MOUNTAINEERING AND HIGH ALTITUDE HEALTH
Human beings are not very well adapted for high altitudes. Above 5,500 meter (18,000 feet), cuts don't heal and women can not bear children. The air is so thin that they can not get enough oxygen into their blood to sustain a fetus growing within their womb. The dry air produces hacking coughs which are strong enough to produce cracked and separated ribs.
Dan Richards, the chief executive of Global Rescue, a travel risk management firm, told Mark Jenkins of National Geographic the number of rescues his travel risk management firm has handled this year involving climbers suffering acute mountain sickness has increased by more than 50 percent in 2013 — 35 total, compared with 20 at the same time in 2012. He thinks climbers rushing to beat the crowds before they are acclimatized may be exacerbating the problem. [Source: Mark Jenkins, National Geographic, June, 2013]
Many climbers get sick. The combination of the high latitude, poor food, bad water. stomach parasites and a new environment give people a Montezuma's revenge-like nausea and diarrhea that is sometimes referred to in the Everest area as the Khumbu Krud. It is not unusual for climbers to get dysentery. Not only are ailments dangerous in their own right they can also mean that climber are at less than their best and more likely to fall or have some other mishap.
The heavy traffic on Everest can be more than an annoyance; the waiting can actually be dangerous. Kuntal Joisher, an Indian climber who summitted in 2016, told the Washington Post. “Since you are moving slow and spending a lot of time waiting and standing still, there is a good chance that your body and its extremities would become cold and susceptible to frostbite. The other problem is every minute spent waiting and walking behind extremely slow-moving traffic means your precious bottled oxygen is getting wasted.”
Book: “Medicine for Mountaineering: And Other Wilderness Activities” Ed. James A. Wilkerson (The Mountaineers)
See Separate Article HEALTH, DISEASES AND LIFE AT HIGH ALTITUDES factsanddetails.com
Lack of Oxygen and Mountaineering
According to mounteverest.net: “Running out of oxygen at a very high altitude means big, big trouble. It's like going in to a wall. You can not compare yourself with someone climbing without oxygen for the entire climb. They have adjusted their bodies gradually, whilst yours will have a shock. If you are on the ridge (8750-meter,28700 ft) and the oxygen is gone, your chances of returning alive are slim and the chance of returning without frostbite almost nonexistent.
Heavy breathing and dry air at high elevations causes the body to lose fluids at an alarming rate. Sometimes water content in the blood drops from a normal level of 50 percent to 15 percent and the number of red blood cells increases, causing the blood to circulate more slowly, increasing the risk of frostbite. Climbers carry stoves to melt snow, the only means of getting liquids. About ten pots of snow equals one pot of water.
The lack of oxygen prevents people from eating and sleeping and makes even simple chores like melting snow, putting on clothing, putting food into ones mouth exceedingly difficult. Each pace above 27,000 feet requires about half a minute. One step...six breaths...another step...six more deep breaths is how the climbers ascend during the final the assault of Everest.
The lack of oxygen in the brain can cause confusion, bad judgement and even self-mutilation. Climbers recall having imaginary conversations, distortions of time and space and hallucinations. Peter Habler, one of the first two men to reach the summit of Mt. Everest without oxygen, said, "In this lonely environment, which is so hostile to life, the imagination conjures up all manner of strange desires or horrifying apparitions."
Describing the final assault towards the Everest summit, climber and filmmaker David Breashears wrote in National Geographic, "A dozen of us set off from the South Col, climbing by out head lamps and the dim light of the stars. Ed broke the trail for us in the knee-deep snow, a herculean effort. Because we were suffering from the physical effects of the thin air at high altitude, we hadn't slept for more than a few hours in the past three days or eaten more than a few crackers. "Our bodies were dehydrated. Our fingers and toes went numb as precious oxygen was diverted to our brains, hearts and other vital organs. Climbing above 26,000 feet, even with bottled oxygen, is like running on a treadmill and breathing through a straw.” [Source: David Breadshears, National Geographic, September 1997]
Strong climbers often have enormous lungs and the ability to function at high levels of aerobic activity for long periods of time. To compensate for the lack of oxygen climbers breathe 50 times a minute compared to 12 times at sea level. Most climbers breath oxygen from 13 pound oxygen canisters carried up to the camps by Sherpas to elevations as high as 27,000 feet. Four liters of oxygen is considered the best rate, but most climbers inhale two liters to make it last longer.
