We all feel the effects of altitude, usually commencing once we reach a height of around 3,000 meters. You should not be concerned by this, but be prepared and respond correctly.

Our itineraries are devised to allow for a gradual ascent and to avoid any acclimatization problems. Your age and degree of fitness may have no bearing on your rate of acclimatization. Be assured that our itineraries are flexible enough to give you more time at a set altitude if you need it. Altitude sickness can be very serious business and your well-being is our primary concern. At some point, Dave or Bill or Peak Promotions staff may feel it best if you descend for safety reasons. If this happens, a guide will accompany you. This does not mean that you may not be able to re-ascend.

Rushing and over exertion often precede altitude problems. The majority of trekkers find only a mild short-term discomfort. Some feel no effects at all. Walk at a slow but steady pace, keep your fluid intake high, wear sunglasses and a hat, take other’s advice and don't hesitate to ask for assistance with your day pack if you feel you need someone to carry it for you.

Acute Mountain Sickness (AMS) by Dr. J. M. Duff, World Expeditions
When we ascend above 2500 meters, our bodies have to acclimatize to the decreasing amount of oxygen available. Most people ascending above this altitude will experience some or all of the following list of symptoms for a few days until they acclimatize.
* headache
* tiredness
* disturbed sleep
* loss of appetite/nausea shortness of breath, cough
* palpitations
* swelling of fingers or face

In order to prevent serious AMS from developing and to keep acclimatization symptoms to a minimum, follow these directions:
* Keep to an ascent rate of 300 meters per day or less at altitudes above 4000 meters.
* Avoid alcohol.
* Avoid strenuous exercise while acclimatizing.
* Do not ascend while experiencing any of the above symptoms whenever possible.

Diamox (acetazolamide) may be useful and / or appropriate in some cases (125 mg morning and night). Diamox will not mask the symptoms of severe AMS.

Note: Anti-malaria pills may cause nausea, vomiting or other symptoms at high altitude. It may be necessary to stop this medication. If you have come from a high risk malarial area it is best to continue this medication. In case of doubt, always consult Dave or Bill.

Treatment of Mild AMS
* Rest at same altitude until symptoms subside.
* Diamox (125 mg morning and night, to be continued for remaining time at altitude).
* Paracetamol, for headache (this is the safest pain killer at altitude).
* Avoid alcohol.
* Examine the person carefully and at regular intervals, asking after and looking for evidence of worsening AMS.
* Roommates should use the "buddy system" to keep an eye on each other.

Severe AMS
Mild AMS can become severe AMS if the symptoms and warning signs are ignored and the ascent is continued. All of the above symptoms described in mild AMS may appear in severe AMS. Two indications that serious AMS is developing are:
* Resting pulse over 110 beats per minute (check morning and night).
* A decrease in urine output after ascent (keep your urine clear and copious).
* Other specific symptoms are described below.

HACE (High Altitude Cerebral Edema)
This is the accumulation of water in or around the brain. Symptoms may include:
* Severe headache, often worse when lying down, not relieved by mild analgesics.
* Nausea or vomiting which may be severe and persistent.
* Dizziness, loss of coordination, staggering, falling, inability to do heel-to-toe walking, inability to tie shoe laces, etc., blurred or double vision, seeing haloes around objects.
* Loss of mental abilities (memory, arithmetic).
* Confusion, hallucinations.
* Change of behavior (aggression, apathy) drowsiness, difficult to rouse, coma.
Note: Any one of these symptoms is proof of HACE

HAPE (High Altitude Pulmonary Edema)
This is the accumulation of water in the lungs. Symptoms may include:
* Cough with or without frothy sputum, which may be blood-stained ("rusty" color).
* Severe breathlessness on exertion.
* Breathlessness at rest (normal respiration rate is 12/14 breaths per minute at rest at sea level, slightly faster at altitude)
* Severe fatigue.
* Drowsiness, difficult to rouse, coma.
* Blueness or darkness in face, lips or tongue.
* "wef' sounds in the lungs on deep inspiration: place your ear on the bare skin on the patient's back below the shoulder blades. Compare with a healthy person.
Note: anyone of these symptoms is proof of HAPE

Treatment of Severe AMS
* Descend immediately.
* Descend as low as possible (at least 500/1500 feet).
* If descent is not possible, the use of a pressure bag will help alleviate the symptoms, at least temporarily, until the victim can descend. A pressure bag is not a substitute for going down, which is always the preferred treatment, but it will simulate a descent of approximately 2000m (6000ft). If the symptoms are severe or worsening, the victim must descend after treatment.
* If the victim is turning blue or lapsing into a coma, administer mouth-to-mouth resuscitation before placing in a Gamow bag. Do not wait for them to stop breathing before doing this.
* Some drugs, such as Nefidipine (20mg at once, followed by 10mg 6-hourly) for HAPE and Dexamethasone (8mg at once, followed by 4mg hourly) for HACE, may help with symptoms of severe AMS. However, these drugs will not cure the condition. The only treatment for AMS is to descend.

Keeping Warm on High Altitude Treks
The key to keeping warm is to plan adequately. When you reach your guesthouse in the afternoon, change into your warmer clothing before you get cold. It is far easier to maintain body heat than it is to regain warmth. Have quality layers next to your skin; a dry, clean thermal layer of reasonable thickness is ideal.

Guesthouses will be warm and the rooms are more than adequate. Get into your sleeping bag slightly "overdressed" and remove layers as you become too warm. If you undress too much, you lose body heat that can take a long time to regain. Your water bottle that will have been filled with boiling water at dinner can be wrapped in an item of clothing and used as a hot water bottle.

If rain is approaching, put on your waterproof gear before you get wet. Much body heat is lost through your head and neck. Keep your head warm with a beanie or a thermal hood and use a scarf or high necked top. Wear gloves / mittens and have a spare dry pair - polypropylene or wool.