Did you know that in a group of 5 trekkers, at least 1 of them shows mild symptoms of Acute Mountain Sickness (AMS)? This is something we’ve noticed a lot over the past decade after leading hundreds of treks in the Himalayas. What we’ve also seen is that in most cases, trekkers don’t recognize their symptoms as AMS and rather attribute it to something else completely. 

AMS could prove dangerous if not caught in the early stages!

Yes, that’s right. If not diagnosed and treated at first, it could quickly climb on to a person mid way through his trek and turn out to be more serious. So in this article, I’m going to talk about 5 of the most common symptoms that you may not recognize as AMS and by the end of the article, you’ll know what signs to look out for, the next time you’re up in the hills. 

To begin with, let me try and tell you what AMS is in brief – Acute Mountain Sickness is your body’s way of telling you that it’s not adjusting well to the high altitudes. Now WebMD and Google will tell you to look out for a headache as it’s the most common symptom of AMS, but it’s important to note that in quite a few cases, people with AMS don’t experience any sort of headache at all. Therefore it becomes critical to recognize the symptoms I’m writing about. 

Always remember the Golden Rule for traveling in the mountains which says about suspecting and treating AMS as your first priority and then moving onto anything else.  

The first and most often ignored sign of AMS that I’ve seen among trekkers is having a bad stomach. A lot of trekkers develop a case of diarrhea wherein they blame their loose motions on the food and water around them. But you shouldn’t do that. Gastrointestinal symptoms are often seen in the milder stages of AMS so it’s essential that you take them as a sign of AMS, treat them, and then continue on with your trek. 

The second sign for AMS that trekkers neglect is nausea. They suffer from feeling like they’re about to vomit any second but wait for actually vomiting before terming it AMS and then treating it. Never make the mistake of delaying. Remember the golden rule, and treat your nausea as a sign of AMS. Trekkers also complain about a loss of appetite during the period and attribute it to dehydration, which you should avoid doing.

During my many expeditions, I’ve often seen trekkers complain about not getting enough sleep, and them tossing and turning in their sleeping bags all night. Now it’s easy for first-timers to blame this sudden outburst of insomnia on a change of surroundings and not being used to tents or sleeping bags. But shivering in your tent and being unable to sleep isn’t normal, especially when your body feels tired and exhausted after having trekked all day. So if you’re unable to sleep, please treat it as a sign of AMS first and foremost. 

 That brings me to my penultimate symptom – Extreme Fatigue. Now I’ve noticed this on many of my treks where a trekker who’s extremely fit and well-paced and ahead of the pack on Day 1 of the trek, feels exhausted and fatigued the next day and is barely able to keep up, and by the end of Day 3, he’s seen struggling for breath and lagging behind while climbing. This isn’t normal, extremely for people who are fit, as they’re expected to maintain a stable pace each day of the trek. If you ever encounter such a situation yourself, please treat the fatigue as AMS first.

The fifth and final sign that goes unrecognized as a symptom of AMS is this inexplicable case of uneasiness or restlessness. I’ve observed quite a few times when a trekker isn’t able to pinpoint exactly what’s going on but they can tell you that something for sure is wrong with their body, and sometimes their mind too. You must be aware of this and treat it as a signal your body is sending you regarding AMS. 

That brings us to the end. By now I hope you’ve built upon your understanding of AMS and will be better equipped to handle it on your next trek. You must keep in mind that this isn’t an exhaustive list of symptoms and that high altitude affects each person differently. Many people might show a range of symptoms with different intensities. Therefore it becomes critical to stay alert and notify your trek leader or other members in your group and always treat these symptoms as AMS first. Never forget the golden rule. 

If this article got you thinking about AMS, we have a lot of other resources on our platforms. 

To understand how to treat and prevent AMS, you can find the video on our YouTube channel helpful where we talk about AMS in detail, especially its treatment. 

Besides, you can always write to me at trekwithswathi@indiahikes.com  with any queries you might have after reading this piece. Be sure to share this with your trek mates. 

