5 KEY THINGS
1) Gastro
It’s easy to get sick in a 3rd world country. Dehydration from gastro issues will impact your ability to deal with altitude too. It pays to be paranoid:
Never put anything to your lips. Unless you’ve cleaned it personally. Includes all cutlery, crockery, bottles, etc, etc.
Never brush teeth with local water. Use bottled water.
Never drink bottled water. Unless you hear the seal crack as you open it.
Never eat raw vege or fruit. Unless you personally clean them. With certified bottled water.
Never eat meat in the hills.
Wash hands often. But you’ve learned this one recently eh.
2) Extreme cold
Keep hydrated and well fed, and bring the good gear.
3) Altitude
This is a very readable run down from a guy who’s been up Everest a few times.
Which links to this Princeton outdoor guide.
And Jerry found this guide from an experienced trekking guide - how to prevent it & treat it.
Finally - this is a good place to start the ‘science’. Which leads to this medical note about altitude … in short:
“Above an altitude of 3,000m, individuals should not increase their sleeping elevation by more than 500m per day and should include a rest day (ie, no ascent to higher sleeping elevation) every 3 to 4 days.”
Note: Others say this should be 300m. And others say 700m is ok too.
FYI
- our trip plan adheres to this ‘rule’.
- you and guides will carry all altitude medications.
- guide carries medical oxygen, including at the 50th Everest feast for the Annapurna team.
- guide carries portable altitude chambers.
- checking: guide carries a pulse oximeter.
4) Medications
Kathmandu can supply all meds at low cost. If money is most important, buy in KTM. If safety is most important, buy at home.
Visit your doctor now - for all travel needs and special meds needed.
This US CDC note does a good job of saying how to manage altitude and use the meds:
* Key prevention technique is deep breathing at all times?
* I’m ALL for waiting to see what happens, and taking Diamox IF needed. Also does away with the issue of being confused about feeling AMS symptoms that might just be a reaction to preventative Diamox. But ...
* We fly from 1,400m to 2,850m (sleep 1 night Lukla), then fly to 3,600m (sleep 2 nights Khote), then walk to 4,360m (sleep 2 nights Thagnak), then walk to 4,950m (sleep 2 nights Khare), then walk to 5,415m (sleep 1 night Mera La), then walk to 5,800m (sleep one night high camp) … hence this contains a few days pushing the ‘500m per day’ rule, so this may be a GOOD CASE for starting Diamox the day we land in KTM?
* If taking Diamox AMS preventative - its 125mg 2x per day (or double dose, as needed), hence need about 15 x 250mg pills.
* If taking Diamox AMS treatment - its 250mg 2x per day, hence need about 30 x 250mg pills.
* If taking Dex AMS treatment - its 4mg every 6hr, hence need about 10 x 4mg pills - descent is top of mind.
* If taking Dex HACE treatment - its 8mg 1x plus 4mg every 6hr, hence need about 10 x 4mg pills - immediate descent is key.
* If taking Nife HAPE treatment - its 30mg every 12hr, hence need about 5 x 4mg pills - immediate descent is key.
Bottom line - if we all have a small stash 5-10 of each of the HACE/HAPE pills + 20-30 Diamox depending on your personal view about needing to take them preventatively or not, then we’re all good to go.
5) Oh, and Covid
Singapore Airlines has all you need to know here.
If you want to know more, you can also read this.
And to take it over the top, you can try this too.
Bottom line: Get all paperwork done, wear face mask and shield/glasses on plane, sanitize hands like a crazy person. (Note: We have a doctor supervised pre-departure test setup at our Kathmandu hotel the day we fly to Singapore).