Nomads On Wheels

Category: AMS guide

  • AMS : All you need to Know

    Acute Mountain Sickness Guide – All You Need To Know

     

    In my previous post about how to prepare for Ladakh, I talked about how Ladakh was one of the most extreme places and the things you should know before visiting Ladakh. I had also mentioned that of all the ‘dangers’ that pose a threat to someone visiting Ladakh. Altitude Sickness or  Acute Mountain Sickness or AMS is the one thing you really should know well about before visiting Ladakh or any high-altitude destination for that matter. The topic of how to avoid altitude sickness is a big one but I will try to be precise here. So buckle-up and be rest assured that by the time you are on the other side, you will have a clear idea about how to have a safe and wonderful trip to Ladakh.

     

    Khardung La – One of the High-Altitude Passes

    What is high-altitude?

     

    When you are visiting a mountainous region, you know that with every kilometer you move ahead you are also gaining altitude. But you have been to places like Manali, Shimla, etc. before and you have never been bothered about AMS, then why now? Well, that is because you have not really been to heights which are at a ‘high altitude’. To be considered at high altitude — the height at which the effects of lack of oxygen in the air starts showing – up in the human body — you have to be at a height of at least 8,000 feet (2,348 meters). Most people can easily go up-to this height without much discomfort or problem. However, anything beyond that and up to 18,000 feet can be dangerous to many and is called very high altitude. Anything beyond 18,000 feet, extremely high altitude.

     

    What are the symptoms of Acute Mountain Sickness or AMS?

     

    The symptoms of Acute Mountain Sickness start showing up soon after you have moved to a higher altitude. The symptoms vary depending upon how bad one is affected by AMS. Having said that, the basic symptoms to keep an eye open for are the following:

    • Loss of appetite
    • Nausea
    • Lightheadedness
    • Rapid heart-beat
    • Feeling exhausted
    • Mild headache
    • Dizziness

    While these symptoms by themselves are not dangerous, they can turn life-threatening within a matter of hours. if you don’t go to a lower altitude quickly enough (more on that below).

    In Ladakh, you always go higher and higher

    Severe symptoms of Acute Mountain Symptoms

     

    If the symptoms mentioned persist even after more than a couple of hours after you have reached a high-altitude destination and proper rest but not progressing you can just stay put and let your body acclimatizes. However, if you find yourself struggling more and more and have started to find it difficult to breathe coupled with other symptoms like coughing, inability to walk in a normal way, rush to a nearby hospital. Hospitals in Leh are well-equipped to handle cases of mild to moderate AMS. If you still don’t get better, the hospitals would suggest you rush to a lower altitude. If they do, don’t even have any second thoughts about it, rush to somewhere lower.

     

    Things to keep in mind when gaining altitude rapidly, Ladakh

    How do I keep AMS away?

    The the most important way to try to keep AMS away is to let your body acclimatize to the high altitude. More so if you have flown in from the plains. The body needs time to get used to working at much lower levels of oxygen than it generally does. If you don’t give it that time, you are inviting AMS. Try to do the following and you will in all probability, be able to keep AMS at bay:

     

    • Acclimatize. Whether flying in or otherwise, take the first day at Leh very slow. Rest, rest and rest. Or maybe just a brisk walk. No activity on this day.
    • Climb gradually. Ideally, a day’s rest after every 2000-3000 feet of climb beyond 10,000 feet but in real-world scenarios, try to make the ascent as gradual as possible. Take the road instead of flying-in to Leh. Choose the Srinagar-Leh highway over the Manali – Leh highway, which is steeper.
    • Climb high, sleep low. Cross high-altitude areas during the day but by night, sleep at lower altitude. One that should at least be significantly lower than the highest point you have crossed that day.
    • Drink lots of fluid (not alcohol). Green tea, water, juice whatever. But drink. Keep yourself hydrated.
    • Keep the energy-supply going. Dry fruits, chocolates or anything that packs a punch in it. The point is to never run low on your energy levels.
    • Do not exert yourself. No jumping, no dancing, no running around. Totally no un-wanted physical activity.