Drop in a comment with your thoughts or questions, if any, and we will get back to you.

5 Signs You May Not Recognise as Acute Mountain Sickness (AMS)

In this post, I’m talking about something you would surely want to know — how to prevent altitude sickness.

I’d like to first put a disclaimer — there’s no fool-proof way of preventing altitude sickness.

All these methods I’m putting down will reduce your chances of getting altitude sickness. And from our experience, they’re worth it.

I’m going to break this down into three parts.

As you already know, altitude sickness occurs when your body has not acclimatised well enough to the altitude.

Giving your body enough time to acclimatise is the most effective way to avoid altitude sickness.

That’s why you’ll see that we have “acclimatisation days” on our high altitude treks like Rupin Pass, Roopkund and Goechala. These are days where you simply rest at a particular campsite, without too much exertion.

So, splitting your itinerary as much as possible and taking it slow is most effective in preventing altitude sickness.

However, keep in mind that the amount of time required to acclimatise is different for every individual. Ideally, you should increase your sleeping altitude just by 1,000 ft every day.

But the Indian Himalayas climb very quickly. The difference in altitude between camps is high, usually between two and three thousand feet. This is because there is either no place to camp in between or there are no water sources etc. 

We call this a “forced accent”. You are forced to ascend more than required.

This makes you more susceptible to altitude sickness.

There are certain medicines that help you acclimatise faster.

Trekkers and mountaineers all over the world use a medicine called Acetazolamide (Diamox) to acclimatise faster.

This medicine is a diuretic. Our founder wrote a detailed article about how Diamox works. Give it a read.

In a nutshell, though, this medicine helps you acclimatise faster by increasing your breathing rate.

So for most treks that gain altitude too quickly, taking a preventive course of Diamox really helps. Especially if your trek climbs above 13,000 – 14,000 ft.

In fact, even for those who suddenly go up to high altitudes, like those who drive or fly to Leh, we recommend Diamox.

| Dosage: Start with a dosage of 125 mg (half a tablet) every 12 hours 2 days prior to your trek (usually when you arrive at Delhi). Increase it to 250 mg (full tablet) every 12 hours from the day you get to the base camp and continue until you complete the trek.

| Side effects: There aren’t too many side effects of taking Diamox. You feel a numbness/tingling sensation in your hands and feet. You pee more often (which means the medicine is doing its job). Some claim that they get a bit of loosies after Diamox. Generally, a Digene takes care of this. 

Keep in mind that Diamox is a sulfa-based drug. If you’re allergic to sulphides, avoid Diamox.

As an alternative to Diamox, you could keep a strip of Dexamethasone tablets with you. This is a steroid and reduces muscle inflammation in the body. It does not help speed up acclimatisation per se. So if you get hit by AMS, take Dex as an alternative. The dosage is 4 mg every six hours. Avoid taking Dex as preventive medicine though.

While Diamox reduces the chances of AMS hitting you, it isn’t a fool-proof medicine. Even those who are on a course of Diamox can get hit by AMS. 

So it’s important for your body to do its bit to acclimatise.

It’s imperative that you prepare your body to function well with lesser oxygen. You can do this by simply increasing your cardiovascular endurance.

Cardiovascular endurance is basically the ability of your lungs, heart and blood vessels to deliver oxygen to your body. Naturally, someone with higher cardiovascular endurance has a higher probability of acclimatising faster to high altitude.

Although there’s no proven correlation between altitude sickness and fitness, we can talk from experience. On our treks, we have found that it’s usually unfit people who are more prone to AMS. When I’m talking about unfit, I’m not talking about overweight or underweight. I’m talking about plain physical endurance.

Funnily though, we’ve also seen that super-fit trekkers climb too quickly, and then suffer from AMS at the next camp. If you are fit, keep the ego behind. Climb slowly.

Are hydration, good diet and warmth helpful in preventing altitude sickness?

By themselves, none of them are strong points to keep altitude sickness at bay. But together, they help in the general well-being of your body which could reduce chances of altitude sickness.

