Altitude and acclimatisation

Altitude and acclimatisation:  Africa Natural Safari

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Altitude and acclimatisation

Kilimanjaro is a trekkable Mountain and the walks, where they around sea level would be relatively easy – it’s the altitude that makes this such a tough climb. Altitude and altitude sickness are the aspects of the climb that worry most people even if you have been to altitude before.

So why is altitude a problem? Putting it very simply the air pressure reduces as you climb higher. In every litre of air there are less molecules of all the constituents of air, most importantly for us, fewer oxygen molecules. At the top of Kili you are getting roughly half the number of oxygen molecules per breath than you would at sea level.

Our bodies need oxygen to function and create energy. In response to less oxygen your body goes through a number of physiological changes. One is to build more red blood cells (the oxygen carriers). This is why athletes often train at altitude, a higher concentration of red blood cells improves performance. However this takes time to complete, usually around 3 weeks. In the meantime your body carries out ‘emergency procedures’ as a coping strategy. These result in deeper and faster breathing. Shortness of breath on exertion and increased frequency of urinating. You may also experience disrupted sleep, night time urination, disrupted breathing during sleep and weird altitude dreams. These are all entirely normal responses.  So you can start to feel pretty bad at altitude. The critical threshold is at 4200m (about 13,775ft). The upshot is that your need to rest, drink a lot of liquids, preferably water, and keep on eating.  

In order for your body to adapt your ascent should be slow. Advice these days is to walk higher during the day than your sleeping altitude, the walk high sleep low maxim. Sleeping altitudes should not be increased by more than 300m per day. Following this advice an ascent of Kili would take around 12 days-2 weeks.

Why do we ascend Kili more quickly? To be honest the main reason is simply tradition. In the past many climbs were done over 4 days, up and down! It has also been done in 1 day by a very few day individuals but we wouldn't recommend it! Over the years the time spent on ascent has extended. More recently, we are seeing more and more climbers sensibly opting for 7 and 8 day climbs. 

Altitude sickness – signs and symptoms

Altitude sickness is officially called Acute Mountain Sickness (a.m.s.).  usually will start to kick in around 2500m -3000m above sea level (a.s.l.). A.m.s can be broadly categorised into mild, moderate and severe.

Mild symptoms

typically will present as:

                headache

                loss of appetite/nausea

                fatigue

                disrupted sleep

             swelling of hands and/or face

You may experience one or all of these symptoms and they can last anything from several minutes to several hours.

Mild symptoms are actually quite normal on an ascent up Kilimanjaro. You shouldn’t panic if you experience any of them but you must tell your guide. We want to monitor your health at all times for your safety and comfort.

Moderate symptoms 

typically are

              moderate to stronger headache

              loss of appetite/nausea/vomiting,

              increased fatigue

              increased sleep disruption

              swelling of hands and/face

Again one or all may present. Moderate symptoms need to be monitored closely by your guide.

With both mild and moderate symptoms it’s usual that after drinking water or other liquids, food and rest they will start to abate. Headaches can be treated with paracetamol/ibuprofen. However, if your symptoms show no improvement or if they worsen your guide will make a judgement on your ability to continue.

Severe symptoms

These usually manifest as repeated vomiting and/or severe headache that does not respond to pain killers and extreme fatigue. Descent is the only option here.

We understand how unnerving your first time to high altitude can be. We’ve all been up there for the first time too. We feel that one way of roughly assessing yourself is to use what we call the ‘hangover scale of a.m.s.’. You may have noticed that the symptoms of a.m.s have a strong correlation with a hangover.

So, if you feel like you a beer or two too much last night, you have mild level a.m.s. This is normal, nothing to worry about but tell your guide.

If you feel like you had several beers or a bottle of wine too much last night, you have a moderate response. You must tell your guide. It’s highly likely that your symptoms will abate but your guide will need to monitor your progress carefully.

If you feel like you had several tequilas too much – it’s time to descend immediately!

Some climbers may experience some level of a.m.s almost daily that then resolves and ascent can continue and make successful summit to Uhuru Peak. Some climbers may only experience some mild symptoms on the final ascent. We are all different. There are many factors that can affect an individuals’ response to altitude at any one time and still much of the physiological mechanisms of acclimatisation are not yet fully understood. Even a person’s response to altitude can vary on different ascents.

We know we’ve said this before (and we’ll say it again no doubt) but the best thing is to look after your body by walking slowly, resting, drinking lots and eating well.

Our guides are trained in using the Lake Louise method of a.m.s assessment. They also carry pulse oximeters to measure your blood oxygen levels. We use these as an additional assessment tool when moderate a.m.s symptoms present. Again, people tend to have different ranges of normal levels and oximeters are not relied on as a stand-alone assessment method.

