Saturday, April 16, 2011


When a person ascends to altitudes above 2000m, the body has to acclimatize to the decreasing amount of Oxygen available. The three main acclimatization mechanisms are:
Deeper breathing and an increased respiratory rate (from 8 to 12 breaths/min at rest at sea level to around 20 breaths/min at 6000m). This starts immediately on arrival at altitude Producing more urine. This starts after few hours and takes a day or two. If this mechanism is not efficient, the characteristic puffiness of early AMS appears in the face, hands and feet (water retention) An increase in the number of red cells in the blood. This only begins after a week at high altitude. If the ascent is too fast and/or the height gain too much, these mechanisms do not have time to work and symptoms and signs of altitude illness (also called high altitude illness or altitude sickness) will appear. Altitude illness becomes common above 2500m and presents in the following ways:

AMS (Acute Mountain Sickness): common but not life-threatening if dealt with correctly
HACE (High Altitude Cerebral Edema): less common but life-threatening
HAPE (High Altitude Pulmonary Edema): less common but life-threatening

Depending on the altitude gain and speed of ascent, the incidence AMS ranges from 20 to 80%. HAPE is roughly twice as common as HACE and together they occur in approximately 1 to 2% of people going to high altitude. These three forms of altitude illness can vary from mild to severe, and may develop rapidly (over hours) or slowly (over days). HACE and HAPE can occur individually or together.
People often refuse to admit they have altitude illness and blame their symptoms on cold, heat, Infection, alcohol, insomnia, exercises, unfitness or migraine, and risk death by continuing to ascend.

Warning: do not ascend with symptoms or signs of altitude illness, as this has led to many deaths from
In any group there will be ‘fast’ and ‘slow’ acclimatizers needing different ascent rates. While a flexible
schedule is always preferred, the fact is that many trekkers are on tight schedules (often, but not always, members of commercial groups) leading to a higher incidence of altitude illness. Slow acclimatizers in these tight schedule situations are at extra risk, and prompt diagnosis and treatment becomes even more important. However, even if a trekker has a flexible schedule, they may still feel pressurized to ascend with symptoms (by pride, peer pressure, rivalry, not wanting to appear weak, etc). Interestingly, fit and impatient young people can be more at risk of altitude illness than unfit and patient older ones! Flexible schedule Tight schedule

AMS varies from mild to severe and the main symptoms are due to the accumulation of fluid in and
around the brain. Typically, symptoms appear within 12 hours of the ascent. If the victim now rests at
the same altitude, symptoms usually disappear quickly over several hours (but for ‘slow acclimatizers’
this can take up to 3 days!) And they are now acclimatized to this altitude. AMS may reappear as they
ascend higher still, as acclimatization to the new altitude has to take place all over again.
Symptoms & signs
A diagnosis of AMS is made when there has been a height gain in the last few days, AND:
The victim has a headache (typically throbbing, often worse when bending over or lying down)
PLUS there is one or more of the following symptoms:
− Fatigue and weakness
− Loss of appetite, or nausea, or vomiting
− Dizziness, light headedness
− Poor sleep, disturbed sleep, frequent waking, periodic breathing
In AMS, the victim’s level of consciousness is normal. The Lake Louise Score can be helpful as a guide to quantify your diagnosis of AMS and assess progression.
Note: AMS and HACE are two extremes of the same condition and it can help to think of AMS as ‘mild
Note: the only early signs of altitude illness in a young child (under 7 years old) may be an increased
fussiness, crying, loss of interest and/or loss of appetite.
HACE is the accumulation of fluid in and around the brain. The important symptoms and signs are: severe headache, loss of physical coordination and a declining level of consciousness.
Typically, symptoms and signs of AMS become worse and HACE develops (but HACE may come on so quickly that the AMS stage is not noticed). Also, HACE may develop in the later stages of HAPE.
Symptoms & signs
A diagnosis of HACE is made when there has been a height gain in the last few days, AND:
The victim has a severe headache (not relieved by ibuprofen, paracetamol or aspirin)
There is a loss of physical coordination (ataxia):
− Clumsiness: the victim has difficulty (and often asks for help) with simple tasks such as tying their
shoelaces or packing their bag. When examined they fail to do, or have difficulty doing (or refuse to do!) the finger-nose test
− Staggering, falling over. When examined they fail to do, or have difficulty doing (or refuse to do)
the heel-to-toe walking test or the standing test
Their level of consciousness is declining:
− Early on, this presents as loss of mental abilities such as memory or mental arithmetic. When asked, the victim cannot do or have difficulty doing (or refuse to do) simple mental tests
− Later on, they become confused, drowsy, semiconscious, unconscious (and will die if not treated
urgently) Other symptoms and signs that may appear:
− Nausea and/or vomiting, which may be severe and persistent
− Changes in behaviour (uncooperative, aggressive or apathetic, “Leave me alone”, etc)
− Hallucinations, blurred or double vision, seeing haloes around objects, fits or localized stroke signs
may all occur but are less common

