Know everything about Acute Mountain Sickness (AMS) before your Ladakh trip

Being a doctor even though I knew in theory what Acute mountain sickness or AMS is, I never realised its seriousness until I fell victim to it in my trip to Ladakh. So here’s my story and info on AMS that you need to know before you head out to Ladakh.

My experience with Acute Mountain Sickness (AMS)

On the 7th day of my Ladakh trip (18th August 2021), I started my journey from Manali and headed to Pang. On the Leh – Manali highway, there’s a section called the Gata Loops which consists of 21 hair pin bends. It’s a steep ascend from 11000 feet to 15000 feet above sea level once you reach the top.

Already I had ascended from 8000 feet in Manali to 11000 feet at the start of Gata Loops. I made it to the top at around 1pm. Half way through , I started having headache, giddiness, fatigue and breathlessness. Little did I realise that I was having symptoms of AMS!

A little further, I found a group of riders sitting by the roadside. I stopped by them and asked why they were sitting in the middle of nowhere. They said they were having symptoms of AMS. Great! I got company. So we all waited for half hour. We had diamox tablets and since I had breathlessness, I took a lasix tablet as well. After we felt a little better, we continued riding.

We reached Pang around 5pm. I found a large group of riders in Pang who stopped there for refreshments before they headed to the next village. Initially I thought I’ll join them but my condition grew worse as time went past.

I became so breathless, exhausted and nauseous to a point where I couldn’t carry my own luggage for a few steps. The owner of a noodle stall took me to his private tent and helped me unload the luggage.

As the sun set, I could barely breathe, barely sit up and barely concentrate. With all my riding gear still on except for the helmet, I lied down in the tent. My whole life flashed in front of my eyes when I thought I was dying. I cried tears of joy being proud that I made it this far. And then I passed out.

I woke up at 2am with severe toe pain. By then breathlessness had reduced and I had a new problem of half frozen toes. Temperatures had dropped to 3 degree celcius that night. Anyway long story short, I survived to tell the story.

Nobody has to go through what I went through if you take the necessary steps to prevent and treat AMS and that’s what I’m going to share. If you want to see the video of me struggling to breathe, go check this out. https://youtu.be/2mHOStTaWb8

What is Acute Mountain Sickness or AMS?

Acute mountain sickness or AMS is a group of symptoms you are likely to experience at an altitude above 8000 feet from sea level due to decreased levels of oxygen pressure. When body fails to acclimatise, it starts showing symptoms of AMS

Symptoms of Acute Mountain Sickness

Common symptoms of Acute Mountain Sickness or AMS includes headache, dizziness, fatigue, exhaustion, blurring of vision, lack of concentration, nausea, abdominal cramps and diarrhoea. AMS progresses to High Altitude Pulmonary Edema (HAPE) and High Altitude Cerebral Edema (HACE) both of which are fatal when left untreated.

High Altitude Pulmonary Edema (HAPE)

High Altitude Pulmonary Edema is when AMS progresses to breathing difficulty and chest heaviness, where the fluid in your body seeps to the lung due to low oxygen pressure in the atmosphere and you drown in your own fluid. If not treated at this stage, HAPE is life threatening. Note that HAPE gets worse at night.

High Altitude Cerebral Edema (HACE)

High Altitude Cerebral Edema (HACE) is when you develop confusion, extreme lethargy, disorientation and hallucination, where the fluid accumulates in the brain causing swelling of the brain and eventually compression of the brain in the tight skull compartment. HACE also is life threatening and if not treated immediately can lead to coma and death.

Why do you develop AMS?

The human body acclimatises to high altitudes by making necessary adjustments in lung, heart, circulation and other parameters to make oxygen available to the body, but takes time to do so. When you ascend to levels more than which body can acclimatise in a day or two, different organ systems starts to fail due to the lack of enough oxygen in the blood stream.

Gastrointestinal symptoms like nausea and diarrhoea are due to indigestion because of less oxygen available to digest food. HAPE and HACE develop due to less oxygen pressure needed to keep the body fluid in their respective spaces.

How to prevent Acute Mountain Sickness or AMS?

1. Acclimatise

Check the elevation of the place you are headed to. If it’s above 8000 feet from sea level, stay at the lowest point before the ascend for at least a period of 24 to 48 hours to acclimatise.

Subsequently, it’s ideal to keep your ascend to 2000 feet per day from baseline and not more than 4000 feet if you are on a tight schedule. Your body will find it difficult to cope up with ascends more than 4000 feet per 24 hours.

