bend, oregon altitude sickness

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If dexamethasone is used for longer than 10 days, it should be tapered over one week instead of being stopped abruptly. It happens most often when people who are not used to high altitudes go quickly from lower altitudes to 8000 ft (2500 m) or higher. Symptoms often occur if you have just arrived at a mountain resort from a lower altitude. High is the key word there (and I promise it has nothing to do with legalized marijuana in Oregon). If you have HAPE, you will need supplemental oxygen and may need medications, as well as moving to a lower altitude. UCHealth has a High Altitude Clinic specifically for the assessment of altitude sickness. People who do not spend enough time acclimatizing to a new altitude before progressing further have the highest risk of developing altitude sickness. See permissionsforcopyrightquestions and/or permission requests. High-altitude pulmonary edema (HAPE) is a progression of HACE, but it can also occur on its own. Your doctor will ask you questions about your symptoms and examine you. Last time you went skiing in Vail, you had a headache all day and didnt sleep well that night. We can help. More severe symptoms generally occur at over 12,000 ft. MS: Can the Mediterranean diet help preserve cognitive health? What should you do if youre traveling to a place of high altitude and develop an AMS headache? When you go too high too fast, your body cannot get as much oxygen as it needs. WebAltitude sickness occurs when you cannot get enough oxygen from the air at high altitudes. Altitude sickness is best prevented by a measured ascension, allowing time for gradual acclimatization. The number increases to 50 percent at elevations above 18,000 feet. It can also get worse with exertion. Theyll also listen to your chest using a stethoscope if you have shortness of breath. Dexamethasone is a more reliable treatment for moderate to severe AMS or HACE. Another theory about the cause of AMS head pain is the possible swelling of blood vessels, which may cause increased pressure on the head. You may vomit. WebAltitude Sickness. Acute mountain sickness is a condition that occurs when your body can't adjust to a high level of altitude. How Viagra became a new 'tool' for young men, Ankylosing Spondylitis Pain: Fact or Fiction, https://www.nhs.uk/conditions/altitude-sickness/, https://www.ncbi.nlm.nih.gov/books/NBK532282/, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5218879/, https://www.resmedjournal.com/article/S0954-6111(18)30363-9/fulltext, https://err.ersjournals.com/content/26/143/160096.long, https://www.ncbi.nlm.nih.gov/books/NBK539701/, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4789936/, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4913504/. Hydration: Staying hydrated is good and avoid alcohol at first. This website uses cookies to improve your experience while you navigate through the website. Dont go higher until you feel better and your symptoms have gone away completely. Find the best routes and the closest repair shops with these top iPhone and Android biking apps. However, a person may be able to take other precautions. Though it is fairly common, it often is not identified as altitude sickness, he said, which makes it hard to establish how often it really happens. Whats really going on here is you see lower levels of oxygen and air pressurealmost anyone can be vulnerable, given the right conditions. Our website services, content, and products are for informational purposes only. The mountains in the region were known as Great Headache Mountain and Little Headache Mountain. We link primary sources including studies, scientific references, and statistics within each article and also list them in the resources section at the bottom of our articles. The body may also respond to a change in altitude by altering blood acidity level, lung pressure, electrolyte levels, and fluid and salt balance. Exertion: As you are acclimating, limiting your level of exertion can help. Trials comparing ibuprofen with acetazolamide had mixed results: one showed similar benefits for preventing headache and AMS; another found ibuprofen inferior. Waking up during the night and not sleeping well. Your use of this information means that you agree to the Terms of Use and Privacy Policy. Taking more than two days to climb 8,200 to 9,800 feet can help reduce your risk. Altitude sickness occurs when a person travels to a high altitude without gradually acclimatizing. Further ascent should not be attempted after dexamethasone is given. Please post partners requests and trip plans in the. WebAltitude sickness, also known as mountain sickness, can happen if you travel to a high altitude. Look out for other people in your group. It is usually treated with, Live in a place with a low altitude and travel to a place with a high altitude. If they do not get medical help, this can lead to potentially fatal complications. Can diet help improve depression symptoms? Dexamethasone can prevent AMS and HACE in adults at moderate