Failure or difficulty doing any one of these tests means the victim has HACE. If the victim refuses to
cooperate, assume they are suffering from HACE. If in doubt about the victim’s performance of the tests, compare with a healthy person. Be prepared to repeat these tests to monitor progress.
• Finger-nose test. With eyes closed, the victim repeatedly and rapidly alternates between touching
the tip of their nose with an index finger, then extending this arm to point into the distance (useful test if the victim is in a sleeping bag or cannot stand up).
• Heel-to-toe walking test. The victim is asked to take 10 very small steps in a straight line, placing the heel of one foot in front of the toes of the other foot as they go. Reasonably flat ground is necessary and the victim should not be helped, but be prepared to catch the victim if they fall over! Excessive wobbling is difficulty (to do the test), falling over is failure.
• Standing test. The victim stands, feet together and arms folded across their chest, and then closes their eyes (the victim should not be helped, but be prepared to catch the victim if they fall over! Excessive wobbling is difficulty (to do the test), falling over is failure.
• Mental tests are used to assess level of consciousness. You must take into consideration preexisting
verbal/arithmetic skills and culture; it is a decline in ability over time that is significant.
Examples of tests include: “Spell your name backwards”, “Take 3 from 50 and keep taking 3 from
the result”, or ask their birth date, about recent news events, etc.

HAPE is the accumulation of fluid in the lungs. The important sign is breathlessness. HAPE may appear
on its own without any preceding symptoms of AMS (this happens in about 50% of cases) or it may develop at the same time as AMS or HACE. Severe cases of HAPE may result in the development of
HACE in the later stages.
HAPE may develop very rapidly (in 1 to 2 hours) or very gradually over days. It often develops during or after the second night at a new altitude. HAPE can develop while descending from a higher altitude. It is the commonest cause of death due to altitude illness. HAPE is more likely to occur in people with colds or chest infections. It is easily mistaken for a chest infection/pneumonia. If you have the slightest doubt, treat for both.
Symptoms & signs
Reduced physical performance (tiredness, fatigue) and a dry cough are often the earliest signs of HAPE
− Early stages: more breathless than usual with exercise, takes a little longer to get breath back after exercise
− Later stages: marked breathlessness during exercise, takes longer to get breath back after exercise. This finally progresses to breathlessness at rest
− At any stage, the victim may become breathless while lying flat and prefer to sleep propped up

Breathing rate at rest increases as HAPE progresses. (At sea level, resting breathing rate is 8 to 12 breaths/min at rest. At 6000m, normal acclimatized resting breathing rate is approximately 20 breaths/min) A dry cough As HAPE gets worse; the cough may start to bring up white frothy sputum. Later still, this frothy sputum may become bloodstained (pink or rust coloured): this is a serious sign ‘Wet’ sounds (fine crackles) may be heard in the lungs when the victim breathes in deeply (place your ear on the bare skin of the victim’s back below the shoulder blades; compare with a healthy person)
Note: wet sounds may be difficult to hear (or absent), even in severe HAPE
As HAPE gets worse, lips, tongue or nails may become blue due to lack of oxygen in the blood
There may be: fever (up to 38.5ÂșC), a sense of inner cold, or pains in the chest or even upper belly
As HAPE worsens, the victim becomes confused, drowsy, semiconscious, and unconscious (and will die if not treated urgently)

