TIM BOAC AGP - Trekking To Everest: Part 2 - Mind The Altitude !

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https://www.facebook.com/notes/tim-boac-agp/trekking-to-everest-part-2-mind-the-altitude-/995632700473372

Part 1: https://www.facebook.com/notes/tim-boac-agp/trekking-to-everest-part-1-a-walk-in-a-park/988945831142059

Trekking To Everest: Part 2 - Mind The Altitude !

TIM BOAC AGP·TUESDAY, APRIL 26, 2016

The Everest BC trek holds a special place in my heart. Back in 1998, it was my very first Himalayan trek and a big one at that. I was then a budding trip organiser and it was a big break in experience organising a Himalayan trek. Since then, I've successfully managed more than 60 organised trips to popular high altitude destinations in Tibet, Pakistan, Sikkim, western China, East Africa as well as other parts of Nepal, but this is one trek which is most memorable & fun. Well, 1998 is the year of the successful 1st ascent of Everest by a Singapore group led by David Lim and I can’t say that we were not inspired by it.

Then, internet was basically just email and Netscape and Altavista was the most popular search engine. Google? Haha, still incubating and totally unknown yet! Broadband was less than 1 Mbps. What nostalgia, those were the days.

Information generally was still restricted to guidebooks and Lonely Planet guides were my bibles. Thinking back, it's a world's difference from today where you have instant information at your fingertips, whether at home, office, on the bus/train or heck, even in a public toilet. Hell man, there's simply no excuse for ignorance in knowledge.

One of the main things which makes the Everest BC trek so memorable was its high altitude, which gives you such an intense & humbling experience such that the trip is so unforgettable. In simpler terms, it is suffering which you’ve never experienced before. This is especially so for those of us who've never been to and stay above 4000m for more than 24 hours. Ours was a camping trek and the cold was so bad that it froze our butts when we had to use the toilets, and yes toilets at most teahouses then were just a drop-hole in the ground with some wood panels hammered around it. Even then, most of us preferred it to our own tented portable toilet which is also a hole in the ground but less appealing. When the wind blows, especially at Pheriche, you can hear the whistling sounds as the wind cuts through the visible cracks in the wood walls and the cold assaulted our butts. To those who thought their Kinabalu experience was high or cold, it should not even count as you spend only an hour or so at 4095m at a “warm” temperature of around 5°C . It is precisely of the humbling altitude and the freaking cold that a trek to EBC be memorable for the right reason so that we can remember it as an awesome and enjoyable mountain experience, and not the intense/agonising physical & mental experience which most of us tend to remember it by. So things have to be done correctly right at the beginning at the planning stage. It is amazing that even today with the tonnes of information available on the net, the level of ignorance regarding trip preparations is still mind-boggling.

Back in those "nostalgic" days, you can still find the basic information on AMS (acute m ountain sickness) relating to its symptoms, prevention, and treatment. For any trip organiser and trek leader preparing their teams for any high altitude trek, such information are a "must" know. People are putting their lives in your hands and you have the moral responsibility to ensure that you have what it takes to do the job well, if not the specialised training (ie. WFR), then at least the knowledge and the means to act if/when required.

It is very important that the hazards of traveling to high altitude be made known and basic knowledge of mountain sickness and its management be shared with the clients. Altitude sickness occurs as the result of the body’s failure to adapt to higher altitudes, especially too high too quickly as in the case of the EBC trek. No excuse for a trek leader to be ignorant on such hazards. Please get acquainted with such knowledge & sharing if you’re in the business of making money out of arranging such tours for clients.

Can I avoid getting AMS? If your agent tells you that you can't do much about (preventing) AMS, you better raise your red flag alert. Fact is AMS can be prevented and minimized. Anyone who has done enough research (it's so easy in this age of fingertips internet compared to 10 years ago) will be able to come up with a list of at least 5-6 ways of minimizing or even total prevention (if you're the lucky type) of mountain sickness. Cross out that agent from your list if he can't share much on this basic question.

If you’re a cheapskate (sorry, I can’t resist using this term) and want to save $$ by signing up with the lowest-priced agent you can find (in this case that will be those amateur social outdoors groups in your country, or local Nepali trek operators in Nepal itself), you’ll get what you pay for. As the saying goes, “you pay peanuts, you get monkeys”. Most likely you’ll just get a day-to-day itinerary and a simple what-to-bring list. And of course a short itinerary which put you in danger of being heli-evacuated. You better do your homework on this vital topic of altitude & acclimatisation more thoroughly than you would study for your final university examinations as you can NOT expect these bargain-basement organisers/agents to provide you with the valued advice nor service(s) which are standard features by full-fledged professional adventure travel agents. Good luck.