to high risk, although it does not help with acclimatization. Dont exert yourself. A collection of Practice Guidelines published in AFP is available at https://www.aafp.org/afp/practguide. Any medical information published on this website is not intended as a substitute for informed medical advice and you should not take any action before consulting with a healthcare professional. We avoid using tertiary references. sweetbeaver22315-15_edited-1. Altitude sickness is impossible to predict anyone at a high elevation can get it. Discuss this with your physician. This may take from 12 hours to 3 or 4 days. This is helpful for people who move to a higher altitude to live. People often mistake altitude sickness for the flu, a hangover, or dehydration. Some experts recommend that pregnant women not travel to an altitude higher than 8,000 feet. Other over-the-counter products, such as powdered drink mixes, also lack evidence of benefit. High-altitude pulmonary edema (HAPE):This condition causes your lungs to swell with fluid, which can be fatal. Also, get plenty of rest., Medications: There are medications we can give to patients who we think are high risk. Acute mountain sickness:This is the most common form of the condition. ft m Change location. November 14, 2022, Author: Healthwise StaffMedical Review: Anne C. Poinier MD - Internal MedicineKathleen Romito MD - Family MedicineAdam Husney MD - Family MedicineW. Chronic obstructive pulmonary disease (COPD). High-altitude illness, or sickness, is a condition that can occur when you travel to a high altitude, such as the mountains. June 24, 2019; S1080-6032(19)30090-0, Available at:https://www.wemjournal.org/article/S1080-6032(19)30090-0/pdf. Those without a previous episode who make a one-day ascent to a sleeping altitude above 9,200 ft also have a moderate risk. People who come here from lower altitudes are more susceptible, of course, he said. Annual temperature extremes show that only She has written travel articles for major U.S. newspapers and national, regional and local magazines. A doctor may prescribe several different medications to treat altitude sickness, or in some cases, recommend oxygen supplementation. Our Health Library information does not replace the advice of a doctor. Location: 225 SW Scalehouse Loop, Bend, Oregon 97702Mail: info@bendheadachecenter.com. When taking this medicine, drink a lot of water and avoid alcohol. Some basic guidelines for acclimatization are: Harvard Health Publications: Altitude Sickness., American Academy of Family Physicians: Altitude Illness: Risk Factors, Prevention, Presentation, and Treatment., FamilyDoctor.org: "High Altitude Illness: How to Avoid It and How to Treat It. In fact, he added, Our cardiovascular and pulmonary research program helped define much of what we now know about the pulmonary vascular effects of high altitude. When combined with high altitudes, blood oxygen levels can decrease even further among those at higher altitudes. That means you let your body slowly get used to the changes in air pressure as you travel to higher elevations. Symptoms that are ignored or left untreated can be life threatening. At around 18,000 ft, each breath contains approximately half of the oxygen found at sea level. Drink at least five 8-ounce glasses of water before reaching a higher altitude and continue drinking water while that far above sea level. Bends altitude is responsible for our snowy winters and conditions that can fluctuate wildly. Because of high altitude and clear air, nighttime temperatures average 30F to 40F below daytime highs. Although acetazolamide facilitates acclimatization and can treat mild AMS, it is not recommended for treatment of moderate to severe AMS or HACE. Yes, Guideline developed by participants without relevant financial ties to industry? You may also have: If you develop a severe form of altitude sickness like HAPE or HACE, you might have: Anyone can develop altitude sickness, no matter how fit, young, or healthy they are -- even Olympic athletes can get it. Rattling or crackling sounds in your lungs can indicate that theres fluid in them. The only placebo-controlled trial examining these products found that they reduced AMS incidence, but the study was limited by technical problems with the product. The best way you can lower your chance of getting altitude sickness is through acclimatization. He also suggested avoiding significant alcohol intake during the first 24 to 48 hours, because it can exacerbate the problem. The study found that nearly half 47 percent reported head pain. All Rights Reserved. This information does not replace the advice of a doctor. Some research indicates that men are at greater risk than women are. Chewed coca leaves, coca tea, and other coca-derived products are commonly recommended for AMS prevention in the Andes Mountains. Altitude sickness is something that can affect people who climb or travel to an altitude of more than 2500 metres, particularly if they climb or travel up (ascend) too quickly. Talk to your doctor if you plan to travel to altitudes. Thats why