2. Hydrate

Drink at least 2 to 4 Litres of water every day. How hydration helps to keep the fluid pressures intact in high altitudes is a topic of discussion beyond the scope of this post. Yes, toilets are not easily available along the Ladakh routes but that shouldn’t stop you from hydrating well.

3. Diamox

Diamox or Acetazolamide is a drug that prevents fluid accumulation and helps in acclimatising faster. 250mg taken 12 to 24 hours prior to ascend and continued for 2 days twice daily after the ascend is the recommended adult dosage.

Diamox is ideal for folks who’ve had AMS previously as the second episode can be more severe. Do consult a doctor before the trip itself to know the dosage according to your body weight

How to treat Acute Mountain Sickness or AMS?

1. Stop and descend!

If you experience AMS even after taking all the necessary precautions, the first thing to do is STOP! Stop ascending for the day or at least for a few hours and drink as much water as you can. If it’s getting worse, decent as soon as possible till you fell better, to a village or town below and stay for 24 to 48 hours to get acclimatised. Descending to a lower altitude is the main treatment in worsening AMS.

2. Treatment protocol

Consult a doctor prior to your trip and have a treatment protocol for AMS beforehand. Diamox 250mg twice a day helps in relieving symptoms and acclimatising faster. Paracetamol 650mg or Aspirin for headaches.

How to treat High Altitude Pulmonary Edema (HAPE)

When AMS progresses to HAPE, first thing to do is to descend to an altitude more than 2000 feet or until symptoms get better. Take supplemental oxygen till you descend.

If you don’t have access to oxygen, seek help of the army personnel. They are angels to civilians. You can carry portable oxygen cylinders in case you’ve experienced AMS before or you have no option but to ascend more than 4000 feet in 24 hours.

Nifedipine helps in treating HAPE. It’s not recommended to take nifedipine without a doctor’s advice as it can lead to hypotension and it’s own complications.

How to treat High Altitude Cerebral Edema (HACE)

Before treating, first thing is to recognise the symptoms. HACE cannot be recognised by you because you’ll be in altered sensorium. You’ll need to educate your travel companions to detect signs and symptoms of HACE so it can be caught early.

Even in HACE, the mainstay of treatment is to descend to a lower altitude as soon as possible, ideally more than 2000 feet or until symptoms get better. Oxygen supplementation should be given till you descend or till you reach a medical facility.

Dexamethasone helps in decreasing swelling in the brain. It should be administered only with a doctor’s advice. If not treated immediately, HACE results in death within hours to onset.

Does being fit help in prevent Acute Mountain Sickness or AMS?

People often misunderstand AMS to be a sickness of the less fit and start training in gym or engage in some sports in preparation for their journey to Ladakh. Although being fit is ideal for overall health, sadly fitness level doesn’t matter in prevention of AMS.

AMS is body’s response to low oxygen pressure and the susceptibility is almost entirely determined by the genetic makeup of the individual. So take necessary precautions even though you think you are fit.

Once I’m acclimatised, am I protected from AMS for life?

No. Once you are back to lower altitudes, your body returns to normal. You are more likely to develop AMS in a much severe form the next time you are headed to high altitudes,. You need to be prepared and take all necessary precautions to prevent it.

All in all prevention is better than cure. Small steps taken ahead can prevent your dream trip from being ruined by Acute Mountain Sickness or its severe forms. While you are acclimatising in Leh, here are some things to do to keep yourself busy – https://bulletstrings.com/7-things-to-do-in-leh-while-you-are-acclimatizing/

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Frequently Asked Questions (FAQs)

How long can Acute Mountain Sickness (AMS) last?

Symptoms of AMS can last till you get acclimatised which usually takes 24 – 48 hours or till you descend to a lower altitude.

Can Acute Mountain Sickness (AMS) cause permanent damage?

Although people who’ve experienced AMS once are more likely to experience it again in a severe form, AMS do not cause any permanent damage if treated promptly.

What are the first signs of Acute Mountain Sickness (AMS)?

The first symptoms of AMS include breathlessness, headache, fatigue, dizziness, blurring of vision, nausea or abdominal cramps.

How can I prevent Acute Mountain Sickness (AMS) naturally?

Spend 24-48 hours at the lowest point of your planned ascend to acclimatise. Do not ascend more than 4000 ft per day. Drink lots of water, eat healthy and sleep well.