HEALTH

The Altitude

While our experience has shown that maintaining hydration, observing rest days at significant elevations, and maintaining a good level of base fitness can mitigate potential problems, it’s important to acknowledge that everyone will experience the effects of high altitude to some degree. For those unfamiliar with altitude, pre-trip concerns may arise. However, rest assured that our guides are extensively trained to assist you through the acclimatization process.

Expect to encounter mild symptoms such as headaches, akin to the sensation of wearing tight sunglasses for an extended period. These ‘pressure’ headaches can typically be alleviated by over-the-counter medications like Panadol, Ibuprofen, or by simple remedies like drinking more water, resting, and practicing pressure breathing techniques. It’s crucial to prioritize relaxation, whether it’s through reading, taking short naps, or leisurely activities, to facilitate your body’s adjustment.

Upon reaching new altitudes, one may experience sensations akin to a mild hangover. It’s imperative to adopt a slow and steady pace, refraining from attempting to match the pace of locals.

As part of our acclimatization program, we incorporate ‘active’ rest days. These involve gentle walks to slightly higher elevations, following the principle of ‘climbing high, sleeping low,’ which significantly aids in acclimatization.

Altitude Sickness

Altitude sickness, also called Acute Mountain Sickness (AMS), hypobaropathy and soroche, is an illness caused by exposure to the low air pressure, especially low partial pressure of oxygen, which many trekkers experience at high altitudes.

AMS is caused by exerting yourself at high altitudes, especially if you have not been properly acclimatised. It is most common at altitudes above 2400 metres. Over 6000m above sea level, the air pressure (and the amount of oxygen it contains) is less than half that at sea level, and has been said to be comparable to working with only one lung.

AMS can be serious, especially as it can be debilitating, and it generally occurs far from places where medical treatment can be easily administered.

Not everyone suffers from AMS, of course, and it is very difficult to predict who is or is not vulnerable to it. Generally speaking, a fit person is less vulnerable than an unfit person, because their cardiovascular system can operate at low pressures longer without as much strain. Even so, anyone can be vulnerable at altitudes above 3500 metres, no matter their fitness level, if they have not spent some time getting used to the low atmospheric pressures first.

Avoiding Altitude Sickness

1. Walk high, sleep low. It is best to gradually climb higher each day, then descend lower to sleep. This lets you gradually become accustomed to lower pressures, and then recover somewhat overnight.

2. Slow and steady. You need to keep your respiration rate low enough to maintain a normal conversation. If you are panting or breathing hard, you must slow down. Overworking your heart and lungs substantially increases your chance of becoming ill.

3. Drink much more water than you think you need. Proper hydration helps acclimatisation dramatically. You need to drink at least three litres each day. As dehydration presents many of the same symptoms as altitude sickness, your chances of being allowed to continue are best if you stay hydrated.

4. Diamox. The general consensus of the research is that Diamox is helpful in avoiding AMS. We recommend you google Diamox and its effects yourself. It is a prescription drug, and you should consult with your doctor before taking it.

it should be taken before trekking, not after symptoms develop.

Note: you can not find Diamox in Pakistan, so need to bring it.

Preventing dehydration

Even if you avoid diarrhoea, you can easily become dehydrated at high altitudes. The lower air pressure forces you to breathe more quickly and deeply, and you lose a lot of water through your lungs. You will also be exerting yourself, and sweating.

The upshot is, as you might expect, that you will have to drink more water. You need to drink at least 3 litres of fluids every day while trekking. Even when you don’t feel thirsty you have to drink this amount as a minimum – preferably more.

Stay on the look-out for signs of dehydration in yourself and your fellow trekkers. The most common symptoms include thirst, dry lips, nose or mouth, headache and feeling fatigued or lethargic. If you think you may be dehydrated, there are two ways to tell:

The color of your urine. Clear or light straw-colored urine means you are probably not dehydrated. Yellow or orange wee means you have not been drinking enough, and you need to up your fluid intake quickly.