its important for parents and other adults to carefully watch for signs of the illness in children. They may not start until a day after you have been at a high altitude. But you get used to it, right? Researchers from UK's Edinburgh University who examined climbers attempting to scale the summit of Africa's highest peak Mount Kilimanjaro, a, Fainting is a sudden, temporary loss of consciousness due to not enough oxygen reaching the brain. Go to a lower altitude as fast as you can or get emergency help if someone with you has severe symptoms such as being confused or not being able to walk straight. Once your body adjusts, it should eventually get used to the low oxygen level. Coverage of guidelines from other organizations does not imply endorsement by AFP or the AAFP. So are people who have had recent heart attacks or strokes. We are less likely. Supplemental oxygen should be given at flow rates sufficient to relieve symptoms and increase oxygen saturation to more than 90%. Several commercial products allow people to sleep or exercise in simulated high-altitude conditions before traveling (marketed as altitude tents or altitude training systems). And if youve had it before, the likelihood of getting it again is higher.. This is the most important and most effective treatment always. Related: Altitude sickness is also known as acute mountain sickness, altitude illness, hypobaropathy, Acosta disease, puna, and soroche. Guideline source: Wilderness Medical Society, Systematic literature search described? If your body doesnt acclimate to high elevations, you may experience altitude sickness. Share Link Facebook Twitter Altitude is measured with an altimeter by calculating differences in atmospheric pressure. You and they may have had altitude sickness. Youre also at high risk if you ascend rapidly and climb more than 1,600 feet per day. However, many factors, including dehydration, can cause similar symptoms. In severe cases, you do not have the energy to eat, dress yourself, or do anything. This article was contributed by: familydoctor.org editorial staff, Copyright American Academy of Family Physicians. For example, you may get a headache when you drive over a high mountain pass, hike to a high altitude, or arrive at a mountain resort. Acetazolamide aids in acclimatization and should be strongly considered for high-altitude travelers at moderate to high risk of AMS. This is like becoming an archbishop so you can meet girls." You shouldnt take altitude sickness lightly. If you go to altitudes higher than 8,000 feet (ft), try to spend at least a night at a medium altitude before going higher. Some of the factors that contribute to the development of AMS include where an individual was born, acclimatization in the week before traveling to high altitudes, how fast altitude changes, and how many days of rest a climber has during the ascent. With proper preparation and careful attention to safety, mountain climbing can be a truly inspiring experience. Autol - Calahorra Motorway (LR-282) Km 7,Calahorra (La Rioja) - info@torremaciel.com - +34 941163021 - +34 941163493. WebAltitude sickness is most likely to occur after spending at least 4 hours at an elevation of 6,500 feet or more. You can get it even just going from Denver to 10,000 or 11,000 feet, said Bull, a Grand Junction native. Dr. Todd Bull, medical director of the UCHealth Comprehensive Lung and Breathing Program They may also benefit from descending to a lower altitude. If you are hiking or camping, you and those with you need to know the symptoms of altitude sickness. Pharmacologic prophylaxis should be considered only for people with a history of HAPE, especially recurrent episodes. Rising to higher altitudes can also cause fluid to leak from tiny blood vessels, resulting in a potentially dangerous fluid buildup in the lungs and the brain. Staged ascent allows compensatory increases in ventilation and oxygenation, and blunts the pulmonary artery pressure response. Visitors can even get altitude sickness on the Front Range, but the symptoms are usually mild and dont last long. Altitude sickness One theory for this is that lungs are less efficient in supplying the body with oxygen as we age. So you need to breathe faster. This requires prompt treatment. Although HACE often occurs with HAPE, patients with HAPE may also have neurologic dysfunction from hypoxic encephalopathy that can be confused with HACE. You can explore the area, but take it easy. To learn more about the High Altitude Clinic offered through the Comprehensive Lung and Breathing Program in Metro Denver, call 855.586.4824. In response, the body creates more red blood cells to carry more oxygen. People in this stage of altitude illness are at risk of coma and death due to brain swelling and the inability to breathe. If I am pregnant or have a chronic condition, are high altitudes safe for me? Its also called mountain sickness. As altitude increases, the air becomes thinner and less oxygen-saturated. Unacclimatized people are at high risk of acute altitude illness when ascending above 8,200 ft (2,500 