"You feel dying"

Christiane Fux studied journalism and psychology in Hamburg. The experienced medical editor has been writing magazine articles, news and factual texts on all conceivable health topics since 2001. In addition to her work for, Christiane Fux is also active in prose. Her first crime novel was published in 2012, and she also writes, designs and publishes her own crime plays.

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Mountain tours in the Himalayas, summit storms on Kilimanjaro - trekking trips to great heights are the trend. Altitude physician Rainald Fischer explains in a interview when it becomes dangerous and how you can protect yourself.

Priv. Doz. med. Rainald Fischer

Priv. Doz. med. Rainald Fischer is President of the German Society for Mountain and Expedition Medicine. He is a resident doctor in a pulmonary practice in Munich Pasing. In addition to sleep medicine and the therapy of cystic fibrosis patients, his scientific focus is on mountain and altitude medicine.

Dr. Fischer, such a view from a really high peak is of course terrific. However, the air becomes noticeably thin in the high mountains. Not everyone can take that.

That's correct. Some develop an acute mountain sickness. Symptoms range from headache to nausea, vomiting and dizziness to insomnia. This is called “Acute Mountain Sickness”. Even if you only get the moderate form, you feel dying.

They say it gets critical from an altitude of 2500 meters.

That is the classic threshold. Until then, the body's immediate reaction with increased breathing and increased pulse is sufficient to counteract the lack of oxygen. Beyond this limit one can get sick of heights.

What happens in the body

We don't know exactly. For example, we can't predict when it will and when it won't. All we know is that when we rise, atmospheric pressure drops and the oxygen content of the air drops. As a result, the brain and other tissues are less well supplied. It becomes life-threatening when pulmonary or brain edema occurs. Then the only thing that helps is a rapid supply of oxygen and medication - but above all, removal from a height.

That sounds dramatic.

It is. If a climber can no longer control his movements properly in addition to the symptoms of acute mountain sickness, his life is in acute danger. Because that is an alarm signal for an incipient brain edema. Later on, there are also disturbances of consciousness, such as delusions, and those affected make wrong decisions and behave incorrectly. You seem downright crazy. If the brain edema continues, they fall into a coma and die.

Water also collects in the lungs when you suffer from altitude sickness.

Yes, the first clue is severe shortness of breath under exertion. Later there is a cough, which can be accompanied by bloody, frothy sputum, and there is an audible rattle when breathing. Pulmonary edema also inevitably leads to death if one does not leave the altitude.

But not everyone gets altitude sickness.

Right, the reaction to the lack of oxygen varies from person to person. However, the height and the speed at which you climb up are also decisive. Of the people who ascend relatively quickly to an altitude of three and a half to four thousand meters within a day or two, about 50 to 60 percent get altitude sickness.

Are there groups of people who are particularly vulnerable?

We know that younger, sporty people are particularly at risk. But that's probably more because they try too hard and get up too quickly. Otherwise, neither physical fitness nor gender play a role. And also not whether you have any previous illnesses. Interestingly, not even smoking is a risk factor. All we know is that someone who has been sick of heights is more likely to get sick of heights again.

Interestingly, Tibetans do not get altitude sickness, while altitude sickness does occur among the Indian Andean inhabitants.

That's correct. The fact that the Tibetans do not get sick of heights is certainly a consequence of genetic selection. Unlike the Andean peoples, the sick from the Tibetan plateau could not descend into deeper regions. Only those whose genes were more favorable to life at height survived.

And if I have particularly unfavorable genes, will I always get sick?

No. Those who acclimatise themselves optimally do not get sick. One hundred percent.

That’s reassuring. And how does it work?

Above all, that means climbing up in stages. From an altitude of 2500 meters you should not pack more than 300 to 500 meters of altitude on it per day. And every 1000 meters it is best to take another rest day. It is also important that you only exercise moderately physically, so that you do not get even more lack of oxygen.

What if the strategy doesn't work?

In the case of mild symptoms of altitude sickness, it is sufficient to take a day of rest. But if the symptoms get more severe, descend to the height at which you were still symptom-free.

So you would advise against travel offers such as “In five days on Mount Kilimanjaro”?

Most of them can't do that. It's almost 6000 meters high! 80 percent of those who climb it get altitude sick. In the best case scenario it is very uncomfortable, in the worst case it is fatal.

Doctor Fischer, thank you for talking to us.

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