After lunch, we make our way down to the river. By the log bridge leading to the Northern ridge, we run into a man dressed in black leather trousers, a black jacket, high boots and a fedora. "Hi, I am Dr. Nick Mason," he says with a smile. Dr. Mason is British, this season's volunteer doctor-in-residence at the Machhermo Rescue Post just opposite. He is delivering a lecture on altitude sickness for trekkers at 3 p.m. today, and if we weren't doing anything, could we attend.
We take a short walk down the river to the yeti attack site. Afterwards, we hike across to Namgyal Lodge for Dr. Mason's talk.
The Machhermo Rescue Post is affiliated to the International Porter Protection Group, and has been in operation since 2003. Run entirely by volunteer doctors-in-residence, aided by Chhewang Sherpa, manager, the post offers medical care primarily for porters, as well as for locals and trekkers who may have contracted altitude sickness and in extreme situations, even arranges rescues.
The day we arrived in Machhermo, a 22 year old Nepali porter lay dying on its Northern ridge. He had gone up to Gokyo with a Swiss group and developed AMS at 4800m. Not wanting to interrupt their trek, the group leader paid off his dues and told him descend. Alone. He collapsed a little way from Machhermo. A group of British trekkers, a few of them doctors, found him unconscious by the trail, and got their Sherpa to carry him into the rescue post. His condition was critical. The Machhermo Rescue Post deals with cases such as these practically every day.
Apart from running the clinic, the rescue post is also in the process of building a shelter for porters in Machhermo where, as in some other high altitude areas of Nepal, porters have to sometimes spend nights in exposed caves due to lack of space in the lodges. The organisation needs donations, and you can see a full account of the good work they do at http://www.ippg.net/
A short digression on altitude sickness: read this!
Who should read this? Anyone who feels like attempting this trek, or indeed any trek above 4000m, at some point of time(which probably includes some of you to whom this link was sent). Here's a statistic. More than 60% trekkers in the Everest Region suffer some form of altitude sickness. 37% get AMS, a more serious version. For about 13%, it takes a life-threatening form. There is only one cure for AMS. DESCEND!
Who's at risk? Most of all, people travelling in a group. The person feeling ill conceals symptoms to avoid holding back fellow-trekkers. Almost always. This behaviour is more common in all-male trekking groups. Secondly, the super-fit. AMS has nothing to do with fitness, smoking habits etc. How well a person adjusts to altitude depends on various factors, including genetics. Those who are fitter usually ascend faster, increasing the risks. Third, anyone. Even Sir Hillary could get it, at 3000m. Also, if you have ascended to 5000m safely on one trek, nothing prevents you from getting it at 2800m on your next.
Here's how it works. At 3500m, your lungs are taking in about 60% oxygen with every breath as compared to at sea level. At 4000m, you are down to 50%, i.e. your oxygen intake per breath is halved. At 5000, it's slightly over 40% and so on. To compensate, your body generates more red blood cells, and gets rid of fluids at a very high rate to increase your blood's haemoglobin concentration. So, if you have to get up to pee twice in the middle of the night, it's a sign your body is adapting. At -15 degrees, as you fumble for your sleeping bag zipper, it'll be hard to stay convinced that this is good for you. Your breathing will also become faster and deeper to compensate for the low oxygen content.
This is if everything goes well. If it doesn't, and you have a headache and/or nausea, dizziness, shortness of breath or insomnia that won't go away and gets worse with time, you are getting acute mountain sickness (AMS) and need to descend to the last altitude where you spent the night and felt well in the morning. Since AMS kicks in about 6-12 hours after you have crossed your personal acclimatization line, you might have to descend far to feel better. (What complicates things in the Himalayas is to descend, you often have to ascend first. The rescue post and the Himalayan Rescue Association call Machhermo The Death Valley. One has to walk miles before losing any altitude. The gentle, loping ascent which attracts trekkers to the Gokyo trail becomes their undoing if they get sick.)
