forms, a quick death, so make sure you learn how to identify the symptoms.
The rarely visited Langthang Valley leads to the Zalung Karpo La – one of the best viewpoints in Ladakh (Trek 1)
Never ignore any symptoms of altitude sickness! If you have a headache combined with dizziness, sleep disturbance, loss of appetite, nausea or vomiting, do not ascend; descend or stay at the same altitude until you recover completely. If you have more severe symptoms that may include breathlessness at rest, fast, shallow breathing, cough, chest tightness, drowsiness and loss of coordination while walking, descend immediately. If it happens at night do not wait until the morning – your life may depend on an immediate descent! If you have previously trekked at high altitude and been unaffected, do not assume that you will never suffer from altitude sickness; it is a fickle condition.
However, providing that you follow a few simple rules, you should not be seriously affected. Search for Altitude Sickness on the Internet, and check the following sites: www.ismm.org; www.high-altitude-medicine.com; and www.merckmanuals.com/professional.
THE EFFECTS OF HIGH ALTITUDE
Learn as much as you can before you go, and check out the medicines on offer to aid acclimatisation: see below. Note the main symptoms above: these in themselves are not a reason to stop the trek, but are good indicators of problems that may be overcome by taking a rest. At altitude difficulty is often experienced with sleeping, breathing patterns may be erratic (Cheyne-Stokes breathing), and the heart might thump a bit disconcertingly; however, none of these is unusual. It is also dangerous to overexert yourself on arrival at any destination, thinking you have no symptoms. These often only begin to appear after an hour or more.
It is particularly important to walk very slowly at all times, especially when climbing any hill. Be sure to admit any problems (if only to yourself at first), and don’t be pressured by your trekking peers. If you experience any serious effects before a pass, you should consider descending. Carrying on with mild symptoms, perhaps just a mild headache, is acceptable so long as it does not get worse or persist all day and night.
Peaks of the Gyamshu massif as seen from the Zalung Karpo La (Trek 1)
Continuing to ascend with any persistent symptoms can lead to the serious risk of pulmonary and cerebral oedema, or even death; sometimes complications from altitude sickness can strike very quickly. There are deaths each year in the Himalayas, where the criterion is ‘Descending is the only safe cure, at any time of day or night.’ However, in Ladakh descent is not an option in all locations. It is therefore of the utmost importance to acclimatise before going higher. For this reason, many groups spend a few days sightseeing in and around Leh before starting their trek.
What else can you do to ward off the effects of altitude? Many trekkers start a course of Diamox (Acetazolamide), a diuretic that thins the blood, makes you urinate more and is generally considered to be of some benefit, although it can have the disturbing side-effect of pins and needles in the fingers. Another option is to try coca. Not the smoking variety, but a version of the substance used by natives of Peru and Bolivia. Coca is available as homeopathic tablets that some trekkers swear by. It can be difficult to locate these in the UK, but French pharmacies stock them, should you be limbering up in the Alps before your trip. Also recommended by some are ginkgo biloba tablets, which appear to work for reasons not yet defined. It is suggested that these can be taken twice a day for five days before arrival and once a day during the trek, but consult your doctor beforehand as they can affect blood count and are not suitable for everyone.
Gamow bag and oxygen cylinders
A Gamow bag is a large plastic bag into which a person suffering from serious altitude sickness can be cocooned under higher air pressure to mimic a lower altitude for a limited period. Mountaineers have, of course, used oxygen for years at altitude. If you are with a commercial trekking group, your staff might have one of these and know how to use them.
Lingshed village (and gompa just above) seen from the Hanamul La (Trek 5)
Other possible ailments on trek
The air at high altitude is drier than at lower elevations, so greater water loss than normal occurs through breathing. Due to processes that take place in our bodies urination is more frequent. Another reason for greater fluid loss during trekking is the enhanced physical exertion at altitude. Therefore one needs to drink more than at lower elevations – you should drink about 5 litres of liquid (preferably water) a day (remember that consumption of coffee, tea and alcohol increases fluid loss). Observe your urine; if it is dark in colour, you must drink more.
Long exposure to direct sunlight may cause dizziness, headache, nausea, weakness or mental confusion. These are symptoms of sunstroke and may lead to severe medical disorders. To avoid it, protect your body, especially the head, from the direct sun. Always wear a hat or head covering. Consider taking your noon breaks in a shady place during the hot days of summer. If you experience any symptoms, stay indoors or in a cool, shady place and drink a lot of water. If your body temperature rises to about 40°C you must be cooled off. If possible take a moderately cool bath or splash water over yourself repeatedly.
Any traveller to India risks an infection or disease that probably does not exist or is rare in their home country. The majority of diseases are transmitted by contaminated food or water, and many by insect bites. Prevention consists of vaccinations as well as the avoidance of risky food and insect bites. Choose restaurants where dishes are prepared to order: avoid ready-prepared food. Drink bottled or hot drinks. Be cautious with fresh juices and lassi (made from yoghurt): if you do drink one make sure that no ice or water has been added. Eat fresh salads only if you are sure the ingredients have been washed in clean water. Avoid unpeeled fruit.
Travellers’ health is the topic of an annual report prepared by the World Health Organisation (WHO), available at www.who.int/ith. Information for travellers to India can also be found at www.cdc.gov (go to Travellers’ Health, Destinations and then choose India). Read up on the subject before the trip, consult your doctor, discuss the medicines you need to take with you, and receive proper vaccinations. You should also visit your dentist, to make sure your teeth are in good condition.
A useful book to take with you is Pocket First Aid and Wilderness Medicine by Drs Jim Duff and Peter Gormly (Cicerone 2012).
Visas and permits
Unless you are a citizen of Nepal or Bhutan, you will probably need a visa to go to India. If you can, you should apply for it in your home country. You can find contact information for Indian embassies at The National Portal of India website at www.india.gov.in. Usually the tourist visa is valid for six months (90 days in some countries) from the date of issue and it cannot usually be extended. Recently a rather strange rule has been introduced, insisting that visitors who leave India, despite having a six-month visa, cannot re-enter the country for at least two months.
No extra permits are necessary to enter Ladakh, but access to some parts of the region is limited or restricted. The latter refers to areas near the disputed borders with China and Pakistan. For some areas (Nubra Valley, Tso-Moriri Lake),