Hydration helps your body function smoothly. You need at least 4 litres of water every day on a high altitude trek. Every time you urinate, drink enough water, to keep the colour as close to colourless as possible. If it is deep coloured you know you are dehydrated.

Even diet plays an equally important role. It’s important to eat well at high altitude, but not eat too much. We don’t recommend a diet that’s very high on protein. High protein is harder for your body to break down. That’s why we don’t serve meat on our treks. A low-salt, wholesome meal is what we recommend.

Warmth is especially required when you expect temperatures below 5 degrees (which happens on most Himalayan treks). You must especially keep your head, your core, your hands and feet warm. So having enough layers, a woollen cap, gloves and woollen socks are mandatory on high altitude treks. We have seen far too many trekkers in just one or two layers of clothes telling us that they are OK with the cold, that they are not feeling cold. They are simply being heroic, but their core body temperature is dropping.

Alcohol is a big NO, especially if you are not acclimatised to the altitude. I made a video on why it is bad for you a while ago. Watch it here.

Smoking anything is not good either because it’s directly inhibiting the capacity of your lungs to send out oxygen to your body.

Both drinking and smoking, cause dehydration and that’s the last thing you need on your trek!

Overexertion is again something you must avoid at high altitude. Don’t try to cram too much into your itinerary. Take it slow and give your body the rest it needs.

With that, I’m ending my 4-part series on altitude and the body. I hope these articles have left you more informed and that you’ll be able to identify and tackle altitude sickness if you see it.

I’m putting down the links to the previous articles here. Make sure you bookmark them for future use.

> What happens to your body at high altitude

> What is altitude sickness and how do you identify it?

> How to treat altitude sickness – AMS, HAPE and HACE

Prevention of Altitude Sickness with Diamox | How Diamox Works | Dosage and other ways to prevent AMS, HAPE and HACE

How To Prevent Altitude Sickness (AMS), HAPE and HACE

Today’s article is an important one – it’s about how to treat altitude sickness such as AMS, HAPE & HACE.

Before I get into medications and technicalities, I want to share a golden rule with you. And it is not about descending, which most manuals will talk about. It is something you must always remember.

When it comes to altitude sickness, the golden rule is to stop it in its initial stages. The later it gets, the more dangerous it gets, and it could even turn fatal.

To stop it in its initial stages, recognising the symptoms is key. 

In my last post, I told you how to recognise the symptoms of altitude sickness. If you missed my previous post, read it here.

With that in mind, let’s get on to treating altitude sickness.

You need to carry three absolutely essential Life-Saving Drugs (LSDs) with you on a high altitude trek. It does not matter if you are trekking alone or with a group.

These are Diamox, Dexamethasone and Nifedipine. In India, you can buy them off the counter in most pharmacies even though these are prescription drugs. 

Diamox is a diuretic. To put it simply, it helps speed up acclimatisation. 

Dexamethasone (Dex) is a steroid. It prevents your body from releasing substances that cause inflammation. That’s how it helps temporarily treat edema. 

Nifedipine is a drug that reduces your blood pressure. You use it only if you have HAPE. 

Now let’s see how we can treat altitude sickness i.e. AMS, HAPE and HACE with these LSDs. 

1. Let’s start with the easier one, Acute Mountain Sickness (AMS)

AMS is the most common form of altitude sickness we see. It starts off with relatively mild symptoms. But if left untreated, it gets severe and could form into either HAPE or HACE. 

You’ve got to absolutely treat it when it’s mild (no rocket science there).

I’ll let you learn about AMS symptoms directly from someone who was hit by AMS. Read this story well because it is not exactly what you’ll expect. This happened last week.

It’s the story of my colleague Suhas, who was recently on exploration in Uttarakhand.  

He says, “We were at the first campsite, at around 8,500 ft. We had had a long day of trekking, mostly ascending and I was exhausted. Although I didn’t feel like eating much, I took two small rotis (which I couldn’t finish). After eating just one and a half roti and drinking some water, I went to sleep.