Acclimatization and and Snowblindness
Acclimatization is essential for outsiders. A person brought directly to the "Death Zone" — 8000 meters (26,247 feet) — from sea level would pass out within three minutes and die in 10 minutes from lack of oxygen. Fighter pilots, who reach altitude of 8000 meters without supplementary oxygen, fall into coma within 4-8 minutes. Climbers acclimatize by training at gradually higher elevations.
There is no need to hurry or exert your self while acclimatizing. You shouldn't climb higher than 300-500 meters (900-1500 feet) per day. Typically that is not so hard to do and you can easily go farther. But in the short term it could give you is headache and make you sleepless and possibly induce mountain illness in the morning. [Source: Tom Sjogren, mounteverest.net]
Temporary blindness can occur when the brain’s visual cortex doesn’t get enough oxygen. It is also not unusual for blood vessels in the eye break. The condition isn’t painful but it can blur the vision and take six months to heal. Climbers wear dark glasses in part because ultraviolet radiation, which increases at 4 percent per thousand meters, can also cause damage.
Snow Blindness is a painful state that comes from the sun burning your eye cornea. It occurs if you don't wear sunglasses at altitude. According to mounteverest.net: When climbing on oxygen, the warm and moist breathing air will escape your oxygen mask upwards and sometimes clog up your goggles, especially upon climbing down. Your choice will then be to climb "blindfolded" or remove the glasses. You might choose to pull your glasses a bit out from your face, allowing the warm air to pass them. The suns rays will now be able to burn your eyes at the unprotected sides.
“If the weather is overcast you might be tempted to remove the glasses altogether. Yet the rays are just as harmful when cloudy, and the following morning you'll be sorry. After eight years of climbing it finally happened to us. It took only a short time without goggles at our summit descent (shooting film), we noticed nothing, and in the morning we were a mess.Try to keep the glasses on and bring snow blindness medical drops in case you get blinded after all. The ointment will considerably speed up your recovery.
Death Zone
John Branch wrote in the New York Times: On Everest “the area above 8,000 meters from Camp 4 to the summit, a dearth of oxygen and brutal weather kill those who dare stay exposed too long. As altitude increases, atmospheric pressure decreases, and with the thin air comes less oxygen for the lungs and the bloodstream. The body tries to overcome it by sending more blood to the brain, which can cause swelling, leading to symptoms like headaches, nausea and exhaustion. At extreme heights, a condition known as high-altitude cerebral edema can also cause a lack of muscle coordination, impaired speech, confusion and hallucinations. As the body continues to fight for equilibrium, it sends blood to the lungs. High-altitude pulmonary edema results in coughing and major breathing problems. [Source: John Branch, New York Times, December 19, 2017]
“The sun’s strong rays at high altitudes can burn the skin and eyes, causing snow blindness. The subfreezing temperatures, exacerbated by perpetually strong winds, cause frostbite, killing the skin and the underlying tissue, especially in the extremities. Confused and numb, climbers sometimes react to the onset of hypothermia by shedding their clothes, believing they are burning up, not freezing to death. It is why those who die in extreme conditions, like the ones on the slopes of Everest, are often discovered in a state of undress.
According to the Himalayan Database at least 14 mountaineers are thought to have died in the 2010s from acute mountain sickness (AMS), a top Everest killer that causes the brain to swell and fluid to build up in the lungs. According to the New York Times: “Others died from vague conditions like “exhaustion” or accidents that might be related to disorientation from hypoxia” —deprivation of oxygen. “Extra oxygen is an imperfect buffer against altitude sickness, but it lowers the risks considerably.” [Source: Kai Schultz, New York Times, April 23, 2019]
Dr Andrew Sutherland, an Oxford-based surgeon, told the BBC: "In my view, climbers are not climbing beyond their ability but instead beyond their altitude ability. “Unfortunately it is difficult to get experience of what it is like climbing above Camp 4 (8,300 meters) without climbing Everest. “Climbers invariably do not know what their ability above 8,300 meters is going to be like. “The longer you stay up there, in the death zone, the greater the chance you have of dying." He said climbers needed to check that they were not climbing too slowly — a sign something is wrong — and turn back if need be. The slowest safe rate is around 100 meters every one to one-and-a-half hours. If progress is any slower than that, people should abort their attempt. [Source: BBC, August 25, 2006]
Frostbite and Fronstnip
Frostbite is a condition in which parts of the body freeze, turns black and die. It usually occurs on the extremities of the body first: the finger tips, toes and nose. Frostbitten body parts often have to be amputated to prevent gangrene from developing and spreading to the rest of the body, causing severe infection and quite possibly death. Gangrene is a type of tissue death caused by a lack of blood supply. Symptoms may include a change in skin color to red or black, numbness, swelling, pain, skin breakdown, and coolness. The feet and hands are most commonly affected. If the gangrene is caused by an infectious agent it may present with a fever or sepsis.
