Into Thin Air

What could be better than an exotic locale in a foreign country with stunning natural landscape as a backdrop? How about an exotic locale in a foreign country with stunning natural landscape as a backdrop at 10,000 feet—or more?

There’s a reason people love the mountains. The combination of scenery, clear air and the world of opportunities the mountains offer, from hiking to biking and aerial cable car rides, inevitably make for a once-in-a-lifetime experience. Whether you’re into adrenaline-inducing activity, or simply along for the ride, you’ll find your calling high up in the clouds.

But, like all travelers, people with hemophilia need to be weary of one major ailment that plagues many a mountain traveler: altitude sickness (also known by its technical name, acute mountain sickness). The last thing you want to do is spend your vacation inside a hotel room—or worse, in the hospital.

“Acute mountain sickness is a common malady above 8,000 feet, especially if you have not had a chance to acclimatize by ascending gradually,” says Stuart Rose, MD, FACEP. “The prevalence of AMS varies depending on your speed of ascent, altitude gained, sleeping altitude, and individual susceptibility. It can progress to high altitude cerebral edema or be associated with high altitude pulmonary edema.”

So how do you avoid having your trip foiled by a sudden bout of dizziness, fatigue and/or extreme nausea? Dr. Rose, president of Travel Medicine Inc. and director of The Travel Medicine Center of Western Massachusetts, advises interspersing your ascent with rest days and avoiding, if possible, increasing your sleeping altitude by more than 1,000 to 1,500 feet each night.

He adds, “To reduce further your risk of acute mountain sickness, take acetazolamide (Diamox), starting the day prior to beginning your ascent. Acetazolamide is a respiratory stimulant that speeds acclimatization and is about 75 percent effective. It may also reduce the risk of high altitude pulmonary edema.”

But what do you do if you’ve taken the above precautions, are stuck in a foreign country and still need assistance? Dr. Rose advises to go into the situation prepared.

“Hemophilia occurs worldwide, so the expertise to treat is available in many hospitals. However, not every hospital—especially in lesser-developed countries—is qualified. The hemophiliac traveler, especially those going ‘off the beaten track,’ should identify those facilities capable of rendering qualified care in case of emergency. If a traveler goes to www.travmed.com, he can locate hospitals in the country he’s visiting via the ‘Choose a Destination’ section at the top of the home page.”

You can also find a list of hemophilia treatment centers (HTCs) in the region you are visiting in the World Federation of Hemophilia’s “Passport” directory, available at www.wfh.org.  And don’t forget to bring with you a medical alert bracelet and a letter from your HTC detailing your diagnosis, treatment and the medicine you’re traveling with.

But under no circumstances should people with hemophilia “restrict their travel, provided they are adequately prepared and aware of the risks,” Dr. Rose says. Preparation and avoidance of altitude sickness, he adds, is as simple as packing the following: sufficient factor concentrate in its original packaging; sufficient diluent (sterile water to reconstitute the powdered factor); a reconstitution device or transfer needle and filter needle, plus a butterfly needle (for infusion of factor); syringes; alcohol wipes; and a sharps container.

Now that you’re packed and prepared for your summit, here are five of our favorite places to get your altitude on in style.

1. Engadine-St. Moritz, Switzerland

Fly into Zurich, the gateway to the Alps and a cosmopolitan city worth a layover, then hop on the high-speed rail to the Engadine Valley. The southeastern corner region of Maloja is full of high-end outdoor tours. Take a mountain bike ride down from Corviglia, and have a picnic alongside the lake. Or aim for the world’s highest hot tub at the top of the Via Ferrata trail If you simply like to gaze at the mountains from afar, wander around the quaint town of St. Moritz, a popular ski resort destination in the summer, or indulge yourself at the brand new 2,000-square meter spa at the Grand Hotel Kronenhof in Pontresina.

2. Andes, Patagonia

South America’s Andes mountatin chain cuts through Chile, Bolivia, Peru, Ecuador, Argentina, Venezuela and Colombia. One of the most traveled stretches of the Andes is in the southernmost part of the continent, Patagonia, where Chile and Argentina meet.  You’ll find a little of everything in terms of landscape: sprawling ice fields, arid desert, lush tundra meadows, rich rainforests, smoking volcanoes and towering granite spires. For one of the most famed hikes in the area, consider the 52-mile-long loop that encircles Torres del Paine, Chile.

3. Himalayas, Nepal and Tibet

Summiting Everest can be incredibly demanding and expensive, so think very carefully before attempting to realize that dream. Still, you can hike to the base camp, a 44-mile route which starts in the village of Tingri and, climbing 7,000 feet, ends at Everest’s base in Tibet.  You might also consider a more moderate trek in Nepal departing from Annapurna Base Camp with a few days in Kathmandu tacked on to either end of your trip.

4. Kilimanjaro, Tanzania

Tackling Africa’s highest summit, Mount Kilimanjaro, is no walk in the park. The nearly 20,000-foot-high snow-capped stratovolcano takes a full week to ascend and descend, but the time is totally worth it once you see the view from the top. Book a trek through one of the many tour guide companies that make the journey, but do so well in advance, especially if attempting the mountain in high season (January through March).. If sweating isn’t your bag, make your camp at Kilimanjaro’s base and take a safari through one of East Africa’s savannas instead.

5. Banff-Lake Louise, Canadian Rockies

Nestled between British Columbia and Alberta, the Canadian Rockies are one of North America’s most stunning natural wonders. A summer trip promises hiking among the forests and waterfalls, and canoeing atop Lake Louise’s placid and glassy waters, while wintertime allows for ice-skating on the lake and glacier treks through the Columbia Icefields. Split your time between the laidback ski town of Banff  and Lake Louise, or see the mountain range in its entirety by taking a train ride from Vancouver to Banff on the Rocky Mountaineer.

Here are five tips Stuart Rose, MD, FACEP, recommends for beating the altitude.

1. Particularly in remote areas, travelers should have companions who understand hemophilia, its treatment and complications, and who would be able to administer the clotting factor if they traveler is sick or injured and unable to assist.

2. Travelers with mild or moderate hemophilia may not self-administer clotting factor on a regular basis, but should have clotting factor with them in case of accident or injury while traveling.

3. While the lyophilized (vacuum-dried) clotting factor does not need to be frozen or refrigerated, it cannot be allowed to freeze or become overheated. 

4. Travelers should know the location of the nearest facility capable of providing qualified hemophilia care.

5. The traveler should have an insurance policy that covers emergency medical evacuation (such as MedJet Assist), including air ambulance transport.