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Staying healthy while trekking/climbing

Trekking is a wonderful experience but sickness is sometimes a problem.
Here are some guidelines on staying healthy; if you do get sick consult with your leader.

Arrival

Changing time zones knocks people, add the stress of winding up at work and many people arrive feeling slammed, needing a holiday. This is the time you are most likely to get sick; try to take it easy, and definitely take multi-vitamin tablets. If travelling from America the flights are particularly long with annoying stopovers and a brutal time change; we recommend arriving a day earlier to recover. We still arrange an included airport transfer an extra night at the hotel is cheap.

Drinking water

Do NOT drink tap water anywhere. 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 our hygiene.

Diarrhoea

This is a common problem in developing countries. In normal circumstances when you get diarrhoea you visit a doctor and they conduct some tests and this is the best way to make an accurate diagnosis. However while trekking obviously this is impossible so you may have to be your own doctor if there is no real doctor close by, and consult with your leader.

First, diarrhoea will not normally kill you so urgent treatment is not necessary nor always recommended. Many people over-react and start taking drugs at the first loose stool. Instead wait a few days and see what happens.

Unless it is particularly severe, for example food poisoning, there is no need to stop trekking, just drink lots of water 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 sweat a lot so it is important to replace the fluids you lose. Dehydration make 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. 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 litre 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!

The "Khumbu Cough"

If trekking for a prolonged period at altitude, especially in the Everest region, this usually strikes. This is the perpetually running nose and a usually 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, there is 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. First 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.

Vaginal infections

If you have experienced these before then it is very worthwhile taking along the medication just in case.

Acclimatization and altitude sickness

When trekking or climbing above 3000m/10,000ft it is important to take into account the effect of altitude on your body.

All our trek itineraries are planned with sound acclimatization in mind.

We always discuss acclimatization and altitude sickness as part of the trek briefing. Ask for our separate sheet if you want more info than below.

AMS - Acute Mountain Sickness

Commonly called altitude sickness, this has the potential to affect all trekkers from 2500m and higher. Your body needs days to adjust to smaller quantities of oxygen in the air - at 5500m/18,044ft the air pressure is approximately half that of sea level, ie there is half the amount of oxygen (and nitrogen). This is approximately equivalent to the top of Kala Pattar, in the Everest region.

For treks below an altitude of about 3000m/10,000ft it is not normally a problem. AMS is caused by going up high too fast and can be fatal if all the warning signals are ignored. Note that it is not the actual altitude, but the speed at which you reach higher altitudes which causes the problems.

Altitude sickness is preventable. Go up slowly, giving your body enough time to adjust. These are the 'safe' rates for the majority of trekkers: spend 2-3 nights between 2000m/6562ft and 3000m/10,000ft before going higher. From 3000m sleep an average of 300m/1000ft higher each night with a rest day every 900-1000m/3000ft. Ultimately it is up to you to recognize the symptoms, and only ascend if you are relatively symptom-free.

Normal symptoms at altitude

Don't expect to feel perfect at altitudes of more than 3000m. These are the normal altitude symptoms that you should expect BUT NOT worry about. Every trekker 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 2500-3800m 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 (a good sign that your body is acclimatizing: at Gokyo, Sean from Canada's record, 18 times in one day).

Precautions

DO discuss your trek fitness and suitability with your doctor, especially if you are overweight or over 50!

Precautions

Anyone with heart, lung and blood pressure abnormalities or a continuing medical condition should have a check-up and get a medical opinion before setting off. We suggest anyone over 50 years old get a professional checkup that includes a heart stress test. Many recently-retired people have made it to the top of Kala Pattar (5554m/18,222ft) 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. Kathmandu is horribly polluted but most asthmatics feel better once 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 trek 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 bring the medicine you are normally prescribed.

Immunizations

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

The most accurate immunization advice for visiting Nepal is on CIWEC Clinic's page, Kathmandu's most professional medical clinic. It is worth reading very carefully and printing this advice out, plus what follows, before getting your shots. American doctors (perhaps to avoid getting sued) tend to jab far more needles than is useful. The best people to consult about the vaccinations are clinics specializing in travel medicine.

Malaria in Nepal

Carried only by the lowland Anopheles mosquito, malaria exists in the Tarai in Nepal (ie below 1000m/3281ft), and across much of the rest of rural Asia. There's no risk in Kathmandu or while trekking and the risk in Pokhara appears to be theoretical only. If visiting Chitwan April to October then you can consider taking tablets to protect against malaria. The actual risk, especially since you are there for a short time, is minimal, and the side effects of some drugs less than minimal.
Whether you are or are not taking anti-malarials, the first line of protection, is to avoid being bitten. The Anopheles mosquito is active only between early evening and dawn so you should cover up well between these times and use mosquito repellent on any exposed skin. All the better lodges at Chitwan spray the whole compound regularly with mosquito killing chemicals.

Malaria in India

There is NO malaria in the regions we trek in. The risk of picking up malaria in Delhi or on the bus ride from Manali to Delhi is extremely small, probably not worth worrying about. You should use mosquito repellent on the bus. The rooms in the Delhi hotel as often sprayed.

Hepatitis A

Usually passed on in contaminated water; immunization 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-Diptheria

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.

Japanese Encephalitis B

This disease is transmitted by mosquitoes and there have been sporadic outbreaks in the Tarai (lowland Nepal) and India. Western doctors based in Kathmandu suggest the vaccination only for people working in the Tarai for extended periods. In other words you DON'T need this 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 minimal 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 injections should be started within a week or so of being bitten.

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