You will ascend to high elevations on your trek. This presents additional physical risks and challenges. It is important that you know how to minimize these risks and the discomforts of high altitude trekking.

Pace:
You are probably familiar with the famed fable of the overzealous hare whose lack of tact defeats him in a race against the slow yet persistent tortoise. As you undertake your Kilimanjaro trek, heed the wisdom of the tortoise and maintain a slow and steady pace. This could be the single most important factor to a successful climb. The reason is that going slowly, even early on when you are feeling strong, allows your body to acclimatize to the altitude. If all your energy is directed toward physical exertion, then your body’s ability to acclimatize is compromised. Some people have the misconception that they can “catch up”, once they reach camp or while sleeping, but the respiration rate will be much lower while resting, and the body will direct its energies toward maintaining vital functions. There is absolutely no substitute for climbing slowly.

Your guides will most likely remind you to slow down, so heed their advice and pace yourself; you will have plenty of time to make your ascent. Let your breathing control your pace, and not your pace control your breathing.

Hint: One effective method for establishing a slow and steady pace is to breathe only through your nose for the first two days of the climb. (You should continue this effort as long as you can). It will help your energy levels for the difficult part of the trek, and reduce water loss from the body. Always breathe deeply and slowly, which will help oxygenate your vital organs and help you acclimatize better.

Gait:
One way you can save energy while climbing is to learn a technique of walking called the Rest Step. The Rest Step is a disjointed walk designed to keep your metabolic rate below the red line in high-altitude conditions. The Rest Step is patience in action: step; pause for one beat before pushing off the back foot; take another step and pause for another beat. Step. Pause. Step. Pause. Step. Pause. The idea is to spend the minimum amount of time possible using your leg muscles to support the weight of your body. You can practice this at lower elevations, as it may be your modus operandi when you near the summit. Your trekking poles will help you do this more effectively since when you pause you can lean on your stick.

On the final ascent, the desire to sit down may be greater than you’ve ever known. It’s okay to rest, and rest often, but lean on your trekking poles, and “lock” your knees to relieve your leg muscles. It is very important that your trekking pole(s) are sternum height, which is a comfortable height at which to rest your body. It’s important to refrain from sitting, as your body will loose heat quickly and it may be difficult to get back on your feet.

Acute Mountain Sickness (AMS)
Becoming a keen observer will serve you well on this climb. You’ll have to pay close attention to your body and react accordingly. Altitude affects people in many different ways, and some have easier times of it than others. The onset of altitude sickness can come slowly or quickly, and in various forms, so it’s always prudent to closely monitor your self and report your changing condition to your guide(s).
Your ability to acclimatize will be dependent on the level of oxygenation of your vital organs, most importantly the brain. Since oxygen levels are decreasing as we ascend, the only way to adjust are to:

1./ increase respiration or
2. / to change the blood chemistry so that it can accommodate more oxygen (by an increase of red blood cells).

The latter will occur naturally as we spend time at altitude, and guidelines from experts in this science denote the following for proper acclimatization: 2,000 feet (610 M) per day, with one day of rest every third day. That translates roughly into 4,000 feet (1,220 M) every three days. In order to climb Kilimanjaro following those guidelines, we would need to plan treks which take nine to ten days to reach the summit. Since an 11 day or 12 days trek is not feasible for most people, we recommend that our climbers take acetazolamide (diamox) to help them acclimatize.

Diamox is well-studied and proven safe (barring an allergy to Sulfa drugs) as a prophylaxis and as a treatment for Acute Mountain Sickness (AMS). It metabolizes bicarbonate (base PH) in the kidneys (which is excreted in the urine), and drives down the PH of the blood. The body balances the PH by excreting Carbon Dioxide (acid PH) gas from the lungs, increasing respiration and thus increasing the amount of oxygen to the brain and other vitals, especially during sleep (increasing the unconscious respiratory rate). It mimicks what your body would be doing after a few days at altitude, and it promotes better sleep. The only drawback is its diuretic effect, and thus the need to stay well-hydrated at all times. Recommended dosage is 125mg to 250mg twice per day. Please consult with your doctor, as Diamox is available by prescription only.

Since the best indicator of your body’s health at altitude is your ability to breathe effectively and oxygenate the vital organs, when we don’t breathe effectively we can expect to suffer from a varying degree of AMS. One of the first symptoms of mild AMS is a headache (HAH – high altitude headache). Other symptoms of mild AMS are: disinclination to eat, nausea, fatigue, sleeplessness and sleep apnea, and edema (swelling) of hands and feet. When symptoms progress to moderate AMS, we experience more severe symptoms of mild AMS, with possible vomiting or an HAH that is not relieved by pain medication or rest. At this point you should be prepared to halt your ascent or possibly begin descending. Continuing with the ascent may lead to acute AMS in the form of cerebral edema, a build up of fluid in the brain. A climber with signs and symptoms of cerebral edema would constitute an emergency evacuation. We remain pro-active to avoid this situation, by monitoring and treating mild and moderate AMS as they occur.

Another form of Acute AMS is lung-related, and again directly relevant to your body’s ability to breathe effectively and get sufficient oxygen. If you notice that you cannot take full, deep breaths, or if your lungs feel restricted, it can indicate pulmonary edema; a build-up of fluid in the lungs. Symptoms include shortness of breath (even while at rest, and especially while lying down), a cough, increased heart rate, and in serious cases gurgling sounds from the chest and spitting up blood-tinged mucus. In serious cases, this would constitute an emergency evacuation.

If any one or combination of these symptoms occur, your body may be trying to tell you that you are either ascending too quickly, that you are dehydrated, under-nourished, or all of the above. Above 12,000 feet (3,650 M) some people will have one or more of these symptoms. If you do experience one or more of the above symptoms, and food and fluid intake has been adequate, then you should inform your guide and consider descending immediately. The guide is in control, and his assessments and plans must be adhered to at all times.

It is critical that you inform your guide/s of any condition that should arise, even fatigue. Always communicate your changing symptoms with your guide.

If you have problems while on the mountain and need to descend, you will be escorted or evacuated down to the nearest campsite or hut, and if necessary to the park gate. For those who experience illness or injury anywhere on the mountain, we carry bottled oxygen (optional), a complete first-aid and medicine kit, a stretcher, a hyperbaric chamber (optional), and mobile communications, in order to assist.