Can Ibuprofen Fend Off Altitude Sickness?

Ama Dablam in NepalThe results of a new study could deliver good news for adventure travelers. According to an article published in the Annals of Emergency Medicine, the over-the-counter medication ibuprofen could be an effective agent in staving off the effects of altitude sickness such as nausea, headaches and fatigue.

The study was conducted in California’s White Mountains and featured 86 men and women who spent two days hiking at altitudes as high as 3381 meters (12,570 feet). Half the group was randomly selected to take four doses of 600 mg of ibuprofen over the course of the study while the other half – the control group – was given a placebo. At the end of the hike, 43 percent of the participants who took the drug reported that they experienced some symptoms of altitude sickness as compared to 69 percent of those who didn’t use the medication.

While the sample size for this study is small, the methodology behind it is strong. For instance, most of the hikers that participated live at or near sea level and all of them spent the night at 1249 meters (4100 feet) before starting their trek. They took their first dose of ibuprofen about six hours before they started hiking and then drove up to 3566 meters (11,700 feet), where they took a second dose as they hit the trail. The participants then proceeded to the highest point of the hike, took a third dose and spent the night at that altitude. The following morning, before proceeding down, they took their fourth and final dose. The results speak for themselves – a 26 percent drop in the likelihood of suffering the effects of altitude sickness.

Many adventure travelers love to visit high altitude destinations such as the Andes, Alps and Himalaya. For those who routinely suffer from acute mountain sickness while traveling, this news could be a potential godsend that allows them to visit places they may not have considered before. Obviously, further research will need to be conducted but the results so far are very promising. Perhaps packing a bottle of ibuprofen, also known as Advil and Motrin, on your next adventure could be the difference between a miserable trip and a great one.

How to choose a reputable adventure travel company or guide

adventure travel companiesAdventure travel” is a nebulous term these days. But whether your idea of a thrill is a Class-III rapid or climbing Everest, there’s one thing that’s ubiquitous when choosing an outfitter: safety. There are hundreds of adventure travel companies worldwide; not all are created equal. There are key things you should look for when choosing a company or independent guide, whether you’re booking a three-week luxury trip, or a one-day backpacker’s special.

I’m not implying adventure travel in general is risky, or that most operators and guides don’t know what they’re doing. There are numerous certifications in place (they vary according to country) to ensure companies adhere to national and industry safety standards.

The following are tips on what to look for or avoid when choosing a company or guide, based on personal experience and what I’ve gleaned from the owners of several highly regarded adventure companies. I’ve done trips with each company, but I have no personal gain in endorsing them: I’ve just found them to be, among the dozens of outfitters I’ve used, the best of the best.

My sources include Mark Gunlogson, president/guide of Seattle’s Mountain Madness, a mountain adventure guide service and mountaineering school; Marc Goddard, co-owner/guide of Bio Bio Expeditions, a whitewater/adventure travel company in Truckee, California, and Britt Lewis, co-owner/guide of Austral Adventures, a custom travel company on the island of Chiloe, in Chile.

I’m also including a few horror stories based on guide negligence. That’s why, the first thing you should do when planning any kind of adventure activity or trip is…

Do your research
Even a brief online search will bring to light any serious breaches in safety or conduct. Safety doesn’t just apply to those who plan to scale the Andes or kayak the Zambezi. Even the tamest “adventures” require guides who are knowledgeable about the area and activity, and are currently certified in emergency first aid and rescue procedures.

[Photo credit: Flickr user Luis Fabres]

adventure travel companiesLest you think I exaggerate the importance of guide knowledge and research, the idea for this article germinated in 2003, when I was visiting Australia’s Kakadu National Park during the “Wet,” or monsoon, season. That time of year brings potential problems such as floods, but it was a widely publicized trial that made an indelible impression.

A negligent guide was charged in the accidental death of a 24-year-old German tourist who’d been killed by a croc, after the guide assured her group a swimming hole was safe. My own guide informed me that just weeks earlier, another company had tried to gun their small tour bus over a flooded waterway, only to have it overtaken and swept downstream. The passengers were eventually airlifted to safety (don’t let these things scare you off of Kakadu in the Wet; it’s absolutely spectacular, and free of crowds).

