Altitude Experience, Lessons Learnt and Top Tips
During the 2019 summer, Dr Ash Willmott was in contact with Dr Sarah Davey, a Lecturer in Sport and Exercise Science at Oxford Brookes University, now Coventry University, and a former physiologist for the English Institute of Sport (EIS) and GB Rowing. Sarah set off to Peru to undertake several treks in the Cusco region of Peru (including Machu Picchu). Here is her story, which touches upon her challenges, experience and top tips for future trekkers in this region.
On arrival to Lima:
Before setting off on her trek, Sarah met a Canadian gentleman who told her his story of experiencing acute mountain sickness (AMS), the ignorance of the tour guides to identify his condition and their poor assistance in ensuring his symptoms did not escalate further. The gentleman was on a guided Salktanay tour, which is a 5 day trek covering 72km (i.e. 6km to 22km per day), with the highest peak of ~4600m. Initially he felt fine with the trek and the altitude, until he reached ~4000m where he started to get a headache and felt nauseas. He slowed down in order to cope with the conditions, however, the guides pushed him on suggesting he was being slow and whinging. When he reached camp on day 1, he had a worsening headache, felt fatigued and nauseous, and just needed to sleep. He went to the tent feeling awful, but none of the guides checked up on him, except the other trekkers on the tour. In the morning he was woken up early (5:30am), but still felt ill and delirious, and said he could not start the trek. The guides tried to make him, but he insisted that he needed to descend from 4000m immediately. He was advised that if that was the case, then someone could help him in 5-6 hours. He was eventually picked up in a car and was placed in the back seat to sleep. After what seemed a few hours of travelling, he eventually woke up with his clothes drenched in sweat and feeling very hot with the sun blazing on him through the car windows. After insisting that they needed to leave now he was eventually dropped off at a hotel in Cusco (~3600m) to recover without receiving any medical assistance but was still suffering from headaches 3-4 days later.
The Lares Trek
The Lares trek is of similar distance to the Inca Trail, but its highest peak is ~4800m as opposed to ~4200m. On the evening prior to flying out to Cusco (~3600m) Sarah’s group (12 members: age range 20-56 years old) were advised to buy 4 Diamox (Acetazolamide) tablets and to take one everyday starting that evening. Sarah had already taken a daily dose of Diamox tablets 2 days prior in preparation for her trek. However, even though this was useful information, no explanation was provided on how Diamox could assist in coping with altitude and preventing AMS, Sarah had to provide this to the group instead as well as providing the new Lake Louise Questionnaire (LLQ), which some people found really useful. With further instruction some people were more willing to take Diamox, otherwise, they were happy to use coca leaves instead (the other recommendation provided by the guide). Additional advice provided by the guide included:
1) When we arrive to Cusco to walk slowly and not to exert yourself;
2) To take deep breathes when trekking;
3) Eat and drink coca leaves when able;
4) To hydrate and drink at least 2L of water per day.
This was valid advice, however, again there was limited explanation provided to the value of these recommendations, nonetheless, Sarah was able to do this instead. However, during day 1 day, Sarah had already developed symptoms of a cold (including a sore throat) and feeling a little fatigued, most likely due to the lack of sleep and travelling in buses and planes.
Upon arriving in Cusco, there was little time to explore aside of tour briefings and collecting equipment, however the altitude was barely noticeable with the exception of going up hills (there are plenty of them in Cusco!!). However, cold symptoms had worsened among the group.
Day 3 was spent travelling around the ‘Sacred Valley’ (altitude ranging from 2000-3000m) by bus and then an afternoon / evening at Ollantaytambo (~2800m). Some of the group struggled with a few short hikes to some ruins, most likely related to the altitude rather than fitness. Whilst at this point Sarah did not find this altitude to be a problem, her cold had developed into a throat infection.
After a 3 hour bus journey, Sarah started her tour with a fairly easy 8km trek (3200-3872m) which included plenty of stops. Whilst Sarah and some other members of the group did an extra walk that day the total group contained a mixture of abilities and fitness levels, with ~5 of the group at the front with the lead guide and the remaining 7 spread out between the lead and last guide. This night the group slept in a tent, and experienced temperatures below freezing and poor sleep (1-3 hours), with Sarah’s cold and throat infection getting worse.
The trek started at 3872m and included a ~17km hike with an elevation of ~4800m. The pace was reasonable, which included plenty of stops for the group to come together. During the breaks the group were advised to chew coca leaves (Sarah did not partake in this as she did not find them useful, but she did have coca leaves in the mornings). The majority of the group felt ok until they reached an elevation of 4500m, where some of the group started to develop headaches and felt nauseous. The guide advised that the group at this point should go at their own pace to reach the summit of 4800m. Sarah started to develop a headache which got worse during the hike to the summit (~4800m). Even though she is fairly fit, she had to take mini stops as she was out of breath and monitored her heart rate to keep it below 140 beat per minute (average for summit was 125 bpm).
Along the way to the summit, Sarah met a lady who was struggling to reach the top due to suffering from a headache and nausea. She felt forced to rush due to the guide always waiting ahead of her and pushing her along. Sarah advised her to ignore her guide and take her time, however she reached the summit still suffering from symptoms of AMS, but fortunately felt better than when she was rushed.
Sarah reached the summit with a headache, but had to wait 15-20 minutes for the rest of the group to catch up. During this time, the headache started to subside, but still remained albeit to a lesser
extent. A few members of the group also had a headache and felt slightly nauseous. Fortunately, after an hour of descending her headache started to ease, however 1 member of the group felt very nauseas, tired and had to take the decent a lot easier, whereby, it took ~5 hours to feel better. That night the group camped at ~3600m, again with temperatures ~-3 °C, which resulted in another poor nights’ sleep.
