Trekking Nepal

AMADABLA

TREKKING THE HIMALAYAS

MUSTANG 1991
KANCHENJUNGA 1993
ISLAND PEAK & MERA PEAK 1994
NARPHU 1996
MAKALU & EVEREST 1998
MANASLU & NARPHU 1999
MILKE DANDA & NORTH 2000
NORTH EAST NEPAL TREK 2002

ARUNACHAL PRADESH TREKS 2003

ADVICE and TREKKING AGENTS

TECHNICAL INFORMATION
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ADVICE and TREKKING AGENTS

I have hesitated to give advice as so much has already been written about trekking in Nepal, but a recent request from some friends to talk to them about their intended climb of Island Peak has changed my mind;

ALTITUDE SICKNESS I suffered this on the first trek to Mustang. Being inexperienced I shared my water on the long climb up to high camp and was dashing around the camp when IT hit me in minutes; headache, nausea, and sickness. The next morning I was in the Cook's tent at first light and downed 11 cups of tea and hot water in succession, that cured my problem; drink regular amounts even if you are not thirsty. A target of three to four litres of liquid a day is not too much. I nearly always wake in the night at altitudes of 4,000m plus and drink from a metal thermos flask, which can also give hot water in the day. A Sigg bottle can suffice if filled with boiling water put inside a sock; and its also a great way to warm up a cold sleeping bag. GO SLOWLY. The people who usually suffer are very fit and of course can climb up quickly but that is a recipe for a thumping headache and sickness. Worse still it can degenerate very quickly into a life threatening situation. The best thing to do always, is to go down. See The Makalu & Everest Trek coming down from Kala Patter; even with the Gamma Bag, although it helped, still a descent to the hospital at Pericha was the best treatment. Climb high and sleep low if possible, it's the night time when it seems worse, so the lower you can sleep the better you will feel. I have taken Diamox tablets but although they might help a little do not depend on them. The blood can thicken at altitude so Aspirin, and according to some of the latest research dark chocolate or a cup of Cocoa, can help to thin the blood. They informed me at the hospital in Pericha on the Everest trek that some sixteen people had died of altitude and related problems in just six weeks of that season.

UIAA Mountain Medicine Centre Information Sheet 3

Intended Distribution: High Altitude Mountaineers
*COPYRIGHT UIAA MOUNTAIN MEDICINE CENTRE*

DIAMOX, DEXAMETHASONE & NIFEDIPINE AT HIGH ALTITUDE

Diamox (acetazolamide) is of some value in the PREVENTION of Acute Mountain Sickness (AMS). Dexamethasone (Decadron) has a place in the TREATMENT of established AMS and Cerebral Oedema. Nifedipine (Adalat) is used for Pulmonary Oedema. I have used the names by which these drugs are commonly known.

DIAMOX

Diamox (acetazolamide) a drug often used in the treatment of the eye condition glaucoma is useful in the prevention of Acute Mountain Sickness (AMS). AMS occurs commonly during visits to 3000-4500m and usually causes a severe headache, exhaustion and feeling generally unwell. Rarely (but even at these altitudes) the condition progresses to cause more serious problems which are potentially fatal - Pulmonary and Cerebral Oedema.

Diamox reduces the headache of AMS and helps the body acclimatize to the lack of oxygen. It also probably reduces the incidence of the complications of AMS mentioned above.

Whether or not one takes Diamox is obviously a matter of personal choice: travel to high altitudes is quite possible without it. I do not recommend the drug as a routine, though there is variation of opinion about this.

How to take Diamox

If you decide to use the drug, I suggest Diamox 250mg (one tablet) is taken twice daily as a trial at sea level for two days several weeks before a visit to altitude. Assuming no unpleasant side effects are experienced, take the drug in the same dose for three days before staying at 3500m and thereafter for two or three days until you feel acclimatised, for about five days in all.

Side Effects

Like all drugs Diamox may have unwanted effects. Tingling of the fingers, face and feet is the commonest; it is not a reason for stopping the drug unless the symptoms are intolerable. Dizziness, vomiting, drowsiness, confusion and rashes have all been reported but are unusual. It makes many people (including myself) feel a little "off colour". Exceptionally the drug has caused more serious problems with blood formation and/or the kidney. Those who are allergic to the sulphonamide antibiotics may also be allergic to Diamox. Carbonated drinks taste strange when you are taking Diamox.