Frostbite is particular danger near the summit where winds can kick up to 90 mph and temperatures can drop many degrees below zero. The development of efficient cold-resistance boots, feet warming devices and Gortex gloves have greatly reduce the chance of getting of frostbite. Some climbers get frostbite after they take off their gloves to take a photograph or use a camcorder.
According to mounteverest.net: Frostbite and frostnip typically occurs in the hands, feet and sometimes ears and the nose. The tissue turns white, you lose the feeling in it, and eventually it becomes black, blisters and finally falls of. Frostbite is thawed in cool water slowly heated to lukewarm. If you thaw the tissue too fast (in too hot water) it will thaw before circulation has returned and the tissue will die of oxygen depravation, the cells bursting. In addition to thawing you need to administer antibiotics to prevent infections. It will take around 3 months to determine the exact damage. Luckily, frostbite often reverses completely. [Source: Tom Sjogren, mounteverest.net]
Never treat a frostbite by rubbing it! Feel your feet sometimes while climbing, stretch the toes, kick the boots in the snow once in a while for improved circulation. Use HotTronics for the summit attempt, don't wear too tight boots. Always wear gators over plastic shoes — or even better use the One Sports shoes. Should you sense a loss of feeling in your feet while climbing — remove the boots and warm the feet in your buddies armpits or crotch (well, that's what friends are for). The herb Ginkgo Biloba is said to expand the fine capillaries and be helpful against frostbite. Drinking lots of fluid is absolutely crucial.
Measures to Take to Get Enough Water
According to mounteverest.net: At camp — don't just lie to sleep, take the time to melt snow and drink another two liters. At night, drink another. You won't believe the difference. In the morning, you will be up and ready to go, instead of the usual headaches, fatigue and all the other altitude pains. In the past two years we have stayed at Camp Two for prolonged periods, at Camp Three without oz and previous acclimatization there, still climbing fast for Camp Four and the summit. At the summit we stayed one hour without oz, leisurely climbed back down to Camp Four, made transmissions and complicated technical work in the meantime — and felt great the whole time! Tina didn't even wear gloves once all the way from Everest Base Camp to summit and back. It was a big change to our first years, when "normal" liquid intake (2-3 liters at the most), left us struggling and suffering throughout most of the climbs. Drink and be merry. Don't drink and you'll end up fighting a battle with altitude. [Source: Tom Sjogren, mounteverest.net]
“If you climb in a commercial expedition, drinking might prove more easily said than done. Two burners and one of them probably failing, to be shared between three climbers. Not enough gas, and a decision to take turns cooking whilst the others might not share your view on the amount needed, could turn the task of getting enough liquid into an impossible one.
“We recommend that you bring a spare burner for your own personal use (the Titanium very light weight stove for instance: "Primus Alpine Titanium" 95 g/3,35 oz/3000 W/ approx US$150) and really be on your leader's back to provide plenty of gas. You've paid some serious money for the services — they can afford one extra sherpa to supply enough of the important things to everyone! Finally — remember that coffee, tea and chocolate are diuretic and won't do the work well. Count in only 50 percent liquid value with those.”
Water purification: We used Swedish liquid water purification called Aqua Care. It has absolutely no taste and is highly efficient. Put a few drops in cold water and you can drink almost anything. No need to boil all water has really helped us to cut down on gas. The snow around camps is often contaminated with human feces and should always be carefully checked and purified. Pour the Aqua care into everything, and make sure that the cooking staff has water bowls with desinfectant in it outside the cooking tent to wash their hands after visits to the bathroom.
