By Gustavo Zubieta Sr, MD and Gustavo Zubieta Jr, MD
Knowledge of what precautions should be taken is very useful for any change from one environment to another. Don't be afraid of high altitude, but be well informed and take precautions. Our experience of over many years dealing with high altitude disease will prove most useful to you. This advice is mainly for travelers to high altitude and not necessarily for mountain climbers, although similarities exist. It is also useful for altitudes in other places or cities.
It is important to mention this because we should not underestimate psychological factors. Exaggerated fear constitutes stress and therefore a great loss of energy. Don't waste your energy, it is fundamental for adaptation. An explanation of exactly how fear acts on an organism would be very complicated, but that fear can produce a fast pulse, just as if you were exercising is a good example.
When you travel to high altitude, some facts should be known:
1.- ALWAYS take simple precautions of basic hygiene. Your organism is immune to the bacteria and viruses that surround you in your usual habitat and not to those of a new environment. You should not ingest unknown foods in great amounts for the first time upon arrival. Digestive enzymes develop a specific capacity and function for each type of food. Although some foods taste very good, one should NOT stuff oneself the first day. In addition, tobacco products and alcohol should be avoided.
2.- Adjustment to high altitude is complex and varies greatly between individuals, and in different trips for the same individual. Some do not show any symptoms; they eat, drink, do exercises, even compete in sporting events. However, tolerance to high altitude does not depend on physical strength. In fact, we have seen some athletes who have suffered High Altitude Pulmonary Edema [HAPE] upon arriving to a high altitude location. It was later learned that as children, they had suffered from pulmonary disease that after recovery was asymptomatic at sea level.
3.- The effects of high altitude also depend on the distance that you have to travel, the difference in season, temperature, and also the time of day of the arrival. Cold weather aggravates the high altitude effects. High altitude is like an allergy to a certain food: some people have a bad reaction, and others don't.
4.- The following advice is geared to the height of the center (3600 m) of the bowl shaped city of La Paz (Bolivia), 3000 to 4100 meters. An escalation of just 500 meters or more creates great differences and newcomers should take additional precautions. After a critical height (3000 meters), the effects grow exponentially. The La Paz airport (El Alto) is at 4100 meters. Upon arrival, avoid all unnecessary inconveniences that take a long time, and go down to the city of La Paz as soon as possible, but don't rush. Arriving at a good hotel will bring comfort and security.
THE PRECAUTIONS that you take depend on your symptoms. A slight headache, particularly at the temples, and a sensation of a lack of air with pressure on the chest can last for some hours. This could be accompanied with vomiting, in which case it would alleviate the heavy feeling of indigestion and later will make you feel better. If these symptoms get worse and persist in the first 12 hours of arrival, take an analgesic, like aspirin or paracetamol, rest in bed, and cover yourself with a blanket.
If the symptoms last 24 or 48 hours and prevent you from sleeping, do not panic, but do call a doctor, preferably a high altitude specialist. The more serious cases should receive adequate medical attention and a precise diagnosis. High altitude sickness generally is associated with some chronic affection that surfaces with hypoxic stress (oxygen reduction). In many cases the manifestations of sickness at high altitude are due to overlooked health problems at sea level. Once diagnosed and treated you may return home in better conditions than before travelling!
DON'T PANIC! Immediate return is not the first solution. The economic costs are very high, and you lose the opportunity to complete your important mission in La Paz, or to share a vacation with relatives or friends.
Children adapt best to the change in altitude, and paradoxically are also those have a greater susceptibility to have High Altitude Pulmonary Edema [HAPE] with around 1% incidence, which can be fatal unless medical help is sought. Symptoms are: shortness of breath, fast pulse rate, phlegm that can be blood- stained and maybe blue lips. You might be able to detect signs of HAPE before a physician is consulted. In 4 out of 5 cases the tongue is white with red spots (ulcers) of varying sizes, that go away when the condition improves. The therapy is generally based in oxygen therapy and rest.
Another affection that rarely presents itself is HIGH ALTITUDE CEREBRAL EDEMA; blurred vision, unable to walk straight, dizziness, lack of coordination and disorientation are typical; delirium and coma in severe cases. Immediate treatment with-no- second-thoughts is also determined by medical consultation.
All who travel to high altitudes should know that the organism is subject to a series of adaptive mechanisms in its new environment This is valid for well adapted high altitude residents, like those born in La Paz or in the Altiplano region (3000-4000 m), who have to go up to the mines or panoramic areas, like ski resort Chacaltaya (5200 m) or La Cumbre (4600 m) on the way to their destination of the Yungas valleys (600 m), for example.
No specific and adequate medication is as of yet known for severe cases of acute high altitude sickness (also know locally as Sorojche). And always remember, that your illness may be associated with a common affection that went untreated. The most frequently detectable causes are broncho-pulmonary disease, hypertension, heart and kidney disease. Nowadays, the tecnology and facilities permit adecuate treatment and health care, in a specialized high altitude clinic. So you have nothing to fear.
The diuretic acetazolamide [DIAMOX], has been recommended to prevent acute illness previous taken one day before ascent to high altitude as a prophylactic. It is not 100 % effective and you should consult a physician prior to its use.
SUMMARY OF NORMAL MECHANISMS OF HIGH ALTITUDE ADAPTATION
1.- More frequent breathing, proportional to the altitude that you rise up to. 2.- Increased pulse (minor tachycardia) 3.- Dryness of the skin and mucous membranes, particularly in the respiratory tracts. 4.- Minor headache in some.
SUMMARY OF CLINICAL ABNORMAL MANIFESTATIONS OF HIGH ALTITUDE ADAPTATION
1.- Exaggerated increase in respiratory frequency, with difficulty breathing and a sensation of a lack of air (dyspnea) and/or cough. 2.- Exaggerated increase in pulse rate (frank tachycardia), with a sensation of heart palpitations, precordial oppression, and a perception of pulses in arteries of the neck and head. 3.- Sensation of pulses in the temples and ear accompanied by nausea and headache. Increase in arterial pressure. 4.- Gastrointestinal symptoms like nausea and vomiting. 5.- Disorientation and lack of coordination.
WHY ARE WE AFFECTED BY HIGH ALTITUDE?
As at sea level, the percentage of oxygen in the air remains 21 % at high altitude. Yet, because of the low barometric pressure, the air is "thinner". Some individuals do not have the capacity to adapt immediately to this lower pressure of oxygen that enters our lungs. When supplementary oxygen is given, it actually is increasing the concentration of the gas in the lungs, compensating the deficit of oxygen that is required by the organism to metabolize nutrients and convert them into energy.
DON'T BE AFRAID OF HIGH ALTITUDE, HAVE A KNOWLEDGE OF IT... AND ENJOY YOUR STAY!!!
@Copyright 1/24/96 IPPA - La Paz, Bolivia