Serious AMS 

They are two serious conditions that can occur at high altitudes. High Altitude Pulmonary Oedema (HAPE) and High Altitude Cerebral Oedema (HACE). Both of which are very rare.

HAPE

This is fluid build-up in the lungs. It can be life-threatening if early symptoms are ignored. If prompt action is taken then the symptoms resolve and leave no permanent damage.

The early symptoms typically are: dry repeated cough, increasing fatigue, shortness of breath and elevated heart rate. These symptoms may have other causes so it may not be clear that HAPE is present at this stage. As the condition develops fatigue increases so that walking becomes difficult and shortness of breath is clear even at rest. This is without doubt HAPE and descent is essential. If symptoms are ignored fluid will continue to build up and reduce oxygen intake that further exacerbates HAPE. This can lead to frothy sputum and rattles when breathing, particularly when laying down.

Descent is the only option preferably with supplementary oxygen being supplied.

HACE

This is the build of fluid on the brain. This can cause severe headaches, loss of co-ordination, confusion, personality shifts and loss of consciousness. This is a serious life-threatening condition, descent is essential.

Fitness, preparing your body (and mind)

How fit do you need to be to take the Kilimanjaro challenge on ? Well, the truth is you don’t need to be super fit. As long as you are in reasonably good shape it’s a do-able mountain to climb. Of course if your life is mostly sedentary then you should take up a training plan to prepare. The best training you can do is to mimic what you’ll be doing on the mountain and that’s walking up and down hills. Walking on the flat is ok for endurance building but your calf muscles will not be engaged in the same way.  Also any kind of cardio exercise will help cycling, swimming or running. You’ll be using your legs a lot for the climb so strength work such as squats and lunges which will build up your thigh muscles are excellent. Most people are fine on the ascent but the descent can cause knee and thigh soreness. This is because your muscles are working in a different way (eccentrically). Strong muscles help enormously. Reverse squats are one of the best exercises to prevent the descent muscle soreness. Don’t forgget to stretch and keep muscles and flexible which also helps prevent injury. We recommend that you seek out a decent gym/trainer to help you prepare and allow a minimum of 3 months to get Kili fit.  

As your arrival and trek day approaches you’ll probably start to feel apprehensive – don’t worry, this is good ! Kilimanjaro is a big mountain and should be approached with respect. Some nervousness is normal and should drive you to prepare properly. Once you are on the mountain just take each day as it comes and enjoy the journey. Don’t focus on reaching the summit or worrying about altitude sickness as this can stress you. Rest assured our guides will be looking after you and please do tell your guides too and discuss your concerns – a problem shared is a problem halved. Equally talk with your fellow climbers and listen to them too. There’ll probably be days when they need help and other days when they will help you… its all about the team effort. Life-long friendships are often forged or existing ones truly cemented on a challenge such as this one.  

Insurance and medical

We recommend that you visit your medical practioner before climbing for a check up to ensure that you are fit enough to undertake a challenge such as this one. Also you'll need to discuss vaccinations and malaria tablets prior to travel. Although there's no malaria above 2,200m you'll still need to be covered for your time spent at lower altitudes. Malaria prophylactics don't prevent you from contracting the disease, though they can help, but they will prevent an infection building to a life threatening level. So it's important that you also bring mosquito repellent for your time at low altitudes. It not necessary for your time on the mountain as your first camp is well above 2200m so no risk of malaria.

You may also wish to consider and discuss the use of 'Diamox' (Acetazolamide) which studies (and our experience) show that it seems to aid acclimatisation for the majority of climbers who use it. It can be taken as a preventative or as a treatment if and when ams symptoms appear. Please be aware though that it’s not suitable for everyone, and even if you are not allergic you may have side effects from the drug itself, typically tingling fingers and feet, so you must do a trial run with it before leaving home.  

You'll need to bring a simple medical kit for personal use - see your kit list section for the full suggested item list. included in this are painkillers - typically used for headaches you may have due to the altitude. We recommend brining a mix of paracetamol and ibuprofen. Ibuprofen also has anti-inflammatory properties and these 2 medicines can be taken in combination as they work in different physiological mechanisms.

Some suggest aspirin due to blood thinning properties of the drug but the effect is probably insignificant in altitude situations

Your insurance must cover you for trekking up to 5895m altitudes. Many standard travel insurance policies do not have this level of cover so check before buying your policy. You’ll also need your policy to include medical, emergency evacuation and repatriation cover. We will not accept any climbers without adequate cover and it is your responsibility to arrange this before leaving home. Please ensure that you bring a copy of your documentation for us in case of any emergency, we can then contact the insurers on your behalf. This must include your policy number, date of expiry and 24 hour emergency medical helpline number.  
Travel and visas

Most people will fly into Tanzania. We have an international airport nearby, aptly named Kilimanjaro International Airport (code JRO). It's just a 45 minute drive from there to the town of Moshi which nestles at the foot of Kilimanjaro. The ideal place to stay before and after your  climb.