The problem is, a certain amount of discomfort is normal at altitude. You may have a headache, slight exertion is supposed to leave you feeling out of breath, you might wake up in the night gasping for air (this used to happen to me over 4000m) because the low oxygen levels in the air have fooled your brain into thinking that there is no need to breathe... All this, believe it or not, is normal. As a result, it's easy to go into denial over one's symptoms.
Here are a few rules of thumb to go by. First, if you have these symptoms (Headache PLUS any of Fatigue/Drowsiness/Nausea/Vomiting/Loss of appetite/Dizziness/Irritability/Disturbed Sleep) DO NOT ascend. If with time, your symptoms disappear, you have acclimatized and can continue on your way. Second, with time, if your symptoms get worse, descend. Third, over 3500m, do not climb over 400m a day. Correction, you can climb more than that, but ensure you are not sleeping more than 400m higher than where you slept the night before. Fourth, put in at least one rest/acclimitization day for every thousand metres you climb. Fifth, drink lots of fluids. Sixth, if you do get sick, once you have descended, recovery will be dramatic. So in case you are wondering exactly how far you need to descend, the answer is descend till you start feeling better.
Left unattended, AMS can develop into its more serious forms, HAPE (High Altitude Pulmonary Edema) and HACE (High Altitude Cerebral Edema). Edema = water in the wrong place. For HAPE, it's in the pulmonary region i.e. the lungs, for HACE, it's in the brain. These are life-threatening. The afflicted person is in no shape to descend alone and must be descendED, either on the back of a yak, or carried by porters or by helicopter. HACE is a severe form of AMS where the patient will weave around as if drunk, and will not be able to walk in a straight line. He'll suffer from a severe headache, and may have any, none or all of the other symptoms. HAPE is more insidious and can strike anyone, anytime, even after 36 hours of acclimatization. The only symptom is you get out of breath after any exertion (which is exactly what you will get at high altitude) and when at rest for 10 minutes, your breathing doesn't return to normal. A sign for companions -- if, at rest, your friend does not seem to be able to finish a normal-length sentence in one breath, he's getting HAPE. DESCEND!
(If you found this scary, good. It's supposed to be. In our 5 days above 4000m, we saw 6 HAPE/HACE cases. I wouldn't want any of my friends to be so sick, so high up, and so far away from any kind of help.)
We take a short walk down the river to the yeti attack site. Afterwards, we hike across to Namgyal Lodge for Dr. Mason's talk.
The Machhermo Rescue Post is affiliated to the International Porter Protection Group, and has been in operation since 2003. Run entirely by volunteer doctors-in-residence, aided by Chhewang Sherpa, manager, the post offers medical care primarily for porters, as well as for locals and trekkers who may have contracted altitude sickness and in extreme situations, even arranges rescues.
The day we arrived in Machhermo, a 22 year old Nepali porter lay dying on its Northern ridge. He had gone up to Gokyo with a Swiss group and developed AMS at 4800m. Not wanting to interrupt their trek, the group leader paid off his dues and told him descend. Alone. He collapsed a little way from Machhermo. A group of British trekkers, a few of them doctors, found him unconscious by the trail, and got their Sherpa to carry him into the rescue post. His condition was critical. The Machhermo Rescue Post deals with cases such as these practically every day.
Apart from running the clinic, the rescue post is also in the process of building a shelter for porters in Machhermo where, as in some other high altitude areas of Nepal, porters have to sometimes spend nights in exposed caves due to lack of space in the lodges. The organisation needs donations, and you can see a full account of the good work they do at http://www.ippg.net/
A short digression on altitude sickness: read this!
Who should read this? Anyone who feels like attempting this trek, or indeed any trek above 4000m, at some point of time(which probably includes some of you to whom this link was sent). Here's a statistic. More than 60% trekkers in the Everest Region suffer some form of altitude sickness. 37% get AMS, a more serious version. For about 13%, it takes a life-threatening form. There is only one cure for AMS. DESCEND!
