"Doctor, why do I feel funny in the mountains?" (includes acclimation tips) (Cover Story)

The woman ahead of me was breathing hard and slowing down. We were attending a Bible conference in the Rockies, and the two of us were hiking back to our cabin after lunch. Step by step we struggled up the wellworn path--a clim that did not look steep at all just a few minutes ago when we left the dining hall. "Wish they'd take out some of those pop machines on the campground," she gasped, "and put in oxygen tanks."

A day or so later I was chatting with another camper. "I am enjoying the sessions," she said, "but this is not a good week for me. I don't know if I'm overstimulated by the preaching or singing, but I feel awful because I can't sleep."

I was having trouble sleeping too, and my head was aching. Eager to get away from city life and into the scenic mountains, I had looked forward to this conference and had hoped to take part in all the activities. But now, four days into the week, I felt amazingly disinterested, tired, downright "funny" up there in the hills. What was wrong with me?

"Acute mountain sickness," said my doctor when I asked him later about my discomfort. "It happens to lots of folks who go to the mountains to hike, hunt, ski, or even just sightsee."

He said modern means of rapid travel have increased the number of persons who fall victim to mountain sickness. As we travelers choose more active and adventurous trips, we jet off to the Rocky Mountains, the Alps, the Andes, the Himalayas--and arrive so quickly that our bodies have little opportunity to adjust to the higher altitude.

According to Dr. Edward S. Orzac, describing mountain sickness in Travel Holiday magazine, "acute mountain sickness is usually caused by engaging in strenuous physical activity before acclimating to the altitudes of 8,000 feet and higher."

Mountain sickness is unpredictable. Some people feel ill at altitudes near 5,000, feet while others feel fine at 10,000 feet. Sometimes altitude problems develop in persons already acclimated to high altitude. An athlete is stricken as frequently as an out-of-shape individual. Surprisingly, children and teenagers--young, strong human dynamos--seem particularly susceptible to mountain sickness.

That was the experience of 17-year-old Trey. A heavily muscled, healthy young man who worked out regularly with weights and skied steep trails with ease, Trey was plagued with headaches and nosebleeds at 8,000 feet. How embarrassing to him to go on a ski trip with friends and then spend so much time at the first-aid station!

Dr. T. Scoot Johnson and Dr. Paul B. Rock, reporting in the New England Journal of Medicine, said they discovered that abrupt exposure to moderate altitude results in illness in 30 percent of the persons they studied. Other statistics published in the Mayo Clinic Health Letter show that 10 to 25 percent of those who ascend rapidly to 8,000 feet will develop mountain sickness. At 10,000 feet the incidence rises to 50 percent; at 12,000 feet nearly everyone will develop some symptoms. The higher and quicker the ascent, the "funniers the feelings."

Acute mountain sickness usually starts during the first 8 to 24 hours after arrival at a high altitude. The sufferer has little energy or appetite. He feels uneasy even if he sleeps, for normal dream patterns are disrupted. Children are prone to nausea and vomiting.

Common symptoms of acute mountain sickness include breathlessness, fatiguq, rapid heartbeat, dizziness, impaired memory, faulty judgment, mood swings, apathy, chilliness, diarrhea, flatulence, water retention, ringing in the ears, and headache. Headaches usually begin the second day at altitude. They are worse in the mornings, worse when the victim is lying on his back, and worse after strenuous activity. Sufferers may notice puffiness in the face, hands, and feet. They may complain of abdominal pain, or mention decreased or darker urine. When asleep, they seem to breathe irregularly. Periods of very deep breaths alternate with periods--up to 10 seconds long--of no breathing at all.

At moderate altitudes these "funny feelings" are generally not life-threatening, and go away within three to seven days. However, some altitude problems can be serious--even fatal.

Highe-altitude pulmonary edema involves the filling of the lungs with fluid, making breathing difficult. Some persons develop this illness at about the 8,000-foot level, but more often it is associated with rapid ascent and immediate physical exertion at higher altitudes. Doctors once called this condition "skier's pneumonia" because they saw it in flatlanders who flew to skiing resorts above 10,000 feet and started skiing immediately upon arrival.

Early symptoms are like those of acute mountain sickness, plus there is a persistent cough, very rapid pulse, and gurgling sounds in the lungs. This is a serious condition requiring immediate descent to low altitude, because the vitim could become unconscious and stop breathing.

High-altitude encephalopathy (cerebral edema) involves swelling of the brain, and seems to strike a day or two after a mild siege of mountain sickness. Its victim becomes confused and disoriented. He may have seizures, or hallucinations, or find it difficult to do things requiring balance and coordination, such as walking a straight line. This illness, too, demands immediate descent to low altitude, or the victim may lapse into a coma and die.

Is the thin mountain air--the lack of oxygen--the problem? Yes, along with air pressure and individual physical differences. Only healthy people in good physical condition should make quick trips to high places. Persons with existing heart or lung disease, anemia, sickle-cell disease, or other acute and chronic physical illnesses should head for the hills only when the need is urgent--and then with caution.

"Next time I go to a mountain conference, what can I do to protect myself?" I asked my doctor. He made the following suggestions--advice you can discuss with your own personal physician.

* Spend a few days at some halfway point between your home and your mountain destination. Not halfway in mileage, but halfway in altitude. The average person lives at elevations under 5,000 feet. Many of us live only a little higher than sea level But most of us want to hop into a car or plane, ride as fast as we can, and get to the mountains right now--and then slow down and soak up the scenery! A quick way to ruin a trip!

* Another possibility for getting acclimated is by gradual daily increments. For example, once you arrive at the 6,000-foot level, advance no higher than 1,000 feet each succeeding day. Be patient in taking the long way up, knowing that on your return trip you can descent to home altitude quickly with no discomfort.

* If you fly to the mountains, your destination the first day should not be higher than, 8,000 feet. Rest a day at this level, then limit further ascent to 1,000 feet a day.

* Spend your nights at 7,000 feet or lower, even if during the day you are spending time at a higher altitude. The amount of necessary oxygen in the blood falls even lower during sleep. "Climb high but sleep low," say experienced mountaineers.

* If mountain sickness strikes, slow down the pace of your activities and get more rest. Eat lightly but frequently. Drink plenty of fluids. Dehydration is a threat at high altitude, and thirst is not an adequate gauge for fluid intake. Stay away from alcohol, tobacco, and caffeine; go easy on salt. Avoid strenuous sports. Set more reasonable goals for yourself. Make a conscious effort to breathe deeply and regularly.

* The prescription drug acetazolamide (Diamox) may help prevent or lessen symptoms of mountain sickness; if taken the day before ascent to the mountains and continued for five days after arrival. The drug has a diuretic effect, making adequate fluid intake especially important to avoid dehydration. If you are allergic to sulfonamides, do not take Diamox.

* My doctor advised against taking sedatives for sleep, because they might mask beginning symptoms of high-altitude encephalopathy. He did suggest ibuprofen or acetaminophen for relief of headache. (Ask your doctor what you should take.)

Still feeling funny? If all else fails, go back downhill. Descending just 1,000 feet can bring immediate improvement in the way you feel. Don't start back up until symptoms subside.

Like magnets, mountains pull us up to new heights. There is something good for the soul, we say, in mountaintop experiences. Like the writer of psalm 121, we all long to lift up our eyes to the hills now and then. I learned that common sense and a few simple precautions make my mountaintop experiences more comfortable.

Barbara Perkins is a pastor's wife who writes from Moore, Oklahoma.