Australia of course, isn’t the problem. It’s just that crocs and corpses make compelling headlines. Sometimes accidents aren’t publicized, lest they impact tourism (In New Zealand, an operator confessed to me a rival company’s fatal bungee-jumping miscalculation a month prior, which put them out of business), and of course there have been dozens of mountaineering and whitewater-related tragedies on commercial trips on various continents over the years. Again, participating in these activities doesn’t make you likely to suffer a mishap. Are they inherently dangerous? Yes, but so is crossing the street, driving a car, or hiking solo.
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What certifications to look for
This depends upon type of activity and country. Says Lewis, “If there aren’t national qualifications or certs, a combination of information is required for form an opinion about an outfitter. How clear and accurate is their literature or website, their answers to your questions, etc.?” I would also add, how long does it take them to respond to your emails or phone calls? A few days is standard, but if you find yourself having to follow-up repeatedly, move on.

Marc Goddard: Ask about the qualifications of each guide. If you’re doing a river trip, find out how many years the guides have been guiding rafts, and on which rivers. Don’t be shy about asking some serious questions: you will, after all, be entrusting them with your life!

Mark Gunlogson: The adventure travel industry has matured, and most activities now have some sort of industry standard. In the case of mountain guiding, there’s the American Mountain Guides Association certification for guide services. Level of first-aid training for guides is also essential to look for, and industry standards apply here, as well.

Signs you’re dealing with a good company or guide
Whether you’re planning a high-end holiday or making a walk-in query in a backpacker ghetto, there are questions to ask and things to look for that signify a solid company. Be aware that hostels and other backpacker-oriented locales are magnets for sketchy outfits. If it sounds too cheap or good to be true, it probably is. If the activity involves something potentially dangerous, don’t bite.

Gunlogson suggests asking the company what’s included and what’s not, so all services are clearly spelled out, including guide qualifications. But, he says, “In the end, sometimes it just comes down to how comfortable a person feels with the company and their interactions with them.”
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Adds Lewis, “Ask a few simple questions about first-aid and emergency procedures. Do they appear to have a plan for unforeseen events? If you’re a walk-in, does their office have a fire extinguisher? Are their vehicles legal for tourist transport? Are the guides certified for the activities for which they’re assigned?”

I learned just how deadly budget guides can be while climbing Cotopaxi in Ecuador with a Mountain Madness guide. We were forced to turn back at 17,000 feet due to extreme avalanche danger. My guide was fully accredited, and his experience includes some of the toughest technical climbs in the world (For my part, I’d been conditioning for this trip for months, at high altitude, upon the advice of Mountain Madness).

We had returned to the refugio, an overnight acclimatization hut located at 15,000 feet. We saw a young, rowdy group of backpackers being shepherded out the door by their equally youthful guides; it was obvious from their attire they were attempting a summit. My guide, concerned, went and had a word with the other guides: They totally blew him off. I didn’t hear about a group of backpackers getting creamed in an avalanche that day, but that experience really clarified for me the potential for disaster posed by cheapie trips targeted at inexperienced backpackers. It’s not worth it.

On a related note:
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Look for red flags
“If they’re farming you out to a local outfitter, it could be a red flag,” says Goddard. “But the big warning is if they don’t know who their guides are, or what their qualifications are.” Some companies do “outsource” to local guides or outfitters, It’s not always a bad thing, and in fact can be positive, because you get someone with insider knowledge and you support the local economy. It comes down to their qualifications and relationship with the parent company.

Gunlogson adds, “Ask about guide qualifications, number of years in business, and hidden costs regarding services.” A reputable company willingly discloses information.

Ask for referrals
Lewis suggests asking for past client’s emails, and contacting them about their experience. You can also look at reviews on sites like TripAdvisor.com, or search travel blogs.

Listen to your gut
If you have a bad feeling about a guide, it’s best to pay heed. On my same Australia trip, a certain American guide led us on an overnight bushwalk in Litchfield National Park. Amongst his many other transgressions, he endangered our lives by having us pitch camp on a narrow sandbar at the base of a waterfall-fed swimming hole (I actually voiced my concern, only to receive a withering look from him). Sure enough, a monsoonal downpour made the water level swiftly rise, leaving us backed into a rock wall. Fortunately, we were able to rescue our tents and gear, and the water receded before we had to swim for it. That’s when I learned to listen to my instincts regarding guides. My sensor went off immediately after meeting this guy due to his arrogance, but I felt obligated to do the trip.

