Staying healthy while climbing/trekking

High altitude climbing and trekking are amazing opportunities to see the stunning Himalayas. Your health is top priority to Ri Guides. Ri Guides are experienced in acclimatisation (your acclimisation process is considered in our itinerary) and common illnesses experienced in the Himalayas.

Acclimatization:

Our itineraries are built keeping in mind the acclimatisation process. We will also give you a briefing about acclimatisation and altitude sickness before the trek or climb and would also advise you to read up about altitude sickness, so that you can be familiar with the symptoms and do not ignore them.

Note: Two full days of rest upon arriving in Leh (3,500m) is a must and make sure you drink lots of water.

Altitude Sickness
It is quite normal to feel symptoms of altitude sickness whilst climbing or trekking above 2,500m. Minor symptoms of altitude sickness can occur even at altitudes of 1,500m. With proper knowledge and by taking precautions you can avoid escalating symptoms of altitude sickness. The incidence of altitude illness, which varies from one individual to another, is directly related to the rate of ascent. It's also significantly related to how long a person stays at that height. Thus, Ri Guides itinerary ensure proper acclimatisation. Being physically fit does not stop you getting symptoms of altitude sickness.
Normal symptoms at altitude

You will experience some symptoms of altitude sickness typically above 2,500m. These symptoms are normal. Every trekker or climber will experience some or all of these, no matter how slowly they ascend.

  • Periods of sleeplessness
  • The need for more sleep than normal, often 10 hours or more
  • Occasional loss of appetite
  • Vivid, wild dreams at around 2,500-3,800m in altitude
  • Unexpected momentary shortness of breath, day and night
  • Periodic breathing that wakes you occasionally - consider taking Diamox
  • The need to rest/catch your breath frequently while trekking, especially above 4000m
  • Your nose turning into a full-time snot factory
  • Increased urination - many trekkers have to go once during the night - it's a good sign that your body is acclimatizing.
Acute Mountain Sickness - AMS

Altitude illness is physiological reaction of the human body to the low oxygen pressure ('thinner' air) that occurs at high altitude. Atmospheric pressure is half that of the sea level, which means half the amount of oxygen. Although minor symptoms such as breathlessness may occur at altitudes of 1,500 metres (5,000 ft), AMS commonly occurs above 2,400 metres (8,000 ft). The key is to go slower with gradual ascent (300-500m/day), as it is not the altitude but the rate at which one reaches higher altitudes which causes AMS.

Mild Symptoms of AMS

You only need to get one of the symptoms to be getting altitude sickness, not all of them.

  • Headache - this is a common symptom. Often a headache comes on during the evening and nearly always worsens during the night. Raising your head and shoulders while trying to sleep sometimes offers partial relief. If it is bad you may want to try taking a painkiller: paracetamol/acetaminophen (Tylenol) or Ibuprofen. Never take sleeping tablets. You could also take Diamox: see below. Headaches arise from many causes, for example, dehydration, but if you develop a headache, assume it is from the altitude.
  • Nausea (feeling sick) - can occur without other symptoms, but often nausea will develop with a bad headache. If you feel better in the morning take a rest day, or if you still feel bad descend.
  • Dizziness (mild) - if this occurs while walking, stop out of the sun and have a rest, snack and drink. Stay at the closest teahouse.
  • Lack of appetite or generally feeling bad - common at altitude due to too rapid an ascent.
  • Painful cough or a dry raspy cough.

In other words anything other than diarrhoea or a sore throat could be altitude sickness. Assume it is altitude sickness, because caution is the safest course of action. Accept that you body needs more time to adapt to the altitude.

Basic rule: NEVER GO HIGHER WITH MILD SYMPTOMS

If you find mild symptoms developing while walking, then stop and relax with your head out of the sun and drink some fluids. If the symptoms do not go away completely then stay at same altitude. If symptoms get worse, descend.

A small loss of elevation (100-300m/328-984ft) can make a big difference to how you feel and how you sleep - descend to the last place where you felt well. If symptoms develop at night then, unless they rapidly get worse, wait them out and see how you feel in the morning. If the symptoms have not gone after breakfast then have a rest day or descend. If they have gone, consider having a rest day or an easy day walking anyway.

Continued ascent is likely to bring back the symptoms. Altitude sickness should be reacted to when symptoms are mild - going higher will definitely make it worse. 

Note also that there is a time lag between arriving at altitude and the onset of symptoms and in fact it is common to suffer mild symptoms on the second night at a set altitude rather than the first night.

