Monday, May 12, 2014

What to do when you have AMS

One of my worse AMS experience was on this mountain.
Mt Elbrus, Caucasus 2004. slow-going, acclimatization climb.

Before you read this post, read previous article about Acclimatization.   

So, you've got AMS.  Don’t panic,  there’s hope.  =)
If one is experiencing severe AMS (with edema), the only sure cure is to go down the mountain! Evacuate ASAP! If unable to evacuate, and if you’re lucky to have a gamow bag (portable chamber) and/or O2 bottles – then this may be life-saving tools.  Use gamow bag with big caution - make one mistake (like sudden release of pressure) and you could kill someone inside. 
This article below is more focused on mild AMS (characterized by headache, nausea, occasional vomiting, lack of appetite, etc.), how to prevent it from progressing to a severe form, or how to fix;
1.      Rest and avoid gaining more (sleeping) altitude.   It means, if you’re sick now, further walking up (to thinner air) to sleep or camp will worsen your AMS.

2.      If you feel that you’re getting worse (consult your guide or team mate) – consider the option of reducing your altitude by at least 1000ft.  The lower the better (the thicker the air) but of course, more effort if you will go up again.
3.      Hydrate!  3li or more.  Just mind your electrolytes when over-hydrating (ensure you don’t significantly wash down all your potassium, sodium, sugar) – over-drinking purified or distilled water may cause big problems.  Best to mix water with juice, or drink other liquids like soup.
4.      With lack of appetite, if would be a challenge to re-energize with food.  I’ve tried (and witnessed AMSd teammates) to consume fruits and was able to.  And try to gulp soups.  Egg drop version would be easiest (and loaded with protein).  In my bad AMS days, I was only able to eat noodle meals with lots of garlic. 
5.      Do breathing exercise.  Inhale more air (get more O2 from thin air), followed by short exhale (it’s hard to hold breath at altitude).  At night, elevate your head (more pillows) to help with your breathing.
6.      Since moving about is difficult (but highly recommended), plan your movement.  Ex. step1, get tissue from my bag, step2- go to toilet,  step3- get my water bottle for refill, step4- go to kitchen for refill.  Trust me, with hypoxic hypoxia (lack of O2) – even simple, outlined tasks can be missed.  And as a consequence, tiring.  Imagine going to the bathroom 100 meters away, only to realize you forgot your tissue wipes.  Easy to do while in the low urban setting, but at altitudes, when your resting heart rate (BPM) is doing 105+, performing very simple tasks shoots that up to 120 or more– it could be physically and emotionally challenging!
7.      Take meds if you have to.  Headache? Take your tested meds (paracetamol or ibuprofen, etc.). just ensure your meds are ‘compatible’ with your other meds or your condition.  Some take diamox (believed to reduce AMS), which somehow failed to cure mine.
8.      If you can, or force yourself to – do a ‘climb high sleep low’ routine.  Even just a hundred meters of elevation may bring magic.  Just go out, grab your cam, walk very slowly and deliberately (presumably during rest day), gain some altitude,  stay for a little while (1hr or more if you can), BUT walk down to sleep at lower elevation.
9.      If you are alone and experiencing bad AMS for the first time -  that might be the worse days of your trekking life.  My advise - best to have a team, a buddy, or a guide who can physically or emotionally nurse you back to your trekking life.

There will be days in the mountain when one feels that all his/her strength and confidence has faded or fading away.  Realize that AMS may sap all these energies and mental strength.  Just live thru it, fix yourself, and climb on!

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