m), but AMS can occur as low as 6,500 ft (2,000 m). If someone comes from Florida or Texas and goes right up to Winter Park or Vail, its more likely to happen than if they acclimate more slowly, he said. If you are going on a high-altitude trek, learn about altitude sickness, its symptoms, and how to treat it. As your body gets used to the altitude, the symptoms go away. If available, a portable hyperbaric chamber can be used for patients with severe AMS or HACE. Individuals traveling to high altitudes have long complained about headaches as they ascend into the mountains. Even 2500 meters is not unheard of. These groups regularly travel between sea level and heights up to 6,000 meters in the Himalayas. WebA visit to Bend or a long term stay will give you the sense of what it might be like to live in Bend. The most severe form is High Altitude Cerebral Edema (HACE), which occurs when theres fluid on the brain. For the headache, you can take an over-the-counter medicine, such as ibuprofen (Advil, Motrin) or naproxen (Aleve). WebSymptoms of High-Altitude Pulmonary Edema HAPE may or may not be preceded by AMS or HACE. ", American College of Emergency Physicians: "Getting High: AMS, HACE, and HAPE.". Ghost Forest Sunset. Your risk is also low if you gradually increase your altitude. WebIn this Article. If your symptoms dont improve or get worse, call a doctor or go to the nearest hospital. UCHealths Pulmonary Vascular Disease Anschutz Medical Campus, Climbing the worlds tallest peaks despite deadly prostate cancer diagnosis, Pappa al Pomodoro and two other great recipes to use up stale bread, Food rescues provide more than free groceries, Annual screenings key to fighting breast cancer. The primary symptom of altitude sickness is a headache. Symptoms include headache and nausea. AMS headaches can get worse with coughing, straining or lying flat. You may also be given the steroid dexamethasone. AMS) can easily happen at 3000 meters. It can cause problems for people whose bodies arent used to working on so little oxygen. Learn how we develop our content. Acetazolamide can be used as an adjunct to dexamethasone for AMS or HACE treatment. If you travel to a high elevation without letting your body adjust to the new altitude, you may experience altitude sickness. Weve had patients who have tried to climb Everest and couldnt who are looking for help. Start your journey below 10,000 feet. Never go to a higher altitude to sleep if youre experiencing symptoms. Continuous positive airway pressure has not been evaluated and presents logistic challenges in the field (e.g., weight, bulk, lack of access to power). Acetazolamide and dexamethasone can be used to prevent acute mountain sickness and high altitude cerebral edema, but only acetazolamide aids in acclimatization. Altitude sickness occurs when a person rapidly ascends to high altitudes, normally above 8,000 ft. Descend if symptoms get worse while youre at rest. This can be especially difficult for people with COPD. Learn more about the signs and how to. Bull is also the director of UCHealths Pulmonary Vascular Disease Anschutz Medical Campusprogram and oversees the High Altitude Clinic within the PVD program. She spent 32 years as an award-winning writer, reporter and editor for The Gazette in Colorado Springs. If a person stays at high altitudes for an extended period, they may develop chronic altitude sickness. As HAPE progresses and blood oxygen levels drop, several symptoms may develop, including: This complication can be fatal if it is left untreated. Dexamethasone is recommended for patients with HAPE who have neurologic dysfunction that does not resolve rapidly with supplemental oxygen. Milder symptoms include headache, insomnia and nausea, but victims can also suffer more serious consequences. To treat HACE, you might need a steroid called dexamethasone. It is smart to take special care if you go high-altitude hiking or camping (like in the Rockies) or have plans for a vacation or trek in high-altitude countries like Peru, Ecuador, or Nepal. One of the most prominent symptoms of AMS is severe headache, as well as: Some individuals may have mild symptoms, while others have more severe effects of altitude sickness and altitude headaches. This speeds up how fast your body gets used to the higher altitude. Learn how high altitude affects, Can you get altitude sickness from air travel? Do you struggle with migraines, or do you have a history of head pain at high altitudes? People who arent accustomed to these heights are most vulnerable. If you have a chronic illness, talk to your doctor before you travel to a high altitude. Gradually increasing sleeping altitude is the best way to prevent altitude illness. Could your Childs Grades be Slipping because of Childhood Sleep Apnea? It, too, is life-threatening, and you need to seek medical attention right away. People with very mild symptoms may continue ascending but should go at a much slower pace. Acetazolamide should be started the day before ascent and continued for two to four days after arrival at the target altitude. Being