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In addition to the information on this page, which again is a summary of our reading and not definitive advice on the subject there are very informative articles on the whole question of altitude from the International Society for Mountain Medicine - written for the non-physician and very readable - and at www.altitude.org, which in the UK is likely to be recommended by you doctor in the literature provided when you get your jabs. The about altitude page talks about the need to acclimatise as you ascend to high altitude; this page provides some more information on what can happen if you do not acclimatise, describing the different signs of Acute Mountain Sickness or AMS. If you are unfortunate enough to suffer from AMS the only cure is descent. As already mentioned AMS is common on mountains like Kilimanjaro because none of the routes is spread over enough days to allow the climber to acclimatise properly. Some suggest that a drug called Diamox can aid acclimatisation on Kilimanjaro treks though it has a number of side affects and our doctor advised against its use. Anyone planning a Kilimanjaro adventure and thinking about using Diamox will need to discuss it with their doctor as it is available only on prescription in the UK. Literature describes 3 levels of AMS: Mild AMS is typified by headache, dizziness, fatigue, breathlessness, loss of appetite, nausea, disturbed sleep, and a general feeling of malaise, often worse at night. These symptoms don't interfere with normal activity, can be treated with normal pain killers and should subside within a few days as the body acclimatises. Literature suggests that as long as the symptoms fall into this mild category, being only a nuisance, you can continue to ascend at a moderate rate but make sure you tell others in your group about how you are feeling, so that they are alert to the fact that you may have the first symptoms of AMS. Moderate AMS is not normal and includes severe headache not impacted by pain killers, nausea/vomiting, increasing weakness/fatigue, breathlessness, and loss of coordination. If the climber is unable to "walk a straight line heel to toe", like the way the police in old movies tested for those suspected of being drunk, then Moderate AMS is a real possibility. This condition is serious and unless you have a trained medic who can administer advanced medication the only way to reverse the problem is immediate descent, preferably a few hundred metres. The literature suggests that a few days at the lower altitude may enable the climber to acclimatise and recommence ascent but given the normal timescales to which Kilimanjaro climbs run that is probably not an option, so in reality moderate AMS is likely to mean that the Kilimanjaro experience is over. Severe AMS is characterised by similar symptoms to moderate AMS but in more severe form. These include shortness of breath at rest, the inability to walk, decreasing mental status, and fluid build up in the lungs. Severe AMS requires immediate descent to lower altitudes - at least 1,000m. Again, on a Kilimanjaro trek the climb will be over for anyone suffering severe AMS and the most important thing will be attention to their well-being and ensuring you get them off the mountain quickly and safely. Although less frequently seen than the above, especially in those who acclimatise properly, there are two other severe forms of altitude illness described in our reading: High Altitude Cerebral Oedema (HACE) and High Altitude Pulmonary Oedema (HAPE). What follows is a very abbreviated summary of various articles such as that from the International Society for Mountain Medicine in an attempt to highlight the life-threatening severity of the conditions. The simple message is descend, descend, descend immediately, irrespective of when the diagnosis is made! HACE is in layman's terms a swelling of the brain and is life-threatening. Its symptoms include headache (though I guess this must be more than just your average headache), loss of coordination, weakness, decreasing levels of consciousness, disorientation, loss of memory, hallucinations, psychotic behaviour and coma. It can lead to death if not treated quickly. Immediate descent as a life-saving measure (1,000m plus) and then evacuation to a medical facility for proper follow-up treatment is imperative. HAPE is similarly serious and results from fluid build up in the lungs and is life-threatening. 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 cough bringing up fluid. Confusion, and irrational behaviour are signs that insufficient oxygen is reaching the brain. Immediate descent as a life-saving measure (1,000m plus) and then evacuation to a medical facility for proper follow-up treatment is imperative. Although not the most interesting reading, basic knowledge of AMS and the need to descend may save your life and, importantly, the lives of those around you who may not appreciate their own predicament. Therefore the message coming out of the literature is, be aware of your fellow climbers and if you see behaviour that is not typical take action immediately. This of course will include discussion of the issue with your guide and any medics in the vicinity. As already mentioned, this is a summary of our reading, which hopefully is accurate for our own safety but everyone contemplating climbing to altitude should research the issue for themselves and not rely in any way on what is written in these pages. We would certainly recommend reading the ISMM and altitude.org articles referred to in these pages and whatever other reliable information you can find on the subject - we are!
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