In my tent, I kept feeling very quesy and at around 10.30 pm, I finally stepped out of the tent and threw up. The uneasy feeling stayed with me all night and prevented me from sleeping. As I tossed and turned in my sleeping bag, I kept debating whether I should wake somoene up, but I didn’t. 

The next morning, after breakfast, I was again not feeling comfortable. I threw up everything I’d eaten. On the trek, when there was an ascent, I started to feel very tired. I was unable to carry my backpack. It was taking me almost double the time that I would normally take to cover the distance. Throughout all this, I never told anyone my symptoms. Finally, it was Arjun and Sandhya who noticed that all wasn’t well with me.” 

What Suhas has said here are classic symptoms of AMS – uneasiness, vomiting, lack of sleep, fatigue, lack of appetite. Notice how he never told anybody about his symptoms? This is also typical behaviour of someone who has been hit by AMS. Notice, also the rather low altitude.

He didn’t have a headache even for a minute! Most trekkers actually wait for a headache to confirm if it’s AMS. That’s not wise.

So here’s what you need to keep in mind. Drill it in. AMS can climb onto you in different ways. Not all the symptoms may show up (especially headache), but some of them will. Remember, the best way to treat altitude sickness is to recognize it early and take all steps to prevent it from getting worse.

Look out for feeling generally uneasy. Especially a bad feeling in the stomach and a pukey feeling. Look out when your pace reduces (and you’ll know it yourself, but don’t fool yourself thinking you’ll get over it). 

Do also keep an eye out for headache’s as they are an indicator of possible AMS.

You need an exceptionally sharp eye to spot these things in others. But if you have AMS yourself, you should be able to identify it. You just need to be aware of the symptoms.

Another way to tell if it’s AMS is if you have a pulse oximeter handy. You’ll find that oxygen levels have dropped. Anything below 85 is usually a low reading. And 83 is not 85. If it is below 85, take steps. 

Now, here’s the important thing. Don’t go trusting the pulse oximeter too much. It is, at the end of the day, just a device. Trust your symptoms more. That’s the only thing we go by in the mountains.

The first thing you must do if you have AMS is starting a curative course of Diamox.  

(I’m using “curative” here as this course is different from a “preventive” Diamox course. I’ll tell you more about that in my next post).

Take 250 mg of Diamox (one tablet). Drink 500 ml of water and rest for an hour. Even if you are mid-trail, try and rest for an hour. Resting is imperative because any kind of exertion depletes your body’s oxygen content.

After this medication, this is what could happen. In an hour’s time, your symptoms may reduce, but may not completely disappear. 

So move to your next camp. Take the rest immediately. After 4 hours (of the first tablet) take another dose of Diamox (250 mg). Keep yourself well hydrated. Avoid exerting yourself. Don’t go on sightseeing walks. 

In all probability, it is going to be evening by the time you have taken the second dose. 

The next few hours are critical. You want to take all the necessary steps before night-fall. If you feel better within two hours of your second Diamox dose, then your body has started to acclimatise. But continue to be on a course of Diamox (250 mg), ever 12 hours for the rest of your trek, starting that night. If you are not feeling better, do not panic. We go to the next level of medication. 

At around 9.00 pm take another dose of Diamox (again, 250 mg). Also, take 1 mg of Dexamethasone (we’ll call it Dex from now on). Dex is going to help reduce inflammation in your body that causes these altitude sicknesses. The Diamox and Dex combination will help you sleep better. 

The next morning, you have to make a decision. 

If you have slept well and feel better with none of the uneasiness, your body has acclimatised. 

Continue your trek but be on a course of Diamox (250 mg) every 12 hours starting that morning. End the course only after you complete the trek.

Remember, it is important, to be honest with yourself at this stage. Continuing on the trek while feeling uneasy can lead to further complications. Additionally, don’t worry about your money, given the circumstances you will be allowed to come back for the same trek for free. (Refer to our trekking policy).  

If you still have a lingering sense of uneasiness, then it is time to accept that your body is not acclimatising despite medication. 

