On thin air

One of the things I take great pride in with regards to my travel habits is the level to copy-of-steven-j-strommer.JPGwhich I preplan for certain contingencies especially those which will hopefully safeguard myself and my companion in the event things suddenly go pear-bottomed.

The usual things like travel insurance, first aid kit, flashlight with extra batteries, camera, and copies of important documents like flight tickets and itinerary and contact numbers for those at home and in country. Certainly passport information would seem like a proverbial “No brainer”. This is especially true in places where the normal course of life tends toward routine chaos due to civil instability or simply this most fundamental institution of civility termed infrastructure and the intrinsic lack thereof.

While the phrase “Shit happens” has more than just a firm grasp on reality (more like a stranglehold) there is often a jaw dropping lack of respect for this all to often sucker punch type of reality check. When it’s most inconvenient, and cruelly compromising, when we tend to be at our most vulnerable, when unfortunately one couldn’t possibly be any farther from home, their friends, and their most influential and most powerful of assets, cold hard cash, that’s invariably when “Shit happens”.

This played out in front of me most recently in the check in counter at the airport in Lima Peru. While my companion and I waited in line, a twenty something young man with a panicked, not to mention outright desperate demeanor that attracted everyone’s (security included) attention stated to the counter clerk unabashedly and for everyone around to hear “I was robbed last night in a taxi cab and they stole everything from me even my passport!” This was in the predawn hour of about five in the morning so it was very possible the cruel irony was that very same taxi might have dropped him off at the airport as one last gesture of local hospitality. It was obvious that this young man was out I’d suppose having one last night on the town and then planned to fly out early the next morning as we all were, instead somehow he had been dealt a bad hand on this particular evening, and so what’s the point of this little soliloquy? Shit happens, and while it’s all too easy to be an armchair (or inline in this instance) critic, I couldn’t help as a very first thought to myself say “ He didn’t make copies of any these documents?” doesn’t everyone do this? Well apparently not, at least in this case. Maybe they stole the copies too. I doubt that would be likely though because only the original would have any intrinsic value. Whatever the case I did see the guy, looking either hung over or harried most likely a combination of both on the plane ride back to Miami, so whatever beneficence they were able to work out at the check in counter it at least got him on the plane, but in our post 9/11 era I have my doubts that his ordeal was over as he still had US customs and immigration to deal with in Miami.

What does this have to do with the title of this article though? Actually not very much, except for the main idea that no matter how much we prepare, research and strive to stave off any circumstance that we might be dealt while traveling abroad, there will in fact usually be something contrary to our wishes that will occur. It can range from the most obvious to the most sublime, but at some point during our adventure, holiday or vacation, it will have you either scratching your head (or something else) or perhaps even smacking it saying “Duh why the hell didn’t I think of that?”

This too was the case recently for me while in Peru, though arguably and fortunately it was of minor consequence unlike the aforementioned gentleman, and in the fact it was somewhat indelicate, it turned out kind of humorous in a sophomoric kind of way.

Peru is known for lots of things potatoes, llamas, Pisco, cocaine and most obviously Machu pichu but the one aspect of the country that preoccupied me most before departure was the altitude of many of the places we’d be and the potential effect it may have on us and how it may impact us during the trip. I poured over the web and asked questions on internet forums, questioned health care professionals that I know and got a wide variety of information that if I may sum it up simply stated was “It affects everyone differently, there’s an approach to minimizing it’s effect and if your not careful you might get sick and could potentially die.” In a way this was somewhat disconcerting because you’re hearing everything from “You’ll be ok” to “It was horrible and I was sick as dog for days and almost died”.

I was going to cover all the bases as best I could because usually in these situations I tend to worry more about my companion than myself, and seem to always develop a worse case scenario where I will have to be the functional one taking care of the other individual, so if this scenario happens at least one of us will be ok and I’d rather it be me.

I started taking my course of medication (Diamox) and despite all the negative affects that I was told it would cause (look them up yourself) and because of course my partner couldn’t take it due to a sulfa allergy (that would figure of course, wouldn’t it?) plus I had quit smoking a few months previously so I figured I should be good to go, even then though some people told me that even that lifestyle change might not matter much. I planned on drinking coca tea which was of course is the holistic local remedy for minor cases of altitude symptoms. I figure I pretty much had all the bases covered right? Wrong.

It didn’t take long for the symptoms to start to make their presence known. The short walk across the tarmac from the plane to the baggage claim of the Cuzco airport was all the time it took. No problem breathing for me just a tad lightheadedness and everything looked bright and shimmering. My companion though was laboring and made sure to let me know in no uncertain terms this was the case.

We would experience varying degrees of this during our stay and strangely enough the there really wasn’t too much acclimation. There was one point outside of Cuzco at the ruins of  “Sexy woman” or some such that my partner was really hurting but a sweet tamale and some fluid went a long way in providing some comfort. Regularly we’d wake up during the night gasping for breath after falling asleep, it was then our limbic brain would take over. During the day while awake it was easy to regulate activity, while asleep that function was left to this area of the brain.

