Planning a ski trip or hiking trip this year? All visitors should know the signs of acute mountain sickness and the symptoms. Learn the early symptoms of altitude sickness and be willing to admit that you have them. There’s a myth that fitness drives your risk. It’s based on genetics, so even if you’re fit, you may experience it. Going quickly from low altitude to high altitude can cause headache, fatigue and nausea. Acute mountain sickness affects more than one in four people who travel above 3,500 meters, or 11,600 feet, and more than half of those who travel above 6,000 meters, or 20,000 feet. The Telluride Mountain Village is at about 9,500 feet but a lot of the surrounding peaks and ski trails are much higher.

When you first get to the higher altitude a significant percentage of people will notice shortness of breath with exertion and a headache. Remember at 9500 feet the effective oxygen is about 29 percent lower. Although air contains 20.9% oxygen at all altitudes, lower air pressure at high altitude makes it feel like there is a lower percentage of oxygen. That would make your effective oxygen inhaled percentage feel like 14.8 percent rather than the almost 21 percent at sea level. No wonder we get more short of breath with exertion at this altitude. At 12,000 feet (3,658 meters) the barometric pressure is only 483 mmHg, so there are roughly 40% fewer oxygen molecules per breath. In order to properly oxygenate the body, your breathing rate (even while at rest) has to increase. Being fit may not prevent altitude sickness but since there is less effective oxygen being fit when you arrive will make your trip even more enjoyable. Also never forget to start a stretching and fitness program well before your trip if possible. Trying to get fit at higher altitudes is difficult. For skiing there are a few exercises that may be beneficial but always check with your physician first. Most of the exercises to become ski-ready can be done without any equipment, from the comfort of your home. Stability balls or Bosu balls can maximize your efforts. Remember to start well before your trip.

Some exercises to prepare your body for skiing:
1. Jump rope, starting for one minute and building to three minutes.
2. Run sprints in your neighborhood, on a track or on a treadmill. Downhill skiing is often like sprinting with short bursts of vigorous exercise.
3. Lunges can be beneficial.
4. Squat but make sure not to overextend your knee over your ankle.

Balance exercises can also be helpful and do not forget your core exercises.

Start your stretching exercise before and during your trip. Using a foam roller or exercise band to help stretch after skiing will may help your muscles recover faster.

Altitude is defined on the following scale High (8,000 – 12,000 feet [2,438 – 3,658 meters]), Very High (12,000 – 18,000 feet [3,658 – 5,487 meters]), and Extremely High (18,000+ feet [5,500+ meters]). Telluride is not unique in the problem of altitude sickness. Other ski areas elevations include: Arapaho Basin Elevation – 11,000 Feet, Breckenridge Elevation – 9,603 Feet, Copper Mountain Elevation – 9,712 Feet, Dillon Elevation – 9,111 Feet, Frisco Elevation – 9,075 Feet, Keystone Elevation – 9,280 Feet, Loveland Ski Area Elevation – 10,800 Feet, and Silverthorne Elevation – 8,730 Feet.

Headache, fatigue, some loss of appetite, nausea, vomiting, light-headedness and insomnia that develop 6 to 12 hours after ascent to this higher altitude all can be symptoms of acute mountain sickness. The problems usually improve in one or two days if the traveler doesn’t go higher. In less than 1% of cases, symptoms can grow worse and turn into high-altitude cerebral edema.

In the mountains you’ll start to see an increase in red blood cells in the blood of people adapting to altitude. The red blood cell, the erythrocyte is what carries the oxygen in the blood and since we are inhaling less oxygen molecules we need more oxygen caring capacity. The heart rate also increases, to supply more oxygenated blood to the tissues, and this most noticeable the first several days.

So how do we prevent some or all of these potential problems? If going to the mountains think about spending a day or two at a lower altitude. Acclimatize gradually. One easy preventive solution is to ascend slowly. Denver is at 5,280 feet and Santa Fe at 7,000 feet and would make great places to spend a day or two prior to your mountain adventures. If going on a significant trekking trip the CDC advises no more than 1,000 feet of elevation gain per day at altitudes above 12,000 feet. Not only should we avoid alcohol at altitude for the first few days but start avoiding it 48 hours prior to your trip. We should be extremely well hydrated the first several days but not with alcohol. Drink lots of water. High elevations can cause fluid loss, so it’s important to stay well hydrated. Stick with water or liquids that replace electrolytes. Avoid sugary or caffeinated beverages such as soft drinks. Sleeping pills may be contraindicated. You very well may notice for a couple of days increased urination which is one response to changes in your body’s acid/base balance and helps your acclimatization process.

Take it easy the first couple of days. Avoid tobacco and alcohol and other depressant drugs including, barbiturates, tranquilizers, and sleeping pills. These depressants further decrease the respiratory drive during sleep resulting in a worsening of the symptoms. Make sure to have a very healthy diet including healthy carbohydrates. Your appetite may decrease at altitude but try and take in an adequate amount of healthy calories. Have healthy snacks available.

What are the Basic Treatment of acute mountain sickness? The only cure is either acclimatization or descent to a lower altitude. Some of the symptoms can be treated with pain medications for headache (like acetaminophen or low dose short term ibuprofen like agents) and Diamox (Acetazolamide). Diamox allows you to breathe faster so that you metabolize more oxygen, thereby minimizing the symptoms caused by poor oxygenation. Diamox stimulates breathing, raises blood oxygen and increases urination. 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. The recommendation of the Himalayan Rescue Association Medical Clinic is 125 mg. twice a day (morning and night and the 250 mg dose was not more effective). Possible side effects include tingling of the lips and finger tips, blurring of vision, and alteration of taste. Side effects subside when the drug is stopped. Since Diamox is a sulfonamide drug, people who are allergic to sulfa drugs should not take Diamox.

You can buy or rent oxygen concentrators and using oxygen at night may help considerably. It is amazing how many changes take place in the body to allow it to operate with decreased oxygen. We essentially discussed here the most common form of altitude sickness which is usually mild. More severe forms and High Altitude Cerebral Edema (HACE) and High Altitude Pulmonary Edema (HAPE) are rare and beyond the scope of this post. Make sure you discuss all recommendations and this information with your health care provider.