Best Food for High-Altitude Mountaineering
According to mounteverest.net:“Spam. Spam. Spam! You will watch it turn into a strange pinkish shade on your frozen tin plate, put it down and shed another pound this week. The opposite of everything your doctor told you is on the other hand the good news on Everest diet! Bring all the fatty goodies, the important thing is that you really like them. Don't experiment by bringing unfamiliar foods from home. [Source: Tom Sjogren, mounteverest.net]
Eat lots of the local vegetables (onions, cabbage, carrots). Really try to finish the heated can fruit that your BC-cook will offer you. It's solluble fiber content is extremely effective against hemorrhoids and constipation. Garlic is excellent for altitude adaptation. It thins the blood. The sherpas eat it constantly and so should you. The smell? HAHA. You're on Everest, pal. The garlic smell will be among the nicest snuff you'll encounter.
Hard salami, processed cheese, peanut butter, jam, tinned ham, some tinned meals, snacks, candy and chocolate — dream it all up and then bring it. Check expiry-dates for ready made sweet pies and other cakes and desserts. Many lasts surprisingly well and are excellent packs of calories (forget about the trans fats for this occasion only).
For high camps; cup-a-soups, instant soups, dried cheese&ham tortellini (a hit), more chocolate, marzipan, hot chocolate powder, milk powder perhaps, some coffee and tea. Cereals and oatmeal for breakfast. Hiking powder meals are not mandatory — try instead instant "real" foods (rice/pasta casseroles, macaroni-cheese meals, "real" soups requiring a few added minutes to cook). If you don't like it at home, you won't like it better on the mountain. Make it as easy on you as you can by bringing foods you actually enjoy.
On the climbs: Candy bars, nuts, crackers. Sports Bars and Sports Jelly. Sherpas eat boiled eggs on climbing. Bring them too — wrapped with some salt in a plastic bag — along with a piece of salami, cheese and bread. The more "real" food you eat at altitude the better you'll perform. Anatolij Buchreew had raw carrots. The occasional canned tuna, salmon and sardines will be a treat. Tubed cheese. Powder Energy drinks. Bring yourself to eat. Extreme weight loss is a fact on Everest — just mere existing at that altitude speeds your metabolism rate by 10 percent. Typically we lose around 10-20 lb. (5-10 kg), even if really stuffing ourselves
High Altitude Health Hassles
Diarrhea: According to mounteverest.net: Visiting the bathroom whilst climbing is a complicated and cold procedure. You have to get into heavy clothing, work your way over a considerable distance (at least that's how it will seem in that condition) jump icy rocks and then do what you have to do in a limited state of privacy...That is if you are lucky enough to be in Everest Base Camp. Higher camps provide even more hostile comforts, not to mention if you suffer sudden stomach attacks while climbing. Stripping in the icefall or while roped at the Lhotse wall is inevitable at times, and memorable always. In 1997, a climber fell and was killed whilst doing his thing on Camp Three. Always be carefully roped Camp Three, even for very short distances! [Source: Tom Sjogren, mounteverest.net]
Everest is not a place for frequent visits to the toilet and antibiotics will prove a helpful friend to you. Diarrhea causes dehydration and disturbance of the mineral balance in your body. Drink plenty and add electrolyte supplement. Since diarrhea is such a pain on Everest, sometimes you will have to take aids like Imodium to halt it. You should be careful with these aids though. They prevent your body to rid of the bad bacteria, and will also affect your digestion so that you won't be able to go properly for some days. Use Imodium or the equivalent only when you really have to.
Khumbu Cough: This cough is very debilitating to your climb. The dry and cold air will have you coughing every second step. You will get slow and weak. If not treated, it could spread to your lungs and cause pneumonia. The best way to prevent it is to wear a mask that heats the breathing air and moisturizes it. We always use those masks, even when trekking close to Everest Base Camp. Since we started to use those masks, we have never coughed again in 3 years. They are usually found in cross-country ski stores. They have a metallic net inserted in a lightweight plastic or cloth shell. If you can't find them you can order them from Sweden. Mail us for the addresses. These masks were originally invented for the Olympic skiing team in Finland and work very well. If you do come down with the cough, the drug Codeine could help. Best cure though is to trek down to around 4000 meters/13000 feet for a few days until it's gone. If it spreads to you lungs, you will need antibiotics.
