BIMONTHLY PROGRAM

MARCH 11, 7:00 PM

Magda is off to Gasherbrum II in May and plans to climb Makalu in 1992. Don't miss the opportunity to hear one of CMC's own world class mountaineers describe her adventures on this eight thousand meter peak. Program time is 7:00 PM at the CMC clubhouse.
 

ELECTION RESULTS

So that the HAMS Section does not get to be a one person show, we will have elections on an annual basis, probably at the January meeting each year. To provide for a smooth transition of power, we will elect a Chairman-elect who will serve as Chairman the following year. Election for this year's Chairman-elect will be held at an upcoming meeting. Interested candidates should contact Joe Fromme at the clubhouse address.
 

ANNUAL SPRING EQUINOX BASH

CMC GOES CLIMBING IN BOLIVIA

SPORTS MASSAGE

   Health disturbances at high altitudes have been known and recorded for centuries, but only in recent years has more attention been paid to the causes, manifestations, effects and treatment possibilities. The basis for this is the drastic increase in the number of people who, for recreational purposes or the love of adventure, have risked great heights. In commercial trekking groups to the Himalayas and the Andes, the average alpinist is afforded the opportunity to stay longer at heights to which they are not accustomed. Thus, the number of people who suffer from health impairments at high altitude is on the increase.
Frequency:

    Research in the Swiss Alps (Ref. 1) has shown that only about 40% of mountain climbers are completely healthy at altitudes over 3500 m (12000 ft), another 40% have altitude related health disturbances, and 20% suffer acute mountain sickness. Results of studies in Nepal (Ref. 2) show that at a height of 4200 m (14000 ft) 43% of those trekkers that were examined showed symptoms of acute mountain sickness. Undoubtedly, it is a fact that health disturbances at great heights lead to a higher probability of accidents caused by errors in judgment and disorientation. This could be an explanation for some of the unresolved catastrophes in high altitude climbing.
Classification and Symptoms:

    The symptoms of high altitude disorders exhibit considerable qualitative and quantitative variation from person to person. The onset of health disturbances is estimated to begin at a height of 2500 m (8000 ft). The mildest form of health disturbance is "high altitude sickness" (Table 1). It makes itself felt through the appearance of one or more discomforts like mild to moderately severe headache, sleeplessness, fatigue, exhaustion and loss of appetite. Occasionally, at heights below 3000 m (9000 ft), swelling due to fluid accumulation in subcutaneous tissue occurs before outward appearances can be observed in facial and lower leg regions. These changes shall be referred to as "peripheral high altitude edema" (= high altitude local edema, HALE). The symptoms of high altitude sickness are harmless, to be sure, but have-a certain warning character and therefore should be heeded.

Causes:

    Even though a large number of single factors have been suggested as causes for the previously described health disturbances, it has been proven that the interaction of several factors can significantly increase the risk of acute mountain sickness. One of the conclusive precursors for the development of high altitude health difficulties and high altitude edema is a too rapid ascent. Even experienced and fit mountaineers find that they are not immune to these problems if they fail to follow the guidelines of a slow ascent to high altitudes.

    An additional factor that cannot be influenced by taking the proper precautions is individual predisposition: even by following the prescribed rules and appearing to acclimate normally some climbers tend to repeatedly get sick. Normally the lack of oxygen at high altitudes has the effect of stimulating breathing (hyperventilation) with the goal of maintaining adequate uptake of oxygen. Extremely well adapted climbers exhibit highly developed lung capacity in contrast to those that axe predisposed to pulmonary edema (Ref 4).
   Other factors in the development of pulmonary edema are pressure and resistance changes in the lung's circulation. Lack of oxygen, even in a healthy individual, leads to a narrowing of certain vessels of the lungs and a resulting restriction in circulation. The result is an increase of pressure of the lung circulation (pulmonary hypertension). Persons who are known to have pulmonary edema problems have a stronger rise in pressure in the lung tissues. Blood in areas of the lungs with restricted vessels gets redistributed to areas that are less restricted. Currently, it is being discussed if this redistribution causes a mechanical shearing action that creates stress for the blood vessel walls. The result would be an increased permeability of the vascular walls to protein-rich plasma. This fluid then seeps into the surrounding lung tissues and then later into the lung air sacs and creates the edema. It is further suspected that strong physical exertion during the climb or after reaching the desired altitude (such as the digging of snow caves) creates further oxygen depletion and contributes to the occurrence of mountain sickness. Cold further increases the pressure in the lung cells.

    Even though training is a requisite to high altitude activities it is no insurance that high altitude sickness will not occur. Lastly, the swelling that is observed in many mountain sickness patients and the decrease in urine output with a corresponding weight increase seem to suggest a change in hormonal systems.

Avoidance and Treatment

    The most important preventive is the slow ascent to altitude (Table 2). Due to varying individual differences in ability to acclimate it is not possible to give a universal prescription.

    It is recommended at elevations up to 4500 m (15000 ft) to sleep no more than 300 m (1000 ft) higher than in the previous 24 hours (Ref. 5). During the day greater elevation differences can be tolerated. Above 4500 m only 300 m increases should be done every other day.
It has been proven favorable to have rest days at the same elevation. Always be aware of the early warning signs such as peripheral edema, resting pulse rates that are 20% higher than experienced in valleys, as well as daily urine output that is less than 1 liter. The following should guarantee adequate liquid intake: 1 liter per hour at strenuous physical exertion (Ref. 6).

    A much discussed medication is Diamox [generic name acctazolamide (Ed)]. It increases the breathing rate necessary at altitude and if taken just before and during the first few clays of climbing it seems to reduce the occurrence of symptoms (Ref. 7). It also may be dispensed in cases of mild to severe symptoms of high altitude sickness. Diamox cannot replace a proper acclimatization schedule! There are differing opinions in professional circles on just how Diamox should be used during stays at high altitudes.
 
    Referring to Table 2, what can be done in cases of manifested symptoms? The safest measure to mitigate high altitude symptoms is descent. Headache can be treated with aspirin or similar mild painkiller. Sleeping pills are not recommended since they depress breathing rates and favor the development pulmonary edema. Diamox can be tried in all cases of high altitude health disturbances. Dexamethason leads to diminishing of objective and subjective symptoms that are moderate to severe (Ref. 8); a use that remains controversial in professional circles. At the appearance of high altitude edema the treatment of choice is always evacuation of the climber to lower regions. If oxygen is available it can be used in the context of first aid but not as a substitute for evacuation.