The final leg of the hike was very easy and included a descent of 4-5 miles (~3600m to ~3000m). However, due to the lack of sleep and harsh conditions, Sarah’s cold and throat infection were getting even worse.
Day 7 included a visit to Machu Picchu, where altitude was no problem for the majority of the group as the elevation is ~2600m.
Day 8 the group returned to Cusco, but with Sarah having not slept properly (only 1-4 hours a night) for 11 days tiredness and fatigue set in.
Following a day of rest in Cuzco, Sarah went on tour to Rainbow mountain (5038m), which included a 3 hour return bus journey, a guided 4km ascent to the summit of Rainbow mountain and a 11km descent. Although the tour was booked through the popular and highly recommended hostel, they thought the tour would be well organised and value for money. However, the tour soon turned out to be not as well organised as they had experienced in the previous tour.
Upon arrival to the main car park (where most of the tours start) they received brief instructions from a tour guide, who was supposed to be bilingual. However, being the only English speakers in the group the English translation soon ceased, and we had to ask for instructions, which were very basic; i.e. walk slowly, meet at summit and only spend 20-30 minutes there.
As there was no guide leading the group, the group immediately separated and even though Sarah was going slow (again trying to keep her heart rate below 140bpm - average for the summit was 125bpm) she found herself at the front of the group. Sarah reached the summit first with one other soon following her footsteps, she stayed at the summit for ~40 mins whilst waiting for her friend and for the rest of the group, which was more time than she wanted to. As Sarah didn’t see the rest of the group or any guides, she decided it was best for her to descend the mountain to a place where the group would eventually meet.
Having spent a further 10-15 minutes waiting for the group with no one in sight, she started to ascend up the mountain again, which this time she found quite fatiguing in comparison to the first ascent (i.e. heart rate escalated quickly to 160 bpm), however, she thankfully saw the group beginning to come down the mountain. The group were then advised to start the 11km return journey, which unknown to them included another ascent over 5000m. Sarah found this ascent quite tough, as she approached the summit (only ~2km) she developed a severe headache and felt dizzy. Sarah had to stay at the
summit again and wait until the guide until the rest of the group arrived. By this point her headache was starting to become unbearable and asked to descend down the mountain, but she was advised to remain at the summit for a further 5 minutes. Eventually Sarah and her friend were allowed to descend, yet her friend was slower and was also starting to feel very nauseous. Sarah decided to stay with her instead of descending quickly, in which the guide was not very sympathetic, accusing them of not preparing ourselves for the mountain, even though they had some partial acclimation based on their experiences over the past 7 days. Sarah’s friends’ symptoms were getting worse, not helped by spending more time at ~4600-5000m. Eventually they completed the 9km descent, but on the 3 hour journey back Sarah had a severe headache so took a tablet of diclofenac which helped ease the pain, but her friend was violently sick. Amongst the members of the tour (10 people), 60% suffered from different levels of AMS.
The next day Sarah developed a very tight chest, which became painful to breathe and so decided to take it easy with the knowledge that it is best not to return to elevation or to physically exert yourself after experiencing AMS. With her symptoms getting worse, she decided to see a doctor to rule out any pulmonary disorder. She acknowledged that the symptoms were probably the result of a chest infection, rather than anything else but she thought it was best to check as pulmonary disorders can sometimes be slow to progress and she did not want to do anything to make the symptoms worse.
The medical clinic she was advised to go to was a travel clinic for tourists. The clinic was busy and was occupied with a lot of patients suffering from altitude sickness and food poisoning. Luckily, she was given the all clear, but was diagnosed with a bad chest and throat infection.
Day 14 involved travelling back to Lima and the UK. Sarah felt a lot better retuning to sea-level but her chest and throat infection still lingered and she developed slight headaches when she exerted herself.
Sarah’s Top Tips:
1) Ensure you book yourself on a reputable tour company with plenty of good reviews and preferably associated with an International tour operator. Shop around and don’t select on price.
2) Select a tour that incudes gradual elevations in altitude. Some countries are better at offering the recommended rate of ascents than others (i.e. Nepal, Africa [Kilimanjaro]).
3) Ensure tour guides speak your language and they are experienced.
4) If you are at the back of a group ensure the guides go at your pace and don’t feel rushed. We all are individuals and have our own fitness levels and rate of acclimation to altitude. To assist with this, try and book yourself on a tour with similar ranges of fitness.
5) If you are a fit individual – get comfortable at going slowly. You do need to go slower than you think.
6) Prior to embarking on the trip ensure you place yourself in a position to have good sleep (i.e. booking 8 bedrooms hostels may not be appropriate).
7) Do not take any risks in developing food poisoning prior to the trek/ascent.
8) Take extra care and slow down your pace if you have acquired an illness prior to any ascents.
9) Understand the benefits of Diamox.
10) Read all about the signs and symptoms of AMS. Ensure you advise people about any developments of these symptoms.
In partnership with Para-Monte, the University of Brighton, Anglia Ruskin University (ARU) and the Environmental Extremes Laboratory (EEL) are continuing their altitude related research and providing vital education to those going to altitude.
For further information please contact Dr Neil Maxwell – Neil.Maxwell@brighton.ac.uk, and follow EEL on @UoB_EEL and Para-Monte on @para_monte.