Heartburn: This is a very common trouble on altitude. Bring Zantac or the equivalent to ease heartburn, especially at nights
High Altitude Emergency Medicines
Epipen: According to mounteverest.net: These adrenaline shots, usually used for allergic shock or severe asthma, are lifesavers as well as killers on a mountain. If in a state of fatal exhaustion, the adrenaline might bring out some power in you, hopefully enough to make it down. Yet, it might just as well give you a heart attack. Obviously, adrenaline shots are an absolute last resort when all hope is out and you are dying anyway. That's the time to shoot up. At all other instances, stay away from it. We always bring them with us, but thankfully never yet had to use them. (Check the expiry date and minimum temperatures). [Source: Tom Sjogren, mounteverest.net]
Diamox: An emergency drug, sometimes also used to speed up acclimatization. It reduces the increase in blood pH resulting from carbon dioxide loss at altitude caused by faster and deeper breathing. Diamox enables you to breathe easier at night (and avoid the Cheyennes), thus enhancing your performance at daytime. We tried it on Denali, peed every 30 minutes, felt our fingers and toes tingle and gave it up altogether after a few days. Diamox doesn't do anything for us. Taking your time while climbing and drinking well is the best altitude beater. We bring Diamox only for rescue situations.
Decadron: This steroid should only be used in emergency situations. Taking it will require immediate evacuation, since Decadron will relieve acute mountain sickness but not cure it. Don't try to rely on Decadron while climbing if you don't wish to die. Bring it with you (pills and shots) for serious situations only.
Nifedipine: Another emergency drug, this one for pulmonary edema, since it lowers pulmonary artery pressure. Again, take it and rush down. We've been told that Nifedipine should be taken in pills slowly absorbed under the tongue. Check with your doctor.
Gamowbag: The Gamow-bag is really helpful when trekkers or climbers suffer from altitude sickness such as HAPE and HACE . The bag rapidly decreases the altitude by a couple of thousands meters and can be the difference between life and death within hours. It works as a converted dive-decompression chamber and builds pressure with a simple footpump. The Himalayan Rescue Association have one at Pherouche and most often there should be at least one around in Everest Base Camp. If your expedition want's to bring the Gamow, it could be possible to rent it. Try your trekking agency. Or buy it at approx US$4000. Surf the net for it.
Oxygen: :Use it for all severe altitude illnesses. 2-3 liters/minute — and DOWN. Higher levels can be toxic. Always bring a spare emergency bottle between 2-3 climbers above Camp Two for rescue.
Those Over 40 More Likely to Die on Everest
Age, not sex, seems to be the biggest determinant for success on Mt. Everest. In the old days, climbers were almost exclusively male and under 40, but in recent decades the demographics of Everest expeditions has changed, with more women and older men trying to reach the summit. Raymond B. Huey of the University of Washington decided to investigate the impact of age and sex on a climber’s chances for success for summitting Everest. [Source: Henry Fountain, New York Times, August 21, 2007]
Henry Fountain, wrote in the New York Times: “Using a database of records of more than 2,200 climbers from 1990 to 2005 (from interviews by Elizabeth Hawley, an American writer in Katmandu who has chronicled expeditions for decades), Dr. Huey and his colleagues calculated the probabilities of reaching the summit and of dying on the mountain for men and women by age. Their study, published in Biology Letters, showed that there was no significant difference in the success or death rate for men or for women, who since 2000 have made up about 10 percent of all climbers. Over all, climbers had a 31 percent chance of making it to the summit and a 1.5 percent chance of dying.
“But the probability of success declined rapidly for climbers older than 40, with those 60 and older (about 4 percent of climbers in recent years) having only a 13 percent chance of making it to the top. Climbers 60 and older also had higher death rates — about one in 20 did not make it off the mountain alive. And those sexagenarians who were strong enough to reach the summit often paid for it on the way down. They had a 25 percent chance of dying while descending.”
