Climbing Kilimanjaro

Safety & Altitude Sickness

Kilimanjaro is potentially hazardous, trekking at high altitude is dangerous. Various medical conditions may complicate matters on Kilimanjaro, especially any issues related to the heart or lungs. Additionally, certain medications may place climbers at a greater risk on the mountain. Therefore those intending to climb Kilimanjaro should seek the advice of their doctor to make sure that they are clear for the trip.

Altitude Sickness and Acute Mountain Sickness are caused by the reduction in oxygen levels at altitudes above 10,000 feet. To help with the effects of altitude sickness you should allow your body time to acclimatize and cope with the lack of oxygen. The best way to do this is by choosing to climb Kilimanjaro using a route that lasts for 6 or more days, or climb Mount Meru before attempting Mount Kilimanjaro to give your body more time at altitude. There is medication that you can take that will help with the symptoms of altitude sickness; however the only cure is to descend from altitude as quickly as possible. You should never underestimate the dangers of Acute Mountain Sickness and must always follow the instructions of your guide.

Unless you have previous experience of trekking, or climbing at altitude; or you have had an opportunity to experience simulated effects of being at high altitude; it is very difficult to know how you are going to react to altitude, or how well you will acclimatize.

Some people may experience symptoms of altitude sickness from as low as 8,000 feet; however more serious effects would not usually arise until around 12,000 feet. The main consideration is not how high you are going, but how quickly you are gaining altitude.

High altitude is defined in the following three categories:

• High Altitude: 5,000 ft – 11,500 ft
• Very High Altitude: 11,500 ft – 18,000ft
• Extreme Altitude 18,000 ft+ (Kilimanjaro summit 19,340 ft)
• The fact is; young, physically fit males are more likely to suffer from acute mountain sickness (AMS) than any other demographic group. This is largely due to their physical ability to ascend quicker than many other individuals.

Acute Mountain Sickness (AMS)

Acute Mountain Sickness or altitude sickness is very common at high altitude. At over 10,000 feet (3,000 m) approximately 75% of people will suffer mild symptoms of altitude sickness.

Altitude sickness is classified as Mild, Moderate and Severe, with High Altitude Pulmonary Oedema and High Altitude Cerebral Oedema being 2 conditions associated with Severe Acute Mountain Sickness.

Mild Acute Mountain Sickness symptoms include:           

• Headache
• Nausea & Dizziness
• Loss of appetite
• Fatigue
• Shortness of breath
• Disturbed sleep
• General feeling of malaise

Symptoms do not usually prevent normally activity but tend to be worse at night. The symptoms usually disappear within two to four days, ascent can continue at a moderate rate as long as the symptoms remain mild.

Moderate Acute Mountain Sickness symptoms include:

• Severe headache that is not relieved by medication
• Nausea and vomiting, increasing weakness and fatigue
• Shortness of breath
• Decreased co-ordination

Symptoms usually make normal activity, such as walking, difficult. The best test for moderate acute mountain sickness is to get the person to walk in a straight-line heel to toe. If a person is unable to walk a straight line it is a clear indication that immediate descent is required.

Severe Acute Mountain Sickness symptoms are an increase in the severity of:

• Shortness of breath at rest
• Inability to walk
• Decreasing mental status
• Fluid build-up in the lungs
• Severe Acute Mountain Sickness requires immediate descent to a lower altitude.

High Altitude Pulmonary Oedema (HAPO) symptoms include:

Shortness of breath (at rest)

• Tightness in the chest, and a persistent cough bringing up white, watery, or frothy fluid
• Marked fatigue and weakness
• A feeling of impending suffocation at night
• Confusion and irrational behavior

High Altitude Pulmonary Oedema results from a lack of oxygen resulting in a buildup of fluid in the lungs. This fluid prevents effective oxygen exchange and as the condition worsens the level of oxygen in the bloodstream decreases, which leads to cyanosis, impaired cerebral function, and ultimately death. Anyone suffering from symptoms must be evacuated to a medical facility for treatment.

