How to travel safely at high altitude

The first stop on our big adventure is Ecuador at 9,186 feet. We currently live in Seattle, which ranges from sea level to 520 feet. Pretty big difference, huh? Well, that difference can make a person really sick.

Photo by Warren Talbot

A few years ago I flew in to Telluride, Colorado for a hiking trip in the fall. It was gorgeous, and we exerted ourselves a little bit too much (plus had margaritas with dinner), and my first night and second day there were a blur. I had terrible dreams when I did manage to catch some sleep, and the rest of the time I was tossing and turning with a raging headache. By morning, I was in a fog and had the lowest energy I’ve ever felt in my life. Oh, and there was the vomiting.

Thankfully we were staying at a lodge and there was an oxygen bar on hand. After 30 minutes of inhaling it, I was as good as new. In fact, I couldn’t believe how sick I had been just a few minutes earlier. It made me a firm believer in altitude sickness and how it can derail a body so fast.

Disclaimer: I am not a doctor, and the information in this post was gained through a visit to a travel clinic and at a seminar on high-altitude travel given by a cardiologist. The information is general and does not cover to any specific health problems you may have. If you have questions about high-altitude travel and your health, you should check with your physician. This information is for information purposes only.

Since our first stop on the trip is at such high elevation, we have been asking a lot of questions. Our nurse Anne at the UW Travel Clinic gave us a prescription for acetazolamide 125 mg tablets to take twice daily starting 12-24 hours before our ascent and continue 24-48 hours after ascent as needed.

This will help us with the adjustment when we land. In an ideal scenario, we would ascend gradually, giving ourselves 3-5 days to get to that level. When hiking this is easier to do than when flying.

The information and warning signs about high altitude sickness are below and are taken from our visit with the UW Travel Clinic, a seminar on high altitude travel by Dr. Andrew Luks at REI, and the CDC website.

What is altitude sickness?

We get sick at altitude (above 8000 feet or 2400 m) because there is less oxygen in the air. Our bodies can adapt to these changes over time, and ascending slowly with plenty of time to rest is key. With flying and shorter vacations, though, we don’t always do that.

The main risk factor is going to high, too fast. It doesn’t matter what kind of shape you are in, your age, or your gender – anyone can get altitude sickness (though not everyone does).

There are normal body changes at altitude:

• High heart rate – this will return to normal after a few days at the same altitude. One thing to test is that you have a quick recovery from exercise. If so, you are just adjusting to the normal symptoms of being at altitude.
• Faster, deeper breathing – you will huff and puff, but at rest your breathing should return to normal. You will notice more sighing and taking deeper breaths.
• Increased frequency of urination – this is part of your body adapting to the altitude.
• Poor sleep – this can even include irregular breathing and sleep apnea, though it will get better with time.
• Swelling of hands, feet and eyes is normal. This will go away when you descend.

Risk factors for becoming sick:

• Ascending too quickly. No matter how healthy you are, ascending to heights over 8000 feet with no rest days is more likely to make you sick. If you feel bad, stop or descend.
• Smoking and drinking alcohol. Seriously, if these will impair your body at low altitude, can you imagine what they will do at high altitude?
• Cockiness. If you are in great shape you are just as likely to get altitude sickness as your couch potato travel partner. Don’t assume because you are a marathon runner that you will not get sick.

The main high altitude illnesses

Acute Mountain Sickness (AMS) is the most common. This usually starts 6-10 hours after arrival at elevations above 8500 feet. Common symptoms are headache, dizziness, poor appetite, nausea, vomiting, fatigue or poor sleep. Headaches can also come from dehydration, so make sure you are hydrated. To officially have AMS you need a headache plus at least one other symptom. In my case, having the alcohol with dinner on my first night probably didn’t help. If the symptoms include vomiting and the other symptoms get really bad, the patient could have severe AMS. The patient usually recognizes he or she is sick. Do not go higher until your AMS symptoms have stopped.

High Altitude Cerebral Edema (HACE) is the next level from severe AMS. This includes swelling of the brain. It is not nearly as common as AMS. It rarely occurs just out of the blue, and the patient will have likely had AMS symptoms. It usually doesn’t happen until 13,000 feet, but not always. To test for this, ask your companion to walk a straight line heel-to-toe. If they can’t do it, they likely have HACE. They often have mental status changes as well (withdrawn, acting confused, and just not themselves). Travel companions are usually first to notice this illness and not the sick person themselves. It is really important to monitor for these changes in each other. If not treated, a person can go into a coma and die.

High Altitude Pulmonary Edema (HAPE) is a fluid build-up in the lungs. It makes it hard to breathe. Unlike HACE, this illness can occur on its own without a prior HAPE or HACE diagnosis. It occurs at altitudes above 8000 feet and usually starts within 1-4 days of reaching altitude. They can develop a dry cough (though coughing is also considered normal at high altitude), and they may cough up a pink frothy-looking material. They can also develop blue lips and fingertips. People with HAPE have a very slow recovery to exercise and are very fatigued. Like HACE, this one can also be fatal and needs to be treated immediately.

Treatment and Prevention

Rule #1 in both treatment and prevention of altitude sickness is to control your ascent. Going to fast or climbing in spite of your symptoms will only increase your chances of severe illness. Control the ascent.

Mild AMS: No need to descend, but you should stop your ascent. Aspirin, Tylenol, and and ibuprofen can be taken for headache, but you should NOT take any narcotics such as Valium. You can also take acetazolamide (requires a prescription). If your symptoms improve, you can climb. If not, stay put or descend.

Severe AMS or HACE: Descend. If descent is not possible, you need supplemental oxygen or a Gamow bag (trust me, you likely won’t have one of these on your trip). You can also take acetazolamide or dexamethasone for treatment (requires a prescription). You should not re-ascend until you are symptom-free without medication, but if you are this sick you should probably just enjoy the current altitude. Why risk it?

HAPE: Descend. If descent is not possible, you need supplemental oxygen or a Gamow bag. Nifedepine (requires a prescription) in the long-acting version twice a day. You should not re-ascend until you are symptom-free without medication. Like the treatment above, though, why push it? Just enjoy the altitude you are on.

If you are planning to travel at a high altitude, planning is everything. Make sure you know the warning signs and pay attention to yourself and your travel companions. Bring appropriate medications with you for treatment, and use common sense when deciding how far and how fast to go.