Kilimanjaro - Lemosho Route

Kilimanjaro – Lemosho Route

Introduction

Given that climbing at altitude involves increased risks, particularly at high altitude, we believe it is helpful to share some general information to anyone considering climbing Kilimanjaro or Mount Meru. We aren’t doctors and we can’t provide medical advice to guests. This is general altitude advice provided by a physician with significant climbing experience. By no means does such information replace the advice from your medical team that knows your medical history and can properly advice you about climbing risks from a medical perspective.

 Altitude Illness

As you ascend to altitudes above 2000m, your body has to acclimatize to the decreasing amount of oxygen available. If the ascent is too fast and/or the height gain too much, these acclimatization mechanisms do not have time to work, and symptoms and signs of altitude illness (also called high altitude illness) will appear. Fortunately, you are climbing with a highly experienced company and you are using the route that provides the maximum amount of time to acclimatize. This significantly reduces the risk of altitude-related illnesses.

If you suffer from any ongoing medical condition, especially: asthma, respiratory diseases, high blood pressure/ heart disease, kidney disease, diabetes, epilepsy or   mental illness, you must consult your doctor before your trip. The doctor needs to have knowledge of the special problems involving high altitude and these illnesses and be informed of the altitude of the summit of your Kilimanjaro climb (5,895 metres (19,341 ft.) above sea level).

Altitude illness can become a problem above 2500m and presents in the following ways:

  • AMS (Acute Mountain Sickness): reasonably common but not life-threatening if dealt with correctly
  • HACE (High Altitude Cerebral Edema): much less common but life-threatening
  • HAPE (High Altitude Pulmonary Edema): much less common but life-threatening

Your Leader is highly trained and experienced and will constantly observe guests. He is very familiar with all the clear signs of the onset of any altitude-related illness. However, if you think you or your ‘buddy’ are becoming ill, TELL YOUR LEADER IMMEDIATELY. He will assess the situation and may order that you descend to ensure you are not at risk. You won’t be allowed to continue as this could result in serious health consequences. Don’t argue that you should be allowed to continue. Your leader is experienced and must be obeyed. You will be escorted down and taken care of. Note: The treatment for all types of Altitude Illness is very simple – DESCEND AND REST. You will immediately begin to feel better and your symptoms will abate.

 Acute Mountain Sickness (AMS)

A diagnosis of AMS is made when there has been a height gain in the last few days, AND:

  • The victim has a headache (typically throbbing, often worse when bending over or lying down)
  • PLUS there is one or more of the following symptoms:
    • Fatigue and weakness
    • Loss of appetite, or nausea, or vomiting
    • Dizziness, light headedness
    • Poor sleep, disturbed sleep, frequent waking, periodic breathing. Use the Lake Louise Score to check (see

http://www.treksafe.com.au/medical/documents/LakeLouisescore_001.pdf).

 TREATMENT OF MILD AMS

  • Take the advice of your climb leader
  • Rest at the same (or lower) altitude until the symptoms clear (this will take a few hours to a few days)
  • Avoid unnecessary exertion
  • Keep warm, drink enough fluid to maintain hydration and occasional sugary drinks
  • Rest in a semi-reclining position if this is more comfortable
  • Medications for mild AMS:
    • Treat headache with ibuprofen or paracetamol
    • Consider treating persistent nausea or vomiting with prochlorperazine (Stemetil™) or other anti-vomiting medication
    • Consider starting acetazolamide (Diamox™) 125 to 250 mg 12-hourly for the rest of the time at altitude
  • Hypothermia, dehydration and low blood sugar (due to not eating) share many symptoms and signs with AMS and may be present at the same time. So always re-warm, re-hydrate, re-sugar

If the illness is more severe, DESCEND. Other specific treatments will be given by your leader/doctor.

HACE (High Altitude Cerebral Edema)

The important symptoms and signs are: severe headache, loss of physical coordination and a declining level of consciousness.

This is a deadly condition and immediate descent is the treatment.

 HAPE (High Altitude Pulmonary Edema)

The important sign is breathlessness.

This is a deadly condition and immediate descent is the treatment.

For more information on HACE and HAPE, see http://www.treksafe.com.au/medical/documents/altitudeillnessfordoctors_003.pdf.