You'll need a passport with a minimum of 6 months of validity from the date of your departure from Tanzania.

Most nationalities require a visa to enter Tanzania. For UK and most European nationalities the visa fee is currently $50.00 and you can buy one on entry. For US citizens the visa fee is currently $100.00. Payments must be in cash and only in US dollars or Tanzanian Shillings. Please note that Visa requirements are subject to change and may change at short notice (though there's not been any significant changes for about 15 years). You may prefer to secure your visa through the Tanzanian Embassy or High Commission in your home country - it will usually mean less waiting on arrival too. 

You may be required to show a yellow fever certificate on arrival at the airport if you are travelling from or through another African country. This applies if you on flights that transfer through, for example, Nairobi or Addis Ababa. If you arrive directly from outside Africa there's no need to produce this document.

Packing and kit list

It's really important to make sure that you have sufficient and suitable kit for the climb. The weather can be very unpredictable and you'll be hiking through a huge variety of climatic zones from the tropical heat at the lower levels to arctic conditions on the summit. Potentially it can be as low -20C or less with the wind chill at the summit. Sad to say that we have on occasion seen some people that have had to turn back from their summit climb because they're too cold. Don't let that be you ! Read on and make sure you are fully prepared by following our comprehensive kit list advice. Remember that your main kit bag that will be carried by one of our crew must not weigh more than 15Kg maximum.

Clothing  

Like climbing the mountain, we'll start at the bottom and ascend to your summit.

Footwear        Happy feet = Happy trekker

Boots -

Your most important bit of kit - you'll be wearing them a LOT ! They must be reasonably sturdy, comfortable and waterproof. If you are going to buy a pair for this trek make sure you get them well in advance and make sure that you can do prolonged walks without any blistering/rubbing or other irritation. We recommend that you find an outdoor shop that can do proper fittings with knowledgeable staff. 

Also make sure you have plenty of room in your boots for wearing thick/multiple pairs of socks for the higher altitude days and the summit. The long descent too requires space in your boots for your toes otherwise you might end up with 'boot bang' - bruised toes and likely loss of toenails in a few weeks. 

Trainers

or similar – for camp (optional)

Socks -

for the first day you can use thin, lightweight wicking walking socks as it’s usually a hot. humid walk. Thereafter you'll be wearing medium weight walking socks and later, especially for summit night, super thick trekking socks, possibly 2 pairs on summit night depending on the type you have.

 Legs

Trekking trousers –

lightweight and mid weight full length or convertible trousers are ideal. There’s no need for padded/fleece lined one, they can be too hot if the sun is blazing. Shorts are ok for the first day.  2 or 3 pairs are enough

Thermal leggings

are recommended – especially for summit night and sleeping

 Torso

Layers, layers, layers – it’s the only way to go. The ambient temperature can change dramatically especially as you reach the higher altitudes. Temperatures can change from feeling like 30C to 4C in a matter of seconds depending on cloud cover and the wind.

Base layers –

thermal wicking base layers are good for the higher walking days, summit night and for sleeping – two would be enough.

T shirts –

avoid cotton material as it doesn’t wick away moisture so any sweat you produce when it’s hot will chill you quickly when the temperatures drop. 3 or 4 will be plenty

Mid-weight fleeces – 2 or 3

Heavier fleece jacket or top

Down /or heavy duty thermal summit jacket

Hands

Light gloves -

 for everyday use.

Super thick heavy duty gloves or mittens -

for summit night especially if using walking poles as your hands are not moving and very exposed to the elements.

Neck

Scarf and/or buff/balaclava–

keeps your neck warm and will give you protection from and that cold slapping wind on summit night.

Head

Sun hat

A warm hat -

Preferably two for summit night if you don’t have a warm hoodie on your jacket

Rain gear

Waterproofs are essential for this trek. Do not compromise on quality here getting wet at altitude can put you at risk of hypothermia and accelerate altitude sickness.

Waterproof (preferably breathable) trousers and jacket.

A waterproof poncho –

we like these. Especially while trekking on the lower slopes as you can throw it on very quickly covering your day pack, and it allows a lot of air circulation to keep you cool in the warmer climatic zones.

Also if it is really heavy rain you can double up the jacket and poncho to keep seriously dry.

 Umbrella - extremely breathable rain protection. 

Your summit night outfit

You really need to get this right as it could affect your chances of reaching the summit. We can’t forecast mountain conditions on any given night so you must be prepared for the worst, and believe us, it can be a -20C howling windy blizzard up there.

