The Pilgrim at High Altitude
Thursday, November 09, 2006
Paul Auerbach, M.D.
The fall issue of High Altitude Medicine & Biology, the official journal of the International Society for Mountain Medicine, is opened with an insightful editorial by Buddha Basnyat, M.D., a long-time friend who resides in Kathmandu, Nepal. Entitled “The Pilgrim at Altitude,” the discussion focuses on the observation that many pilgrims ascending mountains for religious purposes are stricken with mountain sickness, and may die without fanfare, in contrast to highly-publicized incidents among recreational and professional mountain climbers, such as those attempting to summit Mt. Everest.
As commented upon by Basnyat, thousands of religious pilgrims seek to visit the abode of the gods, often at altitudes above 4300 meters. If they become ill with acute mountain sickness, they may not turn back, and so develop high altitude pulmonary and/or cerebral edema. Worse still, others might ascend by helicopter, essentially eliminating any chance for acclimatization to the high altitude.
Unfortunately, scant or no records are kept, so the true incidence of illness is unknown. Undoubtedly, many thousands of visitors to Mount Kailash at 6714 meters have been struck down or even succumbed to high altitude illness. Victims are often elders, and may be misdiagnosed with altitude illness. Some may even feel privileged to die in the shadows of such a holy place.
Doctors of the Himalayan Rescue Association are doing what they can to be available during predictable congregations in Nepal (such as at the Gosainkunda lakeside north of Kathmandu during the August full-moon gathering), but it is impossible to be everywhere in the Himalayas, so education efforts are critical.
I highly recommend High Altitude Medicine & Biology to all physicians and researchers interested in the physiology of high altitude. In this same issue (Volume 7, Number 3, 2006), there is a wealth of fascinating information, including a case report by Susi Kreimler and coauthors about the successful treatment of severe acute mountain sickness and apparent correction of excessive pulmonary hypertension with dexamethasone in a young girl. One case is not proof of cause and effect, but it is intriguing to hypothesize a benefit, which hopefully can be corroborated (or disproven) in the future.
Tags: high altitude, religious pilgrim, medical, physician, health, wilderness medicine, outdoor medicine, healthline
4 Comments:
At Tue Nov 14, 11:29:00 AM 2006,
Kim said…
I'm interested in this, and my "wilderness" is my weed-infested backyard! Once you come down from the altitude, how long do you feel the effects of the altitude sickness? Are we ever likely to see those effects here at sea level or would the victim reaclimate before we'd ever see them?
Good information for me to look up!
At Wed Nov 15, 06:22:00 PM 2006,
Jeremy Joslin, MD said…
I was challenged by your question, and went to Dr. Auerbach's book, Wilderness Medicine 4th ed. In the section on AMS, he mentioned the natural history of the disease (meaning, the natural course the disease would take if uninterrupted by medical intervention) which included information about the duration of illness if STAYING at altitude, but I don't read anything about how long symptoms persist once a person descends.
A quick review of PubMed leaves me with nothing as well. Perhaps this is an area yet to be explored (Dr. Auerbach, please correct me here, if I'm wrong).
From established data, we know that immediate descent is the treatment of choice for AMS, and that correction of life-threatening illness is critically dependent on this. Once a patient descends, the illness usually (but not always) improves.
From anecdotal experience, I can tell you a friend of mine climbed Mt. Whitney and both of us, despite our best efforts at acclimitization, developed AMS (native East Coast'ers who had never been at true altitude). Once descended, my friend recovered in about 6-8 hours while I took a full 24-36 hours before feeling more like myself (and able to peel myself off the hotel floor).
Take these experiences for what their worth, and I'd love to hear others' experiences in duration of symptoms after descent.
At Thu Nov 16, 09:40:00 PM 2006,
Paul Auerbach, M.D. said…
I am not aware of any study that delineates the duration of altitude illness once a person has descended to an altitude where improvement is noted. My presumption is that the factors that figure into the equation are degree of pathophysiology (e.g., amount of fluid in the brain and/or lungs), initial duraton of illness (which is perhaps linked to the overall severity), recovery altitude (e.g., is the victim now at sea level or at a lower, but still "high" altitude), underlying health of the victim (e.g., age, medications, co-morbid conditions), and the individual's particular response to the illness (we know that this varies from individual to individual). I have treated a patient who showed remarkable improvement in a few hours from severe acute mountain sickness after a descent of two thousand feet (from 17,500 feet to 15,500 feet) and an injection of dexamethasone, while a different victim with mild illness that began at a much lower altitude remained quite ill for 6 hours prior to the onset of improvement after a similar descent and identical medical therapy.
At Wed Feb 06, 07:59:00 PM 2008,
Anonymous said…
I developed acute hypertension and chest pain 2 days after rapid descent from Vail which is around 10,000 ft. we skied hard for 4 days-started w/in 2 hours of arrival. I am in very good shape and didn't have problems while there. I have had sob/htn/cp now for 6 days, nml ekg, nml cxr. My husband has had continued insomnia and cognitive problems as well-some anxiety. I know we probably overdid it. I have never had cp or htn- my bp jumps to 160/80 w/ minimal activity now and sob w/ normal walking. any thoughts? only health hx is minor asthma (no wheezing now), mvp-no previous symptoms. help! we are going skiing again in a week. (from Missouri)
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