PREVENTING ALTITUDE ILLNESS

Above 2000m, altitude illness (AMS, HACE and HAPE) is a possibility, and above 2500m it becomes more   common.

  • As a rough guide, above 2500m the maximum daily height gain between sleeping altitudes should not exceed 300m (slow acclimatizers) to 500m (fast acclimatizers), with a rest day every third day (or after every 1000m of ascent). Over 5000m, the daily height gain for the slow and fast acclimatizers is halved to 150m and 250 meters per day, Your leader is well aware of these guidelines.
  • If you must fly or drive rapidly to 2500m or higher, spend a minimum of two nights at your arrival altitude (or lower if possible) or until symptoms disappear, before ascending If ascending rapidly to 3000m or higher, consider using acetazolamide (Diamox™). You will be meeting this pre-climb requirement for acclimatizing.
  • Avoid overexertion and breathlessness while acclimatizing, especially if experiencing symptoms of AMS
  • Drink enough liquid to keep your urine pale and plentiful
  • Avoid alcohol, excess caffeine, salt and protein

Warning: do not ascend with symptoms of AMS and consult your leader/doctor

Acetazolamide (Diamox™)

Acetazolamide does NOT mask the onset of AMS, HACE or HAPE. A dose takes 12 hours to become fully effective. However, taking acetazolamide does not guarantee that altitude illness will not develop. Follow the advice of your physician regarding the use of any medication for AMS, HACE or HAPE.

There are 3 situations where acetazolamide is useful: 1. Prevention of AMS. 2. Treatment of altitude illness. 3. Poor sleep, disturbed sleep or periodic breathing at altitude

Side effects include:

  • Paraesthesiae (tingling) in lips, fingers, toes or other body parts and a metallic taste when drinking carbonated drinks are the most obvious. Both side effects are milder with lower doses and disappear on stopping the medication
  • Acetazolamide can cause photosensitivity (sunburn more easily) so use hats, gloves, sunscreen
  • Extra urine output. The effect of acetazolamide to increase urine output is mild (people pee more as part of the normal acclimatization process as they ascend)
Kilimanjaro - Lemosho Route

Kilimanjaro – Lemosho Route

Introduction

Given that climbing at altitude involves increased risks, particularly at high altitude, we believe it is helpful to share some general information to anyone considering climbing Kilimanjaro or Mount Meru. We aren’t doctors and we can’t provide medical advice to guests. This is general altitude advice provided by a physician with significant climbing experience. By no means does such information replace the advice from your medical team that knows your medical history and can properly advice you about climbing risks from a medical perspective.

 Altitude Illness

As you ascend to altitudes above 2000m, your body has to acclimatize to the decreasing amount of oxygen available. If the ascent is too fast and/or the height gain too much, these acclimatization mechanisms do not have time to work, and symptoms and signs of altitude illness (also called high altitude illness) will appear. Fortunately, you are climbing with a highly experienced company and you are using the route that provides the maximum amount of time to acclimatize. This significantly reduces the risk of altitude-related illnesses.

If you suffer from any ongoing medical condition, especially: asthma, respiratory diseases, high blood pressure/ heart disease, kidney disease, diabetes, epilepsy or   mental illness, you must consult your doctor before your trip. The doctor needs to have knowledge of the special problems involving high altitude and these illnesses and be informed of the altitude of the summit of your Kilimanjaro climb (5,895 metres (19,341 ft.) above sea level).

Altitude illness can become a problem above 2500m and presents in the following ways:

  • AMS (Acute Mountain Sickness): reasonably common but not life-threatening if dealt with correctly
  • HACE (High Altitude Cerebral Edema): much less common but life-threatening
  • HAPE (High Altitude Pulmonary Edema): much less common but life-threatening

Your Leader is highly trained and experienced and will constantly observe guests. He is very familiar with all the clear signs of the onset of any altitude-related illness. However, if you think you or your ‘buddy’ are becoming ill, TELL YOUR LEADER IMMEDIATELY. He will assess the situation and may order that you descend to ensure you are not at risk. You won’t be allowed to continue as this could result in serious health consequences. Don’t argue that you should be allowed to continue. Your leader is experienced and must be obeyed. You will be escorted down and taken care of. Note: The treatment for all types of Altitude Illness is very simple – DESCEND AND REST. You will immediately begin to feel better and your symptoms will abate.