Typically you’ll need to wear

Super thick socks – or 2 pairs mid-weight socks

Thermal leggings

Trek trousers (mid weight)

Waterproof trousers (wind breakers)

Thermal base layer

2/3 additional base or fleece layers

Down or primaloft jacket (recommended rating 700)

Buff and/or scarf

A couple of warm hats or 1 warm hat and jacket hood

Super thick gloves

If you don’t have a down or similar jacket you may need up to 7 layers and a reasonably thick jacket depending on the technical specifications of your kit.

 ** These days there’s so much choice of kit with different technical specifications so it is quite difficult to give a definitive list. If you’re unsure about what to buy we recommend that you seek out a good outdoor shop with knowledgeable staff who can advise you on individual items. **

Wash kit

There are no showers on the camping routes and the camp sites are quite basic so keep it to a minimum.

Hand sanitiser

Tooth paste and tooth brush

Scrubbing brush

Small soap - biodegradable please. We want to Kili looking and feeling beautiful as

                      much as we want you to.

Moisturiser

Talc - for keeping those hard working tootsies dry and happy

Wet wipes - praise for the wet wipe ! The only way to stay feeling and smelling at

                  least a bit fresh.

Vaseline - for chapped lips and skin and it can be useful on summit night to take the

                  the sting out of the face slapping wind.

Ladies -     bring a supply of sanitary products as high altitude can play around with

                   your cycle.

Gents -      you can bring your shaving kit or leave it and get the mountain man look 

                  with an on-trend tache/beard combo.

Sleeping kit

A good quality sleeping bag rated 4 season minimum is essential. Different manufacturers may use different rating systems. Your bag should have a comfort rating to at least -4C. You can add a fleece/silk liner to boost warmth too.

Pillow

Thermarest sleeping mat (optional). Don’t forget we will supply a thick sleeping mat each along with your tent.

Medical kit

Blister kit

Compeed is recommended and plenty of it just in case. Even if you have well-worn in boots. A combination of the heat at the lower altitude the gradient of the trails and multiple longish days walking can cause your feet to sit in your boots slightly differently and play havoc with your most essential tools.

Pain/headache medication

We recommend bringing one or both paracetamol and ibuprofen. Ibuprofen also has anti-inflammatory properties and these 2 medicines can be taken in combination as they work through different physiological mechanisms.

Some paracetamol products contain codeine. These, and any product containing respiratory inhibitors must be avoided as they will slow your breathing rate and increase the likelihood of altitude sickness. For the same reason sleeping tablets should be avoided. Some suggest using aspirin due to its’ blood thinning properties of the drug but the effect is probably insignificant in altitude situations.

 

You may wish to include plasters/allergy antihistamines/any personal medications (which of course have already been ok’d by your doctor during your pre-climb health check). 

Other essentials

Walking poles - highly recommended and often invaluable on summit  night. Helps

                 you to dig into the scree and prevent 'slide back' . Great for the descent 

                 too when your legs may be wobbly with fatigue.      

Water bottles - we prefer to use tube hydration systems such as Platypus/Camelback

                 as they allow you to drink almost hands free. This makes it easier to keep

                 on sipping and maintain a steady hydration level. However the tube will

                 freeze on summit night so you need standard bottles too. We recommend

                 having a carrying capacity of 2 or 3 litres in a tube system. and 2 litres in

                 bottles.

Sun screen - must be high factor. 50+ is best. Bring a high factor sunscreen lip balm

                 too or you won't be enjoying hot drinks or spicy food for a few days.

Sun glasses - with good UV protection.

Head torch - ensure it has a reasonably strong beam so you can see around camp at

                 night.  Spare batteries recommended.

Small travel towel - we'll give you washing water daily.

Snacks - we'll feed you exceptionally well, but bring some snacks too. You will need

                some for summit night. Make sure that they are easily chewable and easy

                to digest. If you bring gels make sure that they don't contain caffeine as

                this will raise your heart rate. Your heart will be working hard enough !

Camera and spare  batteries           

 

Bags

Kit bag - for your main kit that the porters will carry. It must be a soft bag, no hard

               parts or wheels. We recommend a heavy-duty waterproof bag with about

               80-100 litres capacity. If you don't have a waterproof bag then dry bags are

               or even strong plastic bags should be used. Separating your kit will also

               help you be more organised at camp.

Day sack - You'll need one with around 30 litres capacity.  Ensure it fits comfortably

               and has a good hip strap. You should bear most of the weight of your pack

               on your hips not your shoulders. Having the weight on your shoulders can

               lead to shoulder, neck pain and headaches. Your guide will advise on what

               pack each day. Keep it as light as possible about 8 kg including your water

               should be the maximum.

Storage bag - bring a small bag for storing items that you don't need with on the

               mountain.

Treats

You'll need some treats to pep you up.

Sweets or your favourite snacks

A book and/or diary

Music/phone

** there's no electricity supply on the mountain, but you could try a solar power pack

   or bring extra batteries/external charge unit**

 For more information visit www.africanaturaltours.com