Acute Mountain Sickness (AMS)

Khardung La, Ladakh (in the background) is one of the busiest passes. At 17,582 ft (wrongly labelled 18,000 ft) is thought to be the highest motorable road 

What is AMS:

Acute mountain sickness (AMS), also known as Altitude sickness, is a negative health effect of high altitude, caused by acute exposure to low amounts of oxygen at high altitudes. It presents as a collection of nonspecific symptoms, acquired at high altitude or in low air pressure, resembling a case of "flu, carbon monoxide poisoning, or a hangover. (Wikipedia)


Causes
The concentration of oxygen at sea level is about 21% and a pressure averages 750 mmHg. As we move higher, the percentage of oxygen remains unchanged but the amount of oxygen per breath is reduced.

At 12,000 ft (3,658 m) the pressure is only 480 mmHg, so there are roughly 40% fewer oxygen molecules per breath. In order to keep up with the oxygen requirement of the body, your breathing rate has to increase, even while doing nothing. However, the body cannot keep up with the oxygen demand since our oxygen requirement is the same at all altitudes. In addition, for reasons not entirely understood, high altitude and lower atmospheric pressure cause 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.


Symptoms

The most common and first symptom is a headache. The intensity of a headache may vary.
This is usually accompanied by
nausea,
breathlessness,
dizziness,
loss of appetite
disturbed sleep
fatigue and
a general feeling of malaise
Also, note that statistically, 75% of us get mild sickness above 10,000 ft. Generally, these symptoms do not interfere with normal activity and subside within 48 hours. Symptoms do get worse at night when breathing is slower.


Who gets it?
Absolutely anyone. Regardless of age, sex, fitness levels and even those who haven’t been affected on earlier visits to high altitudes. So utmost caution should be taken by everyone.

En route to Polokongka La (~16000ft) 

Acclimatization

The major cause of altitude illnesses is going too high too fast. Given time, your body can adapt to the decrease in oxygen molecules at a specific altitude.

The ideal way to acclimatization is not to fly directly to high altitude, however, if you are to spend at least 24 hrs at 10,000 ft without excreting yourself at all (not even short strolls).

After which you will need to take it easy, do not run or overexert yourself during the entire trip.
DO NOT ignore symptoms and keep your group leader or local contact informed.
Try keeping the stay at the highest location at the end of the trip. Plan your trip to gradually increase in altitude.
If you get continued symptoms or if the symptoms grow, stay at a lower altitude until the symptoms go. If they persist consult the local doctor if available or just travel immediately to a lower altitude.

Hydration: Acclimatization is often accompanied by fluid loss, so you need to drink lots of fluids to remain properly hydrated (at least 3-4 quarts per day). Urine output should be copious and clear drink a sufficient amount of water.

Food: Do not skip meals, since due to AMS you lose your appetite, however you would need to fuel your body especially if you are on a trek. Eat a high carbohydrate diet (more than 50-70% of your calories from carbohydrates) while at altitude.

Sleep: Avoid sleeping during the day (resting is fine), since when you sleep the body slows down all processes including breathing, which causes the symptoms to increase.

others: Avoid tobacco and alcohol and other depressant drugs including, barbiturates, tranquillizers, and sleeping pills. These depressants further decrease the respiratory drive during sleep resulting in a worsening of the symptoms.


Preventive medicine

[DO NOT use Diamox without consulting your doctor.]

Diamox (Acetazolamide) allows you to breathe faster so that you metabolize more oxygen, thereby minimizing the symptoms caused by poor oxygenation. Diamox is the accepted medicine as of now.
However, check for allergies to Sulpher.
If you are on Diamox, drink lots of water to avoid dehydration, since Diamox is a diuretic.

Possible side effects include tingling of the lips and fingertips, blurring of vision, and alteration of taste. Since Diamox is a sulfonamide drug, people who are allergic to sulfa drugs should not take Diamox. Diamox has also been known to cause severe allergic reactions to people with no previous history of Diamox or sulfa allergies. (Curtis, 1998).


I DO NOT recommend any medication to be taken without consulting a proper doctor, preferably one who is aware of your medical history.


Other Local remedies
Carry Camphor with you, it sometimes helps with some of the symptoms like nausea and dizziness, but note that it is not a cure.

Valley of Flowers Trek, Uttarakhand 

Trekking
AMS is usually not a problem for easy to medium grade treks, like treks in the lower Himalayas (up to 12000 ft) Since you gain altitude as you travel higher and acclimatize well. However, if you are starting your trek at a higher altitude. it is recommended to acclimatize at least for a couple of days (2-3 days) at base altitude.

Acute mountain sickness (AMS)
Whatever we discussed till now can also be described as mild AMS. Anything more than mild AMS can be life-threatening. In case of severe acute mountain sickness, the only way out is to travel to a lower altitude.

Disclaimer: This article is for birders, wildlife enthusiasts and tourists travelling to high-altitude places for leisure or light to medium hikes. This article is not for mountaineers and extreme trekkers (over 18,000 ft), since my experience with the same is limited. If you are on a mountaineering expedition I suggest treating this article as an initial read, you will have to read more about AMS in relation to mountaineering.


References:

Altitude information for travellers ascending beyond 3000 meters by Rick Curtis, Outdoor Action Program, Princeton University [1998]

Wikipedia: https://en.wikipedia.org/wiki/Altitude_sickness#cite_note-1

Leeches and How to Avoid Them

About:
Leeches are segmented worms (Annelida) and are related to earthworms, belonging to the Hirudinea family. They have a wide range from temperate (European Leech) to tropical and subtropical forests (Indian Leech).

