Altitude Illness: Prevention and Treatment. Stephen Bezruchka, M.D. Edited by Maureen O’Neill. The Mountaineers, Seattle, Washington. 93 pages. $6.95.
This compact primer has been designed to substitute for the smattering of information and notes on altitude illness that usually accompany climbers to high altitude. It addresses how the layperson may recognize and treat altitude illness in a variety of settings, from resort skiing to expeditioneering in the Himalaya. It also attempts to help people faced with altitude illness in their midst, make informed decisions concerning their predicament by describing different modalities of treatment/options available to them in a systematic fashion akin to a “decision-tree.”
Dr. Bezruchka’s book is well organized and consists of initial chapters that provide background information, a chapter each on diagnosis and treatment followed by chapters on a variety of topics. A useful feature of the book is the use of both feet and meters while defining elevations of locales as well as contact addresses for equipment manufacturers and physicians specializing in altitude medicine.
The background chapters cover a lot of ground and do a fair job at defining various types of altitude illnesses in easy to comprehend terms and analogies. While the book is not designed to be comprehenisve, I was somewhat surprised at some of the omissions in the book. For example, neither the syndrome of adult sub-acute mountain sickness (Anand et al. Lancet 1990) nor chronic mountain sickness (Monge’s disease) were discussed. A more serious omission (page 17) was that of an extremely important, well recognized and ominous sign of HAPE, namely haemoptysis (coughing up of blood-tinged sputum).
The chapter on diagnosis uses a framework and should prove useful to the layperson challenged with the problem of what conditions to consider if someone falls ill at high altitude. Hopefully, future editions will expand on this section and perhaps present some of the information in a flow-chart as well.
The chapter on treatment very correctly stresses descent as the treatment of choice for HAPE, and then lists most of the other modalities currently available. I felt that presenting treatments as a cafeteria menu of choices gave too much credence to newer treatments that have undergone only limited clinical evaluation, often with equivocal results (see Bartsh et al. BMJ 1993 on trials of the Gamow bag), while choosing to ignore established protocols (e.g., diuretics and morphine) that have proven effective in larger clinical studies. Furthermore, this section may actually confuse the reader (as it did this reviewer), on which of these treatments is most appropriate for HAPE. For example, on the subject of whether furosemide should be used for HAPE (page 76), Dr. Bezruchka states “Don’t (use it)” and then later in the same paragraph says “… faced with a serious case of HAPE, most clinicians who carry the drug will likely use it.” The concluding chapters contain useful case studies, question-answers and tables summarizing most of the book.
In conclusion, this book made enjoyable reading and may prove a useful addition to a high-altitude traveler’s backpack. However, given its current weight, c. 76.7 gm. (2.5 oz.), I believe future editions can be made more comprehensive without losing its weight-effectiveness.
Tejvir Singh Khurana, M.D., Ph.D.