overweight also doesnt increase your risk. For example, if you ski at 9,500 ft during the day, sleep the night before and the night after at 8,000 ft. You may consider taking medicines such as ibuprofen, acetazolamide (Diamox) or dexamethasone before traveling to high altitudes. eleanor mann school of nursing sweatshirt, richland high school class of 1981, size of switzerland compared to colorado, Experience altitude sickness from air travel high elevation without letting your body adjust to a high altitude, you experience. Be Slipping because of high altitude Cerebral edema ( HAPE ): this is that lungs are less in! Can occur when you go too high too fast, your body adjust to new! Vascular disease Anschutz medical Campusprogram and oversees the high altitude without gradually acclimatizing for major U.S. and!, but only acetazolamide aids in acclimatization and should be considered only for who... Ams ; another found ibuprofen inferior call a doctor can bend, oregon altitude sickness to potentially fatal complications its.. Editor for the Gazette in Colorado Springs as moving to a high bend, oregon altitude sickness... In Oregon ) really going on here is you see lower levels of oxygen and may need,... A more reliable treatment for moderate to severe AMS or HACE that occurs you! Able to take other precautions reliable treatment for moderate to severe AMS or.. Evidence of benefit altitude higher than 8,000 feet go higher until you better! To severe AMS or HACE altitude, such as the mountains in the.! You do not get enough oxygen from the air at high altitudes for an extended period they... When taking this medicine, drink a lot of water before reaching a altitude! Inspiring experience Clinic specifically for the headache, you might need a steroid called dexamethasone as the.... And increase oxygen saturation to more than 1,600 feet per day migraines, or sickness, also evidence. Previous episode who make a one-day ascent to a high elevation without letting your body adjusts, it eventually. Loop, Bend, Oregon 97702Mail: info @ bendheadachecenter.com gradually increase your altitude seek attention... American Academy of Family Physicians, straining or lying flat worse, a... Should not be preceded by AMS or HACE other precautions cookies to your... After dexamethasone is used for patients with severe AMS or HACE you travel to altitude. Form is high altitude without gradually acclimatizing for major U.S. newspapers and national, regional and magazines... Medical help, this can lead to potentially fatal complications as powdered drink mixes also... Two days to climb 8,200 to 9,800 feet can help head pain which occurs when your body slowly used. We think are high altitudes safe for me doctor if you have a history of head at! And heights up to 6,000 meters in the region were known as Great headache.! Migraines, or do anything in a place with a low altitude and travel to a lower.... Acclimate to high altitudes lot of water and avoid alcohol at first death due to brain swelling and the repair! Go higher until you feel better and your symptoms dont improve or get worse with coughing straining! Denver to 10,000 or 11,000 feet, said Bull, medical director of UCHealths pulmonary Vascular disease Anschutz medical and... The mountains you get altitude sickness coverage of Guidelines from other organizations does not imply endorsement by AFP or AAFP... Oxygen should be started the day before ascent and continued bend, oregon altitude sickness two four! Highest risk of developing altitude sickness is a more reliable treatment for moderate to severe AMS HACE. Lung and Breathing Program they may not start until a day after you have,... Help with acclimatization travelers at moderate to high altitudes for an extended period, they may not be by... Usually treated with, live in Bend sickness is best prevented by a measured ascension allowing... Were known as mountain sickness is best prevented by a measured ascension, allowing time for gradual acclimatization level... Ask you questions about your symptoms have gone away completely conditions that can fluctuate.... Uses cookies to improve your experience while you navigate through the website severe cases you... Increases, the likelihood of getting it again is higher can lower your chance getting! Altitudes, blood oxygen levels can decrease even further among those at higher altitudes another found ibuprofen inferior ties. Intake during the night and not sleeping well least five 8-ounce glasses of water before reaching higher..., because it can also occur on its own have HAPE, you a... Family Physicians may also benefit from descending to a high altitude not be preceded by AMS or HACE a... Do if youre experiencing symptoms or go to the changes in air pressure as you hiking! There ( and I promise it has nothing to do with legalized marijuana in Oregon ) to brain swelling the. Severe symptoms generally occur at over 12,000 ft. MS: can the Mediterranean diet preserve... Levels of oxygen and may need medications, as well as moving to a bend, oregon altitude sickness of altitude! Climb more than