What it's like to get Acute Mountain Sickness on the Everest Base Camp Trek
First, I need to preface this with the fact that I am in no way a doctor or medical professional. This is entirely based on my personal experience while on an Everest Base Camp trek in Nepal. If you are concerned about altitude sickness while trekking, definitely consult with your doctor before your trek, or a doctor on the trail. My main reason for sharing this experience is acute mountain sickness didn’t feel like I expected, and it’s very easy to be in denial about it once you are at a higher elevation. Hopefully, this will help others avoid repeating my mistakes.
So, what is acute mountain sickness? Simply put, it’s an illness brought on from the lower levels of oxygen at high elevations, usually above 8,000 feet. There are varying levels of severity, from a mild headache to High Altitude Cerebral Edema, which is a build up of fluid in the brain and life threatening. Symptoms of mild to moderate AMS include, headache, fatigue, dizziness, nausea, rapid pulse, difficulty sleeping and vomiting or diarrhea. Severe AMS symptoms are, blue skin color, chest tightness or congestion, confusion, cough, decreased consciousness, inability to walk in a straight line, and shortness of breath at rest. There is also High Altitude Pulmonary Edema (a build up of fluid in the lungs) which can occur in patients with AMS, but isn’t thought to be related and can occur with no other symptoms of AMS present. Altitude sickness doesn’t discriminate, and can hit anyone at any time, although people who live closer to sea level are at higher risk. The only way to prevent acute mountain sickness is to ascend slowly and spend time acclimating at higher altitudes, but sometimes that isn’t enough to stop someone from getting sick. The prescription medication acetazolamide (commonly known as Diamox) also helps by speeding up the acclimatization process. Thus, Diamox is not a cure for AMS and mainly works as prevention, but can help if taken in the early stages of AMS.
I had read extensively about AMS before traveling to Everest Base Camp so I figured it would be easy to identify if I got sick. Unfortunately, this was not the case. Everything was going smoothly until Deboche (12,500 feet), where I started coming down with the Khumbu cough and what I assumed was a cold. The air in the Himalayas is super dry and known to cause a dry hacking cough, I hoped I would be able to breathe through my buff on the trek, but it’s already hard to breathe at altitude. Breathing through a buff on top of that felt like constant suffocation. I kept coughing more and more, and it went from a dry cough to coughing up a lot of mucus. I also began to get dizzy, shaky, and achy and figured that was a fever associated with my cough/cold.
Managing to keep it together on our acclimatization day in Dingboche. Also pictured, our guide Sudip, and Nikki of Drawn to High Places
I was managing to keep my spirits high with all of these symptoms for a couple of days, but when we departed Lobuche (16,207 feet) for Gorak Shep (the last town before Everest Base Camp and at an elevation of 16,942 feet) I truly began to break down. We hiked up a small pass and took a 45-minute break at the top. The entire break I felt like I couldn’t catch my breath. I kept coughing so hard I would start to hyperventilate, and my heart rate wouldn’t slow down, even though we were just sitting there. We got up to hike again, and about 20 steps later I collapsed over my trekking poles and managed to squeak out, “I don’t feel so good” before Nikki and our guide escorted me over to a safe place to sit and try to catch my breath again. While sitting there, I decided I was obviously having a panic attack (maybe?) and kept telling myself to get over it, which is obviously the most helpful thing you can tell yourself in the midst of a panic attack (it’s not).
I am unsure how long we sat there before I decided to get up and continue to Gorak Shep. Our guide was carrying my daypack and I started walking as slow as humanly possible so I wouldn’t lose my breath again. We eventually made it to Gorak Shep and took a brief rest before continuing to base camp. Our guide asked if we wanted to rest longer and looked a little concerned about whether I would make it, but I quickly voted to continue because I knew if I laid down I probably wouldn’t keep going. Which in hindsight, was probably a sign that I shouldn’t have kept going. On our way to base camp, I felt no improvement in my condition, and the hike was slow and painful. When we arrived, I flopped onto a rock and silently cried while Nikki painted the scene and our guide took photos. Not really how I envisioned reaching this goal would feel.
“It’s not altitude sickness!!” aka Denial.
Not pictured, the 30 minutes I spent silently crying on a rock once we made it to Everest Base Camp.
We returned to Gorak Shep and decided to take a nap before dinner. I crawled into my sleeping bag and propped myself up on my backpack to attempt to keep my coughing at bay, but I couldn’t fall asleep. In fact, I kept coughing so violently I would start gagging and hyperventilating again. After a few of these coughing attacks, I started panicking and sobbing again. Nikki went to get our guide and he brought me out to the dining room and tested my blood oxygen level, which was fluctuating between the low 70’s and 80’s. I saw those numbers and assumed there was no way it could be altitude sickness and kept telling everyone I had bronchitis. Nonetheless, our guide had me take more Diamox and eat some garlic soup. He went to grab a couple of other guides that were on the same trekking schedule as us, and that’s when things got a little intense. One of the guides was certain I needed to descend immediately via horseback in the dark since the helicopters don’t run after 5pm. I kept telling him it was just bronchitis and I would be fine once I could see a doctor. He told me everyone gets a cough at altitude and even though my blood oxygen was okay, my resting heart rate was alarmingly high. It was a little weird to be sitting there crying like a child while multiple people discussed what to do with me in English and Nepali. After a while, Nikki asked me what I wanted to do. At this point, the extra Diamox I took seemed to be helping and Sarina (another friend trekking to base camp) gave me a couple of puffs of her inhaler which helped my cough. I still felt awful, but faced with the prospect of riding a horse down in the dark/20-degree weather, I decided I would tough it out and stay the night in Gorak Shep. It was a rough night with a lot of coughing and no sleep, but my symptoms didn’t get worse. The main thing I found concerning was my heart rate never slowed down. Even though I was laying in bed, my watch was showing my heart rate at 120 bpm. Double my average resting heart rate at sea level.
