here: Medex Book English Version and Guide to High altitude medicine

Thanks to Mal Haskins for his input into this post. Mal does loads of cool stuff in extremely high places. Check him out here: Vertical Resources 

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*Acetazolamide.

Action: This drug works by forcing the kidneys to excrete bicarbonate which leads to a slightly more acidic blood. Our bodies monitor levels of (the slightly acidic) Carbon Dioxide (CO2) by detecting the blood’s acidity. Making the blood more acidic fools the body into thinking that CO2 levels are higher than they actually are. This triggers an unconscious deeper and faster baseline breathing rate. By breathing deeper and faster more oxygen is taken in.

Acclimatisation: I eluded in the text above that a low dose of Acetazolamide can be used to aid acclimatisation. The normal dose is 125mg twice daily. This only speeds up normal acclimatisation processes, hence if acclimatising to a certain height normally takes 24-48 hours, Acetazolamide can reduce the time by 50%. Stopping the drug will not reverse acclimatisation, the rate will just return to pre-dose speeds. Being a diuretic or fluid pill Acetazolamide also ‘concentrates’ the blood, that is, less fluid in circulation means there are more oxygen carrying red blood cells in every millilitre of blood.

AMS While the mainstay of AMS treatment is rest and descent if possible, Acetazolamide can be used in higher doses to treat the condition. The dose is much higher than for prevention at 250mg every 4-6 hours. The diuretic effect reduces over the course of a few days (by which time you should be feeling comfortable again)

Cheyne Stokes Breathing: Gasping rapidly at altitude means the lungs are clearing CO2 faster than Oxygen is being taken in. As mentioned above, the body ‘listens’ to CO2 levels more closely than to oxygen levels when setting baseline respiration rate. Having the body clear CO2 so efficiently can lead to a drop in respiration rate to nil in some climbers during sleep (as the body reads a low CO2 level and assumes a relative high oxygen level). When the breathing stops during sleep a climber will wake up desperately gasping for air and rather upset about the while situation, not to mention tent-buddies waking to find a friend lying there peacefully not breathing! By artificially increasing respiration rate, a low (125mg) dose of Acetazolamide before sleep can counter this whole scenario.

Random fact: When you drink a carbonated soft drink whilst on Acetazolamide you can feel but not taste the bubbles (which are CO2 and acidic). I have no idea exactly why this is but guess it is due to the blood being more acidic, closer to the pH of the bubbles of CO2 and harder for the taste buds to pick up. It is a really, really weird sensation, try it if you get the chance!

grey Altitude sickness prevention

Insurance for Mountaineering – read the fine print!

grey Insurance for Mountaineering   read the fine print! grey Insurance for Mountaineering   read the fine print! grey Insurance for Mountaineering   read the fine print!
grey Insurance for Mountaineering   read the fine print! grey Insurance for Mountaineering   read the fine print!
grey Insurance for Mountaineering   read the fine print!

 

I’ll begin this story with a happy ending…I think I may have found a way to get mountaineering insurance coverage for my upcoming climb in Nepal.

In short, the only way I could arrange this is to get regular, everyday medical and travel insurance, then to fork out a sizeable sum to a second company that covers medical evacuation only. This is because every company I spoke with, and there were heaps, have exclusions on insurance for “mountaineering using specialist equipment.”

At first I thought I could do what I did last time and insure with BUPA, one package. But things have changed since 2011 when we climbed Manaslu. See the (somewhat farcical) conversation I had online with a rep below:

Please wait for a Customer Consultant to respond.

You are now chatting with ‘Jeanette Jacobsen’

Jeanette Jacobsen: Welcome to ihi Bupa live chat. How may I help you?

Ben: Hi there, I am mountaineering in Nepal this October-Nov. Do you cover this sport?

Jeanette Jacobsen: one moment please

Ben: No worries

Please wait while I transfer the chat to ‘Johanna C. Kreiss’.

You are now chatting with ‘Johanna C. Kreiss’

Johanna C. Kreiss: Regarding mountaineering, we need some questions to be answered from you regarding your trip and coverage.

Ben: Okay, are these questions in the application form when I go to sign up?

Johanna C. Kreiss: we need you to send us an e-mail with the following to travel@ihi.com:

  1. A travel description of the expedition you are going on; for example route, whether you will be trekking or climbing from e.g. south, north etc.
  2. The mountains you will be trekking or climbing as well as the exact altitude.
  3. The kind of equipment you will be using, oxygen, crampons, ropes, harness etc.
  4. If you will be using a guide/sherpa and/or porter?
  5. If you are planning to stay over night during the mountaineering expedition?

