Sickness at Altitude

Despite a climber's best efforts to acclimatise, the lack of oxygen at altitude can still lead to a number of serious and unusual medical conditions. Below is a description of some of the most common problems that the Base Camp medics have to treat whilst on Everest:

Acute Mountain Sickness (AMS)
Commonly known as 'altitude sickness', acute mountain sickness is by far the most common illness seen on Everest, in fact almost all climbers will experience some symptoms at some point during the expedition. Symptoms gradually appear 12-24 hours after arrival at altitude and may consist of:

Headaches
Fatigue
Nausea
Vomiting
Loss of appetite
Dizziness
Irritability
Disturbed sleep

AMS is not usually serious and symptoms generally start to decrease in severity by the third day of arriving at altitude. However, climbers must be cautious as in extreme cases the symptoms of acute mountain sickness may be the early signs of pulmonary or cerebral edema.

High-Altitude Pulmonary Edema (HAPE)

HAPE is a potentially fatal condition that develops when the pressure in the lungs becomes too great and plasma (the liquid part of the blood) leaks into the alveoli (tiny air sacks) in the lungs. As they fill with fluid the ability of the lungs to transport oxygen into the blood decreases. Symptoms may include:

Extreme fatigue
Breathlessness at rest
Fast, shallow breathing
Cough, possibly productive of frothy or pink sputum
Gurgling or rattling breaths
Chest tightness, fullness, or congestion
Blue or grey lips or fingernails
Drowsiness

The only treatment for HAPE is the immediate descent to the altitude that the victim last felt well. Unless supplemental oxygen is available, delay in descending can be fatal. However, the decent may be complicated by extreme fatigue and confusion due to the inability to get sufficient oxygen to the brain. In addition, the stress of the situation, the exposure to the cold and the exertion of the descent is likely to result in an increase in blood pressure which further compounds the condition. HAPE is a real killer on Everest, especially above the 'Death Zone' where it is difficult to assist sick climbers back down the mountain.

If the climber is lucky and is able to descend to a lower elevation they are likely to make a full recovery following one or two days rest.

High-Altitude Cerebral Edema (HACE)

The deadly HACE is probably the most severe condition associated with altitude. It occurs when the flow of blood to the brain increases in response to its call for oxygen, causing an increase in pressure in the blood vessels. This results in the leakage of plasma from the blood vessels into the brain tissue and causes the brain to swell.

The hallmark of HACE is the change in the mental state of the climber and their ability to think. Victims of HACE may experience hallucinations, loss of memory, irrational behaviour, ataxia (loss of co-ordination) and decreasing levels of consciousness. A major problem with HACE is that those suffering from the condition do not believe they have it and continue to climb higher up the mountain. This of course makes the condition even worse.

HACE is extremely serious and the only treatment is to descend as low as possible as quickly as possible. This is of the utmost urgency and any delay is likely to end in death. Descent should be to the last elevation at which the climber woke up well. Baring in mind that the vast majority of cases of HACE occur in those who have ascended with the symptoms of Acute Mountain Sickness, the last elevation at which the victim was well is likely to be the camp at which they slept two nights previous. This is easier said than done, especially above the death zone, and requires the efforts of a big team of people. If the victim is lucky enough to get down from the mountain they are likely to make a full recovery.

Lack of Judgement

Decreased levels of oxygen to the brain can cause the climbers to experience a lack of mental clarity and a reduced ability to make good decisions. Climbers can forget to eat and drink, they may set their oxygen too high or too low and some may even loose all sense of direction.

Ataxia

To conquer Everest climbers need excellent balance and coordination, especially on the knife edge ridges or steep inclines. The portion of the brain that controls these functions requires a large amount of oxygen to function correctly. As the climbers ascend into thinner air the supply of oxygen decreases which may result in the loss of coordination. This is especially dangerous as one wrong step can often lead to fatal consequences.

Sleep Disturbance

When a climber sleeps at altitude the reduced oxygen can cause a strange breathing rhythm. Cycles of normal breathing gradually slows, followed by a period of no breathing at all for up to 15 seconds and then a brief recovery period of highly accelerated breathing or hyperventilation. This breathing pattern can cause a lot of anxiety especially if a climber wakes during the hold period and is unable to take a breath.