Continue to descend until you have got yourself to an altitude of around 8,000 feet. This may take time. But the good thing is that with every 1000 feet that you descend you’ll feel better. 

A word of caution. Just because you start feeling better, do not stop your descent. An abrupt stop can make your AMS come back.  

Now, that’s how you treat altitude sickness such as AMS. It really isn’t difficult. Monitoring symptoms is everything! 

2. How to treat High Altitude Pulmonary Edema (HAPE)

The symptoms of HAPE are very distinct, but you could miss them if you’re not paying attention. 

There are two things you should be able to catch – cough and breathlessness.

If you have HAPE, you’ll cough a very dry cough every now and then. 

Next, notice how you walk around the campsite. If your movements are laborious or your breathing heavy, it is a big warning shoutout. You may even notice yourself breathing heavily while sitting. Anything will tire you. There is always a feeling of fatigue.   

These are the initial stages of HAPE. It is during these stages that you must recognise HAPE and start treatment immediately. 

I hate to say it but if there is any symptom beyond this – like the rattling sound from the chest, or blue-ing nails and lips, then HAPE has advanced. And HAPE escalates very quickly.

To treat altitude sickness such as HAPE, you need Diamox and Nifedipine. (I’m writing this assuming that you may not have canned oxygen with you as our Trek Leaders do. Supplementary oxygen can also work wonders while evacuating a HAPE patient.)

When you have identified HAPE, take 500 mg of Diamox immediately (even if you have taken Diamox a few hours earlier). We are talking about two tablets.  

Follow it up with 20 mg of Nifedipine. In India, we mostly get 10 mg tablets of Nifedipine. So take your first 10 mg, wait for 20 minutes and then take the next 10 mg. 

This will let the tablet settle in slowly. Within 30 minutes of the second 10 mg, you should be able to breathe easier. 

Nifedipine reduces the pressure in your heart and blood vessels. If you remember, I had told you that HAPE occurs because of high pressure around the lungs, when the air sacs start accumulating fluid from your blood. 

Nifedipine eases out the pressure around your lungs, giving it some space to breathe.

With these two tablets in your system, start descending. You should try to lose as much altitude as possible over the next three hours. 

If you cannot reach around 8,000 ft even after six hours, repeat the dose of 500 mg Diamox and 20 mg Nifedipine and continue descending.

You’ll be tired, but it’s a matter of life and death. You need to be at a lower altitude. 

Most trekkers recover upon reaching lower altitudes. You’ll recover too.

Again, it’s very important to remember that the best way to treat altitude sickness is by keeping an eye out for your symptoms and taking the necessary steps such as descending to a lower altitude. You do not want HAPE to escalate.

3) How to treat High Altitude Cerebral Edema (HACE)

The key for treatment of any altitude sickness is early detection. The earlier you catch the symptoms the faster you can take steps to ensure the altitude sickness is controlled. 

It isn’t hard to detect HACE. With HACE, almost always, you’ll have a bad headache (because HACE is a swelling of the brain). You’ll find it hard to do daily activities such as just zipping up your tent, or putting on a jacket. In addition, you may appear dazed and confused to others, saying irrational things. You might keep forgetting things too. 

You may also continue to feel vomity with a general uneasiness. 

All these are symptoms of HACE. It means your brain is swelling with an accumulation of fluid. 

Like HAPE, there’s no treatment to cure HACE. What you can do is prevent its acceleration and keep it from turning fatal. The only way out of HACE is to descend and lose as much altitude as soon as possible. 

To help you do that, start with a 500 mg dose of Diamox and around 4mg of Dex. This combination will stop your brain from swelling, giving you a window of a few hours to get yourself out of that altitude. 

Start your descent immediately. Try to get to an altitude around 8,000 feet as soon as you can.  

If you still cannot reach lower altitudes after six hours, repeat the same dose and continue your descent

Don’t stop until you have reached around 8,000 ft. 

