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Altitude sickness

words: Ulriika Niemelä
pictures: Mikko Lampinen, and Heikki Karinen’s archives

Surprisingly, a Finnish person is one of the leading figures in international altitude sickness research. The person in question is Heikki Karinen, who recently finished his dissertation on the topic at the university of Helsinki. Karinen has been gathering material for his study for several years on Kilimanjaro, Denali, Ulugh Muztagh, and Mount Everest, for example. The leading motive for the research is Karinen’s own passion for climbing. He has been treating altitude sickness patients at Rescue Association’s Manang medical center on Himalaya and set up the world’s highest placed medical center on Mount Everest. Karinen has been through altitude sickness twice himself.

The symptoms of altitude sickness vary, and one may experience them at locations closer than and conditions easier than those in Nepal. Actually, it is likely that many Finnish alpinists have experienced some mild altitude sickness without knowing it.

Traveling from the port of Rostock straight to Chamonix, making it to the summit of Aiguille du Midi around noon, skiing actively all day, enjoying a few drinks, and then spending the night at a high altitude. That is a combination that exposes any skier to altitude sickness; one may feel some headache and nausea the next day, but it often gets mistaken for a hangover.

The symptoms of altitude sickness are headache, fluctuating mood, nausea, trouble with sleeping, swelling, fatigue, and problems with one’s balance. According to Karinen, one should be concerned if there are changes in a ski buddy’s mood and behavior.

“A happy camper becomes apathetic and sad. For example, once a group reaches the camp, the person with altitude sickness may not handle one’s camp routines but does something else instead: sits around, kicks rocks around, starts to write on one’s diary, goes through the contents of one’s backpack, is angry and irritable, etc. It may turn out he/she is experiencing a headache – a hell of a headache, in fact.”

If it’s a mild case, it’s enough to treat it by staying at the altitude where you are and give your body enough time to adapt to it. If there are several symptoms and they are strong, it’s severe and you must hurry and descend.

“You should descend while you still can, for when you can’t do it anymore, your weight poses a logistic problem to others and leads in more problems. There must be at least six people carrying a person on the mountains.”

Karinen experienced dramatic moments during a rescue operation that resulted in him getting sick. Karinen’s expedition was descending a 6000-meter summit on Putrun Himal (in Nepal’s Mustang region), aiming at disassembling a camp on their way back. They found an unconscious man in a tent; he was close to dying of mountain sickness. Karinen stayed at the tent with the man while the others continued their way down to get some help. Karinen carried the man to a ridge located 15 meters higher to make it easier for the rescue helicopter to pick him up. On his way up, Karinen started feeling exhausted and his heart rate jumped. Once he had made his way up, he received a message to his phone that said the helicopter wouldn’t arrive until the next day. Karinen picked up the man again and brought him back down.

“After that, my heart rate didn’t get any slower, and pulmonary edema started developing. It was a race against time: I knew edema was developing and I should’ve gone down, but I was there with the patient. During the night, it was interesting in a way to pay attention to how my state was changing. First, I was lying down even though breathing was harder, but as liquid was building up in my lungs, I first had to stay in a half-sitting position, then in an increasingly upward position, and finally, I couldn’t lean in any direction anymore and had to spend the rest of the night and the following morning sitting.”

As he heard the approaching helicopter, he descended 300 meters to purge his lungs. The symptoms started disappearing. The helicopter arrived as fast as it could.

“As far as I can recall, we were at 5,800 meters. A helicopter can’t function much higher than that. We went to the campsite and picked up the patient. The tent got blown away by the wind caused by the rotor. Finally, we went and picked up the bags; they had been already packed. At that point, I noticed I didn’t have energy to move anymore; there was a 1.5-meter climb up to the copter, but I just stalled on a step and the flight assistant pulled me up. My lungs were so clogged up. As we landed in Manang at 3,000 meters, the patient gained his consciousness and we were able to hydrate him orally. All my symptoms disappeared, too. All in all, descending was the most important factor in terms of getting better.”

Karinen heard afterwards that the patient had originally stayed at the camp to rest as he was feeling nauseous. It was exactly then that he should have descended. The altitude at which you sleep is a crucial factor in terms of altitude sickness.

“As you sleep, your breathing slows down. There’s a little less oxygen in your blood at night. That’s why altitude sickness usually sets in when you’re asleep at night.”

The risk to experience altitude sickness increases above 2,500 meters. What contributes to the risk is a rapid ascent – on a lift or in a helicopter, for example. A suitable pace above 2,500 meters is 300 meters a day. It is advisable to have a resting day every 3–4 days. Above 4,000 meters, it is not recommended to ascend more than 150 meters a day. If equipment must be taken higher up, one should return back to a lower level for the night. Physical stress increases the risk.

“As a rule, you shouldn’t reach your max heart rate when you’re high: recovering is slow, which again increases the risk of altitude sickness.”

If it’s not possible to descend, the symptoms can be temporarily treated with medication and a portable pressure chamber.

“The pressure chamber brings the patient to the air pressure of 2000–2500 meters or lower. It alleviates the symptoms for a while. If that helps in making one conscious or semi-conscious again so one can walk even just to cross the most difficult point, you’re already halfway there. Then, the patient can be re-pressurized at a lower altitude and he/she can walk again, and there’s no need for carrying.”

How well one’s system adapts to conditions on mountains depends on one’s genes. The Andes Indians’ hemoglobin is exceptionally high. Tibetans’ systems accelerate one’s breathing when there is less oxygen available. Surprisingly, in that respect, Finns’ systems aren’t of the worst kind, either.

In a study carried out by Karinen on Kilimanjaro, 75 % of those who ascended rapidly (800 meters a day to 6,000 meters) experienced altitude sickness while 25 % of them had no symptoms.

“I don’t know whether that’s Slavic legacy or not. There is no genetic test available to find out about it, however. Some genetic factors that expose one to altitude sickness are known. Some factors that have to do with good performance are also known.”

Some are more prone to it. Also, even though some adapt well to differing conditions, even those who are very good in terms of adapting fail to adapt if the pace is too fast.

“Those who have tried to make it up Mont Blanc ten times and who have lost consciousness and been carried down just as many times are in the risk group. You will experience it on the eleventh time as well. Also, even if you have made it up ten times without any trouble and you happen to do something a little different on your eleventh time, it is possible you may catch altitude sickness.”

Read more about Heikki Karinen’s travels in the January issue of Huippu.

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