Whether it’s a negative reaction to a guide, concern over the poor/worn quality of the gear, or the activity itself, always listen to your gut.

What to do if you have a bad experience
You have several courses of action. You can go to sites like TripAdvisor.com and travel blogs and write the company up (letting them know about it before taking any action). Says Lewis, “It depends on the country in terms of informing authorities. However, the power of the Internet is a huge reward to a good company and an effective way to punish an unsafe one.”

Adds Gunlogson, “Unless there’s injury and an obvious case of negligence, there’s not too much you can do unless you really want to spend the time and money to pursue it. In the end, word-of-mouth has a cathartic effect for clients if their complaints are ignored. Those companies that understand the power of a former client taking to the Internet do their best to mitigate any potential bad-mouthing, whether justified or not. It lets the client know that their dissatisfaction was acknowledged.”

I say: Playing devil’s advocate, I’ve found there’s usually one client on every trip who seems determined to have a bad time and find fault, even where none exists. DON’T BE THAT PERSON. No one likes a whiner or a complainer, and guides work long hours, under considerable stress. Don’t just sit on your butt: ask what you can do to help, be it chopping vegetables, loading gear, or finding firewood. If you have a legitimate complaint, by all means follow the advice provided above, but don’t go trolling for a refund or discount just to be an a-hole.

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What are the refund policies?
Because shit happens.

Consider climate and seasonal factors
If you want to avoid a monsoon, snow, or inhumanly hot, humid weather, be sure to voice those concerns and do some research on your destination. It also pays to ask about or check on things like growing, spawning, or breeding season of pesky or harmful flora or fauna. Someone I know (her name is Laurel) paid through the nose for a snorkeling trip off a remote island in Southern Thailand. Imagine her surprise when she hit the water and discovered it was peak jellyfish spawn. She spent the remainder of the trip covered in painful, head-to-toe welts that made her the object of much mockery. Far more painful was the knowledge that the scam artists/snorkeling guides knew full well swimming was inadvisable.

Are they a green company?
It matters, and this philosophy also includes hiring locals whenever possible. Don’t let yourself get “greenwashed.”

Honestly assess your own capabilities
You don’t just put yourself at risk (of a bad trip, potential injury, illness, or worse); you jepordize the safety and well-being of other clients. If nothing else, you make your guide’s life hell. Please don’t if you can help it.

Do you trust your guide’s capabilities and judgement?
When you literally trust a guide with your life (and I can only say this about three of them), it’s a sign that that company is doing something right. Never have I been more impressed with guides than the two trips I’ve taken with Bio Bio; Mountain Madness follows a close second.


Consider travel insuranceadventure travel companies
If you’re doing some really hard-core stuff, will be in very remote areas, or have some existing health or physical conditions, it may be worth the extra expense.

Don’t forget to tip
Says Goddard, “I don’t feel tipping is mandatory; it’s done if you feel the guides did a good job. An average tip is 10% of the trip price, a great tip is 20%.” Adds Lewis, “The amount may also depend upon what country you’re in, but it’s always appreciated. Few, if any, guides do their job solely for the money [FYI, it’s not a high-paying job]–there’s a love of people, nature, or the activity that comes with it. But tips are welcome, as they’re a tangible “thank you,” and acknowledge a job well done.”

If you made it this far, consider yourself schooled. Here’s to safe adventures!

[Photo credits: crocodile, Flickr user jean-louis zimmerman; first aid kit, Flickr user 8lettersuk; warning, Flickr user psd; cash, Flickr user Todd Kravos; caving, Laurel Miller]

Bolivia campaigns to legalize coca



Four Loko, meet Coca Colla. CNN reports that Bolivia has launched a campaign to legalize coca, a native plant that has been used for medicinal purposes and as a mild stimulant by the indigenous peoples of the Andes for thousands of years. And yes, coca does contain trace amounts of cocaine. The leaves are used in purified forms of the narcotic, which is what led the United Nations to ban coca in the 1961 Single Convention on Narcotics Drugs. The Bolivian government would like the ban amended to make coca a controlled, but not illegal, substance.

