Acute Mountain Sickness

A Case Study at

Hanle Dark Sky Reserve (HDSR), Ladakh

 

“Before we invented civilization our ancestors lived mainly in the open out under the sky. Before we devised artificial lights and atmospheric pollution and modern forms of nocturnal entertainment, we watched the stars.”

-        Carl Sagan

Foreword

Hanle Dark Sky Reserve (HDSR) is India’s first dark sky region, and is centred at Hanle in Eastern Ladakh around the Indian Astronomical Observatory (IAO).  IAO is a research facility that is run by the Indian Institute of Astrophysics and has one of the darkest and unique skies in India. Amateur astronomers from all over the country were invited to a three-day star party at HDSR during October 12-24. I was one of these adventurers and my account of the event was carried in my previous blog article (see here).

The organizers* had provided extensive guidelines and advisories to all participants on all aspects of the trip, first to Leh, and then on to Hanle, by a long road journey after an acclimatization period of 48 hours at the lower altitude of Leh. In part, their health guidelines stated:

High altitude sickness is to be taken seriously. Leh is at a height of about 3500 m above sea level and Hanle is about 4250 m above sea level. Please note that you can be susceptible to it even if you are in good health in the plains. We recommend that you take the following DO’s and DON’Ts seriously:

Acclimatize: On arrival by flight at Leh, take full rest for 48 hrs without much physical activity as otherwise it will increase the risk of altitude sickness. Complete rest for 48 hrs will allow your body to adjust High Altitude conditions. 

Stay hydrated: Drink plenty of fluids, preferably water, to combat the higher rate of water vapor lost through respiration at high altitudes. 

Consume a balanced diet: Maintain a nutritious diet with adequate carbohydrates and calories to support your body's energy needs in the oxygen-limited environment.

Rest and sleep: Allow your body enough time to rest and recover, especially during the first few days at higher altitudes. 

Don't overexert yourself: Avoid strenuous physical activity, especially during the first few days at high altitude. Overexertion can strain your body and increase the risk of high-altitude sickness. 

Don't ignore symptoms: Be aware of the signs of altitude sickness, such as headache, dizziness, nausea, and shortness of breath. If you experience any of these symptoms, descend to a lower altitude and seek medical attention if they worsen. 

Don't underestimate the environment: High altitude locations can present unique challenges, including extreme weather conditions and limited medical facilities. Respect the environment and be prepared with appropriate gear, supplies, and information.

Please see Health Advisory from the Ladakh administration for further information.

[*Engineer and astrophotographer Mr Dorje Angchuk (Dorje for short), head of the Indian Astronomical Observatory establishments at Leh and Hanle, and Dr Niruj Mohan Ramanujam (Niruj for short), Head of Indian Institute of Astrophysics - SCOPE, Bangalore.]

In spite of observing the guidelines diligently, or so I thought, I was struck by some form of high-altitude sickness, technically known as acute mountain sickness (AMS), which forced me to cut short my night sky observation activities severely and return prematurely from Hanle.  While the disappointment was palpable, a period of about ninety minutes of observation of a spectacularly clear and dark night sky on the first day was fair compensation, though it felt somewhat like an icing minus the cake.

I had given a brief description of what I went through in my last article, promising fuller details later.  Here it is, something of a case study, in the hope that the information contained herein may prove useful to future participants and visitors to Hanle and that it will also contribute in some small way to a better understanding of AMS, especially among people of my own age group.

Personal Background

Aged 85, and having retired from my academic profession at the turn of the century, I have generally led an active outdoor life as evident from my writings in a recent blog article titled ‘Youthful Old Age!…’. My long-standing hobby as an amateur astronomer has been a beneficial catalyst as well.  I have had my share of age-related comorbidities, but none of them interfering with an active outdoor life. My entry to the HDSR Star Party was a voluntary and conscious decision arising from a careful self-evaluation, supported by the following factors:

Previous exposure to high altitude (over 1,500 m) locations:

·      Ooty (alt 2,250 m), Tamilnadu – frequently since 1964

·      Kodaikanal (alt 2,150 m), Tamilnadu – often since 1970

·      Mussoorie (alt 2,000 m), Uttarkhand – one week sometime around 2010

·      Mount Titlis (alt 3,250 m) in the Swiss Alps – half a day in Sep 2017

·      Cusco (alt 3400 m), Peru, for 3 days consecutively in Jan 2019, including a whole day’s travel to and from Machu Pichu (alt 2,450 m)

·      Srinagar (alt 1,600 m), J&K, for one week, including unassisted climbing to the top of Shankaracharya Hill about 300 m higher, in Sep 2022

·      Gulmarg (alt 4,400 m), J&K, by cable car, including unassisted walking to and from the gondola station, a distance of 2 km from the tourist bus stop, in Sep 2022

Preparation before journey to Leh/Hanle on 12Oct23:

·      Consultation with my personal physician and his green signal, including a prescription for Diamox as advocated in the organizers’ health advisory.

·      Purchase of a complete set of new warm clothing and supporting gear for the expected winter climatic conditions at both Hanle and Leh.

