Altitude sickness – An Experience and A Lesson

Born under the zodiac sign ‘Sagittarius’, I guess, is the reason why even the thought of travel and adventure makes me feel alive.  I am a born traveler. To me, seeing new places, meeting new people, discovering new cultures,  and trying out new adventures is something more than a mere hobby. In fact, it’s a necessity, it feeds my soul and makes me agree with the saying, ‘One life is definitely not enough, though, I have no idea who actually said this.

Therefore, not wanting to waste my precious time on earth granted to me by my almighty, and having tried a number of adventures related to water and desert already, this time, I wanted to go for some altitude adventure. “If you call yourself a true adventure enthusiast, then you will book a trip to the Everest Base Camp”, felt like my inner voice said to me, while I was opening my laptop to book my next adventure trip. ‘Ok!’, I said to my inner voice, opened chrome, and typed the Everest Base Camp Trekking. In no time I found what I was looking for and booked it in one shot.

The South Everest Base Camp (5,380 m) and Kala Patthar (5,545 m) – the highest points achieved during the Everest Base Camp trekking, I knew, weren’t a piece of cake. Luckily, had a few weeks left, before the trip,  to get my body and mind ready for the trek. Jogging, uphill walking, cycling, swimming, in fact, I  did everything that my doctor had suggested I do, to prepare for the trek. The days passed quickly and now I was all set and excited about the trip.

My plane landed at the Tribhuvan International Airport (TIA), which is the only international airport in Nepal. Outside the luggage hall, a guy (one of the company representatives) was carrying a piece of paper, with my name written on it. He was also carrying a garland. I went to him and introduced myself. That garland was for me.

In Nepal, people use garlands to welcome special guests. And yes, I felt special. I could feel the world-famous Nepalese hospitality, the moment I stepped onto the land of Nepal. From the Airport I was transferred to the hotel. The same guy completed the necessary check-in formalities, after which I was escorted to my room. The hotel room was far better than what I had expected (had bad experiences before, but this didn’t turn out to be one).  I quickly took a shower and placed my order for lunch, as I had to be ready for the meeting in the afternoon.

Around the afternoon, I went to my agent’s office in Thamel, where I was introduced to my team,  Sherpas, and guides. I was also briefed regarding the itinerary. Then, around the evening, we (all the team members) went for dinner. The typical Nepali food was as tasty as it looked. While having dinner, I could also enjoy the cultural show. After dinner, I went to the hotel and tired and excited, went off to bed quickly.

The excitement woke me up early in the morning. I freshened up and then I was transferred to the airport to board a flight to Lukla (flights to Lukla are scheduled early in the morning). I have no words to express how excited I was. Soon, I was up in the air, enjoying the beautiful terrain beneath. After about 25 mins, I could see a tiny airstrip of Lukla Airport. Woah! Is this where my plane is going to land? Isn’t the runway too tiny? The airport looks tinier than the plane! What if the pilot is not experienced? Questions or let’s say questions full of doubts overwhelmingly flooded my mind.

Negative thoughts had started to take over the positive ones and I had already started to imagine the worst. Now I know why this airport falls on the list of one of the most dangerous airports in Nepal. As the plane approached the land, all I could do was close my eyes and pray for a safe landing. Wanted to open my eyes, but couldn’t. My feelings disappeared, my mind went blank and my body went numb. After a few seconds of numbness, the first thing I could feel was the sharp jerk as the wheels of the plane touched the ground. I opened my eyes, one at a time. The plane slowly came to halt. I breathed a great sigh of relief. There, I was ready to head toward my destination.

At Lukla, I was introduced to the porters and other team members. We had our breakfast at Lukla, while the porters were preparing the luggage to carry. I had my breakfast quickly so that I could capture the beautiful landscape and the scenery around Lukla. After everything was set, we started toward our destination. It was springtime, and everything looked so green and fresh, the air felt fresh, rhododendron forests were blooming all around and we were greeted by the beautiful small settlement of Sherpa people, the monasteries, the prayer flag, and the Mani walls on the way – all new to me and very exciting. Everything seemed so perfect and serene, like a dreamland. We stopped at Phakding for an overnight stay.

The next morning, leaving Phakding, we set off to Namche Bazaar- the main trading center of the Khumbu region. We made our way through the forest, river, and small settlements of the Sherpa people. Since the day was bright and the sky was clear, I could see the first glimpse of Mt. Everest, before reaching Namche. It looked so beautiful and alluring that it made me wish for wings to fly. We climbed the final hill before Namche, before reaching Namche. As per the itinerary, we were going to spend two nights in Namche, before heading further. The next day was solely dedicated to activities that would help us to adjust to the thinning air. We went for a short hike and visited the nearby attractions, like the settlement of Khumjung.

After acclimatization in Namche, we headed further towards Tengboche. As we were walking, I could feel a mild headache. Dehydration was my first assumption, so took my bottle and drank half a bottle of water. Felt like it disappeared for some time, as we continued to walk. We reached Tengboche for an overnight stay. There I could feel my hands and feet swelling. Thought it was because of the cold weather, which usually happens to me during the winter season. I didn’t find it necessary to inform my team leader. I felt very tired and didn’t feel like having dinner. I did have little thought, as my team leader insisted I not sleep hungry. That night I couldn’t sleep properly, I could feel the shortness of breath and it kept me awake, almost the entire night.

In the morning, after breakfast, leaving Tengboche we set off for our next stop, Dingboche. I could feel the shortness of breath getting worse. Had developed a dry cough, which once started persisted for a long time. I tried to use all the energy I had to pull myself up to Dingboche. By now I could feel my body heating with fever. Our overnight stay in Dingboche was only a few minutes away, from where I was standing now. My body was giving up.  At this point, I decided to tell my guide, how I was feeling. I wasn’t even halfway through my sentence and there I collapsed.

