Prepare Well for a Healthy Experience

Trekking on Mt. Kilimanjaro has unique medical implications. Fortunately, the nature of the mountain allows a large number of non-technical, less prepared climbers to reach the summit. All routes on Mt. Kilimanjaro can be safe but preparations must be made to ensure safety. Epics are easier to prevent than extricate oneself from, and thorough planning has significantly reduced mountain sickness cases in our company. Persons trekking on Mt. Kilimanjaro should be in excellent physical condition with a reasonable goal being the ability to run four to five miles in forty-five minutes. There is no absolute medical contra-indication for climbing to this altitude except for certain cardiac and pulmonary diseases for which effected persons should consult their physician. Good conditioning will allow the trekker to enjoy his work at altitude, without total fatigue.

Preparation: In preparation for your trip we include good food, water and protection from the elements. The trekker should consume three to four liters of fluid and eat approximately four thousand calories of food a day. Most estimates by exercise physiologists rate consumption of calories at five thousand per day for trekkers, but weight loss will be inevitable as it is almost impossible to force this many calories down. Appetite tends to fall away and the planned menu must be especially appetizing to entice one. A diet high in carbohydrates seems to help reduce symptoms of acute mountain sickness and increase blood oxygen level, as well as being high in calories. We provide types of foods that deliver carbohydrates at lunch and breakfast, and protein at dinner. A large variety of fruit flavorings are added to your water and are conducive to increasing fluid intake and preventing dehydration.

Our Advice: Any trek other than solo ascents requires team thinking. All must establish good communications between team members and set known goals. Every individual will have personal desires and these should be honestly expressed and "aired" prior to ascend. Tension and discontent can be avoided in this manner.

Mountain Gear: We want to make sure you have all the gear you may need for ascending because the cold can cause problems ranging from minor discomfort to deadly hypothermia. Preparation is always the solution. A person should dress in layers so that proper ventilation can be achieved. It's easy to become overheated while climbing, which produces large amounts of perspiration, causing dehydration and a wet body and clothes. Stopping physical activity in such a condition can be a "chilling" experience; also the temperature change between sunlight and shade, day and night is large, so it's best to have extra warm clothes available.

Common Problems that Can Occur

Heat Loss:

Three major routes of heating loss occur:

  1. Evaporation: mainly caused by wind blowing across the body – best to use a windbreaker.
  2. Conduction: caused when heat is lost from sleeping directly on the ground. To prevent this loss, use an insulation pad like a closed-cell foam or air mattress.
  3. Radiation: best controlled with reflective material. Hats should be worn. The old adage is "cold feet, put on your hat." A person can lose 30% of his or her body heat via his/her head because the vessels of the scalp cannot constrict in response to cold, thus losing valuable warmth.

Cold Pathology

  1. Frostbite is the destruction of soft tissue, usually in the fingers and toes, secondary to the freezing of fluid into crystals in and around the cell of the tissues. Its initial presentation is whitening of the skin; it then turns red and feels hard. Frostbite is usually accompanied by numbness and tingling sensation. Blisters and darkening of the skin are later signs of frostbite. Prevention is the key. Good wool mittens are warmer than gloves because of the physical limitations of the insulations properties of an individually wrapped finger. Double insulation is best and recommended with over mitts. Wool socks and good mountaineering boots provide adequate protection for the feet.
  2. Hypothermia is the lowering of the body’s core temperature, and is considered mild to 35 degrees centigrade, moderate to 30 degrees centigrade. A person can go from normal to severe hypothermia very quickly, particularly if immersion in cold water occurs. Although they can be tremendously uncomfortable, cold feet and toes do not indicate hypothermia, as they do not accurately reflect core temperature. Unfortunately regular fever thermometers do not work well in these temperature ranges. Predisposing factors include improper ventilation and layering of clothes; allowing one to become wet from rain or perspiration; inadequate clothing; exhaustion and/or starvation. The first sign of hypothermia is shaking chills and mental, emotional and intellectual dulling. A person with these symptoms should be kept active and warmed with additional clothing, and near a fire or other heating source. Psychological preparation is good, but has no real temperature-changing effect.

To prevent such emergencies the technique of controlled bivouacking is important to learn. Bivouac consists of using a waterproof cover (bevy bag) preferably Gore-Tex and a good quality sleeping bag.

Hypoxia and Hypoxemia

  1. Hypoxia is low oxygen in the air, which occurs with increasing altitude. This is reflected in the body by low oxygen in the blood called hypoxemia.
  2. Hypoxemia is usually noticeable above 3,500 meters and is marked above 5,000 meters. It is heralded by shortness of breath even with mild exertion. The body responds to hypoxemia by acclimatization. There are three physiological effects of acclimatization. The most immediate change is due to chemicals being released to help the blood free up more oxygen for the tissues.
  3. Current medical thought is that high altitude disease is related to decreased breathing while sleeping at altitude. Thus, the adage, "climb high sleep low." It is known that at high altitude many trekkers hear their tent mates breathing periodically, with long pauses between breaths "Cheyne-stokes respiration." This is considered normal, within limits, but thought to be related to mountain diseases.

