Dr Vinod Gupta
Amarnath cave is located in a narrow gorge on the farther end of Lidder valley at 3,888 m above sea level. The cave is 45 km from Pahalgam and 141 km from Srinagar. The trek begins in July-August. Despite being an extremely difficult trek, millions of devotees come to pay homage to Lord Shiva in one of his Himalayan abodes .Pilgrims have to trek at altitude as high as 14500 feet through rarified atmosphere and inhospitable climate and terrain.
The stresses of high altitude trek include extreme cold, low humidity, increased ultraviolet radiation and decreased air pressure all of which can cause serious health problems for the Yatris. Under these conditions, a yatri may develop diseases like acute mountain illness, high altitude pulmonary edema and high altitude cerebral oedema. During yatra period of year 2011, 106 yatris died while undertaking the pilgrimage.
What causes high-altitude illness?
The concentration of oxygen at sea level is about 21% and the barometric pressure averages 760 mmHg. As altitude increases, the concentration remains the same but the number of oxygen molecules per breath is reduced. In order to properly oxygenate the body, your breathing rate (even while at rest) has to increase. This extra ventilation increases the oxygen content in the blood, but not to sea level concentrations. Since the amount of oxygen required for activity is the same, the body must adjust to having less oxygen. In addition, for reasons not entirely understood, high altitude and lower air pressure causes fluid to leak from the capillaries which can cause fluid build-up in both the lungs and the brain. Continuing to higher altitudes without proper acclimatization can lead to potentially serious, even life-threatening illnesses.
The following are the 3 main types of high-altitude illness:
Acute Mountain Sickness (AMS)
AMS is common at high altitudes. At elevations over 10,000 feet (3,048 meters), 75% of people will have mild symptoms. Many people will experience mild AMS during the acclimatization process. Symptoms usually start 12-24 hours after arrival at altitude and begin to decrease in severity about the third day. The symptoms of Mild AMS are headache, dizziness, fatigue, shortness of breath, loss of appetite, nausea, disturbed sleep, and a general feeling of malaise.
Basic Treatment of AMS
The only cure is either acclimatization or descent. Symptoms of Mild AMS can be treated with pain medications for headache and drug called Acetazolamide( Diamox) which allows you to breathe faster so that you metabolize more oxygen, thereby minimizing the symptoms caused by poor oxygenation. This is especially helpful at night when respiratory drive is decreased. Since it takes a while for Diamox to have an effect, it is advisable to start taking it 24 hours before you go to altitude and continue for at least five days at higher altitude. Possible side effects include tingling of the lips and finger tips, blurring of vision, and alteration of taste. Diamox has also been known to cause severe allergic reactions to people with no previous history of Diamox or sulfa allergies.
Moderate AMS
Moderate AMS includes severe headache that is not relieved by medication, nausea and vomiting, increasing weakness and fatigue, shortness of breath, and decreased coordination (ataxia).. Descending even a few hundred feet (70-100 meters) may help and definite improvement will be seen in descents of 1,000-2,000 feet (305-610 meters). Twenty-four hours at the lower altitude will result in significant improvements. The person should remain at lower altitude until symptoms have subsided (up to 3 days).
Severe AMS
Severe AMS presents as an increase in the severity of the aforementioned symptoms, including shortness of breath at rest, inability to walk, decreasing mental status, and fluid buildup in the lungs. Severe AMS requires immediate descent to lower altitudes (2,000 – 4,000 feet)
High Altitude Pulmonary Edema (HAPE)
HAPE results from fluid buildup in the lungs. The fluid in the lungs prevents effective oxygen exchange. As the condition becomes more severe it can lead to cyanosis, impaired cerebral function and death. Symptoms include shortness of breath even at rest, “tightness in the chest,” marked fatigue, a feeling of impending suffocation at night, weakness and a persistent productive cough bringing up white, watery or frothy fluid. Confusion and irrational behavior are signs that insufficient oxygen is reaching the brain. In cases of HAPE, immediate descent is a necessary life-saving measure (2,000 – 4,000 feet [610-1,220 meters]). Anyone suffering from HAPE must be evacuated to a medical facility for proper follow-up treatment.
High Altitude Cerebral Edema (HACE)
HACE is the result of swelling of brain tissue from fluid leakage. Symptoms can include headache, loss of coordination (ataxia), weakness and decreasing levels of consciousness including, disorientation, loss of memory, hallucinations, psychotic behavior and coma. It generally occurs after a week or more at high altitude. Severe instances can lead to death if not treated quickly. Immediate descent is necessary for life-saving measure. Anyone suffering from HACE must be evacuated to a medical facility for proper follow-up treatment.
How to prevent high-altitude illness?
Take your time traveling to higher altitudes. When you travel to a high altitude, your body will begin adjusting right away to the lower amount of oxygen in the air, but it takes several days for your body to adjust completely. If you’re healthy, you can probably safely go from sea level to an altitude of 8,000 feet in a few days. But when you reach an altitude above 8,000 feet, don’t go up faster than 1,000 feet per day. The closer you live to sea level, the more time your body will need to get used to a high altitude.
Role of Hyperbaric Chambers for Altitude Sickness
Hyperbaric chambers are now available and are very helpful in treating severe forms of altitude illness. They all are similar to the extent that they are air-impermeable bags that completely enclose the patient and are inflated to a significant pressure above ambient atmospheric. This effects a physiological “descent.” This can be demonstrated with an altimeter inside the bag and marked improvements in oxygen saturation are measurable with a pulse oximeter. The extent of the descent depends on the altitude at which the bag is used; as an example, at 4250m (14,000 ft), the inside of the bag is equivalent to 2100m (7,000 ft).
Is it safe to go to a high altitude with a chronic illness like heart disease or lung disease?
If you have a chronic disease, ask your doctor if it’s safe for you to travel to a high altitude. Most people who have a chronic illness, such as heart or lung disease, can safely spend time at a high altitude if their disease is under good control. People who have coronary artery disease, mild emphysema or high blood pressure aren’t at greater risk of high-altitude illness than people who don’t have these diseases. People who have sickle cell anemia shouldn’t go to a high altitude. A high altitude is also dangerous for people who have severe lung disease, such as chronic obstructive pulmonary disease (COPD) or severe emphysema, and for people who have severe heart disease.
What about children& Pregnant Women and high altitudes?
It’s usually safe for children to go to high altitudes but they’re more likely to get high-altitude illness because their bodies have a hard time adjusting to the low oxygen level. A child may not be able to recognize the symptoms of high-altitude illness, so parents and other adults must carefully watch for any signs of high-altitude illness in children. . Some experts recommend that pregnant women should not travel to an altitude above 8,000 feet. If you’re pregnant, ask your doctor for advice before you travel to a high altitude.
Do’s for preventing High altitude sickness
Do check with your physician prior to traveling to higher elevations
Do take time to acclimatize
Do check with your physician prior to taking any medications
Do take it slow and easy when ascending to even high altitudes
Do drink lots of water to combat dehydration and headache
Do bring portable oxygen
Do descend immediately to a lower elevation
Don’ts
Do not ignore the symptoms of altitude sickness
Do not drink alcohol, caffeinated drink, or smoke
Do not ascend any further if you have altitude sickness
Do not accept everything a sick person says since their judgment is impaired
Amarnath shrine is one of the world’s most sacred spots. To experience its spiritual energy you must go there but with the right intention in mind. The AMARNATH Yatra, is a pilgrimage and the intent should be to visit it for peace, both within each person and then the world. One should leave their ego, anxiety and prejudices behind them and keep on chanting Om Namay Shivay.
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