Who's at risk? Most of all, people travelling in a group. The person feeling ill conceals symptoms to avoid holding back fellow-trekkers. Almost always. This behaviour is more common in all-male trekking groups. Secondly, the super-fit. AMS has nothing to do with fitness, smoking habits etc. How well a person adjusts to altitude depends on various factors, including genetics. Those who are fitter usually ascend faster, increasing the risks. Third, anyone. Even Sir Hillary could get it, at 3000m. Also, if you have ascended to 5000m safely on one trek, nothing prevents you from getting it at 2800m on your next.
Here's how it works. At 3500m, your lungs are taking in about 60% oxygen with every breath as compared to at sea level. At 4000m, you are down to 50%, i.e. your oxygen intake per breath is halved. At 5000, it's slightly over 40% and so on. To compensate, your body generates more red blood cells, and gets rid of fluids at a very high rate to increase your blood's haemoglobin concentration. So, if you have to get up to pee twice in the middle of the night, it's a sign your body is adapting. At -15 degrees, as you fumble for your sleeping bag zipper, it'll be hard to stay convinced that this is good for you. Your breathing will also become faster and deeper to compensate for the low oxygen content.
This is if everything goes well. If it doesn't, and you have a headache and/or nausea, dizziness, shortness of breath or insomnia that won't go away and gets worse with time, you are getting acute mountain sickness (AMS) and need to descend to the last altitude where you spent the night and felt well in the morning. Since AMS kicks in about 6-12 hours after you have crossed your personal acclimatization line, you might have to descend far to feel better. (What complicates things in the Himalayas is to descend, you often have to ascend first. The rescue post and the Himalayan Rescue Association call Machhermo The Death Valley. One has to walk miles before losing any altitude. The gentle, loping ascent which attracts trekkers to the Gokyo trail becomes their undoing if they get sick.)
The problem is, a certain amount of discomfort is normal at altitude. You may have a headache, slight exertion is supposed to leave you feeling out of breath, you might wake up in the night gasping for air (this used to happen to me over 4000m) because the low oxygen levels in the air have fooled your brain into thinking that there is no need to breathe... All this, believe it or not, is normal. As a result, it's easy to go into denial over one's symptoms.
Here are a few rules of thumb to go by. First, if you have these symptoms (Headache PLUS any of Fatigue/Drowsiness/Nausea/Vomiting/Loss of appetite/Dizziness/Irritability/Disturbed Sleep) DO NOT ascend. If with time, your symptoms disappear, you have acclimatized and can continue on your way. Second, with time, if your symptoms get worse, descend. Third, over 3500m, do not climb over 400m a day. Correction, you can climb more than that, but ensure you are not sleeping more than 400m higher than where you slept the night before. Fourth, put in at least one rest/acclimitization day for every thousand metres you climb. Fifth, drink lots of fluids. Sixth, if you do get sick, once you have descended, recovery will be dramatic. So in case you are wondering exactly how far you need to descend, the answer is descend till you start feeling better.
Left unattended, AMS can develop into its more serious forms, HAPE (High Altitude Pulmonary Edema) and HACE (High Altitude Cerebral Edema). Edema = water in the wrong place. For HAPE, it's in the pulmonary region i.e. the lungs, for HACE, it's in the brain. These are life-threatening. The afflicted person is in no shape to descend alone and must be descendED, either on the back of a yak, or carried by porters or by helicopter. HACE is a severe form of AMS where the patient will weave around as if drunk, and will not be able to walk in a straight line. He'll suffer from a severe headache, and may have any, none or all of the other symptoms. HAPE is more insidious and can strike anyone, anytime, even after 36 hours of acclimatization. The only symptom is you get out of breath after any exertion (which is exactly what you will get at high altitude) and when at rest for 10 minutes, your breathing doesn't return to normal. A sign for companions -- if, at rest, your friend does not seem to be able to finish a normal-length sentence in one breath, he's getting HAPE. DESCEND!
(If you found this scary, good. It's supposed to be. In our 5 days above 4000m, we saw 6 HAPE/HACE cases. I wouldn't want any of my friends to be so sick, so high up, and so far away from any kind of help.)
posted by Ilovethesmellofnepalinthemorning at 4:06 PM
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