This trip is about convienent and comfortable exploration. There are no days of prolonged hiking similar to what is experienced on our treks. This itinerary does include four short hikes. One on day 4 which is an easy hike to Chimi Lhakhang - a buddhist temple. The second on day 6 is an easy hike to Kurjey Lhakhang. Day 9 includes our third hike which is to Khamsum Yuelay Namgyal Choeten. This is a moderate but brief hike. Our final hike is on day11, visiting the unforgetable Taktsang Lhakhang, as known as the tiger's nest.
Please check with your physician before embarking on strenuous physical activity.
No perceptual physical exertion. Generally just a casual walking pace or a sitting oriented tour. Frequent breaks. No prior conditioning required.
2
Perhaps standing and walking more than a typical day, but with frequent stops. Should
not require prior conditioning for the majority of clients.
3
Physical activity for more than what may be typical in most people’s average day. Prior
conditioning is recommended and will likely improve the client’s enjoyment of the activity.
4
Athletic activity likely requiring most clients to participate in a physical conditioning
program involving cardio and strength training prior to the trip.
5
Physically demanding activities with significant exertion for extended periods of time
(days) requiring top physical condition.
6
Very physically demanding for extended hours over repeated days usually under challenging
environmental conditions. Generally reserved for technical high altitude mountaineering.
Beginner. Have had some prior exposure but typically no formal training or
participation on a regular basis.
I
Intermediate. Participated in formal training and have participated in the
activity for an extended period of time.
E
Experienced. Taken formal training. Participating in the activities for years
and may have even trained or lead others in the activity.
A
Anyone. The activity is appropriate for clients of all prior experience levels.
Altitude Sickness We all enjoy that tremendous view from a high location, but there are risks in going to high altitude and it's important to understand these risks. We post the following information with each of our trips that reach even a mild elevation so people can learn about the changes their body will go through. Much of the additional information is more relevant to our higher altitude treks and mountaineering adventures. Please contact us with any questions you may have.
What is High Altitude?
Altitude is defined on the following scale High (8,000 - 12,000 feet [2,438 - 3,658 meters]), Very High (12,000 - 18,000 feet [3,658 - 5,487 meters]), and Extremely High (18,000+ feet [5,500+ meters]). Since relatively few people have been to such altitudes, it is hard to know who may be affected. There are no specific factors such as age, sex, or physical condition that correlate with susceptibility to altitude sickness. Some people get it and some people don't, and some people are more susceptible than others. Most people can go up to 8,000 feet (2,438 meters) with minimal effect. If you haven't been to high altitude before, it's important to be cautious. If you have been at that altitude before with no problem, you can probably return to that altitude without problems as long as you are properly acclimatized.
What causes altitude illnesses?
The concentration of oxygen at sea level is about 21% and the barometric pressure averages 760 mmHg. As altitude increases, the concentration remains the same but the number of oxygen molecules per breath is reduced. At 12,000 feet (3,658 meters) the barometric pressure is only 483 mmHg, so there are roughly 40% fewer oxygen molecules per breath. In order to properly oxygenate the body, your breathing rate (even while at rest) has to increase. This extra ventilation increases the oxygen content in the blood, but not to sea level concentrations. Since the amount of oxygen required for activity is the same, the body must adjust to having less oxygen. In addition, for reasons not entirely understood, high altitude and lower air pressure causes fluid to leak from the capillaries which can cause fluid build-up in both the lungs and the brain. Continuing to higher altitudes without proper acclimatization can lead to potentially serious, even life-threatening illnesses.
ACCLIMATIZATION
The major cause of altitude illnesses is going too high too fast. Given time, your body can adapt to the decrease in oxygen molecules at a specific altitude. This process is known as acclimatization and generally takes 1-3 days at that altitude. For example, if you hike to 10,000 feet (3,048 meters), and spend several days at that altitude, your body acclimatizes to 10,000 feet (3,048 meters). If you climb to 12,000 feet (3,658 meters), your body has to acclimatize once again. A number of changes take place in the body to allow it to operate with decreased oxygen.
•The depth of respiration increases.
•Pressure in pulmonary arteries is increased, "forcing" blood into portions of the lung which are normally not used during sea level breathing.
•The body produces more red blood cells to carry oxygen,
•The body produces more of a particular enzyme that facilitates the release of oxygen from hemoglobin to the body tissues.
Prevention of altitude illnesses falls into two categories: proper acclimatization and preventive medications. Our trekking routes maximize acclimatization. There are a few ways you can help your body adjust to altitude:
•Stay properly hydrated. Acclimatization is often accompanied by fluid loss, so you need to drink lots of fluids to remain properly hydrated. Urine output should be copious and clear.
•Avoid tobacco, alcohol and other depressant drugs including: barbiturates, tranquilizers, and sleeping pills. These depressants further decrease the respiratory drive during sleep resulting in a worsening of the symptoms.