The next morning we descended to Pheriche (14,340 feet). While hiking down my symptoms started to get worse. I was extremely nauseous, my headache was getting stronger, and I was dizzy and fatigued. Since my symptoms were getting worse while descending, I still kept telling myself there was no way this could be AMS. In my head I obviously had some kind of infection, perhaps it was something more serious than bronchitis, like pneumonia.
Views on our descent to Pheriche.
We arrived at the doctor in Pheriche, which is run by the Himalayan Rescue Association during the busy spring and fall trekking seasons. Doctors volunteer for three months to see trekkers and climbers for a consultation fee of $65 USD. This fee allows them to see the local people for 50 rupees, or the equivalent of 50 cents. They run two clinics on the trail, and during the spring they also run a clinic at Everest Base Camp. All in all, it’s a great organization and I was extremely thankful to have their services available on the trek.
When I walked in, the doctor asked what was wrong and I confidently proclaimed I had bronchitis. He entertained my self-diagnosis for a solid minute but also asked me about altitude sickness symptoms. This annoyed me since I was so sure it was bronchitis. I was slightly less annoyed when he asked me to spell “world” backwards and I had to close one eye and start counting my fingers in order to do it, apparently I thought I was doing math? It felt like minutes later that I finally said, “dlrow” but I told myself this test would be hard for me at any elevation.
Pheriche in the distance, so close, yet so far.
My delay in response must have concerned him a little, because he then had me try to walk a straight line heel to toe. I suddenly realized how much I had been relying on my trekking poles, because this test was a lot harder than I expected. I was able to do it, but it was slow going and took all of my concentration to keep from falling off the line. Not a normal result for someone who is completely sober and definitely doesn’t have AMS.
After these tests and some questions about my headache and nausea, he diagnosed me with moderate acute mountain sickness and a cold. This angered be beyond belief. Even after struggling with his tests, I was so sure I had a chest infection and needed antibiotics—not to double my Diamox dosage and keep descending. Nikki had also developed a cold, so I sat there and internally raged about my diagnosis while he examined her.
Accepting my acute mountain sickness diagnosis.
The next morning we left Pheriche for Namche Bazaar (11,000ft). It was a long hike, and about halfway through I realized I was feeling MUCH BETTER. My energy was back and I was able to hike at my usual pace instead of crawling. I even took my backpack back from our guide after being unable to carry it myself for three days. My confusion suddenly lifted and I attempted the doctors, “spell world backwards” test while hiking and laughed at how much easier it had become. I felt like I had woken up from the world’s worst drunken binge/hangover. I could suddenly function like myself again. I still had a bad cough, but every other symptom was gone. I felt pretty embarrassed at how much I argued and how angry I was at everyone that said I had AMS.
Nikki with her art looking over Namche on our descent.
Lessons learned from my experience with acute mountain sickness:
Even with Diamox and ascending slowly, the 17,600 feet elevation at Everest Base Camp is no joke for someone that lives at sea level. I should have been paying more attention for altitude sickness symptoms and not only the numbers on the blood oxygen reader, which brings me to my next point,
We were told blood oxygen levels of 70 and above were healthy and normal at that elevation. Our guides tested us every night, and I would see my levels in the 80’s or 90’s and assume everything was fine even though I had symptoms of AMS. When we saw the doctor in Pheriche, he said that it’s actually common for your blood oxygen levels to drop significantly when you are sleeping so it’s better to pay attention to your symptoms.
You will get a cold or a cough, don’t blame all of your symptoms on that. I think this was my number one mistake. Almost everyone in our group had a cough or a cold, but not everyone was praying for the sweet release of death quite as much as I was. Symptoms of the flu are very similar to AMS symptoms. Better to be safe than sorry and descend if you need to.
Listen. To. Your. Guide. (also listen to doctors) My second biggest mistake was arguing with two different guides and a doctor about whether or not I had AMS. They have been hiking at altitude a lot longer than I have, and have seen AMS multiple times. I should have listened to them when they were concerned. Which is easier said than done since AMS basically turns you into a drunken idiot, which is my only excuse for being enraged with a medical professional and his diagnosis of my condition.
Don’t assume you get a free helicopter ride if you get AMS. The doctor at Pheriche was extremely annoyed with the amount of trekkers who call for a helicopter and have their travel insurance cover it for “altitude sickness” This is fraud. In his estimation only about 3% of AMS cases he had seen truly required an emergency helicopter evacuation. For mild to moderate cases of AMS, you can usually hike down on your own like I did, or hire a horse if you are unable to walk. Leave the helicopters for actual emergencies.
Would I do it again?
This is a question I have been asking myself a lot. Continuing to base camp when I felt so unwell obviously wasn’t the wisest decision, but also—I didn’t die. What is it about hikers, climbers, and endurance athletes and our ability to ignore suffering in pursuit of a goal? At what point is our drive to reach said goal completely harmful to our health and well-being? Why don’t we stop, or even notice, once it is? Yes, I didn’t die, but what portion of that is just luck that my case of AMS didn’t progress to be more severe? What if I wasn’t lucky and things had gotten much worse? Would making it to base camp have been worth a true medical emergency?
Honestly, I don’t have answers for those questions, even after a week of reflecting. I always saw myself as a conservative and safe decision maker in the mountains, but after this experience I am unsure if I can continue to claim that. I didn’t stop when I probably should have. I didn’t listen to the advice or diagnosis’s of people that knew what they were talking about.
So, would I do it again? Probably.