Specific high altitude diseases are divided into three categories:

  1. Acute mountain sickness (AMS) is the most frequent high altitude disease, and is a failure to acclimatize. Symptoms include headache (common), nausea, vomiting, anorexia, fatigue, insomnia, swelling of hands, feet or face or (peripheral edema), and decreased urine output. Nearly all trekkers will have some of these symptoms.

    Persons with severe symptoms should stop ascending and consider descent for a few days. These symptoms can be reduced or prevented by slow ascend and acclimatization. DIAMOX "acetazolamide," a mild diuretic, is used to prevent acute mountain sickness. It is not a substitute for slow ascent or acclimatization. A small number of trekkers get the potentially deadly high altitude pulmonary edema (HAPE) or high altitude cerebral edema (HACE). No one knows why. The single most common denominator is rapid ascend without acclimatization. HAPE and HACE have not been shown to be associated with sex, race, physical conditioning, or previous symptom-free high altitude work.

  2. Pulmonary edema is heralded by increased shortness of breath, even at rest, gurgling breath sounds "rales," which can be heard with an ear directly placed on the chest "the sound like hair being rubbed together next to the ear" and sometimes the production of a frothy white sputum. The patient usually has a cough and may produce a blood-tinged sputum. Always assume, with these symptoms, high altitude pulmonary edema (HAPE).

  3. Cerebral edema is heralded by severe headache and incoordination. Hallucinations frequently occur, but are usually denied. There are several medical diagnostic signs but only a couple which do not require equipment for testing: 1) a headache unresponsive to aspirin or acetaminophen with codeine; 2) ataxia-incoordination. The test for the latter is heel-to-toe straight-line walking. All people will have some problems with this at high altitude due to cold and clumsy boots, so have a second person walk the line for comparison with the possible HACE patient. If a person cannot walk a competent heel-to-toe straight-line, he or she is considered to have HACE until proven otherwise.

Exhaustion:

Obviously, both mental and physical exhaustion are part of mountain climbing. Forcing fluids and food intake can minimize physical exhaustion; neither of which is pleasant at high altitudes. Adding curry or cayenne pepper to food can usually encourage intake of fluid in most trekkers.

Mental exhaustion is tougher to prevent and treat. It is important to be in a good psychological shape, but setbacks and fatigue can frustrate a person into depression. Forcing oneself to carry out regular daily routine of duties at all altitudes seems to add some sense of stability, which can help.

Sore Feet:

Probably the most common and painful maladies in the mountain are sore feet and blisters. Prevention here is also the best approach. Boots should be well broken in and two or three pairs of socks should be worn. Some prefer wearing tennis or running shoes up to the actual base of technical climb, or until cold conditions are reached.

Lacerations and Abrasions:

When a laceration (cut) or abrasion (scrape) occurs on the mountain, there are two main treatments: a) pressure on all bleeding sites; this will stop bleeding if held long enough; and b) scrubbing the area well with plain soap and water; antibacterial soap is best, but any other soap will do. Try not to place creams or ointments of kind on cuts or scrapes. They make the wound moist and slow healing.

Sunburn:

The strength of the tropical sun is easily underestimated. Its destructive U.V. rays penetrate clouds and are more powerful with increased altitude; snow is also a very effective reflector (60% to 95%). This reflected light is the most damaging and often hits underexposed skin, such as the nose and chin. The lips, neck, and the back of the knees are also very vulnerable sites. Protection is in the form of barriers: silk scarf for lower face and neck, hat, beard, long-sleeved shirt, long socks, etc. Sunscreens, the ones containing Para-amino benzoic acid (PABA) or PABA esters such as Pabanol or PreSun, are the most successful. Choose one with a high sun-protection factor 5% or SPF 8 at least, and apply before exposure to sunlight and at intervals depending on the degree of sweating.

Violent Injury - Some Simple Rules:

  1. Check breathing, pulse and then reassure the patient.
  2. Prevent further injury.
  3. Keep warm and dry, feed and hydrate.
  4. Splint for fractures, both for comfort and control internal breathing.
  5. Trekkers rarely need or request pain medication. Once given, it decreases the injured climber's ability to cooperate or make decisions.
  6. Send for help if someone is available and give complete information on the situation.

Give the Gift of Sight!

Your climb will help give the Gift of Sight to poor patients in Guatemala, Nicaragua, Haiti Peru and Mexico! Learn how your trip can be FREE!

I love this charity with all of my heart. They see a need in Latin America, address it, and go straight to the people that need them the most. No bureaucracy. No BS. Free medical care to give eyesight to people who, if left untreated, would go blind for the rest of their life. And they empower the locals to step up and take part in helping themselves and their community. It should always be that simple. On my Climb for Sight I raised $22,000 US, enough to provide over 100 surgeries free of charge to poor Guatemalan children going blind.

Cathy Brown