High Altitude Cerebral Oedema (HACO) symptoms include:

• Headache
• Weakness
• Disorientation
• Loss of co-ordination
• Decreasing levels of consciousness
• Loss of memory
• Hallucinations & Psychotic behavior

Coma

High Altitude Cerebral Oedema results from a lack of oxygen resulting in a build up of fluid in brain causing swelling of brain tissue. High Altitude Cerebral Oedema usually occurs after a week or more at high altitude. Severe cases can lead to death if not treated quickly. Anyone suffering from symptoms must be evacuated to a medical facility for treatment.

The main concern when climbing Kilimanjaro is altitude sickness. This condition is an acid-alkali imbalance in the blood and body fluids which affects climbers indiscriminately. Whatever your level of fitness, it may not reduce your chances of getting some degree of altitude sickness because almost everyone does – mild headache, nausea, tiredness, loss of appetite are common symptoms.

For your safety you should definitely not be climbing at altitude against your doctor’s advice. You should not climb at altitude if you have sickle cell disease, recurrent pneumothorax (burst lung), pregnant (above 3,500m), a respiratory problem, sore throat, cold, cough, increased temperature or a nose bleed. People who have had laser surgery for short sight may experience vision changes (over 4,500m).

There are no hard and fast rules about who will be affected by these illnesses. Some Himalayan experts who have been climbing for years can experience altitude sickness; meanwhile, inexperienced climbers going high for the first time might feel fine all the way to the top of Kilimanjaro.

The major illnesses are outlined below, but these are such serious issues you should research these ailments further on your own.

High-Altitude Cerebral Edema (HACE)

The most serious altitude-related illness and is caused by a lack of oxygen and is called High-altitude cerebral edema (HACE). The large and small arteries of the brain dilate so they can carry more blood and more oxygen, causing the brain to swell.

One of the obvious results of this swelling, or cerebral edema, is a tremen­dous headache. Other symptoms are confusion, hallucination, an inability to control emotions, and a staggering walk. The staggering walk is often one of the most definitive ways of identifying a HACE victim. Ask the victim to walk heel to toe along a straight line; if the victim has a problem with that they are in trouble and need to descend.

As with HAPE, it is imperative to get the victim to a lower elevation as quickly as possible. Carry the person if you must! Don’t wait for helicopters. The victim must descend until fully well and with absolutely no residual loss of coordination (ataxia).

High-Altitude Pulmonary Edema (HAPE)

An accumulation of fluid in the lungs, can come on quickly and kill a victim within a few hours. Symptoms of High-altitude pulmonary edema (HAPE), include: exhaustion, difficulty in breathing (at rest), chest pain, a gurgling noise in the chest, and a cough with bloody sputum (saliva mixed with mucus).

The best treatment (the only treatment) is to get the victim to a lower elevation as soon as possible, even if that means carrying the person. Oxygen is often used to treat HAPE on mountaineering expeditions (in conjunction with a hyperbaric bag if available), but the best treatment is a fast and immediate descent. The victim should be kept warm or the pressure in their pulmonary vessels may increase even further, and you don’t want that. Adalat (nifedipine) is an important treatment and is used to decrease the pulmonary pressure by dilating the pulmonary blood vessels.

Altitude sickness medicine (Diamox)

Acetazolamide (diamox) is used for the treatment and prevention of altitude sickness; diamox does not mask the symptoms altitude sickness but actually helps to treat the problem.  Side effects of taking diamox include; tingling of fingers, toes and face. Carbonated drinks tasting flat. Increased urination and occasionally blurred vision.  It would be advisable to take a trial course prior to going to Kilimanjaro as any severe allergic reactions are easier to treat here than at a remote location.

