The following article is adapted from a letter written by guide John Van Nostrand to climbers heading to Aconcagua, and is based on John’s many years of experience not only in guiding, but also in healthcare in and out of the hospital setting. While we hope his advice serves you well, please seek medical advice from your healthcare provider prior to following the advice of this article or any other.
General Med Kit Pointers
Overall, your personal med kits should be pretty basic. Outside of personal prescriptions and a few over-the-counter medications, the main thing you will need are supplies to treat hot spots and blisters. As you are getting your personal first aid kits ready for the mountain, here are a few considerations. This is by no means a comprehensive list of what you need.
Please discuss all medication below with your primary care provider. I highly recommend a travel consultation with a provider familiar with the area and a provider that is experienced in high-altitude illness. These recommendations do not take into account individual allergies or contraindications to medications you may be taking, so it is especially important to speak with your provider prior to taking any medications.
Hot Spots & Blisters
I like to use a tape called Leukotape for hot spots if the skin is not broken. Leukotape sticks to skin better than anything else including duct tape and can be easily ordered or found at a pharmacy or drug store. Get the brand name stuff! Have a few alcohol pads to clean the skin with first. One roll of Leukotape will go a very long way, so every person does not need their own roll. Have a small pair of sharp scissors that will cut it.
If you have a blister, I recommend a blister-specific pad covered with a piece of Leukotape. Leukotape should not be applied directly to broken or blistered skin. Plan to have a small supply of blister treatment supplies in the top of your pack so you do not have to empty your whole pack on the trail to treat a hot spot. General blister treatment kits are usually sold with blister pads and alcohol prep pads for sanitizing skin you will cover.
Don’t worry if you aren’t brushed up on altitude illness, we will do a full lecture on it early in the trip. However, I do want climbers to have the right medications in the right dosages and quantities. Editor’s note: one benefit of guided travel in the mountains is the opportunity to learn from decades of experience in subjects like high-altitude medicine!
Diamox (Acetazolamide): For our purposes, Diamox can be used for Acute Mountain Sickness (AMS) prevention and treatment. Diamox is a weak diuretic so please don’t worry about the feared self-limited side effect of dehydration. Bring breakable 250mg tablets, which are breakable (or a smaller dosage if available) and not the 500mg capsule. We will talk much more about this later. I would recommend at least 15 days’ worth. Editor’s note: Diamox can serve a variety of purposes if you are able to take small dosages at a time. 250mg tablets can be split into 125mg or 60mg segments, which means that a user can gradually start taking Diamox. 500mg capsules cannot be split, and require the user to take a large amount of Diamox or nothing at all! In expedition climbing, it is always advantageous to have flexible options for treating medical issues like high-altitude illness.
Ibuprofen: NSAIDs (non-steroidal anti-inflammatory drugs) have an amazing role in high altitude medicine. (Some studies have shown it to be as effective as Diamox in acute mountain sickness prevention and treatment. If you do not have medical contraindications to Ibuprofen, you bring a large supply of it.
Dexamethasone and Nifedipine are emergency high altitude illness medications with serious side effects including psychosis, sleep disturbance, and dangerous drops in blood pressure respectively. These are not routine medications for AMS!
I will have a pulse oximeter. You do not need your own. Cheap pulse oximeters can be inaccurate, not work well in the cold, or on cold extremities. Readings can cause fear and anxiety among climbers who are doing just fine. Editor’s note: pulse oximeters measure blood oxygen saturation and heart rate. They give excellent information on how well the body is acclimating only when used properly, so we recommend leaving pulse ox use to those with specific training.
Most people with traveler’s diarrhea do not need to be evacuated unless one has high fevers, severe abdominal pain, bloody diarrhea, and vomiting. At some point on the trip we will all have an upset stomach. Water hygiene, fluid replacement, and good hand washing are our primary treatments. Most illnesses will only last a few days.
Pepto Bismol: Pepto Bismol treats a variety of abdominal symptoms and is a great medication for travelers’ diarrhea. It is also has some antimicrobial features and it can save you from a course of antibiotics which can do more hard then good. I strongly recommend 20-30 Pepto Bismol tablets.
Probiotic: I will be taking a probiotic 2 times a day while on the trip.
Antibiotics: Most cases of traveler’s diarrhea do not require antibiotics. If you want to bring antibiotics that is fine. Reasonable choices include Azithromycin or a fluoroquinolone such as Levofloxacin or Ciprofloxacin. Note that fluoroquinolones are associated with multiple adverse reactions including tendon rupture!
Imodium: In general it is best to let diarrhea run its course. But, Imodium can be useful in settings without a close bathroom, such as on a plane or an extended bus ride.
Ondansetron (Zofran): A handful of orally dissolving Zofran (ondansetron) for nausea can be useful especially as nausea is a very common effect of altitude, new foods, and/or stress due to climbing expeditions.
Over-the-Counter Pepcid: If you are prone to reflux or heart burn, Pepcid might help an upset stomach.
Tums: Cheap, easy and effective.
Constipation: In general, I have not seen many get constipated my trips. But, I have seen folks who are afraid to use the bathroom and/or not staying hydrated develop issues. If you are prone to constipation bring over-the-counter medications such as Senna or a glycerin suppositories.
Aches & Pains: NSAIDs and Acetaminophen are the go-to agents for mild pain.
Narcotic Analgesics: Hydrocodone and their opioid cousins depress your respiratory rate! Not a good idea at altitude. Along those lines benzodiazepines (narcotic controlled muscle relaxers, “benzos”) also cause respiratory depression along with cognitive impairment and many other side effects. Thus, these are not appropriate at altitude on a routine basis.
Salonpas or Lidocaine Pain Patches: Both of these are incredibly safe if you do not have a contraindication to any of the agents in them. Wearing them at night might help you rest if you have a muscle ache or pain that would otherwise keep you awake.
Insomnia: Bring more ear plugs then you think you’ll need. Between your tent mate, the wind, and other climbers it can be surprisingly loud to sleep in the mountains.
I do not recommend starting a controlled insomnia agent on the trip. Consider bringing Melatonin only. As with narcotics, I do not recommend any sleep medication that may depress your respiratory rate and lead to poor acclimatization. Editor’s note: while it may seem best to “sleep at all costs” on expeditions, most sleep aid drugs depress the respiratory rate. This decreases your blood oxygen saturation, and the body requires oxygen to heal, recover, and rest well. The best sleep-training method for big mountain expeditions is practice – backpack, camp, or climb to train your body to sleep well in a sleeping bag and on a sleeping pad before tackling a 3-week expedition.
Fighting the Bonk: Since I keep some energy gels in my first aid kit, I want to talk about quick-energy products. Many people seem to have an aversion to them. However, I would recommend in the next few weeks while you train you use what every energy gel type products you plan to bring so you get used to the texture, taste, sweetness etc. What I have found is when climbers “bonk” at altitude, their stomachs are usually also upset. When they try an energy gel for the first time in the heat of the moment at 20,000 feet, they just spit it out! So – find one you like and incorporate them into your training. Editor’s note: “bonking” happens when you push your body too far physically with insufficient calories to power it. Most have experienced it, whether during a marathon, on a long bike ride, or after a long hike where the snacks ran out. Keeping your body fueled regularly eating is the best way to prevent bonking, and remember that the summit is only halfway! Keep eating even on the descent from any summit.