•Eat a high carbohydrate diet (more than 70% of your calories from carbohydrates) while at altitude.
PREVENTIVE MEDICATIONS
•Diamox (Acetazolamide) allows you to breathe faster so that you metabolize more oxygen, thereby minimizing the symptoms caused by poor oxygenation. This is especially helpful at night when respiratory drive is decreased. Since it takes a while for Diamox to have an effect, it is advisable to start taking it 24 hours before you go to altitude and continue for at least five days at higher altitude. The recommendation of the Himalayan Rescue Association Medical Clinic is 125 mg. twice a day (morning and night). Possible side effects include tingling of the lips and finger tips, blurring of vision, and alteration of taste which subside when the drug is stopped. Contact your physician for a prescription. Since Diamox is a sulfonamide drug, people who are allergic to sulfa drugs should not take Diamox. Diamox has also been known to cause severe allergic reactions to people with no previous history of Diamox or sulfa allergies. Frank Hubbell of SOLO recommends a trial course of the drug before going to a remote location where a severe allergic reaction could prove difficult to treat.
ACUTE MOUNTAIN SICKNESS (AMS)
AMS is common at high altitudes. At elevations over 10,000 feet (3,048 meters), 75% of people will have mild symptoms. The occurrence of AMS is dependent upon the elevation, the rate of ascent, and individual susceptibility. Many people will experience mild AMS during the acclimatization process. Symptoms usually start 12-24 hours after arrival at altitude and begin to decrease in severity about the third day. The symptoms of Mild AMS are headache, dizziness, fatigue, shortness of breath, loss of appetite, nausea, disturbed sleep, and a general feeling of malaise. Symptoms tend to be worse at night and when respiratory drive is decreased. Mild AMS does not interfere with normal activity and symptoms generally subside within 2-4 days as the body acclimatizes. As long as symptoms are mild, and only a nuisance, ascent can continue at a moderate rate. When hiking, it is essential that you communicate any symptoms of illness immediately to your trip leader. Basic treatment of the symptoms of mild AMS include pain medications for headache and Diamox (see above).
MODERATE AMS
Moderate AMS includes severe headache that is not relieved by medication, nausea and vomiting, increasing weakness and fatigue, shortness of breath, and decreased coordination (ataxia). Normal activity is difficult, although the person may still be able to walk on their own. At this stage, only advanced medications or descent can reverse the problem. Descending even a few hundred feet may help, and definite improvement will be seen in descents of 1,000-2,000 feet (305-610 meters). Twenty-four hours at the lower altitude will result in significant improvements. The person should remain at lower altitude until symptoms have subsided (up to 3 days). The best test for moderate AMS is to have the person "walk a straight line" heel to toe. Just like a sobriety test, a person with ataxia will be unable to walk a straight line. This is a clear indication that immediate descent is required. It is important that the person descend before the ataxia reaches the point where they cannot walk on their own. (which would necessitate a an evacuation).
SEVERE AMS
Severe AMS presents as an increase in the severity of the aforementioned symptoms, including shortness of breath at rest, inability to walk, decreasing mental status, and fluid buildup in the lungs. Severe AMS requires immediate descent to lower altitudes (2,000 - 4,000 feet [610-1,220 meters]). There are two other severe forms of altitude illness, High Altitude Cerebral Edema (HACE) and High Altitude Pulmonary Edema (HAPE). Both of these happen less frequently, especially to those who are properly acclimatized. When they do occur, it is usually with people going too high too fast or going very high and staying there. The lack of oxygen results in leakage of fluid through the capillary walls into either the lungs or the brain. High Altitude Pulmonary Edema (HAPE) results from fluid buildup in the lungs. The fluid in the lungs prevents effective oxygen exchange. As the condition becomes more severe, the level of oxygen in the bloodstream decreases, and this can lead to cyanosis, impaired cerebral function, and death. Symptoms include shortness of breath even at rest, "tightness in the chest," marked fatigue, a feeling of impending suffocation at night, weakness, and a persistent productive cough bringing up white, watery, or frothy fluid. Confusion and irrational behavior are signs that insufficient oxygen is reaching the brain. In cases of HAPE, immediate descent is a necessary life-saving measure (2,000 - 4,000 feet [610-1,220 meters]). Anyone suffering from HAPE must be evacuated to a medical facility for proper follow-up treatment.
High Altitude Cerebral Edema (HACE) is the result of swelling of brain tissue from fluid leakage. Symptoms can include headache, loss of coordination (ataxia), weakness, and decreasing levels of consciousness including, disorientation, loss of memory, hallucinations, psychotic behavior, and coma. It generally occurs after a week or more at high altitude. Severe instances can lead to death if not treated quickly. Immediate descent is a necessary life-saving measure (2,000 - 4,000 feet [610-1,220 meters]). Anyone suffering from HACE must be evacuated to a medical facility for proper follow-up treatment.
- fitness readiness