Nutritional Altitude Supplement (ALTI-VIT)

ALTI-VIT is a unique vitamin formula which has been developed to support your bodies requirements at Altitude. Its ingredients include: Siberian Ginseng, Vitamin C, Reishi Mushroom Extract and Ginkgo Biloba, ALTI-VIT is a nutritional altitude supplement to assist with: oxygen uptake, energy production, immune function and sleep quality. ALTI-VIT contains 100% natural ingredients and is available without prescription. More information on the benefits and effects can be found on the ALTI-VIT website.

Analgesics (pain killers)

Ibuprofen/Nurofen is effective at relieving altitude induced headaches.

Acclimatization

• Most of the steps to aid your acclimatization and reduce the symptoms of altitude sickness will be taken by your guides, but it may be useful for you to know some preventative measures along with a few of the signs and symptoms.
• On arrival in Moshi, do not overexert yourself, or move higher for the first 24 hours after arriving. We recommend that you take it easy, perhaps by relaxing by the pool.
• Climb high and sleep low; when possible, sleep at an altitude lower than the highest point you have walked to.
• If you begin to show symptoms of moderate altitude sickness, don’t go higher until symptoms decrease.
• If symptoms increase, go down! Always take the advice of your guide as your health and safety is the most important thing to them.
• Remember that all people acclimatize at different rates. Do not worry if you appear to be the only person in your group suffering, it may just be that it has affected you sooner than other members of your group.
• Stay properly hydrated; acclimatization is often accompanied by fluid loss, so you need to drink lots of fluids to remain properly hydrated (at least four to six liters per day). Urine output should be copious and clear to pale yellow.
• Take it easy and don’t overexert yourself. I cannot emphasize strongly enough the words of the guides “pole, pole” meaning slowly, slowly. It really will increase your chances of getting to summit.
• Avoid tobacco, alcohol and other depressant drugs including, barbiturates, tranquilizers, sleeping pills and opiates such as dihydrocodeine. These cause a worsening of symptoms.
• Eat a high calorie diet while at altitude.

Hypothermia and Frostbite

East Africa’s mountains lack the extremely cold temperatures found in many mountain ranges of the world, but hypothermia and frostbite can still occur.

Hypothermia is a condition in which the body’s core temperature drops below normal. The victim becomes weak and often begins to shake. The obvious response is to warm the victim by providing warm liquids, high-energy foods, hot-water bottles, and even crawling into a sleeping bag with the person (both of you nude for better heat transfer).

In frostbite, soft tissue is destroyed as body fluids freeze into crystals around the cells of the tissue. In the initial stages, the skin is white and hard.

In mild frostbite, when the skin is still soft (sometimes called “frostnip”), the affected area can be rewarmed fairly easily by placing the part someplace warm—under an arm, in a sleeping bag, in the crotch, or against the bare skin of a companion (the chest is good). The rewarming process may be painful, but is usually without long-term problems.

When an appendage is seriously affected by frostbite, the best thing to do is to evacuate the victim without rewarming the frostbitten area. Rewarming a frostbit­ten area often causes more damage than the actual frostbite. Often, a victim can walk out on frostbitten feet but must be carried if the feet are rewarmed.

If your evacuation must include another night out, rewarming the frostbitten area is inevitable. Modern medical thinking now dictates that rewarming be done quickly. Use water between 38 and 41 degrees Celsius (100–105 degrees Fahrenheit) and soak the frostbitten part for 30 minutes. Do not massage the affected flesh in any way. Once the frostbitten area is warm, wrap it with a loose bandage and keep it warm until a full evacuation can be made. Refreezing of a frostbitten part will cause further damage.

The best prevention for both hypothermia and frostbite is to dress properly. Dress in wools and fleece fabrics; never wear cotton clothing! You should also keep yourself well hydrated and well fed.

Denial
Denial is a huge issue on big mountains, especially with people who are adamant about reaching the summit. You need to admit when there is a problem. Don’t succumb to denial just because you are weak or because you aren’t leading the pack. Denial can lead to the very serious, life-threatening problems described above.