9. How do people who fly in from Delhi / Srinagar acclimatize?
Many people who fly in are affected by AMS from the air port itself, they take it easy for the first 2-3 days at Leh; majority of them become OK and enjoy the holidays. There are cases where the AMS becomes acute; under medical advice, people have cancelled their trip and taken the next flight back to Delhi / Srinagar.
10. What about people living in hilly areas permanently?
Studies have shown that mutations happen in genes of people who live permanently in high altitudes. The South American Andean tribes evolved to have bigger chests, larger lungs, higher hemoglobin levels and a special breathing rhythm.
Likewise the Tibetan studies have shown that more children with higher oxygen saturation rates survived, indicating evolution to hypoxic condition.
A great resource here is Prof. Cynthia Beall, a physical anthropologist at Case Western Reserve University in Cleveland, Ohio, linky to this interesting articles:
Three High-Altitude Peoples, Three Adaptations to Thin Air
The bottom line, people adopt to high altitude living and live normally.
11. What can be done to prevent AMS?
Climbing slowly and acclimatizing is the best way to avoid or minimize the effects of AMS.
• If you cross 10,000 feets it is best not to exert or move up higher for the first day. Experts advise an increase of 1000 feets per day and a full rest day for every 3000 feet gained. Even seasoned climbers stick to the dictum of climbing more than 1000 feets but coming back to sleep at lower altitudes.
• If symptoms persist or increase, move down ASAP.
• Drink lots of fluid to keep yourself hydrated, twice your normal intake is OK and a thumb rule is minimum of 3 liters of water per day.
• Sleep is NOT the best solution; sleep depresses respiratory system, light activity is better.
• Eat a diet high in carbohydrate, more than 70% of the diet. Altitude increases blood glucose utilization and reduces fat as a source of energy. Carbohydrate burn 8-10% less oxygen for metabolism compared to fats and diets high in carbohydrate has demonstrated lesser incidence of AMS. Some carbohydrate dense foods are rice, rotis of whole wheat, wheat bread, liberal spreads of honey and jams, glucose drinks, dry fruits specially dry dates, cakes / pastries, energy chocolate bars etc.,
• Do not use tobacco, alcohol or anti depressant drugs, all of them increase chances of respiratory depression.
12. What is the medical treatment for AMS?
Diamox (Acetazolamide) is the most widely used drug. It works by acidifying the blood which triggers increased breathing and drives more oxygen into the booed. The action of Diamox also increases bicarbonate diuresis, frequency of urination will increase.
Diamox is a sulfa drug, if you have sulfa allergy, DO NOT take it. Some side effects include ringing sensation in the ear, numbness, tingling, taste alterations and vibrating sensations in the hands and feet.
Recommended dosage for AMS: 250 mg every 12 hours, to be discontinued once symptoms disappear. Children – 2.5 mg/kg body weight every 12 hours, to be discontinued once symptoms disappear. For periodic breathing: 125 mg, 1 hour before bed time, to be discontinued once you move below the threshold altitude. For prophylaxis of AMS, mountain experts advise taking 125 mg, every 12 hours, 24 hours before reaching high altitude.
Some basic concepts about Diamox need to be clarified. Experience from reading many blogs, articles suggest there are misconceptions floating around:
• Diamox does not mask symptoms of AMS. If a person acclimatizes, symptoms resolve, if not symptoms persist then AMS is on. Diamox only helps you combat faster. This drug is trusted in practice by most high altitude climbers and is used widely to help combat AMS.
• Diamox will not help you survive if you keep climbing with AMS. With or without Diamox, if your symptoms persist, stay put or climb down.
• If Diamox is stopped suddenly, symptoms will not worsen. If you stop taking Diamox while acclimatizing and if AMS is still present, symptoms will reappear.
• Starting on Diamox is effective even after symptoms of AMS appear.
• Diamox is not a substitute for acclimatization, it aids in acclimatization.
• Many physicians and doctors in the plains are clueless about Diamox use in AMS. Your ophthalmic doctor would probably know about its use in Glaucoma, but not likely in AMS.
Dexamethasone is a steroid used to treat edema. How it works in AMS is unknown, this drug removes symptoms of AMS fast, but has the potential to mask symptoms of AMS. Be sure that effects of the drug has worn off and AMS symptoms have disappeared before starting for higher altitudes. Recommended Dosage to treat AMS: 4 mg, 6th hourly. Being a steroid this has to be used under the strict supervision of a doctor.
Analgesics like aceclofenac, Ibuprofen and paracetamol are effective to relieve headache. Stronger analgesics like Tramadol, Dextropropoxyphen and benzodiazepines like diazepam that act centrally MUST be avoided as they can depress the respiratory centers. Temazepam has been used for treating periodic breathing effectively.