DEXAMETHASONE IN ACUTE MOUNTAIN SICKNESS

The potent steroid dexamethasone (Decadron) has an important place in the treatment of Acute Mountain Sickness. I usually suggest it when someone has an incapacitating headache.

DEXAMETHASONE IN CEREBRAL OEDEMA

Dexamethasone is also used in the treatment of the life threatening complication of AMS, cerebral oedema. It is due to fluid collecting within the brain. Patients become irrational, drowsy and confused over a period of hours and their walking becomes unsteady. Double vision may occur.

How to take dexamethasone

Take dexamethasone 8mg as tablets (usually 2mg size) initially followed by 4mg every 6hrs. Treatment would normally only last for one day, i.e. a total of 20mg in one day.

If AMS symptoms (headaches) still persist you should not be going higher and should seek medical advice if available. Descend if you can. You can continue to take dexamethasone for a second day but it is unlikely to help, i.e. it usually works in the first few hours. If cerebral oedema is suspected, descent is essential. Oxygen or a pressure bag should be used if available.

Precautions and unwanted effects
Like all drugs dexamethasone may have unwanted effects. In these very short courses the problems are few. However, the following may occur:

Peptic ulceration
If you have indigestion or are known to have had an ulcer, a medical opinion is usually advisable before taking dexamethasone.

Mood changes Steroid drugs sometimes increase excitability and may make one feel `high', or rarely confused. The risk is small.

NIFEDIPINE IN PULMONARY OEDEMA

Nifedipine (Adalat), a drug used for angina and high blood pressure, has an important role in the treatment of high altitude pulmonary oedema.

If you diagnose pulmonary oedema (breathlessness, crackly breathing) you should anyway be evacuating the patient to low altitude, giving oxygen, and using a Pressure Bag, if available. Give immediately nifedipine 20 mg by mouth, and 20 mg nifedipine every 6 hours, for one day.

If you are in doubt, this treatment is unlikely to cause anyone much harm.

UNDIAGNOSED SERIOUS ILLNESS AT ALTITUDE

It may be very difficult to diagnose what exactly is wrong when someone is gravely ill at altitude. Both treatments, i.e. dexamethasone and nifedipine can be given simultaneously. In my view these drugs should be carried in a small first aid kit, by climbers, and, in the context of high altitude climbing, can be used without medical supervision.
See also Information Sheets 1 (AMS) and 4 (Pressure Bags).

In Britain, these three drugs are sold only on a doctor's prescription: since they would be used for foreign travel a private prescription would usually be given.

Suggested prescriptions

Some physicians may be uncertain about prescribing these drugs for altitude-related illnesses. If so, the following guidelines may be helpful:

Acetazolamide 250mg tablets, one twice daily for five days

Dexamethasone (2mg tablets) 8mg at once + 4mg six hourly for 24 hours (12 x 2mg tablets)

Nifedipine 20mg tablets, one six hourly for 24 hours (7 x 20mg tablets)

Note

Anyone taking these medications should be aware of potential recorded unwanted effects, written details of which should be supplied with them by the dispensing pharmacist.

Dr Charles Clarke
May 1999

Link to BRITISH MOUNTAINEERING COUNCIL HOME PAGE; http://www.thebmc.co.uk/default.asp

TRAVEL INSURANCE try the B.M.C. they have a number of highly competitive policies, also do not forget that some credit cards have free insurance; I use mine every year and it has more than paid its way.

SUN BLOCK a good quality sun-block in conjunction with the right head gear and clothing can make for a burn free trek. Your skin will dry out so some form of cream will not go amiss and can help cracked and sore fingers.

BOOTS don't go out and buy a new pair of leather boots, that old battered pair as long as still waterproof will not give any problems at all. The new pair will give you blisters and you will end up walking in your trainers. New foot pads are an excellent idea and can give a surprising amount of extra comfort to old boots.

SOCKS do go and buy new wool mix socks, three pairs is about right, the thicker the better, but make sure they fit with your boots. Thin socks can be worn especially at the end of the days trekking.

TRAINERS yes do take a pair of trainers; a lot of the time they can be ideal for trails, as long as it's dry.

SANDALS I have not trekked in the trekking sandals as they seem to allow your feet to get filthy but are a treat to change into after a hard days trekking.