Indian species:
In India species of the genus  Haemadipsa, Myxobdella, Hirudo and Poecilobdella are known to prey on humans. The H.z. zeylanica (Japanese mountain Leech) can occur up to 3500 m (11,500 ft). (Chandra, 1991).



Occurrence:
Leeches are found all over the country in appropriate habitats. However, they are most commonly encountered by wildlife enthusiasts and birders in NE India and the Western Ghats.

Leeches wait at the edge of a leaf to hitch a ride on a passing prey or can crawl up the leg from the ground. However, they are also known to fall on to prey on overhanging branches.

The level of the infestation in any forest depends on how wet the forest is, and also on the season. Thus wetter evergreen forest like in the NE India and parts of Southern Western Ghats India has leeches almost throughout the year. Other relative dryer forests like the ones in Northern Western Ghats, some Western and Central Himalayan forests are found mostly during the monsoon season.

Eaglenest WLS haven for birders and Leeches. Pic: Asif N Khan

Phansad WLS Dry Season. Pic: Asif N Khan

Prevention:

There is no way that you can completely avoid leeches when you’re walking in a leech-infested forest, but you can most certainly minimise the encounter and also prevent bites.




1) Clothes:

Wear long sleeve, shirts and trousers. Wear 'closed' shoes, and avoid sandals or slippers in a leech-infested forest. Tuck your pants into socks this will prevent the leech from crawling in your shoes.

2) Leech socks


Possibly the easiest way to avoid leeches is a Leech Sock. One can buy it directly or get it made with help of your tailor. Wear it like a sock and tie it just below your knee, this will prevent the leech from getting in between your toes and feet.  Around Bombay, you can get the Leech socks at Decathlon (www.decathlon.in) and Adventure 18 (www.adventure18.com) Leech Socks usually tend to slip down, this will defeat its purpose, thus you will have to costly keep checking them.

You can read this article from Borneo on Leech Socks (http://goo.gl/lRpwix).

Simple Leech Socks, that can be made on your own

5) Tobacco

Tobacco is another me deterrent to leeches, usually, socks are stuffed with tobacco to avoid them, but a decoction can also be created for the same.



Tobacco Decoction:

Soak tobacco in water overnight, preferably use hot water. After the soaking strain, the decoction adds Castor Oil to the solution and transfer it into a small bottle fitted with a spray cap (easily available at railway stations) to carry around and spray on your clothes and pants. The smell of the tobacco is able to slow down the leech and ultimately intoxicate it. But it takes time, there’s no immediate effect. Also effective is Snuff or powder tobacco, (Mishri).


 A Few Things to remember:

Few Things to remember while walking in a leech-infested forest:

1. Do not lean on a tree or sit down on leaf litter in the forest. If you need to stop and take a rest, find a spot with direct sunlight, leeches avoid dry and hot places.

2. Keep Walking, if it is for a short distance you can avoid stopping.

3. Wear double layered socks

4. Wear a lighter shade of socks, so you can see the leeches climbing up on them, the same applies when buying leech socks. Choose white or lighter shades.

5. Do not rush into the forest if you see a bird or any other wildlife, try and avoid

6. Another way to avoid leeches is to restrict your birding activities to the tar roads, especially in the NE.

7. Use cotton to plug your ears if you are sleeping in a tent in a leech-infested forest.


Once bitten...


If you can stand it the easiest and safest method is to let the leech have its fill and fall off on its own (it should take about 15-20 mins to do so) leeches are not known to spread diseases like other pests.



Removing the Leech:

Once you have located the leech, try and locate its head (anterior) sucker. This will be the most the larger disc. Pull the skin near the sucker to tighten the skin, then slide fingernails underneath the sucker, and 'peel' the leech off. The leech will immediately try to reattach itself, so flick it off right away. Never pull off the leech, since this can leave its sucker attached to your body.

Treating the Wound:

The leeches while feeding secret an anticoagulant to prevent the blood from clotting before they can get their fill. Thus when a leech is removed the wound might bleed for several hours or in very care cases for days. This is what makes leeches feared more than any other parasite in the forest like ticks or mosquitoes.

Treat the wound like any other wound:
Clean it with rubbing alcohol or another first aid cleansing solution like Savlon or Dettol (if you are using Dettol remember to dilute before using) then apply a bandage to it. Since the wound will continue to bleed change the band-aid frequently. Avoid leaving the wound open, since like any other wound it will be susceptible to infections, especially if you are hiking or trekking in the forest. The wound will itch as it heals.




Salt and other remedies:
(Dos and Donts)

There are other ways to get off a leech which is not always recommended, like applying salt, and alcohol or simply burning the leech with a match or a cigarette. These methods will get the leech off but it is more likely that the leech will regurgitate into the wound, which can cause infections. However if the leech has attached itself to a place where it is difficult to reach its sucker (list nostril or ear), use alcohol or salt.




 Always remember you are in the forest and leeches and other insects are a part of the echo system, using extreme steps like insecticide or aerosol (like deodorants) defies the purpose of an educational camp and is a very irresponsible way of avoiding leeches and enjoying the forest.

Mollem NP, Goa. Pic: Asif N Khan

References and further reading:

If you wish to learn about leeches in detail you can check this publication by the Zoological Survey of India (ZSI):

http://faunaofindia.nic.in/PDFVolumes/hpg/008/index.pdf




* Information obtained in this blog is from personal experience and the internet, thus in leech bite cases, it is best to seek medical attention. Pictures used in this blog are obtained from Google Images and may be subject to copyright.


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