Pinch or press firmly on an area of exposed skin. If it does not spring back instantly, or stays pale and bloodless for more than a second or two, you are probably dehydrated.

Avoiding diarrhea

Make sure that your hygiene is as good as possible to avoid picking up a stomach upset. Needless to say, a bout of diarrhea can make a two week-long strenuous trek unpleasant or even impossible.

On the trek itself, we make sure that your food is pure and uncontaminated. You will need to carry a water purification filter or tablets to ensure all water that you drink is safe.

Make sure you follow these simple rules at all times:

If you are not absolutely certain water is pure, do not drink it.

Wash your hands thoroughly after using the toilet, and before eating or handling food of any kind.

Do not eat raw vegetables or salads. Cooked, preferably boiled veggies only.

Avoid any cold drinks, and ice of any kind.

Water from sealed bottles is generally fine, as are fizzy drinks, wine and beer. Hot tea and coffee are good, as they have just been boiled.

If you do get diarrhea, the most important thing you can do is to stay hydrated. The best thing to drink is a rehydration solution like Dioralyte.

Read more about dehydration below.

Over the counter medicines like Immodium (or anything containing loperamide) are only for short term, mild diarrhoea. Some doctors recommend taking a single, 500mg dose of Ciprofxin, or any ciprofloxacin antibiotic in an emergency situation. This is a prescription medicine, and you should discuss it with your doctor before your trip.

Malaria

In Pakistan, the risk of malaria is not prevalent in higher altitude regions like Skardu or most Karkoram treks we organize. However, travelers should be aware of the risk of malaria in areas below 1,500m, particularly in regions like Islamabad, Naran, Chilas, Rawalpindi, it’s essential to take anti-malarial medication and follow preventive measures such as wearing long-sleeved clothing and using DEET-based mosquito repellent to avoid mosquito bites, especially during dusk and dawn when mosquitoes are active.

Sunburn and UV Protection

While a high altitude trek is hardly a day at the seaside, you will be vulnerable to sunburn if not properly protected. The thin atmosphere at high altitudes blocks much less UV radiation, even on cloudy days.

The three most important things you can do to avoid sunburn are:

• Apply SPF 30 or higher sunscreen to your face, nose and ears at least 30 minutes before going out into the sun, and reapply regularly. High SPF lip balm is also a must.
• Wear a wide-brimmed hat that shades your face, nose and ears.
• Wear UV-protective sunglasses, category 2-4.

At higher altitudes the sun’s rays are intensified and even on a cloudy day they can penetrate through and still burn you. And do not forget that the sun is at its strongest between 10:00-14:00 hours each day.

Eating well

Many trekkers experience loss of appetite at high altitudes. This is a real problem, as you will be burning an extra 2000 or more calories a day, and not replacing them can cause real problems.

Just like staying hydrated, you have to eat heartily even if you are not hungry. Meals heavy in carbohydrates are best, because they are easier to digest at high altitudes and provide long-term energy.

It is important to keep plenty of small snacks with you, as you will have to keep your energy levels high. Take a favourite treat to make it easier to eat when you do not feel hungry, but avoid anything with honey or syrup, or anything chewy as they are likely to freeze tooth-crackingly solid above 5000 metres. Chocolate, nuts and seeds, biscuits, savoury snacks and boiled sweets are generally better choices.

Body temperature

Every mountain environment has its own climate, and Karakoram has several different weather zones at different heights. Conditions change quickly, and you will be moving between zones as well. A hot and dry day can be followed immediately by snow or rain. Wearing a layered outfit is generally the wisest way to make sure you stay healthy and reasonably comfortable in all conditions.

Above all, make sure to wear warm, wind-and water-proof, breathable clothing on your trek. Get high quality gear too, as this is definitely the real thing. Storms, high winds and freezing temperatures must be expected, and poor quality equipment will fail.