Coca leaf is considered saced amongst Andean peoples, and historically has been used to combat everything from altitude sickness to rheumatism (it has anaesthetic properties). The leaves are also used as a digestive aid, and to suppress hunger, thirst, and fatigue. Coca is traditionally chewed or used or as a tea, but now, coca-infused energy drinks are taking the market by storm. Las year, Coca Colla was introduced; it was such a hit that a new beverage, Coca Brynco, debuted this week.

Bolivian president Evo Morales–a former union leader for coca growers–is on a mission to convince the rest of the world of coca’s legitimate non-addictive uses. Bolivian Foreign Minister David Choquehuanca has embarked this week on a tour of Europe, hoping to convince EU leaders to support the campaign. The U.S. is not onboard the coca train, and filed a formal objection to legalize it on Wednesday. January 31st is the deadline for all UN members to cast their votes.Bolivia is the third largest coca producer in the world, after Colombia and Peru. If legalized, it could provide a signficant economic, uh, stimulus to the country. In addition to energy drinks, Bolivia hopes to use coca in toothpaste, and even flour (I don’t understand that one, either).

I’ve chewed coca while trekking in the Peruvian Andes, and it definitely helps ease altitude-related symptoms. Quechua porters on the Inca Trail (who are employed to haul all of the gear) chew coca incessantly. I have no doubt that, in addition to genetic adaptability, coca aids their miraculous ability to carry loads nearly equal to their body weight, at high speed, even when barefoot. It’s said that coca is what enabled the Incas to build Macchu Picchu.

There are certainly pros and cons to lifting the coca ban, but hopefully world leaders can overlook the stigma long enough to evaluate the medicinal value of the plant.

Himalayan High: dangers of the trek

Over the past few weeks I’ve shared all kinds of thoughts on an Everest Base Camp trek, one of the best long distance hikes anywhere in the world. I’ve also shared my thoughts on the best ways to prepare for the trek and which gear items you should bring along with you to the Himalaya. In this, the final article in the Himalayan High series, I’ll share some thoughts on the potential dangers of the trek.

Beyond a shadow of a doubt, the biggest danger that anyone trekking in the Himalaya will face is the altitude. It is the great equalizer when it comes to determining success or failure on a high mountain trek, and even the most physically gifted and prepared hikers can be laid low by the thin air. Common symptoms that are brought on by altitude include headaches, dizzy spells, nausea, shortness of breath, and a loss of appetite. More serious signs of AMS, or Acute Mountain Sickness, include lethargy, sometimes to an extreme level, an inability to sleep, and vomiting.

Most of the members of my trekking group experienced at least one of those symptoms to some degree or another. Nearly everyone reported headaches and nausea of varying degrees, with a few experiencing serious issues. Of our 12 person group, two were unable to complete the trek to Base Camp. One of those suffered considerable nausea and was lacking in strength, so he elected to go down of his own accord. The other, had a full on case of AMS, and was lethargic to the point of not being able to stay awake. She was slurring her words considerably and was physically ill to the point where she couldn’t keep any food down. It became so serious that she had to be carried down the mountain by our porters, and would eventually recover at a lower altitude.
As for myself, for the most part I suffered few problems from the altitude. I would often start the day with a slight headache and feeling a bit hung over, but once we hit the trail, I would soon shake off the sluggishness altogether. Unfortunately, I did suffer one side effect that has troubled me in the past – the inability to sleep well at altitude. I’d go to bed each night exhausted from the long day on the trail, and almost without fail, I’d wake up in an hour or two later, and be wide awake for most of the rest of the night. It was rather frustrating, especially over a 12 day hike.

Unfortunately, there isn’t a whole lot you can do about altitude. It is nearly impossible to prepare for unless you already live in the mountains, and as I said, it effects everyone differently. The best advice I can give is to make sure you’re proceeding up the trail at a slow, measured pace, and take the acclimatization process very seriously. Also, ask your doctor for a prescription of Diamox before you go. It is a drug that is very popular with mountaineers and helps ward off many of the effects of altitude sickness.