TEE-SHIRTS and UNDERWEAR cotton Tee-shirts tend to dry slowly and smell, so a nylon or other man made fibre is preferable and will dry quickly and keep you cooler. Higher up layers of course are the answer, but I object strongly to the outrageous prices that are charged for the high tech garments so resort to thin wicking garments and fleece pullovers brought cheaply and discard able at the end of the trek.

GLOVES take at least two pairs of gloves; a thin pair for general use and handling cameras, etc. and make sure your warm pair really are as fingers on some routes can be exposed to frost bite. The thick all wool Dacks are very good as even when wet they are warm.

HEAD GEAR take the biggest sun hat you can find. Never mind how silly it looks; high up with the high intensity ultraviolet burning your face off you will be glad to have the choice to wear it. Of course a good warm wool or fleece hat is essential on those cold frosty mornings.

HEAD TORCH the new L.E.D. head torches made by companies such as Petzl are outstanding, very light-weight, the bulbs won't blow and they only take small batteries and so save a lot of weight. Do take an alternative torch as well though; they are very desirable and easily lost.

UMBRELLA yes! I always take a collapsible umbrella. It works very well low down keeping the sun off and is a lot cooler than a sun hat, it is also very useful in the rain enabling you to walk along without having to put on the rather warm Gortex jacket. A plastic Poncho can be brought in Kathmandu for about 200R. This can also keep both you and your rucksack dry in a downpour.

MEDICAL ADVICE try the MASTA web site www.masta.org Its comprehensive in its advice. You should have a comprehensive medical kit. If you are not going on an organized trek one of the essentials as far as I'm concerned is antibiotics. If you find you have a bad dose of diarrhea and/or sickness a course of Cyproxin will cure the problem in a couple of hours. Also it is an outstanding for curing chest infections. If I feel I'm going down with a chest infection on my way to altitude I tend to take a course sooner rather than let an infection get a grip. Above 4,500 meters your body is slowly degenerating anyway so it's no good waiting for things to get worse. Leave your sightseeing till the end off the trek, you should aim to be out of Kathmandu as quickly as possible that's were you will pick up a stomach bug or flu.

SLEEPING BAG after the Kanchenjunga trek when I brought a new sleeping bag that turned out to be under filled and therefore well below the specification I vowed never again to be that cold. A good four or five season down sleeping bag is essential, it's much easier to keep cool than trying to get warm with a underrated bag. I also have a Polartek type liner which can be used at lower altitudes to sleep in or for additional warmth in extreme situations.

SKI STICKS although I'm not a general user of these implements there are occasions where they can prove very useful such as steep assents and descents and they are light.

PORTERS now you have got all this gear; take a look at the average porter he will be doing most of the trek in flip-flops with no socks at all carrying from 30 up to some 80 kilos. If you are going high make sure your porters are properly equipped. Don't make the mistake of kitting them out in Kathmandu, they will have sold most of the gear before you even set off. Porters do die on the high passes, many of them are not used to high altitudes and come from the lowlands seeking work. There have been times when my porters have suffered with the altitude so do not think they are immune just because of their carrying capacity. I try and carry as little as possible, remember you are giving employment to someone in a very poor country so why struggle when you can pay about two or three pounds a day to have the bulk of your load and usually one other carried for you.

THE COOK food becomes the most important part of the trek so do go out of your way to make sure you have a good cook and I do not hesitate to interfere to make sure the hygiene is right; basically they have no idea about hygiene. Towards the end of a long trek you will find them wiping the dishes with a filthy black towel and that's when you go down with the trots. Take a new tea towel for each week of the trek and burn the old one. If you are keeping up with the cook and cook boys you are going too fast. The Cook and his staff have to be the fittest members of a trek, packing up and often leaving last, passing everyone to be ready at the next stop with a meal and hot drinks.

CLIMBING I am not a experienced climber but I would say that unless you are confident of your ability take at least a climbing guide with you, he should know the routes and be as proficient as yourselves. Although some of the Trekking Peaks like Mera Peak are technically easy you are still at high altitude and invariably you are pushing on owing to time constraints. It is a serious undertaking and many of the other so called Trekking Peaks are definitely only for the very experienced and proficient climber. Remember climbing up is the easy bit, getting down again is another matter, if in doubt take advice and always have a rope just in case. On the Chulu Pass I watched as climbing Sherpas were searching for the body of a Japanese climber who had gone climbing on his own.