Serious Symptoms of AMS
  • Persistent, severe headache
  • Persistent vomiting
  • Ataxia - loss of coordination, cannot walk in a straight line, looks drunk
  • Losing consciousness - cannot stay awake or understand things very well
  • Liquid sounds in the lungs
  • Very persistent cough
  • Real difficulty breathing
  • Rapid breathing or feeling breathless at rest
  • Coughing blood or pink goo or lots of clear fluid
  • Marked blueness of face and lips
  • High resting heartbeat - over 120 beats per minute
  • Severe lethargy and drowsiness
  • Mild symptoms rapidly getting worse
  • Ataxia is the single most important sign for recognising the progression from mild to severe AMS. This is easily tested by trying to walking a straight line, heel to toe. Compare with somebody who has no symptoms. 24 hours after the onset of ataxia a coma is possible, followed by death, unless you descend.
Basic rule: IMMEDIATE AND FAST DESCENT WITH SEVERE SYMPTOMS

Descend as far down as possible, even if it is during the night.  The patient must be supported by several people or carried by a porter/horse - his/her condition may get worse before getting better. Later the patient must rest and see a doctor. People with severe symptoms may not be able to think for themselves and may say they feel OK. They are not. If they may become combative, ignore.

Other medical conditions that occur in high altitude
  • High Altitude Cerebral Oedema (HACE) - this is a build-up of fluid around the brain. It causes the first 4 symptoms of the mild, and the severe symptom lists.
  • High Altitude Pulmonary Oedema (HAPE) - this is an accumulation of fluid in the lungs, and since you are not a fish, this is serious. It is responsible for all the other mild and serious symptoms.
  • Periodic breathing - the altitude affects the body's breathing mechanism. While at rest or sleeping your body feels the need to breathe less and less, to the point where suddenly you require some deep breaths to recover. This cycle can be a few breaths long, where after a couple breaths you miss a breath completely, to being a gradual cycle over a few minutes, appearing as if the breathing rate simply goes up and down regularly. It is experienced by most trekkers at Namche, although many people are unaware of it while sleeping. At 5000m/16,404ft virtually all trekkers experience it although it is troublesome only for a few. Studies have so far found no direct link to AMS.
  • Swelling of the hands, feet, face and lower abdomen - remove rings. An HRA study showed that about 18% of trekkers have some swelling, usually minor. Females are definitely more susceptible. It is not a cause for concern unless the swelling is severe, so continuing ascent is OK.
Medication: Diamox (Acetazolamide)

This is a mild diuretic (makes you pee a lot) that acidifies the blood which stimulates breathing.

It is suggested that most people trekking above 3,500m should take it using the logic that it has the potential to reduce the number of serious cases of AMS: the benefits may outweigh the risks. This topic still requires in depth research. Diamox is a sulfa drug derivative, and people allergic to this class of drugs should not take Diamox. People with renal (kidney) problems should avoid it too. (It also sometimes ruins the taste of beer and soft drinks). The side effects are peeing a lot, tingling lips, fingers or toes but these symptoms are not an indication to stop the drug.

The fully accepted recommendations are to carry it and consider using it if you experience mild but annoying symptoms, especially periodic breathing that continually wakes you up. The dosage is 125 to 250 mg (half to a whole tablet) every 12 hours. Diamox actually helps the root of the problem; so if you feel better, you are better. It does not simply hide the problem. However this does not mean that you can ascend at a faster rate than normal, or ignore altitude sickness symptoms - it is still possible to develop AMS while taking it. Note that it was recommended to start taking the drug before ascending for it to be most effective. For starting a trek in Leh this is not necessary, but it does help.

Diamox is not an antibiotic, and so while it works well taken regularly, it doesn't have to be taken regularly.

General precaution

DO discuss your trek fitness and suitability with your doctor before your trip.

Precautions with pre-existing conditions
Heart, Lungs and blood pressure issues

Anyone with heart, lung and blood pressure abnormalities or a continuing medical condition should have a check-up and get a medical opinion before booking a Himalayan trek. We suggest anyone over 50 years old get a professional check up that includes a heart stress test. Many recently-retired people made it to the top of many mountains and pass above 5,000m, so age need not be a barrier. The older you are, the more important prior fitness preparation is.

Asthma

This is no reason to avoid trekking. Look after your medication - wear your inhaler on a chain around your neck or keep it in a pocket. There is still the normal risk of a serious attack so brief your companions and trip leader on what to do.