I woke up in a hospital bed in Kathmandu. The nurse on duty told me that I was affected by altitude sickness, which had already progressed from acute (mild) to High- Altitude Pulmonary Edema (HAPE), by the time I was brought to the hospital. I wasn’t familiar with the term HAPE, but from her tone, I could figure out that it was something serious. Therefore, I decided to google it later. She also told me that they had to call an air ambulance to rescue me, as the situation had become worst.  After listening to her, all I could do was, thank the Almighty for giving me my life back and thank all those people, who were involved in bringing me from Dingboche to the hospital in Kathmandu, ON TIME.

I couldn’t get to the base camp of Mt. Everest, but the experience was no less than getting to the base camp. I regret not telling the team leader when I felt the very first sign of altitude sickness.

Anyway, after returning to my country, I did a little research on Altitude sickness. I already knew that the decreasing amount of oxygen with the increment in altitude is the main cause of altitude sickness. Altitude sickness is also known as mountain sickness and usually occurs when people move from a low altitude (below 1,500 m) to a high altitude (above 1500 m), which gets worse as people move to a very high altitude (above 3,500 m) or the extremely high altitude (above 5,500 m), in less than a day. However, the thing that I didn’t already know was that Altitude sickness is also equally triggered by:

1. Rapid ascend
2. Overexertion within 24 hours of ascent
3. Insufficient fluid intake
4. Hypothermia
5. Consumption of sedatives or alcohol

Nevertheless, the pace of development completely depends upon the body’s ability to adjust to the increasing altitude and decreased amount of oxygen. Basically, there are three main types of altitude sickness:

1. Acute (mild) altitude or mountain sickness is the mildest and the most common among all other altitude sicknesses. Symptoms associated with Acute altitude sickness include headache, dizziness, fatigue, insomnia, nausea, decreased appetite, and shortness of breath.
2. High –Altitude Pulmonary Edema (HAPE) is caused by the accumulation of fluid in the lungs that prevents the proper exchange of oxygen. Symptoms associated with HAPE include several symptoms of acute mountain sickness, shortness of breath at rest, fever, gurgling respiration, and persistent dry cough. It usually occurs at a very high altitude, that is, above 3,500 m. The onset can either be gradual or sudden and requires immediate treatment.
3. High – Altitude Cerebral Edema (HACE) is caused by the accumulation of fluid in the brain that results in the swelling of the brain tissues. It usually occurs at a very high altitude (above 3,500 m) or extremely high altitude (above 5,550m). Symptoms associated with HACE include any symptoms related to acute mountain sickness or high-altitude pulmonary edema, confusion, impaired walking and coordination, and lethargy. It also required immediate treatment

Both HAPE and HACE are potentially fatal.

After reading the symptoms, I figured out that in my case the altitude sickness had already progressed from Acute to HAPE. Hadn’t I been rescued and treated on time, I would have been dead by now. Or, things would have been different, if only I were aware of some of these symptoms (commonly known as early symptoms) – headache, fatigue and insomnia, stomach illness, dizziness, loss of appetite, nausea or vomiting,  swelling of hands, feet, and face, nose bleeding, shortness of breath upon exertion, a persistent rapid pulse that my body had started to show as soon as we left Namche and headed towards Tengboche.

Things could still have been different if only I had discussed some of these symptoms (commonly known as the later symptoms) – shortness of breath even when resting, fever, persistent dry cough, symptoms similar to bronchitis, extreme fatigue, headache, nausea that my body had started to show as we left Tengboche and headed towards Dingboche.

Altitude sickness is diagnosed by the patient’s clinical condition. Other tests, like Chest X-ray, CT scan, or MRI are also used occasionally.

Moreover, I had all the chances to prevent it, but I did not. I was stupid and I should admit this.  However, anyone reading this article, please be informed that the points that I am going to discuss below are very much useful in preventing altitude sickness if you are planning an alpine climb any time soon. So, I would like you to read them very carefully:

• Always start to walk below 3,000m
• Avoid overexertion within 24 hours of ascent
• Plan a rest day to acclimatize after every 900m of elevation gain
• Keep yourself hydrated by drinking lots of water (4-6 liters a day) or any other fluid like soup or Electrolyte drink mixes.
• Take acclimatization hikes prior to ascending further
• Although you climb high, make sure you sleep low
• Eat high-calorie diet
• Pressure breathing or purposeful hyperventilation is also recommended. This helps to clear out the stale air and carbon dioxide in your lungs and intake more oxygen.
• Avoid alcohol, tobacco, caffeine, nicotine, sleeping pills, antihistamines, or any other depressant drugs, both prior to and during the trek.
• If you are prone to altitude sickness make sure to take preventive medication (Acetazolamide, commonly known as Diamox is the best one), 24 hours before your arrival at high altitude. Ibuprofen or Aspiring should be helpful in the case of headaches or other symptoms of altitude sickness.
• In case you see the symptoms of altitude sickness, don’t go higher until the symptoms decrease. If the symptoms show no sign of decreasing or if they increase rather than decrease, move as down as possible. It is the best treatment for the patient with altitude sickness.

If you follow these golden rules, I am sure you will be able to prevent life-threatening sickness caused by altitude anywhere around the world. As for me, no altitude is as interesting as the altitude of the Everest Base Camp, therefore, I have already booked my trip to the Everest Base Camp again. Having learned a very important lesson, regarding altitude sickness, in my earlier attempt at the Mt. Everest base camp, this time I am going to be more careful, and prepared, utilize the lesson learned, and only return after getting to the base camp.