One ailment that was difficult to avoid is the dreaded Khumbu Cough. It is a dry, sometimes painful, hack that practically everyone hiking in the region contracts. The cough is a result of the extremely dry air and cold temperatures, causing an irritation of the bronchi in the lungs and seems to be exasperated by high levels of exertion. Everyone in my group, without exception, suffered the Khumbu Cough to some degree, including myself. But in an odd twist, my cough wasn’t so bad while I was actually in Nepal, but managed to somehow get worse after I came home. Avoiding the cough is not easy, but wearing a mask or covering your mouth and nose with a Buff, can help limit the damage.

The next most common problem that most travelers in the region experience is gastrointestinal issues, most often brought on by the food or water. Trekkers will generally eat each evening in the teahouses that they are staying at, and while the food doesn’t taste half bad, it has the potential to be problematic for exhausted hikers who are already dealing with all kinds of other conditions. The fact that all food items, and pretty much everything else for that matter, has to be carried up the mountain by porters, gives it ample opportunity to spoil, especially items that easily perishable such as meats and cheeses.

Like many places in the world, the water can be a challenge to deal with as well. You can fill your water bottles for free in most teahouses, but you’ll want to treat it with water purification tablets or use a filter of some kind before drinking it. If you don’t, you’re likely to suffer terrible GI issues, which isn’t a fun thing to experience when you’re out on a trail for hours at a time.

Fortunately, I was once again spared any GI issues, but other members of the group were not so lucky. Some suffered from travelers diarrhea, and were frequently looking for a private rock to serve as shelter while they heeded the frequent calls of nature. Others had outright food poisoning, getting sick from the food in general. My advice is to stick to basic foods and avoid anything exotic. You’ll also want to avoid meats and cheeses when ever possible, especially as you go higher.

As on any hike, you do run the risk of physical injury while trekking the Khumbu. There are plenty of places on the trail where you can slip and fall, damaging more than just your pride. Twisted ankles and knees are a real possibility, especially considering that some portions of the trail are make-shift stairs carved out of rock. After climbing up those stairs for a couple of hours, your tired legs are more likely to cause a stumble, and while there were a few such incidences in my group, no one was seriously injured.

One other common concern for travelers heading to Nepal is a potential chance encounter with the Maoist Rebels that are known to inhabit the countryside and remain active there, despite the fact that they won control of the government a few years back in democratic elections. In the past, those rebels were known to shake down trekkers for money and occasionally kidnap them as well. But those days are behind us, and visitors can now roam the countryside with out too much fear. They were seldom an issue on the road to Everest to begin with, and on my trek there was little sign of them outside of a few propaganda posters.

Like any trip to remote region of the world, there are always inherent dangers. But the amazing scenery, friendly people, and wonderful culture make this journey one that is well worth taking. Despite suffering issues from altitude, exhaustion, and an extremely nasty cough, I still enjoyed every minute of my adventure in the Himalaya, and suspect that any adventurous traveler would feel the same.

Adventure travel insurance: a cautionary tale

Awhile back we posted a story on the importance of travel insurance for adventure travelers. In that article, we discussed the value of carrying travel insurance, which can safeguard someone from trip interruptions or even cancellations, and the loss of baggage that can result in very important, sometimes specialized, gear going MIA. But we also talked about how adventure travelers are often visiting remote places, which can be dangerous if they need emergency medical attention or have to be evacuated from that location. On a recent trip that I took to the Himalaya, I saw that scenario play out in a very real and potentially dangerous way, and I was reminded that it is not enough to just have purchased insurance, you also need to remember to bring the actual policy along with you as well.

A few weeks back I had the opportunity to go on a truly epic trip when I made the trek to Everest Base Camp. This is one of those journeys that is high on the “life list” for a lot of travelers, as you spend 2+ weeks hiking through the Himalaya, staying in rustic teahouses and soaking up the local mountain culture while surrounded by some of the most beautiful and dramatic scenery that you’ll find anywhere on the planet. It is a hiker’s dream come true in a lot of ways, but, as you can probably imagine, it is also a physically demanding experience that many would hardly classify as a “vacation”.

