Altitude sickness (also called mountain sickness and high-altitude sickness) is the sickness caused by ascending too rapidly in high elevation especially above 3000m that does not allow the body enough time to adjust to reduced oxygen and changes in air pressure. It usually happens if not experienced or acclimatized before in that elevation. It may happen even if it is experienced before. If elevation gained quickly either on walking or horse rise, driving or by plane/helicopter, it can sudden strike. It is always wiser and safer to travel slowly in higher elevation that helps to acclimatize. While travelling on foot, altitude sickness symptoms usually develop in 10 to 24 hours of reaching a higher elevation and may get better in a day or two of acclimatization in the same elevation. If getting better, trip can be continued slowly in higher elevation otherwise descending to lower is safe. Type of Altitude Sickness and symptoms: 1. Acute Mountain Sickness (AMS): Early stage with following mild symptoms- Shortness of breath, fatigue, hangover, loss of appetite, headache, dizziness, nausea, vomiting, muscle aches, insomnia etc. 2. High Altitude Pulmonary Edema (HAPE): Severe stage with more intense symptoms - Instead of feeling better, the symptoms get more intense like breathing difficulty, severe headache, fatigue, chest tightening, insomnia, walking difficulty, blurry vision, loss of body coordination, mental confusion, Irrational behaviour, dry tongue, blue-tinged skin and nails due to lack of oxygen, frequent coughing due to fluid in lungs, frothy or tinged pink Sputum with blood from the damaged lung tissue. It may be life- threatening which is the most common cause of death from altitude sickness. This is severe life-threatening stage for which helicopter rescue with medical support is required urgently. 3. High Altitude Cerebral Edema (HACE): Most severe stage with most intense symptoms It is due to fluid in brain and air drop in nerve system. This is the most severe stage that may lead to coma for which helicopter rescue with medical support is urgently required. 4. HAPE and HACE: In severe stage, fluid builds up in lungs, brain or both for which helicopter rescue with medical support is urgently required. People of high risk from altitude sickness No matter how one is fit, young or healthy, may suffer from altitude sickness. It depends on person's body system, previous experience of high altitude, ongoing physical activity and acclimatization in the atmosphere. As per the experience, men seem at greater risk than women but the reason is unknown. People who have some diseases and are in following condition may be in risk of altitude sickness: heart failure or cystic fibrosis, sickle cell anemia, a high-risk pregnancy, unstable angina and COPD. Being physically more active in high elevation or gaining elevation quickly has high chance of the sickness. The way to know altitude sickness Above 3000m, along with shortness of breathe and headache with one or more symptoms of the altitude sickness seem together, it can be figured out as altitude sickness. Treatment of Altitude Sickness (symptoms may appear above 3000m) -Breathe deeply every few minutes to decrease the level of carbon dioxide in their blood. -In fact, there is no dependable medicines for the treatment of altitude sickness but aspirin or paracetamol is okay in the usual recommended doses. -Medications like nifedipine and dexamethasone are often used for the treatment of the altitude sickness that helps to reduce risk of fluid accumulation in lungs. -Administer oxygen from a portable oxygen cylinder. ¬¬ -Stay warm in same elevation, have rest and plenty of hot fluid (water, ginger tea, garlic soup with little red pepper, no coffee), the mild symptoms usually go away in a day or two. -If the symptoms are completely gone away, the trip can be continued in higher elevation slowly. -Instead of getting better, if symptoms remain the same or worsen, it is wiser to descend to safer place (below 2000m) as soon as possible. -If symptoms are moderate but seems impossible to descend or rescue quickly, Portable Altitude Chamber (PAC) or supplemental oxygen can be used. -Steroid called dexamethasone to treat HACE and supplemental oxygen and medications to treat HAPE might be needed. -Experience doctor can figure out HACE or HAPE by listening chest with a stethoscope or take chest X-ray or brain MRI or CT scan. -The best and ultimate treatment of altitude sickness is - descend, descend and descend to lower elevation below 2000m! Some guidelines for travelling in high elevation (above 3000m) to prevent Altitude Sickness - Take necessary advice from doctor or experienced people before your trip. -Pack all necessary first aid items including medications and warm clothes. -Walking slowly and acclimatization are the best ways of lowering the chance of altitude sickness. Walk always with experienced and authorised guide. -Drink at least 3-4 litres of liquid per day (no alcohol / no coffee not above 4000m except the people who are accustomed in high altitude). -Consume - ginger tea, garlic soup, red pepper and szechuan pepper (timmur) mixed pickle every day. -Always start journey below 3000m where the oxygen is sufficient to everyone. - If travelling in high elevation by flying or driving, spend at least a day below 3000m or around for acclimatization. -Starting acetazolamide tablet (Diamox) below 3000m may be helpful but it drains out the urine frequently. Should drink plenty of fluid to maintain water in the body. Salmeterol inhalers and even Viagra-like drugs are often used to prevent fluid building up in the lungs. -Sleep at least 50m below than the elevation gained while travelling during the day. -If travelling around 5000m or above, acclimatization day should be: 1st around 3500m, 2nd around 4200m, 3rd around 4900m. -If helicopter landing above 4200m, stay maximum 15 minutes on the ground otherwise it may be harmful or even fatal. -Avoid smoke, sleeping pills and unprescribed medicines and hyperactive activity in high elevation. -Stay in same place for a day or two if mild symptoms appear and proceed journey if symptoms disappear otherwise descend to the elevation below 2000m. -If severe symptoms appear, seek for emergency rescue with medical support, descend to below 2000m then treatment.