Diabetes

If it is 'well-controlled', diabetes is no reason to avoid normal trekking. You cannot afford to lose the medication so keep it with you at all times and warn you friends on the procedures in case there's an emergency. Your increased energy expenditure will change carbohydrate and insulin levels so it's very important to monitor your glucose levels frequently and carefully and to keep blood sugar levels well controlled.

High blood pressure (hypertension)

Blood pressure will fluctuate more and be higher than usual while on a trek. You should seek the advice of a doctor who is aware of the history of your condition.

Previous heart attacks

Studies have yet to be conducted but it is likely that the level of exertion required on a trek is more significant than the altitude factor. Seek the advice of your doctor.

Epilepsy

There is a moderately increased risk of a seizure at altitude, but is not a reason to stop you trekking. You companions must be briefed on all the relevant procedures.

Past history of chest infections

If you are prone to these then bring the medicine you are normally prescribed.

Immunization

This information is given in good faith but with NO responsibility.

The best people to consult about the vaccinations are clinics specialising in travel medicine.

Malaria

Carried only by the lowland Anopheles mosquito, malaria exists in below 1000m/3281ft), and across much of the rest of rural Asia. There's no risk while trekking.

There is NO malaria in the regions we trek in. The risk of picking up malaria in Delhi or en route to/from Manali is extremely small, probably not worth worrying about. You should use mosquito repellent.

Hepatitis A

Usually passed on in contaminated water; immunisation is considered a must by most doctors unless you have had hepatitis A before. The vaccine is Havrix and a full course will give up to ten years protection.

Hepatitis B

This disease is avoidable since, like AIDS, it's passed by unsafe sex or contaminated blood products. A vaccine is available.

Meningitis

Occasional cases of meningococcal meningitis occur in Nepal. It is an often fatal disease but the vaccine is safe and effective and should be obtained.

Cholera

The World Health Organization no longer recommend this vaccination.

Typhoid

Prevalent in Nepal and India and if travelling extensively vaccination is recommended. It is less necessary for trekking.

Tetanus-Diphtheria

This vaccine is recommended if you have not had a booster in the last 10 years. Many doctors advise a tetanus booster every time you intend to travel for any length of time.

Polio

If you escaped immunization as a child a series of vaccinations is recommended. If you have not had a booster as an adult, one may be required. Check with your doctor.

Measles, mumps and rubella

If you did not have these diseases (or the vaccinations) as a child you may need a vaccination.

Rabies

This deadly virus is transmitted by the bite of an infected animal, usually a monkey or dog. The risk of being bitten is small but it has happened. A vaccination is available but even if you've had it you'll then need a follow-up course of two further injections. If you've not been vaccinated and are unlucky enough to be bitten, a series of six injections should be started within a week or so of being bitten.

General health advice
Arrival

Changing time zones knocks people about and add the stress of finishing up work, arrival is the time when you are most likely to get sick. Try to take it easy, drink lots of fluids, maintain a healthy diet and get plenty of rest. If travelling from America the flights are particularly long and there is a brutal time change; we recommend arriving a day earlier to recover. We can help you arrange an airport transfer and an extra night at a hotel.

Drinking water

Do NOT drink tap water anywhere except where we specifically discuss. Use bottled or filtered water to brush your teeth even. While trekking we provide filtered and/or boiled water, and our kitchen crews are serious about hygiene.

Diarrhoea

If you experience this, consult your leader.

When diarrhea first occurs, wait a few days and see if it stops.

Unless it is particularly severe, for example food poisoning, there is no need to stop trekking, just drink lots of water (preferably with some with electrolytes/oral rehydration solution) and listen to your body: if you feel hungry, eat, and if you don't then take lots of soup and light foods.

If the diarrhoea is still definitely troublesome after a few days and you are fairly sure of what type it is then you may want to treat it, do consult with your leader.

If you have a pre-existing condition such as stomach ulcers, gall bladder problems, previously perforated intestine etc, be especially careful with self-diagnosis and treatment.

Dehydration

While trekking lower down in the valleys, it is hot and you will sweat a lot, so it is important to replace the fluids you lose. Dehydration makes you feel tired and lethargic and can give you a headache. The symptoms are similar to AMS so the easiest way to avoid confusion is to always keep hydrated.

