Going Up

Thanks to a tip from my friend Tod Schimelpfenig at WMI of NOLS (www.nols.edu), I checked out an article--available free if you type "High Altitude Medicine and Biology" into Google--entitled “Incidence and predictors of acute mountain sickness among trekkers on Mount Kilimanjaro.”

Kilimanjaro, the highest point on the African continent at a smidge over 19,300 feet, is notorious for altitude illness due to the rapid altitude gain it requires. Schedules and park fees apparently drive people to make the ascent from just about sea level in 5-6 days. While the study has some significant limitations, it showed a high rate of Acute Moutain Sickness (45%) and no protective effects from a mid-climb rest day or from acetazolamide. The study suggests, but does not prove, that you can go so high so fast that an occasional rest day or acetazolamide does not help.

The study also reports that a large number of climbers continue to ascend even though they have the signs and symptoms of AMS. You will also see, should you choose to read it, a reportedly and amazingly high rate of High Altitude Cerebral Edema (18%).

David Shlims, MD, long a doc for the Himalayan Rescue Association, gave the staff of WMI three, simple, golden rules for altitude at the WMI Staff Meeting in 2007:

1) If you feel unwell, it is altitude sickness until proven otherwise.
2) Never ascend if you have symptoms of altitude sickness.
3) If you are getting worse, then descend immediately.

Wise words indeed.

Eyeball Injuries

Just a few days ago, my younger daughter, aged 7, and I sat in the office of the local eye doctor. She, the doctor, announced my child's distress was due to a scratched eyeball. And thus this blog. Scratches to the eye that do not involve any loss of sight--which the local doc made sure of--are best treated with an ophthalmic ointment and no patch. They usually heal faster, in a couple of days, without a patch, and foregoing the patch allows the owner of the eye to keep walking in the woods--if that's where you are--without being blind in one eye. I probably would not rinse the eye unless I had sterile eye wash. The abrasion will hurt, and tears will pretty much wash out the wound. A small, inexpensive tube of eye ointment is available OTC and a great idea for a first aid kit. Out there, tell the eye owner to keep sunglasses on as much as possible. If pain is really severe, however, after an injury to the eye, I would seek medical attention for the patient. I would, however, not necessarily place a patch over the eye. If I saw blood leaking from an open wound in the eye and/or if there is a loss of ability to focus that eye, I would seek medical attention also. Remember, however, the patient will be usually be light-sensitive, and that is not a loss of ability of focus. With a bleeding wound to the eye, I would patch the eye. If a hike out is then required, please assign someone to walk, at all times, with the patient.