RUCKSACKS if you are going to carry weight make sure your rucksack has a broad supporting waistband; that is where the weight should be located. The length of the back is also very important and the actual weight of the sack. Every little bit of weight at altitude makes a difference so that huge cheap monster sack from the market might not feel such a good idea plodding up a steep incline high up. I learnt my lesson on Mera Peak, a small lightweight but strong sack for higher altitudes is essential. I  say  again, with a broad waist band, but I have found a lot of difficulty getting a 30 kilo light sack able to carry weight. Stuff Bags, I am  renowned for not being very organized but with a little forethought a stuff bag for each category of clothing clearly marked on the outside can save much rummaging around.

DOWN JACKET if you have not got one, hire one in Kathmandu, it's one of the best ways to keep warm and I class it as an essential piece of equipment.

GAS your gas mix will differ at altitude. There can be problems with regulations flying it out but it can be brought in Kathmandu at a price. Check direct with your trekking agent, he might get you a good stock and save a lot of hassle.

MONEY do not send money or any items of value by post to Nepal. It will go missing. Even if you can get someone to act as a currier for you, it is difficult to find someone trustworthy to pass on valuables. Remember you can hire a porter for as little as 150 Rupees a day about £1.50. We seem like millionaires with all our expensive equipment and gear though violent crime is not a problem, it's just that bribery and corruption are the norm. The large banks in Kathmandu will accept credit cards to draw money. 

TENTS if you hire a tent check it out thoroughly before leaving Kathmandu. It's too late up the trail to find it's leaking water and the zips are knackered.

TREKKING AGENTS

Classic Journeys

was Classic Nepal

I joined their Kanchenjunga Trek in 1993 and have kept in touch since, always finding them very helpful.

Noel Walsh and Ann Brooks

www.classicjourneys.co.uk

info@classicjourneys.co.uk

I have changed my mind on the way to go about trekking. I would suggest that you negotiate a fixed cost for the organizing of the trek then pay for the rest of the trek direct; porters wages, food, etc then you can be sure that the money is going on the trek and not into an agent's pocket. This is how we organised the Mera Peak and Island Peak Trek but you may find some resistance as this is not the normal way of doing things.

Costs

Expect to pay 200 Rupees a day for a porter

A Cook about 250 a day

A guide 250 to 300 Rupees a day

Your negotiations should include a figure for the hire of the trekking kit and tents.


Nima and Tenzing Sherpa

I will never use this agency again. Out of some 135,000 Rupees only 55,000 was sent on my trek in 2002 so I had a hard time. Also I had paid Nima some 220$ U.S. to get some 50 school books and pens to the school at Sedowa. I still have no proof they ever arrived. In 2002 I took 40 books and pens to a new school at Shimbuk, it cost just 700 Rupees. Corruption is rife in Nepal and westerners are now treated with contempt, the main motive being to take as much off you as possible.

Dealing direct with agents in Kathmandu can save money.

Jiban Ghimere

Sherpa Shangri-la Treks

Jiban organized my first trek into Narphu for me and has always proved very helpful.

His organization can arrange anything up to a full Everest expedition.

www.shangrilatrek.com

shangrilatreks@hons.com.np

OTHER USEFUL WEB SITES

www.trekinfo.com

FLIGHTS

I have used K.E. Adventure Travel to Organize my flights for the last few treks but this time, 2002, was a fairly last minute arrangement with my having to pick up my tickets from the airport. Baggage allowance was only 23 kilos so on flying back I got caught with 7 kilos excess and it cost  me 175$ US. Check your weight allowance and insist on at least 30 kilos. I checked the internet just before leaving. I could have saved £100 by booking at the last minute. As it was the 2002 flight with Gulf Air it was the most expensive I have had to pay; £580. Many flights have been taken off the Kathmandu route.

For more information please contact me

David Ketley

Dunge Valley Hidden Gardens
& Hardy Plant Nursery,
Windgather Rocks, Kettleshulme,
Nr. Whaley Bridge, (Stockport)
High Peak, SK23 7RF,
ENGLAND
Tel / Fax: 01663 733787

E-mail me at david@dungevalley.co.uk

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