The Author, Shauky Putoo is a full time adventurer & has been organising activities in Very High Altitudes in Greater Himalayas, trained in wilderness medicine, rescue & Basic Life Support Systems, apart from being a coach for mountain, aquatic & aero sports. presently looking after Operations of O2 Adventure & Travels, & can be contacted via email to or +91 9419550663.

Sunday, April 10, 2011


BURZAHOM usually called as Burzahama was the first Neolithic site to be discovered in Kashmir. It is located on a Plateau between the banks of the Dal Lake and the Zabarvan hills, about 5 km from the famous Mughal garden of Shalimar. After the discovery and excavation of Burzahama, other Neolithic sites were discovered in Kashmir at places such as Begagund, Brah, Gofkral, Hariparigom, Jayadevi-udar, Olichibag, Pampore, Panzogom, Sombur, Thajiwor and Waztal, all located on Plateaus mainly in the south-east parts of the Kashmir valley.
Burzahom translates as 'place [hom] of birch [burza]' in Kashmiri. Burnt birch found in the excavations showed that birch trees must have been common in the area in the Stone Age. Plentiful food from the forests on the Himalayan foothills, an abundant water supply from the lake, and a raised location protected from seasonal inundation ensured that the Burzahama plateau remained continuously settled from the New Stone Age to the Early Historical period.
Neolithic [New Stone Age] Phase I c.3000 B.C.

The earliest Neolithic homes at Burzahama were pits dug below ground level using stone tools. The sides of the pits were plastered with mud. These pits must have provided the early Neolithic people of Burzahama protection from the elements during bitter winters in Kashmir .The pits were usually round or oval, and narrow at the top and wide at the base. Holes discovered around the pits were probably used to fix wooden poles to give support to roofs made out of tree branches. Some of the deeper pits had a few steps leading down while the pit-dwellers people would have stepped down into the shallower ones.

The early Neolithic people of Burzahama made simple gray or reddish-brown hand-made pots in different shapes and sizes. They also made polished stone tools and tools out of animal bones and antlers. The bone tools included harpoons for fishing, needles for sewing, and arrow-heads, spear-heads and daggers for hunting. Ash, charcoal and pieces of pottery were found in the pits. Some of the pits had stone or clay ovens and a grinding-stone was found in one pit. The early phase I of the Neolithic at Burzahama did not yield any burial sites.

Phase II c.2000 B.C.

During this phase, the Neolithic people of Burzahama started to live in mud huts at ground level. The pits were filled up and plastered with mud and sometimes covered with a thin coat of red ochre to serve as a floor. Stone and bone tools with a better finish compared to the earlier ones were discovered. The pottery was generally hand-made shiny black pottery. A red wheel-made pot filled with 950 beautiful beads made of semi-precious stones was discovered at the site.

Many burials of this phase were discovered, usually under house floors or in the compounds. Red ochre was smeared on the bodies before burial. Apart from human burials, animals were sometimes buried along with humans or in separate graves. The buried animals included wild animals like wolves, ibex and antlered deer and domesticated animals like dogs, sheep and goats.

Scientists have identified seeds of wild and cultivated types of wheat, barley and lentils of different kinds found at Neolithic levels of Burzahama.

Megalithic Phase III

The Megalithic period is associated with the setting up of menhirs or single standing stones, which can still be seen in Burzahama. The pottery was fine-to-medium red-ware mostly made on the potter's wheel. Bone and stone tools were gradually discarded in favour of copper tools. Rubble structures of this Period have also been found.

Early Historical Phase IV

Mud-brick structures at the site reveal that the site was occupied up to the early historical period. The pottery was fine-to-medium red-ware mostly made on the potter's wheel. Iron objects have been found belonging to this period.