Snow Blindness

Snow blindness can be a serious problem when climbing on high snow covered mountains. As a climber moves higher up the mountain, the levels of the dangerous ultraviolet (UV) light increases. In fact for every 300 metres a climber ascends the level of UV exposure increases by approximately 4%. Therefore, at the summit of Everest the level of UV light is 30 times higher than that at sea level. This is further compounded by the snow on the ground that can reflect up to 80% of the harmful rays back at the climbers. On the summit climbers often get excited and remove their goggles to take in the view and have their picture taken. Without noticing, for every second their eyes are not protected, the sun is quite literally burning the cornea of their eyes. They don’t know it yet but they will soon become completely blind making their descent nearly impossible. If they do manage to descend, usually as a result of a huge team effort, the climbers are immediately sent to the medical tent where an ointment and a local anaesthetic is applied to the eyes to ease the excruciating pain. The climbers are then confined to their tents with dark pads over their eyes until they recover which usually takes around 48 hours.

Sun Burn

The levels of UV light can reach dangerous levels high on the slopes of Everest. With the snow reflecting the rays the climbers are at real risk of getting seriously sun burnt. The climbers must wear high SPF sun screen at all times and should reapply it about every two hours. However despite the precautions no climber ever returns from Everest without some evidence of sun burn.

Frostbite

Temperatures on Everest fall well below freezing making climbers extremely susceptible to frostbite. At or below 0°C (32 °F) blood vessels close to the skin start to constrict. This constriction helps to preserve core body temperature. However, in extreme cold, or when the body is cold for long periods, this protective strategy can reduce blood flow in some areas of the body to dangerously low levels. This lack of blood leads to the eventual freezing and death of skin tissue in the affected areas which usually requires amputation. There have been some very nasty instances of frostbite on Everest. In 1996 Beck Weathers, unconscious, was left for dead on the mountain during a storm. Somehow he regained consciousness and staggered, snowblind, to safety. He did however loose both of his hands and his nose to frostbite.

Hypothermia

The cold temperatures and the strong winds on Everest can cause the body to rapidly lose heat. The body naturally starts to shiver to try and generate body heat from the rapid muscular shaking. However if the body temperature falls below 35°C (95°F) hypothermia starts to take hold. There are three stages of hypothermia:

Stage 1: Shivering becomes stronger and the victim becomes unable to perform complex tasks with their hands as they become numb. Breathing soon becomes quick and shallow, they begin to have trouble seeing and start to feel tired. It is quite common that climbers in stage 1 hypothermia begin to feel a warm sensation surging through their bodies as if to suggest they are in recovery, however this is usually a sign that they are in fact heading into stage 2.
Stage 2: In stage 2 the shivering is more violent, the victim becomes pale and lips, ears, fingers and toes may turn blue. Although the victim may appear alert, their movements become labored and slow, their muscle co-ordination is reduced and they begin to stumble.
Stage 3: At body temperatures below 32°C (89.6°F) the shivering usually stops. Difficulty speaking, sluggish thinking, and amnesia start to appear; inability to use hands and stumbling is also usually evident. When the body temperature falls below 30 °C (86.0 °F) the exposed skin becomes blue and puffy, muscle coordination becomes very poor, walking becomes almost impossible, and the victim displays incoherent/irrational behavior. Eventually the major organs begin to fail and death occurs soon after.

Pneumonia (The Khumbu Cough)

At altitude the dry and dusty air, coupled with the climbers increase in respiratory rate and relative dehydration may lead to pneumonia. The resulting severe coughing, known as the Khumbu cough, can be strong enough to crack the climbers ribs. The only cure is rest and a course of antibiotics.

High Altitude Tooth Ache

This painful condition occurs when a pocket of air gets trapped in fillings. It can irritate a nerve, loosen the filling or can even pop the filling out.

High Altitude Flatus Expulsion (HAFE)

Yes this is exactly what it sounds like. As the climber ascends the external pressure decreases, therefore the difference in pressure between the body and the atmosphere increases. This causes an abnormal amount of gas to find its way into the intestines and, unfortunately for their fellow climbers, causes an increase in the urge to dispel the said gas!