Emergency Care Near Everest
Molly Loomis wrote in smithsonian.com: “A middle-aged woman squats motionless on the side of the trail, sheltering her head from the falling snow with a tattered grain sack. Luanne Freer, an emergency room doctor from Bozeman, Montana, sets down her backpack and places her hand on the woman’s shoulder. “Sanche cha?” she asks. Are you OK? The woman motions to her head, then her belly and points up-valley. Ashish Lohani, a Nepali doctor studying high-altitude medicine, translates. “She has a terrible headache and is feeling nauseous,” he says. The woman, from the Rai lowlands south of the Khumbu Valley, was herding her yaks on the popular Island Peak (20,305 feet), and had been running ragged for days. Her headache and nausea indicate the onset of Acute Mountain Sickness, a mild form of altitude illness that can progress to High Altitude Cerebral Edema (HACE), a swelling of the brain that can turn deadly if left untreated. After assessing her for HACE by having her walk in a straight line and testing her oxygen saturation levels, the doctors instruct her to continue descending to the nearest town, Namche Bazaar, less than two miles away. [Source: Molly Loomism smithsonian.com, May 31, 2011]
“Freer and the rest of the Everest ER doctors have been in camp for less than 48 hours and already they have dealt with a deceased body from a few seasons past, inadvertently unearthed in the moraine by Sherpa constructing camps, and have seen close to a dozen patients in their bright yellow dining tent as they wait for the clinic’s Weatherport structure to be erected. One Sherpa complains of back pain after a week’s worth of moving 100-plus pound boulders — part of preparing flat tent platforms for incoming clients. Another man can hardly walk because of a collection of boils festering in a sensitive region. A Rai cook who has worked at Everest Base Camp for multiple seasons is experiencing extreme fatigue and a cough, which the doctors diagnose as the onset of High Altitude Pulmonary Edema.
“With the exception of the cook, who must descend, all the patients are able to remain at base camp, with follow-up visits scheduled for subsequent days. Each man I ask explains that without Everest ER’s help, they would either have to wait for their expedition to arrive with the hopes that their team leader would be able to treat them, or descend to see a doctor. The ability to stay at Everest Base Camp is not only logistically easier but also means the men do not risk losing their daily wage or, in the case of some lower-tier companies, their job.
“The ER’s locale might be glamorous, but the work is often not. Headaches, diarrhea, upper respiratory infections, anxiety and ego-related issues disguised as physical ailments are the clinic’s daily bread and butter. And although the clinic’s resources have expanded dramatically over the past nine years, there is no escaping the fact that this is a seasonal clinic housed in a canvas tent located at 17,590 feet. When serious incidents do occur, Freer and her colleagues must problem solve with a severely limited toolbox. Often the handiest implement is duct tape. “There is no rule book that says, ‘When you’re at 18,000 feet and this happens, do x.’ Medicine freezes solid, tubing snaps in the icy winds, batteries die — nothing is predictable,” says Freer. But it’s that challenge that keeps Freer and many of her colleagues coming back.
“While Everest ER is now a well-established part of the Everest climbing scene, there have certainly been bumps in the trail, particularly that first year in 2003. While the Himalayan Rescue Association backed the idea of the clinic, Freer had to find financial support elsewhere. Critical pieces of equipment never arrived, and one day while treating a patient, the generator malfunctioned, rendering radios and batteries needed for oxygen concentrators useless; the foot pedal to the hyperbaric chamber broke; IV fluids were freezing en route to a patient’s veins; and all the injectable medications had frozen solid. As if that weren’t enough, the floor was covered in water as the glacial ice melted from below.
“There have also been mountain guides who say that although they are grateful for the care the doctors provide, they lament Everest Base Camp’s ever expanding infrastructure of which Everest ER is just another example. Everest ER lessens an expedition’s ethic of self-reliance and the all-around know-how on which the guiding profession prides itself. But nonetheless, since Everest ER first rolled back the tent flap, the clinic has seen over 3,000 patients” as of 2011. “Among the approximately 30 critical cases, there have been causes for celebrating as well, including marriage proposals, weddings and women who discover that their nausea and fatigue are due not to dysentery, but a long- awaited pregnancy.”
Image Sources: Wikimedia Commons
Text Sources: New York Times, Washington Post, Los Angeles Times, Lonely Planet Guides, Library of Congress, Nepal Tourism Board (ntb.gov.np), Nepal Government National Portal (nepal.gov.np), The Guardian, National Geographic, Smithsonian magazine, The New Yorker, Time, Reuters, Associated Press, AFP, Wikipedia and various books, websites and other publications.
Last updated February 2022