·      In-depth study of medical advisory and related information provided by the organizers of the HDSR Star Party.

[Note: The confidence I felt about a successful participation in the HDSR Star Party arose principally from my experience just last September during my 8-day visit to Kashmir, including a strenuous journey by a combination of walk, 2 km each way, and a gondola ride to the mountain top in phase 2. I did not feel discomfort of any kind anytime.]

Details of two episodes of altitude sickness symptoms experienced at Hanle during the HDSR Star Party:

·      First episode on the evening of 12 Oct 23:

I had been under the night sky for about ninety minutes before Niruj announced that it was time for dinner and we could return to the field for a long night session thereafter.  As before, he led me up to a point and went ahead of me after assuming that I could find my own way.  Till then I had suffered no discomfort whatever and had no inkling of what was to happen to me half way back to the guest house. Then it happened all of a sudden and totally unexpectedly.

I suddenly felt extreme difficulty in continuing to walk back and began to breath heavily after each step I took.  I forced myself to stand still for a short period before taking another step, and even this was quite hard.  After repeated short breaks like this, I managed to get back eventually to the building and then on to my room where I felt so exhausted that I had to take a long rest before going for a late dinner.  After dinner, I narrated my experience to Dorje who asked me a number of searching questions, advised me to forget the post dinner visit and rest completely overnight, and promised to review the situation the next day. Next morning, when I reported to Dorje that I felt rather tired in spite of a great and uninterrupted sleep overnight, he asked me to continue to rest indoors with frequent intake of oxygen for which a portable supply machine was available.

·      Second episode on the evening of 13 Oct 23:

Before dinner that evening, Dorje himself found it prudent to conduct me to the observation area and it was quickly clear to both of us that I was seeing nonexistent phenomena in the sky that made no sense at all.  The star filled night sky, so spectacular the night before, appeared to be filled with wispy clouds of irregular shapes and sizes and visible through what looked like the upper parts of tall thin swaying trees, with hardly any stars visible. The whole area looked totally unfamiliar to me despite the experience of the previous night. It took me less than a minute perhaps to realize that I was in a delusional state of mind.  It didn’t require any convincing that I was suffering from some kind of altitude associated sickness. Incidentally, I experienced no symptoms of a physical nature any time during this episode.

Dorje escorted me back to my room, put me on oxygen and advised me complete rest after a quick dinner.  Again, I slept well, apparently free of any disturbing symptoms the next morning.  However, it was Dorje’s considered opinion, backed up by his long experiential evidence, that I should return to Leh (about a thousand meters lower in altitude) as soon as possible.

Subsequent Events

On 14th morning around 11 am, after a fleeting visit to the Observatory site housing the famous Himalayan Chandra 2 m Optical Telescope on the nearby hilltop, I was escorted in a car out of Hanle to Leh.  The entire journey was comfortable and as enjoyable as the inward one, my camera constantly at work from an even better vantage point. On reaching Leh, I was taken to the local government hospital for a medical examination as arranged by Dorje.  The physician who examined me strongly advised me that I should stay the rest of the day in the hospital for precautionary treatment with oxygen for five hours and a course of drips for about three hours.  During this period, one of the staff of IAO was constantly at hand, attended to all my needs, and took me to the guest house at Leh immediately after the medical treatment.

I stayed indoors at the guest house the whole of the next day, again without any major symptoms, and left for Bangalore via Delhi the following morning.  In due course, I reached my home in Mysore.

Summation

    · The medical advisory circulated by the organizers among prospective participants was very clear and exhaustive regarding safety, guidelines and precautions, and included detailed do’s and don’ts under health guidelines. It also contained adequate information on high altitude sickness and related medical emergencies.

    · IAO’s own visiting physician had examined me medically at its office in Leh before giving the green signal for the journey to Hanle.

    · My assessment that I could participate successfully in the HDSR Star Party was based on my current state of health as well as previous exposure to high altitude locations as listed above.

    · The one aspect in which I could have taken greater care of myself is hydration. Though I did not feel unusually thirsty at any time, I should still have increased my daily intake of water substantially at both Leh and Hanle. This was not done because of my pre-existing medical condition that required limited hydration, something that I was habituated to. This may have been the single most serious contributory factor to my affliction.

    · Being afflicted with some form of high-altitude sickness at the Star Party was as unexpected as it was disappointing.

    · The organizers handled my medical emergency in a thoroughly professional manner, and I am grateful for this.

Postscript

It gave me no feeling of relief to learn, even before returning from the trip, that I was not the only one to be afflicted by some form of high-altitude sickness, which seems to be rather pervasive in the very low humidity and low atmospheric pressure prevailing in the Ladakh region. Apparently, there were several other cases requiring medical attention, all with young participants.  I met one of them on my way back at Leh who was eager to return to the party at Hanle, but had been persuaded not to, understandably disappointed as well. 

For me, the most enduring memory of the visit is not the acute mountain sickness that afflicted me, but the incredible view of the night sky at Hanle, with the Milky Way visible to my eyes like never before.