Ben: No worries, shall do

Johanna C. Kreiss: Yes, and we need to look further into your trip. please be aware that we do not cover mountaineering that requires specialised climbing equipment

Ben: What is specialised? As in carabiners, ropes, ice axes

Johanna C. Kreiss: yes, exactly

Ben: Okay, that’s me out then, thanks for your time!

Johanna C. Kreiss: You are welcome sir

The Oxford dictionary defines mountaineering as “the sport of climbing mountains.” When saying  they “cover mountaineering” they are technically correct…but, by that rational, you could technically walk up the nearest hill and call it mountaineering expedition. Saying that you cover mountaineering, but not with ixe aces, crampons, ropes etc is like saying a Facebook status update is computer programming, or riding a bike to the French patissere down the corner is Tour de France training.

So, reading around a few helpful blogs  I discovered that many climbers split insurance and have one for travel/medical and one for medical evacuation. Two main options here:

Global rescue:

Looking around I found a guy on the Lonely Planet forum who described a trek to Everesst Base camp. He developed HAPE, and very wisely, his guide got him on a helicopter and straight to a hospital in Kathmandu. When he contacted the company (within 24hours like they want, still a very sick man) he was told that in the product disclaimer it says he needed to contact them first. As Yaks were available (yet completely unrealistic given his condition) they said he will not be covered. The Nepalese embassy took his passport, effectively locking him into the country until his bill was settled…this is only one mans experience and I don’t want to base my decision on this alone but, it does not look promising.

Many helicopter companies do not send out hep until they have insurance details and I don’t fancy being stuck on a mountain trying to argue with a company via Sat phone about if I need a chopper or not, I would want to just get out!

On top of this Global rescue are expensive. Due to the length of the trip I would require to sign up for a year-long membership which would set me back a cool $655. Compared to the thousands of dollars a helicopter trip would cost, and considering they would likely not send one to an uninsured climber, this may be my best bet…

GEOS – leading provider: 

Currently for the evacuation insurance these guys are my leading option. I just need to confirm a little detail in their exclusions. See my enquiry below:

Hi there,
I am leaving for Nepal in 2 weeks for a climbing trip to Ama Dablam (6856 mtrs). Have medical and travel insurance but need Medical evac. Wondering if I would be covered as a client on a mountaineering expedition as I found this in the exclusions:

any Member taking part in or training for:
(a) expeditions, time trials and/or record attempts where an expedition is defined as “an organized journey or voyage for a
specific purpose: especially but not exclusively for exploration or for a scientific or military purpose and organized by a third party or an organized journey requiring a permit”.

Specifically wondering about the “organized by a third party or an organised journey requiring a permit” part…

I will update this post when I get a response and let you know the outcome of all this research.

The main takeaway message from this post is to READ THE FINE PRINT. I would hate any of you guys to be stuck in a bad financial or life threatening situation because the insurance product you bought is not what you thought it was.

Blue skies and happy feet,

Ben

UPDATE 23rd September –  GEO never replied to my enquiry,  have booked medical evac with Global resuce, individual cover was not too bad price-wise without the security update (trust a war will not break out in the Khumbu). https://www.globalrescue.com

Note: information in this post was accurate at the time of writing. This is intended as a personal memoir of my experiences and in not meant to replace your own research and information. All decisions relating to insurance are yours, and yours alone.

Cool trees

You have got to hand it to them; trees never judge, bitch or moan, and they make oxygen, which is amazing when you think about it. Every tree in the world, no matter how ragged or sad-looking, is busily making the earth more habitable for you, so go on, give ‘em a hug!
Here are 29 of my favourite trees from around the world:

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Training for mountaineering update

Training for mountaineering… What does it take to sit on top of tall, pointy mountains as featured in cliché motivation posters? To be honest, even though I have done it before, I still have no bloody clue. I’m completely making this up as I go! Maybe the last summit was a complete fluke. Maybe this time will be different…

In exactly one month I will be stepping off a plane in Kathmandu and heading off into the hills with a good mate of mine. Despite being busy with my studies, some relief pharmacy work and organising my book launch (scheduled for a week after I return, which will  be a challenge considering I slept for a month after my last climb), I am pleased to report that my training has come along apace. Since my first Ama Dablam training blog post  my fitness has improved immensely. My waist is 6 cms smaller and I am 7 kgs lighter. Finally I am starting to look less like Homer Simpson and more like the guy to the right!