Once you have reached a lower altitude, lower your dosage of Dex to 2 mg, followed by 1 mg every 6 hours. Dex needs to be weaned away and cannot be stopped immediately. 

What you should know about altitude sickness

Altitude sickness is not something that is too difficult to understand or treat. The main problem that plagues the trekking community is lack of knowledge about it. 

Through this post, I hope you have learnt what to watch out for and how to tackle any symptom. 

Of course, it’s not easy to figure things out overnight. It requires years of experience to actually put a finger on the issue and treat it. But with a basic understanding of the science behind it, there’s a lot you can do to make someone with AMS feel better and save him.

Also, know that communication is the key to treat AMS! 

If you’re trekking with Indiahikes, always keep your Trek Leader informed of your symptoms. You’ll, of course, have your own Health Card to keep track of your vitals and your symptoms.

The most important thing when it comes to treating altitude sickness is the need, to be honest, and vocal about your symptoms. Failing to mention your concerns or potential symptoms to trek leaders is a massive disservice to yourself. Our trek leaders are well equipped to treat altitude sickness and the earlier they know the faster they can act.

If you’re trekking solo or with a group of friends, then it’s imperative that all of you have this knowledge of treating altitude sickness. Share this article with them. 

On another note, we have designed a supremely useful guide about altitude sickness. You can download it for free and save it on your phone for offline use. It could come handy next time you’re on a trek. 

After reading this, head over to the most helpful post of them all, on how to prevent Acute Mountain Sickness altogether! 

How to recognise symptoms and treat altitude sickness, Acute Mountain Sickness, High Altitude Pulmonary Edema & High Altitude Cerebral Edema

How To Treat Acute Mountain Sickness (AMS), High Altitude Pulmonary Edema (HAPE), High Altitude Cerebral Edema (HACE)

Today I’m talking about a term we’re all familiar with — altitude sickness.

Before you read this, I hope you’ve read my previous article about how altitude affects your body. If you haven’t, then read it now. It is important that you know some background first. You’ll find it here if you missed it.

Interestingly “altitude sickness” itself doesn’t mean much.

It is a blanket term for different kinds of illnesses — it could be something as simple as a slight swelling in your fingers to something as severe as fluid accumulation in your brain.

For the most rudimentary understanding of the term, “altitude sickness” means that your body is not adjusting well to altitude.

With that in mind, today, I’ll talk about the most common forms of altitude sickness we see on our treks — AMS, HAPE and HACE.

Let’s start with the mildest form and progress to the more nasty forms.

AMS is very common when you’re trekking in the Himalayas.

Well, in a team of 20, we see at least 3-4 people showing symptoms of AMS. Most of them recover within a few hours.

We’ve also noticed that all of them don’t show symptoms at the same time. Some of them might show symptoms at a lower camp, some at a middle camp and some at a higher one.

Some show symptoms even while descending!

But it’s something you should keep in mind. AMS doesn’t always affect you while ascending. It might have hit you at your previous campsite or at the highest point on your trek, and the symptoms might show up the next day when you’re descending.

So you have to be vigilant at all times. There’s no way out of it.

Getting to the symptoms, I’ll tell you what we see most often.

Most trekkers affected by AMS display gastrointestinal symptoms. They either go to the loo very often, or they feel nauseous. They sometimes vomit. Especially late in the evening or after bedtime.

In our experience, GI symptoms (gastrointestinal) are a lot more frequent than the notorious headache that all manuals will tell you about.

Having said that, we have seen trekkers suffering from persistent headaches too. It builds up while trekking. It persists through the afternoon and evening. Most confuse it with dehydration. Or they assume it’s the heat. Most often they are right, but they could be very wrong too.

You’ll often hear them saying “I’m feeling uneasy.” They won’t be able to explain that uneasiness.

There are more symptoms — fatigue, loss of appetite, dizziness.

Of the three, look out for trekkers who are supercharged on day one and suddenly lagging behind on day two. (They’ll most likely tell you that they’re slow because they are taking in the scenery. Most of them don’t like to admit to any symptoms.)