The basic rules are; drink as much and as often as you like, (that does not include alcohol!) even if it seems like a lot. Then drink some more. This can include soups and lots of tea, but even with a lot of liquid food, you should drink a lot of water too. Many people find that with dinner they often drink more than a liter of water, catching up on what they should have drunk during the day. A great guideline is the expression: A happy mountaineer always pees clear!

Dry Cough

If you are trekking for a prolonged period at altitude in colder weather, this usually strikes. This is a perpetually running nose and an initially mild productive cough. It is caused by breathing excess quantities of dry cold air - so much that you partially injure your bronchi. A cold or infection is the normal cause of this but in this case the irritant is only air however your body reacts almost identically - quantities of clear or white goo. Get rid of it when you can, and expect plenty more waiting to well up. Since there is no infection it is pointless taking antibiotics. Throat lozenges help so take plenty.

Bronchitis

An inflammation of the bronchi from an infection, ie identical to the Khumbu Cough but instead caused by an infection. Differentiating this from the Khumbu Cough is difficult, but you perhaps experienced a fever and/or some chills. The cough may be more productive. Since it can be a viral or a bacterial infection, taking antibiotics will not always help and is not particularly recommended.

Blisters

Since you spend most of your time walking, blisters are really worth avoiding. Use boots that have been worn in if possible. Test your boots by carrying a pack up and down hills - along level ground there is far less stress on your feet.

Normally you can feel a blister developing - some rubbing, or a hot spot, or a localised pain. Stop and investigate, even if it occurs during the first 5 minutes, or just in sight of the top of the hill; immediate action is best. The trick is to detect the symptoms before the blister develops. Put tape on or investigate what may causing the problem.

Blister Treatment - If you develop a blister then there are several approaches. If it is not painful then perhaps surround it (not cover it) with some light padding, eg moleskin, and see how it feels. If it is painful and causing problems then pierce it - clean the skin and sterilise the needle; holding the needle slightly above a candle or match flame for a second or two is effective. Do not cut away the dead blister skin until after a few days when it is dried out and no more use for protecting the delicate skin underneath. You can put protective tape over the top with some cotton wool to protect the blister, and some people even put the tape straight over the blister, with no protection.

If you have had a previous history of blisters or think that you are likely to get them take preventative action first. Use moleskin, a strong waterproof zinc-oxide tape or similar, and tape up troublesome areas first. Tape before you take your first step and be religious about checking, and replacing, the tape.

For more information, the UIAA Medical Commission provides comprehensive valuable resource for climbers and hikers on mountain medicine. An emphasis is put on health problems that only occur at high altitude.
http://theuiaa.org/mountain-medicine/medical-advice/
Fitness and Training

“...Greater fitness leads to more opportunity.” - Mark Twight.
“Training makes you weaker, recovery is what gets you stronger.” - Steve House, Scott Johnston.

We suggest that you train for at least six months prior to departure. If you get your mind and body in top condition, you can reach the high passes or the summit of a mountain easily and enjoy the journey getting there.

Improve your cardiovascular strength and muscular endurance:

- If you have more than 3 months prior to departure, go for long, slow runs on rolling terrain or go swimming and cycling.
- Within 3 months prior to departure, carry a weighted pack (increase the weight up to 18-25kg) up and down hills, stairs and mountains. The steeper the ascent the better, and try to ascend at least 300m at each training session.
- To avoid knee stress while training, fill up water containers at the base of a climb and empty out the water at the top of your climb.
- Wear boots similar to what you’ll wear on the trek or expedition.
- Always listen to your body while training and rest prior to departure.

Improve your muscular strength:

- Regularly do core stability exercises - plenty can be found on the internet.
- Do the following 2 x a week to maximise your strength: box step-ups, squats and lunges and pull ups. Carry weights while doing these exercises when it becomes easy.

Improve your climbing and general outdoor skills:

Our expeditions suit people who have some high-altitude experience, basic glacier mountaineering skills (e.g. self-arrest and roped travel), climbing, trekking and camping experience.
Our trekking trips suit people who have trekking and camping experience.
- attend a basic mountaineering skills course
- go climbing regularly and build rope handling skills and an understanding of gear
- go multi-day hiking and camping.

For those with weak knees, use trekking poles and/or bring an athletic knee brace to take weight off or support your knees.
Inform your doctor.

Get a full medical check up prior to any training and inform your doctor about your trek/expedition. Get appropriate immunizations prior to departure.

Please email Ri Guides:

- Inform us of any physical conditions
- To ask any questions about your fitness or training.