Makalu Expedition – 60 Days

To enable all trekking & expedition members to acclimatize well and hence maximize their chances of success, our trekking & expedition programs are prepared with sufficient time for acclimatization. Adaptation to the altitude takes time and there can be no short-cuts, even if supplementary oxygen is used in the final stages. The atmospheric pressure at the base camp is half of that at the sea level. A thorough program of acclimatization is built into the itinerary which consists of regulated height ascents, followed by descents and rests before the final ascent to the summit. Yes it is very important for all trekkers and climbers because this will prevent the climbers to get rid from altitude sickness.

Although our guides from Great Nepal Treks carry first aid medical kit, it is better to carry a supply of first aid items for your own personal use according to your health conditions. Here are the list of some general as well as some special medications you may require:
– Antiseptic cream (Betadine)
– Sunblock SPF 30+
– Throat lozenges
– Painkillers and anti-inflammatory such as Aspirin, Paracetamol, Ibuprofen etc.
– Band-aids, bandage, compression bandage and ‘Second Skin’ for blisters
– Re-hydration salts. (Trioral, Electrobin, Oral Rehydrating Salt)
– Dextrose glucose tablets
– Water treatment tablets
– Your prescription medications
– Antibiotics for longer climbing and expedition style trips

You will be affected by high altitude problems if it is your fist trip at a high altitude. The altitude has some important beneficial effects on the human body and your trips have been designed to enable these. Please familiarize yourself with the information on AMS (Acute Mountain Sickness) and understand how to avoid it and read on benefits of high altitude and take advantage of these to improve your body’s metabolism.

Altitude sickness is the reaction of the body adjusting to decreasing amounts of oxygen. The high altitude slowly decreases the flow of oxygen means the higher you climb, the flow of oxygen is very thin resulting the malfunction of body. Altitude sickness most commonly occurs from above 2,800 meters (9,200ft) but this is different for everyone – there is simply no way of knowing your own susceptibility prior to being at altitude thus it is vital for you to monitor your own health. AMS occurs when the body is unable to adopt at the higher altitude having less amount of oxygen. At an altitude of 5490m (18000 ft.), the oxygen availability becomes just the half of the availability at sea level. While only a third of oxygen is available at the summit of Mt. Everest. Symptoms may be mild and subside/go away after a day’s rest, or if it is ignored it could lead to death.

Symptoms can appear within 1-2 hours although most often appear 6-10 hours after ascent and generally subside in 1-2 days as the body adjusts to altitude. They may reappear as you continue to go higher. Symptoms of AMS usually occur gradually and can be one or a combination of the following:
• Headache: Due to the less amount of oxygen in air, the blood influences the blood vessels to spread wide in order to supply more oxygen to the brain and which cause them to show the early symptom of AMS.
• Dopiness: The trekkers or climbers feel very sleepy but could not.
• Shortness of breath: The breathing pattern changes as the breathing becomes faster and deeper than normal in order to get enough oxygen and rapid pulse
• Loss of appetite and nausea: Despite of physical exercise, the trekkers don’t have an appetite to eat.

High Altitude Pulmonary Edema (HAPE)
If one accumulates of fluid in the lungs and mild fever then, there is a chance of High Altitude Pulmonary Edema (HAPE). The filling of fluid in the lungs is Pulmonary Edema. The fluid blocks the passage of fresh oxygen to get into the lungs which causes the shortage of oxygen. Though the exact reason for the HAPE has not been identified, scientists think that pressure of blood vessel around the lungs is directly proportional to the altitude. As a result the smaller blood vessels leak allowing the fluid to escape to the lungs. The treatment for the HAPE victims is to give the oxygen at the rate of 4 liters a minute, using Portable Altitude Chamber (PAC). In case of unavailability of PAC bag or oxygen, one is taken down to the low altitude which is the only way of life-saving. HAPE can also lead to unconsciousness which may also results to death in a short period of time.

High Altitude Cerebral Edema (HACE)
HACE is the accumulation of fluid in the brain due of the swollen blood vessels to the brain. HACE is also seen within a couple of hours and can send the patient to coma and take his/her life in just few hours likewise to HAPE. The excessive flow of blood to the brain due to the low-level oxygen causes vasodilation which eventually leads to leakage of blood vessels to the brain. A 4 to 8mg of dexamethasone is given as a first dose to those who suffer from such sickness and then 4mg Diamox is given an every six hours gap. Similarly, 2-4 liters/minute oxygen is given and one is taken to down if it is necessary.