Watch, especially, for not wanting to eat.

What I’ve learnt is that when you’re at high altitude, any symptom you have must first be attributed to AMS and then to anything else.

If these symptoms are treated immediately, AMS can be cured and the trekker can proceed further. Most of our trekkers who have mild AMS go on to complete the trek after medication.

If left untreated and ignored, mild AMS could transform into its more sinister cousins – HAPE or HACE.

2) What is High Altitude Pulmonary Edema (HAPE)

An abnormal accumulation of fluid in parts of the body

HAPE is an advanced form of AMS. And a more dangerous form.

I really would not want to see you or anyone getting HAPE. This is when things have started to turn nasty. It requires a very experienced hand to get you out of this mess.

I’m saying this because HAPE can and does turn fatal very quickly. I am not trying to scare you. These are things that happen at high altitude.

When a trekker has HAPE, fluid from his blood leaks into air sacs in his lungs (because of high pressure in the arteries of his lungs).

To put it simply, HAPE is like death by drowning. The trekker’s lungs are drowning in his own body fluids.

And when his lungs are incapacitated, you can imagine what could happen. The rest of his body will soon stop functioning.

The symptoms of HAPE start off much like AMS symptoms, with fatigue, loss of appetite and difficulty in breathing.

But HAPE could appear suddenly without AMS preceding it too. It’s very normal for HAPE to climb onto a trekker within hours — we notice that it worsens at night when the trekker sleeps and his breathing becomes shallow. So sleeping at high altitude with mild HAPE is a big NO.

For this, identifying the symptoms is very important. And the symptoms of HAPE are pretty evident.

The HAPE-affected trekker is absolutely exhausted. He/she finds it difficult even going up to the toilet tent. His breathing is heavy, even during mild walks. An experienced trekker will hear him breathing hard even while sitting.

He coughs quite a bit. A dry kind of cough. Not often, but obvious enough.

And here’s the final, sure-shot evidence: When you put your head to his chest, you’ll hear a rattling, gurgling noise. You don’t need a stethoscope. You just need to keep your head near his chest.

Scary as it might sound, there’s light at the end of the tunnel — HAPE does not occur too regularly. And it can be treated.

At Indiahikes, from January 2017 until April 2018, we have seen just 12 cases of HAPE on our treks. All of them were evacuated to safety.

The key lies in identifying symptoms as early as possible and acting quickly.

It’s a similar case with HACE. Let’s talk about that next.

3) What is High Altitude Cerebral Edema (HACE)

HACE is as serious as HAPE because the altitude is now playing with your nerve centre.

When a trekker is affected by HACE, his brain starts to swell. This happens because blood vessels in the brain dilate, filling the brain with fluids.

Since HACE affects the brain, the symptoms are clearly identifiable.

A headache is almost universal amongst trekkers who have HACE — headache that won’t go with any medication.

You’ll find affected trekkers acting a little strange — they generally talk excitedly or show irritation. Their behaviour is sometimes quite irrational. One trekker we know asked for a helicopter to evacuate her. This sounds rational, but when you know the trekker’s normal behaviour, she would never say something like that.

They sometimes walk woozy, as if sloshed after a night of drinking.

This is medically termed ataxia, where the brain tells the body something, but the body does something else. It’s a basic loss of muscular coordination.

You may also see them struggling to talk, hallucinate, unable to see clearly.

Don’t ask a trekker affected by HACE to do simple math, like 5+3. They have been affected by HACE, but they are not idiots. They will get it right but may still be affected by HACE.

A trekker who’s been hit by HACE deteriorates within hours and could go into a coma.

So it’s important to act before it gets severe.

Thankfully, HACE is very very rare. From January 2017 until April 2018, we have seen just two cases of HACE. We have documented one of them here in detail.

What you need to know about altitude sickness

What is altitude sickness - Detailed symptoms of Acute Mountain Sickness, High Altitude Pulmonary Edema and High Altitude Cerebral Edema.

Acute Mountain Sickness

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