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.

Getting High on Your Holiday

Sure, we’ve all thought about it and some of us do it often. Getting high on your holiday trip can be pretty fun, in fact. I mean really high, above 11,500 feet (3500 m). Not everything cool is on a beach at sea-level. Ruins in the Andes, trekking in the Himalayas and chasing back country powder are a few things you have to get high, to do. These trips are all “dream vacations,” so why risk a problem with altitude sickness?

High altitude is considered to be 1500 – 3500 m (4950 – 11,500 ft) while very high altitude covers 3500 to 5500 m (11,500-18,050 ft). Anything above 5500 m falls into the extreme altitude category. Altitude sickness is not related to physical fitness and can have some deadly consequences, if not recognized and treated promptly.

Accute Mountain Sickness generally includes symptoms of headache, worse at night or during straining, nausea/vomiting and dizziness. The symptoms are often described as a “bad hangover”.

Some conditions associated with more severe forms of altitude sickness or AMS (acute mountain sickness) include HACE (high altitude cerebral edema) and HAPE (high altitude pulmonary edema). These conditions involve swelling and fluid accumulation in the respective tissues. Swelling of the brain, as seen in HACE, can present as marked stupor and confusion. HAPE, with fluid collecting in the person’s lungs, often starts as a cough followed by progressive shortness of breath.

As with most things, prevention is better than treatment. Prevention of AMS and it’s associated conditions centers around a slow, gradual ascent to altitude. This gives the body a chance to acclimatize and adjust to the physiologic demands of life at the new altitude, even if only for a few hours or days. This can be a problem for people traveling by car or plane to an area of high altitude, simply because they ascend very rapidly.

Symptoms of AMS can begins quickly, in as little as 2-3 hours after arrival to altitude, which means you can get off your plane and begin to feel bad, even before you arrive at your hotel! In an ideal world, all travelers going to higher altitude will be able to have a slow and controlled ascent, gaining no more than 600-900 m (1,980 to 2,970 ft) per day. However, this is not always practical. Anytime there is suspicion of an altitude related illness, stop ascending, immediately. If symptoms do not improve, consider a descent to lower altitude, for a few days of further acclimatization. Some expedition physicians also believe that most all medial problems, at high altitude, are to be considered AMS until proven otherwise.

There are a few medications used to combat AMS and a few good arguments, both for and against their use. The medicine that is most commonly used is called Acetazolamide. This medicine causes an acidosis, designed to combat the alkalosis caused by hyperventilation at high altitudes. Designed to be taken a few days prior to ascent, during the time at altitude and for a few days after descent, Acetazolamide is both a prophylactic medicine as well as a treatment. There is some controversy over the ideal dose to be used and I consider this article a good source of information, along with an article that favors a higher dose.

Against Acetazolamide Use:

Everything in life is a trade off and medicine is a perfect example of this. Side effects of Acetazolamide include a metallic taste, especially with soda, and frequent urination. Acetazolamide is a sulfa-based drug and allergic reactions can occur. Some studies have show than judicious exercise, on the first few days of arrival to altitude, can be effective in AMS prevention and that only 25% of travelers to resort communities at 8,000 and 12,000 feet have altitude illnesses.

For Acetazolamide Use:

A dream vacation can be ruined by many things and with 25% of travelers in an high altitude zone experiencing AMS symptoms, why risk spending your trip with a headache, or worse. Most vacation trips to high altitude zones last 7-10 days and Acetazolamide is a cheap and very effective medication for control and prevention of AMS.

Some other treatments for AMS, HACE and HAPE include dexamethasone and inhaled asthma medications like salmeterol. For the hard-core out there, Gamow bags can be used, especially on mountaineering expeditions. Ginko Biloba is also currently showing promise in AMS treatment/prevention.

As with most travel-related illnesses, prior proper preparation prevents poor performance. Understanding altitude illness and being aware of it’s symptoms can help with early recognition and treatment, thus preventing a ruined trip and health risk. To learn more about AMS check out these sites:

The International Society for Mountain Medicine

The High Altitude Medicine Guide

CDC Traveler’s Health Yellow Book: Altitude Illness