Dr K K Aggarwal

Am i fit to travel to mountains

In summer most people like to travel to mountains either for holidays or for a spiritual retreat.  In both situations it works like a detoxifier for the mind providing an atmosphere devoid of routine stresses of life.

Most spiritual destinations are situated at high altitude and require a 7-10 days to complete the retreat.  This 7-10 days visit with frequent halts provides inner happiness through sequential mental detoxification (let go of desires); intellectual and ego detoxification (let go of expectations and of ego) and physical detoxification (let go of attachments).

Many precautions needs to be taken so that this spiritual journey does not end into a sickness as at high altitudes one can end up with high altitude related sicknesses.

 Amarnath Yatra is one such spiritual destination. The snow- build Amarnath Shiva Lingam is situated at an altitude of 13700 ft (5486 m) and is regarded as one of the most sacred places in India. An altitude over 3,000 meters (9,843 feet) is usually defined as high altitude.

 The Yatra tour demands good health and physical fitness. People with problems of hypertension, diabetes, heart ailments, epilepsy and asthma should consult their doctor before planning for the Yatra. One should start the physical fitness program several weeks before starting the journey. Walking regularly is the best way to prepare. One should take appropriate quantities of the right medicines for a wide variety of ailments.

Preventing mountain sickness

Acute Mountain Sickness depends on the elevation, the rate of ascent and individual susceptibility. Most visitors suffer from some symptoms that will generally disappear through acclimatization in several hours to several days.

Symptoms are worse at night and include headache, dizziness, lethargy, loss of appetite, nausea, breathlessness and irritability. Difficulty sleeping is another common symptom, and many travelers have trouble sleeping for the first few days.

Acute mountain sickness (AMS) can be very serious, with the most serious symptoms being High altitude pulmonary edema (HAPE) and High altitude cerebral edema (HACE), which can be fatal. Symptoms of HAPE include weakness, shortness of breath, even at rest, impending suffocation at night, and a persistent productive cough with white, watery, or frothy fluid. Symptoms of HPCE may include headache, ataxia, weakness, hallucinations, psychotic behavior, coma and loss of memory. Both approach and strike at night and can be fatal! Immediate descent is the surest treatment.

A gradual ascent allows the body to acclimatize to higher altitudes and the decreased oxygen supply. The formula is to give a night halt between 7000 to 10,000 feet, night halt for every 1500 feet climb and full day halt for every 3000 feet climb thereafter.

One should avoid exercise in the first few days. One should attempt to do half of the activities on the first day while the body is working to acclimate to higher altitude oxygen conditions.

No alcohol should be consumed especially in the first few days and no smoking should be done on the journey.  This is true for those going for holidays. For those going for spiritual retreats both in anyway are prohibited.

One should drink enough water each day so that the urine runs clear.

One should eat enough calories. Low cal diets at high altitudes can sabotage health. A well-nourished body can adjust to changes better than an under nourished one can. One should take high carbohydrate diet.

One should avoid taking tranquilizers and sleeping pills. These will depress the respiratory drive and limit oxygen intake. Some medication also helps to prevent AMS, like acetazolamide and nifedipine.  Pregnant ladies should avoid high altitude visits. Patients with chronic diseases should take a medical clearance.

The pitfalls and precautions in an elderly pregnancy

Aishwarya Rai is pregnant – time to celebrate and yet be careful.

Aishwarya Rai was born on 1st November 1973 and is about 38 years old now. As reported, she is pregnant. Everyone wants to know about her pregnancy outcome. We wish her well and pray that the outcome is a healthy mother and child.

Now more and more working women are choosing to become pregnant at a later age. This comes with its own set of medical challenges and we take this opportunity to address specific issues related to the older gravida or women =35 years of age at the estimated date of delivery.

• There is higher risk of fetal aneuploidy (trisomy 21, 13, 18). Aneuploidy is the condition of having less than or more than the normal diploid number of chromosomes. To diagnose aneuploidy, one may be advised to undergo invasive amniocentesis or chorionic villus test. The other alternative is to screen using maternal serum testing and ultrasound evaluation of fetal nuchal translucency to adjust the mother’s age-related risk.
• There is higher prevalence of Down syndrome in offspring of older women. One may ask for the screening for Down syndrome.
• Age and obesity are risk factors for development of type 2 diabetes mellitus, as well as gestational diabetes.
• There is an increased risk of congenital anomalies in older women and hence, a detailed second trimester ultrasound examination may be required to look for significant structural anomalies, especially cardiac anomalies.
• Many pregnancy complications occur with increased frequency in older gravidae and they are spontaneous abortion, low lying placenta, pregnancy-induced diabetes, pre eclampsia, pre term birth and cesarean delivery.
• There are also more chances of preterm delivery, low birth weight, intrauterine growth restriction, and stillbirths.
• Most pregnancies at age 37 will need to be delivered at 39 weeks of gestation on medical grounds.
• Chances of IVF pregnancy at this age are higher and hence a twin or a triplet delivery is likely.

Dr KK Aggarwal
Group Editor in Chief

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Dr KK Aggarwal
Group Editor in Chief