    Medicine for High Altitude – Diamox dosage for altitude sickness

     

    Altitude sickness is not something that can be ‘treated’ with medicines. The medicines prescribed just increase your body’s capability to get used-too faster while trying to mask the mild symptoms. Just like different people acclimatize at different rates and AMS affects different people differently, the effectiveness of the medicines which are generally prescribed for AMS– Diamox (Acetazolamide) & Dexamethasone — too varies from people to people.

    Having said all this, I would like to iterate that all the information here is for you to keep in mind. If you take it slow and easy, in all probability, you will not face any issues related to AMS. Keep in mind that things like light head-ache and loss of appetite when you are at a higher altitude which would fade away on their own.

     

    So, be relaxed, go with a happy mind and come back with memories of a lifetime.

     

    *For taking any Medicine consult with Doctor first 

  • AMS Survival Guide

     AMS Survival Guide

    Traveling to Ladakh is fraught with challenges and one of the biggest challenge and threat to travelers visiting Ladakh is that of Acute Mountain Sickness (AMS).
    Acute Mountain Sickness occurs due to scarcity of oxygen at high altitude, and inability of our bodies to adjust to low oxygen content in air. Acute mountain sickness is defined as: In the setting of recent ascent to high altitude, headache with at least one of the following symptoms: nausea, vomiting, anorexia, fatigue or weakness, dizziness or lightheartedness and lack of sleep.
    While majority of travelers to Ladakh experience some or all of the symptoms of moderate AMS (headaches, nausea, vomiting, fatigue, loss of appetite and shortness of breath while walking), few get affected by severe AMS (shortness of breath at rest, inability to walk, decreased mental status and fluid buildup in lungs). Severe AMS can in some cases, lead to permanent brain damage or even death.
    Hence it is best to exercise caution while traveling to Ladakh and keep an eye on your health, as well as that of your co-travelers.
    This practical AMS Survival Guide aims to give you the information you can use and is tailored for those planning to visit Ladakh.

    Which is the best route to avoid AMS?

     

    Srinagar – Leh Highway is lower in altitude than Manali – Leh Highway, with the highest point being 13,479ft (4,108mtr), Fotu La pass. In comparison, Manali – Leh Highway’s highest point is 17,585ft (5,360mtr), Tanglang La pass. And for the 200km long stretch between Zingzing Bar and Rumtse Village, altitude never dips below 13,780ft (4,200mtr).
    Hence it is our recommendation that you take the Srinagar – Leh Highway, if you have the time and wish to avoid getting hit by severe AMS.
    You can also take the Shimla – Kaza (Spiti Valley) – Keylong route to Ladakh, which too will help you gain altitude gradually. However, please do not rush through it, since it will not only lessen your chances of gradually acclimatizing to high altitude, but you will also miss out on the wonderful sights en route.

    What if I have to take the Manali – Leh Highway while going to Leh?

     

    If you just have to do Manali route first or if that is the only route you are planning to cover, then it is best to avoid spending the night at Bharatpur, Sarchu or Pang. Instead you should stay at Keylong, Jispa or Darcha and then start in the wee hours of the morning for Leh. If you have to spend a night between Baralacha La and Tanglang La, then Sarchu is safer bet than Bharatpur and Pang.
    Whatever you do, do not attempt to cover Tso Moriri en route to Leh. Since it is even higher in altitude than Pang and will drastically increase your chances of getting hit by severe AMS as well as increase the time you spend at extremely high altitude.

    What if I am flying to Leh?

     

    If you are planning to take a flight to Leh, thenk make sure to spend the first couple of nights in Leh or at places like Alchi or Uleytokpo, which are comparatively lower in altitude than rest of Ladakh.

    Is there a particular pattern in which I should travel in Ladakh to avoid AMS?