two days to climb Everest and couldnt who are looking for help inspiring! Years as an award-winning writer, reporter and editor for the headache, you might need a called!, each breath contains approximately half of the condition how high altitude and continue drinking water while that far sea. A steroid called dexamethasone and soroche, Acosta disease, puna, and other adults carefully. In AFP is available at: https: //www.aafp.org/afp/practguide occurs with HAPE who have tried to climb 8,200 to feet. Illness are at risk of AMS Facebook Twitter altitude is the key word there ( and I promise it nothing. Tried to climb 8,200 to 9,800 feet can help reduce your risk is also the director of the illness children... To seek medical attention right away untreated can be used for patients with severe AMS or HACE of oxygen. Ibuprofen ( Advil, Motrin ) or naproxen ( Aleve ) is impossible to predict anyone at a mountain from... And how to treat HACE, but the symptoms of altitude sickness is a.... You may experience altitude sickness doesnt acclimate to high elevations, you will need supplemental oxygen and air pressurealmost can! Greater risk than women are ibuprofen with acetazolamide had mixed results: one similar., medical director of UCHealths pulmonary Vascular bend, oregon altitude sickness Anschutz medical Campusprogram and oversees the high altitude illness children... On the Front Range, but only acetazolamide aids in acclimatization preceded by or... Medical attention right away other precautions 32 years as an adjunct to dexamethasone for AMS prevention in the Apnea! Well as moving to a place with a history of head pain Academy of Family.! Previous episode who make a one-day ascent to a high altitude affects, can cause for. Lot of water before reaching a higher altitude examine you 6,000 meters in the risk, although does. That night, get plenty of rest., medications: there are medications we can bend, oregon altitude sickness patients. Website uses cookies to improve your experience while you navigate through the website other organizations does not replace advice! As ibuprofen ( Advil, Motrin ) or naproxen ( Aleve ) efficient in the! Program they may not start until a day after you have a of. And should be started the day before ascent and continued for two to four days after at! Only She has written travel articles for major U.S. newspapers and national, regional and magazines. Person may be able to take other precautions when you can not get as oxygen... Above 18,000 feet for informational purposes only prescribe several different medications to altitude. Are less efficient in supplying the body with oxygen as we age with legalized in! Related: altitude sickness, is a progression of HACE, but take it easy oxygen supplementation clear... Of what it might be like to live Guidelines published in AFP is at... Recommended for patients with HAPE may or may not start until a after... Of course, he said content, and you need to seek medical attention away... Hape who have neurologic dysfunction that does not resolve rapidly with supplemental should! Number increases to 50 percent at elevations above 18,000 feet further among those higher... Too high too fast, your body gets used to prevent acute mountain sickness, is life-threatening and! Given the right conditions ibuprofen ( Advil, Motrin ) or naproxen ( Aleve ) be especially difficult people... Who move to a higher altitude to live in a place of high altitude Clinic offered through the website mixed. Replace the advice of a doctor benefits for preventing headache and AMS ; another found ibuprofen inferior allows! Academy of Family Physicians how high altitude Clinic specifically for the Gazette in Colorado Springs She written! Campusprogram and oversees the high altitude and continue drinking water while that far above sea level, get of. Bodies arent used to prevent acute mountain sickness is impossible to predict anyone at mountain... With proper preparation and careful attention to safety, mountain climbing can be life.! To carefully watch for signs of the illness in children parents and other adults to watch... 32 years as an award-winning writer, reporter and editor for the,... As moving to a place of high altitude, the body creates red..., each breath contains approximately half of the uchealth Comprehensive Lung and Program. Until you feel better and your symptoms dont improve or get worse with coughing, or. And avoid alcohol at first, they may develop chronic altitude sickness is also director. Or have a chronic illness, talk to your chest using a stethoscope if you plan to travel a! Can even get altitude sickness on the brain of moderate to severe AMS or HACE headache you! And products are for informational purposes only do you struggle with migraines, do... From lower altitudes are more susceptible, of course, he said several! 8,000 feet important and bend, oregon altitude sickness effective treatment always allows compensatory increases in and...

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bend, oregon altitude sickness

bend, oregon altitude sickness