Oxygen: Oxygen can help combat effects of AMS, small amounts will help patients, continuous oxygen inhalation is recommended only for serious cases. Oxygen is available in many district hospitals and main military centers in Ladakh for genuine cases.
In high passes like Kardung Ka and Chang La, the Indian Army has medical officers with finger Oxymeters to find out severity of AMS for affected people. Oxygen saturation below 60% on the Oxymeter is considered requiring medical attention, levels above 70% are good. Most of us, when tested at Chang La had levels above 70% and were pronounced OK.
Gamow bag is used for AMS. This is a portable high pressure sealed bag inside which the patient is placed and air pumped in, increasing oxygen concentration inhaled, simulating reduction of 5000 feets immediately. A 2 hour session is enough to reset the body dynamics to near normal and the effects last around 10-12 hours, enough time to move the patient to lower altitude. The whole gizmo weighs 7 kg and is even rented out for trekking expeditions.
In Ecuador, Peru and Bolivia tea made from
coco plant is reported to be very effective for AMS. In India,
COCA6X, a homeopathic drug is reported to be effective for AMS.
Gingobiloba, an ayurvedic drug was used but no conclusive evidence exists for its efficacy.
From experience of people going to Ladakh, two schools of thought have emerged. One set start taking Diamox somewhere around Srinagar / Manali or 24 hours before they start reaching heights of Zojila or Sarchu. Another set start with Diamox only after symptoms start. The 3rd set, ignorant or indifferent about AMS, don’t take anything and majority of times come out unscathed. Ignorance is bliss here, until hit by AMS
I had moderate AMS at Kargil, symptoms were improving and hence decided to take paracetamol and not Diamox. 2 days of moderate activity, hydration, deep breathing and paraceetamol to relieve headache was therapeutic. Eventually on day four I was OK without any medicine and back to near normal levels, on day six I was fully normal.
There are those who carry oxygen bottles and use it when needed, but these get exhausted very fast. Experience on the Malani-Leh and Srinagar-Leh route is full of stories where Indian Army help patients reach the nearest medical facility.
13. What are the medical facilities available in Ladakh?
On the Manali – Leh route, district hospitals are at Kullu, Keylong. At Manali there are private hospitals which can cater to emergencies.
In Leh there is a district hospital and the military hospital there is very well equipped and caters to the public needs. There are also private doctors and hospitals in Leh for emergencies.
There’s a well equipped district hospital in Kargil and medical dispensaries at Drass, Mulbek, Trespone, Sankoo, Panikhar and Padum.
In real emergencies J&K tourism can arrange IAF helicopters which involves guarantees of payment and about Rs.75,000/- per hour of flying.
14. How can one enjoy a holiday with AMS hanging over their heads?
Ladakh is NOT a holiday destination; it is an ADVENTURE Holiday destination. The key word here is ADVENTURE. Many times travel agents / marketers package it like a morning walk without explaining fully the difficulties of the destinations.Facilities are basic, you may have to live rough, eat what you carry / is available and chances of room-service very low.
Like any other, it has its beauty and risks, AMS is one of them, and you need to take a calculated risk. Many people who mistake Ladakh tour to be the garden variety holiday destination could be in for a shock. There are cases where people have abandoned their bikes, cars at Leh and taken a quick flight back to Delhi; unable to combat AMS or after finding the driving conditions too tough. Conditions could change overnight, temperatures could go below zero, snow falls, rivulets and landslides can block out roads for days, and vehicles could get trapped in huge traffic blocks. But for a responsible and prepared tourist who travels with his eyes wide open, this would be like an ADVENTURE destination no other place in the world can offer.
15. So much information on AMS is scary; do I need so much information?
Agreed, so much may appear too much. Responsible living is all about being informed fully about both sides of the coin, taking informed decisions and taking calculated risks. Everyday living is full of calculated risks.
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Sources: The FAQ’s are made after reading many articles, books, blogs, personal discussions with people affected with AMS, experiences of Leh road travelers, my own experience with AMS and research papers from all over the web. This presents the current thinking of the subject.
Acknowledgements: Thanks to all the contributors who have written on the subject and discussed extensively with me on the subject.
Disclaimer: The FAQ’s are designed to give basic information about AMS for a prospective traveler to high altitude. This in no way is complete as AMS research and medication is evolving constantly, the reader is responsible to update his knowledge and take own decisions based on his own judgment. He/ She is advised to take medication after getting sound medical advice from an authorized doctor.
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