He tried to sleep, but every time he rolled over, he felt the
fluid rise, and would often cough up some of the yellowish liquid.
"I felt like I was choking," Boyer, an emergency room physician
in Portland, Ore., says of the experience now. "I knew I had to get
back down to base camp before I drowned." The sickness was a
crushing blow. Boyer, an avid climber who was considered by his
peers as the best athlete on the American Medical Research
Expedition in 1981, knew he had to get off the mountain. He also
knew he was seriously ill and wouldn't reach the summit. To high
altitude climbers, Boyer's sufferings are well known.
For at least a century, the world's tallest mountains have
beckoned to climbers eager to bag their peaks. But even the very
experienced, most of them exceptional athletes, know how quickly
anyone can be incapacitated by ailments at high altitude, ranging
from minor headaches and dizziness to severe bouts of nausea and
vomiting that can sometimes lead to death.
The boom in popularity of high altitude trekking over the last
two decades has brought many people to high altitude who are unaware
of its potential dangers. Not surprisingly, altitude sickness is
common among travelers to the Himalayas, often befalling newbie
trekkers despite their brightly-colored fleece jackets and newly
buffed hiking boots.
The Merck Manual of Medicine says that 25 percent of those who
travel to altitudes of 9,000 feet get some form of altitude
sickness, and 50 percent over 14,000 feet.
And, as many skiers know, even as low as 7,000 feet — roughly the
altitude of the ski resort city of Park City, Utah — mild cases of
Acute Mountain Sickness or AMS can occur, usually as headaches that
go away after a few days.
It is when climbers go to extreme altitudes above 14,000 feet
that severe cases of AMS and other high-altitude sickness can kill.
While AMS is the most common, the two most feared problems are a
build up of fluid in the lungs or brain, known as high altitude
pulmonary edema (HAPE) and high altitude cerebral edema (HACE),
"HAPE and HACE are the real killers," says Dr. Peter Hackett,
professor of medicine at the University of Washington and an expert
on high altitude physiology. Hackett says that while both ailments
are dangerous, HACE is the least understood and the more dangerous
of the two.
The reason, Hackett says, is that so little is known about the
brain. "It's a whole lot easier to look down into someone's lungs
than it is to crack somebody's skull open to look at their brain,"
While altitude sickness can affect anybody, Hackett's studies
suggest that some people are more susceptible than others. "There's
definitely a genetic component," says Hackett. But even Nepal's
legendary Sherpas, who regularly live at altitudes as high as 14,000
feet, can be afflicted by altitude sickness.
Hackett says scientists are only beginning to understand what
happens to the body and the brain at altitude. What they do know is
that above about 8,000 feet the decrease in air pressure causes a
person's capillaries to expand, and in some cases leak, causing a
build up of fluid in a part of the body such as the lungs or the
This can lead to extreme pain, dementia and death. At 10,000
feet, the atmosphere is only 50 percent of that found at sea level.
Above 25,000 feet, an altitude ominously known as the "death zone,"
the atmosphere is just 25 percent of that found at sea level. The
summit of Everest stands at 29,035 feet or 5.4 miles above sea
Dr. Brownie Schoene, professor of medicine at the University of
Washington who studies altitude sickness, says that one reason
altitude sickness is so common at high altitude is that many people
aren't educated about how to deal with it.
While many well-established guiding outfits make stops at lower
altitudes to allow clients to adjust to altitude, known as
acclimatization, Schoene says some of them still try to get people
up to the top of a mountain as quickly as possible, which is a
recipe for getting ill.
"It's better than it used to be," Schoene says. "But for the most
part people don't have a clue."
Gordon Janow, program director for Alpine Adventures
International in Seattle, says guiding outfits, particularly those
in the United States, are well aware of altitude's dangers, and that
their clients' health is always a top concern.
"We're constantly watching our clients, keeping tabs on how
they're feeling," he says.
Schoene says the most important thing is to be aware of the
symptoms of altitude sickness and, if symptoms occur, to drop to a
lower altitude and wait for them to disappear. Persons with HAPE —
men get it five time more frequently than women — often experience
an irritating cough that produces frothy, often bloody sputum.
People with HACE can experience dizziness, extreme tiredness,
nausea and a loss of basic motor skills, especially in the hands.
They often exercise poor judgment which can be particularly
dangerous because it can lead people to ignore or deny their
condition or to lose their footing and fall into a crevasse.
Treating the Symptoms
While the best treatment is to reduce altitude, there are some
immediate ways to treat altitude sickness.
A drug called Diamox is often prescribed for HAPE and acts by
stimulating breathing, so the sufferer takes faster and deeper
breaths, thereby getting more oxygen. Another, called Decadron,
reduces tissue swelling and can be effective for HACE. Hackett also
says new, unconfirmed studies suggest that Viagra can be an
effective means of treating both HACE and HAPE.
It's important to remember that these drugs can reduce symptoms
but, Hackett warns, should not be a substitute for reducing
Also, new devices such as or hyperbaric chambers known as Gamow
bags are provided by some guiding companies. Gamow bags are
collapsible, portable chambers made of fabric. A person afflicted
with AMS can be placed inside of the bag and the pressure can be
increased by another climber operating a foot pump.
"It's always better to be safe than sorry," Hackett says.