     

    Once you arrive in Leh (either by land routes or by flight), you should still be cautious about your sleeping altitude and only gain it gradually by doing Nubra Valley first, followed by Pangong Tso and then Tso Moriri, Hanle etc.. This is due to the fact that even though you have to travel on the highest motorable road, Khardung La, to reach Nubra Valley, it is lower in altitude than Pangong Tso and Tso Moriri.
    In fact irrespective of your mode of transport and route, you should aim to spend at least first couple of nights in Leh, in order to acclimatize and unwind, before proceeding to any of the above destinations.
    If despite taking all the precautions, you still feel effects of AMS at Pangong Tso or Tso Moriri, then instead of spending the night there, you can return to Tangste (in case of Pangong) or Chumathang (in case of Tso Moriri) to sleep at a lower altitude and minimize the effect and danger of AMS. Normally descent of just 300-900 meters (1,000-3,000ft) is enough to make you feel better.

    Which medicines can I take to avoid AMS?

     

    For AMS Related Problems, use herbal medicine Gingko Bilabo
    (Avoid Diamox anyway which causes Nausea).
    Why Gingko Bilabo ?
    Read more at: https://photoseek.com/2012/acclimatize-to-high-altitude/ )

     

    Diamox:

     

    While Diamox can somewhat speedup acclimatization process, by making your body breathe faster and help increase overall oxygen intake, it isn’t a surefire way to avoid AMS and it will not help if you take it only after you start feeling the effects of AMS. It is better off as a preventive medicine.

    Current recommendations are 125 – 250 mgs twice daily, starting a day before ascent and continuing for a couple of days at the height or even for the entire duration of stay. If severe symptoms develop, Diamox will not be useful and in such cases, descent is the best way out.
    Diamox has various side effects, ranging from numbness and tingling in the fingers and toes, nausea, vomiting and diarrhea, drowsiness and confusion. It will also make your cold drinks taste flat and increase urination. So make sure to drink water regularly to keep yourself hydrated.
    You should consult with your family doctor, before taking Diamox, especially if you are on any medication. Also since Diamox is a sulfur drug, it cannot be taken by those who are allergic to sulfur drugs.
    Taking a test dose a few weeks before your trip to see whether you experience any severe side effects of Diamox is a good idea.
    Dexamethasone:

     

    2-4 mg of Dexamethasone every 6 hours is also effective in preventing and treating AMS. The mechanisms of action of dexamethasone in relieving AMS symptoms are unknown. Its relative effectiveness compared to Diamox has not been established, but it likely is equivalent to Diamox. Dexamethasone should only be taken in consultation with your family doctor/physician.
    Disprin/Aspirin:

     

    Those who do not wish to take Diamox, blood thinners like Disprin, Aspirin etc. can not only help reduce some of the symptoms of AMS eg. headaches, but also help your blood carry more oxygen.
    Oxygen Cylinder: You can also carry portable oxygen cylinders, which are available at chemist shops and should provide you temporary relief, in case you or those traveling with you start to feel uneasy.

    What other precautions I should take?

     

    You should avoid spending too much time at high altitude passes.
    You should drink water at regular interval and water mixed with glucose or electrolytes to keep yourself hydrated and keep your energy levels up.
    You should avoid overexerting yourself and take frequent breaks while walking or climbing stairs.
    You should avoid overeating and eat light yet frequent meals.
    You should avoid smoking and drinking till you are fully acclimatized, since alcohol is known to cause dehydration.
    You should immediately approach hospital or an army base if you or a fellow traveler starts showing symptoms of severe AMS.
    You should follow trekker’s mantra of climbing high and sleeping low i.e. even though you might travel across high altitude passes during day, you should try and sleep at lower altitude places.
    And of course, travel to Ladakh with an open mind and an open plan, and avoid trying to stick to a plan/itinerary at the cost of your own health and wellbeing.

    Disclaimer:

    This article has been written by a traveler and shouldn’t be confused with medical advice. You should always consult a doctor before taking any medicines and read other opinions and articles on AMS eg. this one High Altitude: Acclimatization and Illnesses, to arm yourself with the knowledge that can help you and those traveling with you to Ladakh.

    Please Note :For Medicines Please consult with your First