 Acute Mountain Sickness (AMS)

A diagnosis of AMS is made when there has been a height gain in the last few days, AND:

  • The victim has a headache (typically throbbing, often worse when bending over or lying down)
  • PLUS there is one or more of the following symptoms:
    • Fatigue and weakness
    • Loss of appetite, or nausea, or vomiting
    • Dizziness, light headedness
    • Poor sleep, disturbed sleep, frequent waking, periodic breathing. Use the Lake Louise Score to check (see

http://www.treksafe.com.au/medical/documents/LakeLouisescore_001.pdf).

 TREATMENT OF MILD AMS

  • Take the advice of your climb leader
  • Rest at the same (or lower) altitude until the symptoms clear (this will take a few hours to a few days)
  • Avoid unnecessary exertion
  • Keep warm, drink enough fluid to maintain hydration and occasional sugary drinks
  • Rest in a semi-reclining position if this is more comfortable
  • Medications for mild AMS:
    • Treat headache with ibuprofen or paracetamol
    • Consider treating persistent nausea or vomiting with prochlorperazine (Stemetil™) or other anti-vomiting medication
    • Consider starting acetazolamide (Diamox™) 125 to 250 mg 12-hourly for the rest of the time at altitude
  • Hypothermia, dehydration and low blood sugar (due to not eating) share many symptoms and signs with AMS and may be present at the same time. So always re-warm, re-hydrate, re-sugar

If the illness is more severe, DESCEND. Other specific treatments will be given by your leader/doctor.

HACE (High Altitude Cerebral Edema)

The important symptoms and signs are: severe headache, loss of physical coordination and a declining level of consciousness.

This is a deadly condition and immediate descent is the treatment.

 HAPE (High Altitude Pulmonary Edema)

The important sign is breathlessness.

This is a deadly condition and immediate descent is the treatment.

For more information on HACE and HAPE, see http://www.treksafe.com.au/medical/documents/altitudeillnessfordoctors_003.pdf.

PREVENTING ALTITUDE ILLNESS

Above 2000m, altitude illness (AMS, HACE and HAPE) is a possibility, and above 2500m it becomes more   common.

  • As a rough guide, above 2500m the maximum daily height gain between sleeping altitudes should not exceed 300m (slow acclimatizers) to 500m (fast acclimatizers), with a rest day every third day (or after every 1000m of ascent). Over 5000m, the daily height gain for the slow and fast acclimatizers is halved to 150m and 250 meters per day, Your leader is well aware of these guidelines.
  • If you must fly or drive rapidly to 2500m or higher, spend a minimum of two nights at your arrival altitude (or lower if possible) or until symptoms disappear, before ascending If ascending rapidly to 3000m or higher, consider using acetazolamide (Diamox™). You will be meeting this pre-climb requirement for acclimatizing.
  • Avoid overexertion and breathlessness while acclimatizing, especially if experiencing symptoms of AMS
  • Drink enough liquid to keep your urine pale and plentiful
  • Avoid alcohol, excess caffeine, salt and protein

Warning: do not ascend with symptoms of AMS and consult your leader/doctor

Acetazolamide (Diamox™)

Acetazolamide does NOT mask the onset of AMS, HACE or HAPE. A dose takes 12 hours to become fully effective. However, taking acetazolamide does not guarantee that altitude illness will not develop. Follow the advice of your physician regarding the use of any medication for AMS, HACE or HAPE.

There are 3 situations where acetazolamide is useful: 1. Prevention of AMS. 2. Treatment of altitude illness. 3. Poor sleep, disturbed sleep or periodic breathing at altitude

Side effects include:

  • Paraesthesiae (tingling) in lips, fingers, toes or other body parts and a metallic taste when drinking carbonated drinks are the most obvious. Both side effects are milder with lower doses and disappear on stopping the medication
  • Acetazolamide can cause photosensitivity (sunburn more easily) so use hats, gloves, sunscreen
  • Extra urine output. The effect of acetazolamide to increase urine output is mild (people pee more as part of the normal acclimatization process as they ascend)