These symptoms where easy to deal with and were in fact expected, it was the unexpected ones, the ones that weren’t in the guide books or the travel web sites that were the most uncomfortable and disconcerting. By the time we had gotten to the hotel and I was sitting down to my very first cup of coca mate was when I felt my whole lower gut make a quarter turn to the left. I thought this was curious, as I had only had a light breakfast due to the early flight and the need for an even earlier arrival to the Lima airport. While I could feel this change occurring and I was trying to pretend to be listening to everything our guide was telling us, not to mention in his thickly accented unreasonably fast speech not helping, I suddenly felt like I had something the size of a football lodged in my gut that needed immediate expelling. Very strange that’s for sure, I’m usually pretty attuned to my body and rarely suffer any GI disorder when on the road, but this wasn’t the usual quickstep type thing we all dread. This was something different. Finally Ruberio finished his litany of information he felt mandated to subject us to, and also at that very moment our room was ready. We were told to rest a few hours to acclimate. It couldn’t have come a moment too soon as I felt ready to explode. I made a beeline right to the bathroom and prepared for the worst.

I’ll spare you any graphic details not because I’m kind, but mostly because there weren’t any. As with any gas at altitude it expands and that’s just what had happened to us. My companion probably stated it best “This is not a trip for people who are just starting to get to know each other.” especially if they are prone to being shy about bodily functions around strangers or the other gender. We were able to derive great entertainment and laughter out of it all. It was rather indelicate at times in public places all depending of course on how much you care about the sensibilities of others.

While this should have just been common sense and easy to figure out beforehand, and while I read and read all about altitude and it’s effects on us not one place or with one person I read or spoke with did I get one clue about this harmless yet very unsubtle symptom. This will allow me to give you all the one little gem that I wasn’t able to glean for myself anywhere except through personal experience:

Pack some Simethicone; you’ll be glad you did.

  6 comments for “On thin air

  1. P. David Mozley, M.D.
    December 26, 2007 at 2:14 am

    Flatus is an evitable consequence of good health. Most humans pass gas per rectum an average of 10 times per day (see the Merck Manual at http://0-www.merck.com.mill1.sjlibrary.org/mmhe/sec09/ch119/ch119b.html). Bowel gas can be a complex solution of many substances, but it is composed predominantly of carbon dioxide (which is inert) and methane (which makes it flammable). These two by-products of efficient metabolism are colorless and odorless. It’s the other aromatic skatols dissolved in them that are, shall we say, notable.

    The amount of notable substances in flatus can be reduced by taking tablets containing chlorophyll or charcoal. While estimates vary, it might be useful to think of these treatments as requiring lead times of at least 24 hours before producing benefits.

    Relatively long lead times are also useful for simethicone, aromatic oils, and other anti-foaming agents. As a consequence of their anti-foaming action, people feel less “gassy”, or bloated. But, their ability to burst foam bubbles doesn’t mean they reduce the gas that must be eliminated. In fact, with the exception of some carbon dioxide that can diffuse into the blood and then be exhaled through the lungs, they don’t. That is, there is no scientific evidence or theory to suggest that antiflatulents reduce flatulence. As a consequence, starting these anti-foaming treatments shortly before, or upon, arrival should actually make the problem worse.

    As Mr. Strommer alluded to, a sudden drop in barometric pressure can also lead to the bursting of foam bubbles (pressure times volume equals a constant, so if pressure drops, the volume of the gas in the bubble must increase). Maneuvers that slow GI transit reduce the problem by decreasing the rate at which gas is delivered to the exit, while anything that speeds motility will make it worse.

    Drinking coca tea exacerbates the situation by manipulating the same regulatory systems that leads to colonic inertia in patients with Parkinson’s disease. Dopaminergic stimulation of the gastrocolic reflexes by coca tea starts in the stomach antrum. This makes the effect on the colonic motility relatively rapid, and tends to ensure that the people who pass out this tea in the airport get their just desserts.

    Interestingly, most of the other things that physicians seem fond of advising people to do for their alimentaric health also exacerbate the problem. Yogurt, fiber containing foods, and physical exercise are all going to increase gastric motility and thereby makes things worse.

    Although a number of medications slow GI transit, the most reliable and cost effective drug on the market today is whiskey. Peppermint schnapps and crème de menthe contain natural carminatives that prevent gas buildup. So while there is no scientific evidence to support my professional advice, from the rules of Aristotelian logic it would seem to follow that the best thing one can do before heading to a high country is drink plenty of minty whiskey. Even if I’m wrong about the pathophysiology, then making sure your travel mates drink plenty of flavored whiskey should palliate the morbidity described by Mr. Strommer.

  2. als
    January 4, 2008 at 6:40 pm

    very nice advice P. David. And now a little advice re the inevitable hangover to follow might be in order. I.e. puke or not, etc.

  3. January 7, 2008 at 2:15 pm

    Definately puke, you don’t need an MD for giving that advice just and ex drrinker’s advice ;-))

  4. J.R.Arters
    February 21, 2008 at 5:03 am

    Gee whiz I get flatulence enough at sea-level.
    Maby thats how Andes Mints came about.

  5. February 21, 2008 at 11:23 am

    Spook!

    lol Funny about the Andes mints never thought about that in the context of Dr.Mozley’s advice, interesting observation and it probably has some holistic merit 😉

  6. Profile photo of Steve Strommer
    August 31, 2010 at 1:28 pm

    I’m EXTREMELY glad you found something useful out of the post Kim!
    I’ts the main reason I enjoy putting whatever info I think might be of use to someone out here and I feel really lucky the guys at Polo’s Bastards allow me to do so.

    Best,
    Stiv

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