Breathlessness
– A dry cough, developing to a wet one with blood-tinged discharge or saliva
– Tightness in the chest & blueness/darkness of face, lips & tongue
– Low fever up to 38°C/100°F
– Severe fatigue, progressing to coma

– Severe headache symptoms not relieved by painkillers or lying down
– Confusion, disorientation & drowsiness
– Nausea/vomiting
– Loss of balance or coordination
– Blurred or double vision/retinal hemorrhage

Certain medical conditions (such as respiratory disease) or medications (such as sleeping pills) can increase the risk of altitude sickness – it is important that you inform your guide of any medical conditions or medications before ascending to altitude. You can help your body to acclimatize and avoid altitude sickness by:
– Avoiding alcohol, tobacco and substances that can interfere with good delivery of oxygen to the body or cause dehydration
– Eating small, frequent meals high in carbohydrates
– Drinking plenty of water – the test of sufficient amount of water intake is ability to urinate colorless urine
– Taking it easy or have a rest. Walk at a slower pace than you would at sea level and avoid over-exertion
– Climb the mountain gradually and stop for a day or two of rest for every 600m/2000ft above 2,400m/8000ft
– Climb high but Sleep at a lower altitude if possible
– Learn how to recognize early symptoms of mountain sickness
Since our Guides from Great Nepal Treks are very professional and well trained about altitude sickness, they will guide you during your trekking and expedition activities in Nepal.

Most travelers are able to successfully acclimatize by following the previously mentioned guidelines. However, there are instances where medical treatment is required. Ultimately, the best treatment for acute mountain sickness (AMS) is to descend to a lower altitude and rest. Early diagnosis is important. Acute mountain sickness is easier to treat in the early stages. The guide will monitor you all the time for symptoms and will pace you appropriately to minimize your exposure to AMS.Cooperating with the guide and reporting if any of the above-described symptoms are seen allows your guide to undertaking appropriate and timely action to minimize your exposure to AMS. Sufficient time for acclimatization (After 3000 meters) is also another method to minimize AMS. Following precautions can be done in order to get rid of AMS:
Don’t ascent up rapidly.
• Never use alcohol, sleeping pills and smoking.
• Drink more fluid 3-4 liters a day, clean boiled water / tea / coffee / soup / juice etc.
• Climb high and sleep low.
• Don’t go trekking alone, take guide/porter.
• Follow the advice from your guide, hotel, local people, guidebook.
• Descent if mild symptoms rapidly getting worse.
• Never leave or descent sick person along.
• Avoid getting cold.
• Take an easy and comfortable trekking route even if it is longer.
• Sleep more than normal.
Your Guide will carry some medications in First Aid Kit and may suggest for medication such as Ibuprofen, Paracetamol, combination of them or specific AMS medication. Standard and effective medication for prevention of AMS is Acetazolamide (Diamox) and it may be given to help improve breathing and reduce mild symptoms. This drug can cause increased urination. Ensure you drink plenty of fluids and avoid alcohol when taking this drug.With severe cases of AMS, our guide will contact our office in Kathmandu and arrange your evacuation by helicopter. Before we accept you on the trek we will require that you purchase health and travel insurance including helicopter rescue and hospitalization.

You never know when the unexpected situation comes and put you in hearse condition whether you are professional or beginners. Our professional guides do their best to make you well with first aid support. If the situation goes worse, you will be evacuated by Helicopter. You are entirely liable for all the expenses incurred in evacuation. So, before coming to Nepal, please make your travel insurance. Ask your guide to arrange a runner to the nearest communication point and inform office about requirement of a helicopter. For evacuation, we require the name of the sick person and the exact location from where helicopter can airlift you. You should not leave the place after calling Helicopter for evacuation though you are feeling better than before.

On the trek, there is a facility of purchasing safe drinking water in teahouses.It is better if you carry the water purifying pills on your own. On camping trek, the water will be treated with Potassium permanganate or Iodine. On the trail, water from the streams is safe to drink, but better not to use it directly for drinking.

Security and a safe journey is our core objective of trekking. Our guide holds licenses issued by the Nepal Government and our staffs are local, honest, kind and genuine. But we also insist you to take care of your own personal belongings. If you are on ‘camping trek’ please take your main bag inside the tent once you reach campsite and put all bags and belongings in the middle of the tent when you feel sleepy. Your guide assigns a Sherpa on turn wise basis to guard the campsite throughout the night. If you are on ‘Tea house arrangement, never leave your baggage unattended and keep your lodge room locked when you go out. Feel safe since you are in the hands of ethical trekking company in Nepal.