For my trek to Base Camp I signed on with a guide service in Nepal, and one of the prerequisites for joining the trek was that you had to have travel insurance to cover any potential medical needs that might arise. The policy was also suppose to cover an emergency evacuation should the need arise. I was cautioned before my arrival in Kathmandu that I would need to show proof of insurance when I joined the group, and anyone that couldn’t provide that proof would not be allowed to begin the trek. With that in mind, I purchased my insurance, which included special coverage for activities that were deemed dangerous, such as high altitude trekking, and printed off my policy to include with my various other travel documents.

True to their word, proof of insurance was requested in our initial meeting in Kathmandu. There were a dozen of us on the trip, and when we first gathered for that pre-trek meeting the night before we were to set out, our guide handed us a form to fill out. That form included a number of standard questions, including passport information, emergency contact person, and of course, the policy number and insurance company that we had purchased our insurance from. I dutifully filled out the form and handed it back in, not really thinking much about it afterward.

Fast forward a few days and we’ve all settled into the trek to one degree or another. Some members of the group are clearly more comfortable on the trail than others, and the level of suffering ranges from “barely breaking a sweat” to “dear God how much further?” By now, we know that there are a number of potential dangers on the trip, including fatigue, the dreaded “Khumbu Cough”, and other usual suspects such as contaminated water or food related issues that are the bane of any traveler’s existence the world over. But the most obvious danger was from the altitude, which was having an effect on all of us to one degree or another. For most, that meant shortness of breath or headaches. For others, it included loss of appetite or an inability to sleep. But for one of us, it was having a much more dangerous effect. One that could have proven life threatening.

One of the members of our group was a young lady who was traveling by herself, and had decided at the last minute to join the trek to Everest. She loved the thought of an adventure in the Himalaya, and had always dreamed of seeing Base Camp. Unfortunately, thanks to the effects of altitude, she would never reach that point.

The initial signs that something was wrong first appeared a couple of days into the trek. Whenever we would stop for an extended break from hiking, this young lady would invariably fall asleep. Whether we stopped for a short tea break or for an extended lunch, she would quickly nod off in her chair, and at the end of the day, when we’d reach our teahouse, she would be asleep within minutes. At first, these little naps were a point of good natured ribbing, but when they continued, a few of us began to worry.

After about five days on the trail we reached the village of Dingboche, which is located at about 14,468 feet. While there, our intrepid young lady’s altitude sickness became very serious. Her little cat naps turned into her not being able to stay awake at all, and when we spent an extra day there as part of our acclimatization process, she ended up in bed the whole day. When, our guide checked in on her late in the afternoon, he found that she was delirious, slurring her words, and cold barely identify her whereabouts. Soon there after, she became physically sick, and it was abundantly clear that she needed to be evacuated from the mountain, and quickly. Thank goodness we all had travel insurance! After all, it was required to be on the trek, right?

Turns out, it wasn’t really a hard and fast rule that it was required. It seems that while we were all filling out those forms back in Kathmandu, our now very sick young lady didn’t have her policy printed out, and wasn’t unable to complete the form. In her defense, she did try to access her policy via the Internet, but web access was spotty at best, in Kathmandu, and rolling blackouts, an all too common occurrence in that city, didn’t make that process any easier. As a result, she was allowed to go on the trek, even though she hadn’t filled out all the paperwork, and when she was truly in need of a helicopter evacuation, one couldn’t be called because she didn’t have her insurance paperwork in order.

Fortunately, the guides and porters of the Himalaya are an incredibly strong and hearty lot. Knowing that our girl’s life could very well be in danger, a group of porters put her on their backs, and physically carried her down the mountain to a hospital located in another village. Under the watchful eye of the doctors there, and after spending a night in a hypobaric chamber, she was feeling much better the next day. But the trek was over for her. She would descend to a lower altitude, and wait for the rest of us to eventually come down and join her.

The moral of the story is an obvious one of course. Make sure you have all of your travel papers in order before leaving the country, and if you purchased travel insurance, print it and bring it along as well. After all, it doesn’t do you any good to buy that policy, and then not have it readily available on the off chance that you’ll need it. That may seem like common sense, but it wasn’t obvious to that young lady on my trek, who was a very experienced traveler, and had spent time in dozens of countries all over the planet.