I am swimming 3 kms two to three times a week. The last time I went to the pool I was super-motivated and busted out the first 1.5 kms without a rest. My lungs are feeling strong thanks to yet another wild theory of mine. You see, I figure that swimming is one of the best ways to train for a low oxygen environment. I have been trying to teach my body to function under ‘oxygen stress’ (my term)  by not breathing when I want and alternating between a breath every five and one every six strokes. Once I tried breaking my swim down into laps of ten. I breathed once every 10 strokes on the first lap, 9 on the next and so on. This meant that when I did breathe I needed  to be efficient. This hurt, but I could feel myself pushing through all sorts of uncomfortable I-want-to-breathe barriers. Surely all this helps my breathing efficiency. Maybe. Another wild Ben theory…

I have recruited a rag-tag ‘team’ of dudes to rock climb with. Once a week Davide, the barista from over the road, and his mate, as well as my paragliding buddy Juan join me to ‘hang out’ at the climbing gym. All the lads are new to the sport, but they love the challenge and excitement. I am loving the company, making new friends and fun of it all. Rock climbing is amazing training. When you get tired, you fall off. This gives a surge of adrenaline that makes it possible to go again and keep on climbing beyond normal tired.

On top of climbing and swimming, I train with the slack-line during breaks from my book launch and study work. I can now wear my rucksack (big red, naturally) with 12 kgs inside on the slackline. This is super-exciting considering I could hardly stand on the thing a few months ago. Also, if climbing does not work out for me, I can run away to join the circus as a tightrope walker.

Queue shameless brag video:

 

All those oft-forgotten balance muscles that sub-consciously twitch and keep us upright get an amazing workout on this contraption. I have found muscles down the side of my legs and in my bum, which I didn’t know existed. If you have absolutely no imagination at all, you may be wondering how slacklining would help with mountaineering. Below is a short video, which shows just how important balance is on mountains:

 

I think maybe the next goal for the slackline will be to do it as Jette throws slushy ice at me, or get her to spray me with a hose in the nighttime. She’d enjoy that!

Anyway, that’s the latest on my training for the big climb. Did I mention that the Red Rucksack now has GPS capabilities? As we climb I will be updating here via sat phone, and tracking our progress using a GPS spotter. The GPS SPOT will be stuffed in my pack and plotting our exact location to a very detailed map as we climb. Thankfully, Ama Dablam is near Everest so there are some amazingly detailed maps available of the region. You will even be able to see, in real time, which ridge line we are sitting on, and which cliff we are climbing. High tech gizmos meets Yak transportation. BOO YAH! Yeah…I’m starting to get excited, and I look forward to having you tag along!

Do you have any questions about the expedition? Do you want to know any specific details? Please comment below and I’ll try to answer any question before I go. Note: while I’m in Nepal communication will be one way, so I will not be able to see comments or answer any questions so get in now.

Thanks for joining me.

 

Ten travel tips for Vanuatu

grey Ten travel tips for Vanuatu

Tanna Island flight

 

Ten travel tips for Vanuatu

  1. The price of eating out is equivalent to Australia; don’t expect a cheap Thai-holiday.
  2. Robbery and scams are minimal, however, don’t be dumb about things. Keep your valuables locked in your room and your packs in sight.
  3. Kava is a local drink with mild sedative and anesthetic properties. Australians can bring back 2kg before customs becomes interested.
  4. Mt Yasur is one of the world’s most reliably active volcanos. It is also one of the most easily accessible – go there!
  5. Don’t book any activities before going. You can stroll down the main street of Port Vila and book with the companies direct.
  6. Walking through town, there are many times you would be forgiven for thinking you are in Jamaica – they lurve that Reggae music mon!
  7. Locals are super friendly – numerous times a local would fall into stride with us and just start chatting. It takes a while to relax into this lovely island mentality without thinking ‘SCAM!’
  8. Groceries are expensive; the few times we cooked for ourselves it would have been cheaper to eat out. 3 tomatoes cost $5 Aus and 100g of bacon was $5.50
  9. Efate is the main island with a population of around 240,000.
  10. Did I mention; go to Mt Yasur.

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This business partnership has expired.” Ben has no idea what adventures are in store when he sets out to discover what lies over that next mountain.

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