Anyway, regarding the definition, prevention, symptoms, treatment, medication etc. just go google for it and you’ve tonnes of info on hands. Hence no need for me to touch on this. A good start is http://www.altitude.org/ and https://en.wikipedia.org/wiki/Altitude_sickness

Some myths and facts:

Altitude Can Kill and Does Kill: Every year, dozens of people - hikers on trekking holidays, climbers on mountaineering expeditions, and even local porters who're more used to high altitude - die of altitude sickness. Many of these cases are needless deaths, most of which are preventable especially hikers on trekking holiday as the scenarios are usually man-made, not due to the wrath of nature ie. unseasonal snowstorms (which can and do happens in the Annapurna & Everest trekking regions). Without timely medical intervention, there would have been more casualties each year.

Back in 2001 when I did my K2 BC trek, as we hiked to Broad Peak BC for lunch on our way to K2 BC, there was an orange tarp-covered object lying just below on the glacier awaiting heli-evac. We learnt that it was the body of a 19-year old French boy who had passed on the morning before. He did not feel well and had skipped dinner the night before and went to his tent straight to rest with his hiking group not suspecting anything. The next morning he failed to wake up, permanently. Suspected cause of death was HACE - quick silent killer. Our hearts couldn’t help but be jolted by the cold face of death right in front of us. If their trekking guide and or team members were more vigilant, assistance could have been sought from the climbing expedition team at Broad Peak BC itself which should have life-saving altitude aids.

Further on in the evening at K2 BC itself, one member started to develop AMS symptoms and as morning breaks, she’s still feeling bad. With our trek agent being the biggest operator of K2 expeditions, it was no issue using their Gamow bag to revitalise her. It was an experience watching the whole process at work. After less than 2 hours in the bag, she’s back to her lively and chirpy way. We all prayed silently our lucky stars that we had such a reliable operator and that everyone are feeling great to be alive & kicking at 5100m. Borrowing the famous phrase from Galen Rowell, “in the throne room of the mountain gods”, we can’t help but be humbled by the majesty of the mountains before us. Yes, the Karakorams are totally awesome, even more so than the Himalayas. Must go!

Sensible Itinerary & Acclimatisation: As regrettably illustrated by the recent heli-evac case in my earlier note (Part 1), there is a limit as to how short a sane EBC itinerary should be. Not enough leave? Then forget about EBC until you have enough, or risk having an unforgettable holiday for the wrong reason. If you still die die want to trek Everest, then do the Everest View trek and be satisfied with seeing Everest from afar for the time being. If it may make you happy, the picture above is exactly Everest View from Tengboche. Not bad, right? I think it’s good enough for someone who can’t squeeze out more leave from work. In our local Singlish saying, “no prawn? then make do with fish”.

Roland Hunter in his comment to David Lim's post, highlights the even crazier case of (let me quote in full) "a Malaysian group who were doing the trek Lukla to Lukla in 7 days and four of their trekkers also had to fly out. I measured one of the groups's blood oxygen saturation at Pheriche (she descended that day from Lobuche) and her level was 45%!! Luckily doctors at HRA had arrived that day and she was on oxygen overnight then flown out in the morning. If the doctors had not been at HRA she would have been in serious trouble." It’s scary that we have such (stupid) people on the EBC trail.

If we say 10 days was crazy, then 7 days is nothing less than kamikaze. Why do such gung-ho groups have to come from Malaysia and Singapore? These trekkers may have ample rainforest and lowland trek experiences but were completely clueless when it came to high altitude. The trip leaders can only be described as amateur and ignorant, and if they’re a company, as irresponsible in not understanding the risks of high altitude trekking and not doing things the right way (otherwise how can you account for such insane short itineraries?). The Indian Chiefs (no pun intended) may be charismatic and popular with team members, but that does not excuse them from not having the right basic & necessary knowledge in taking the appropriate remedial actions when things go wrong. To think of depending on the local Nepali trek operator to take care of things is really naive, and if I may say again, irresponsible. When things went wrong, I hardly see any show of regret and humbleness. Where is the duty of care owes to the clients?

On a similar note, go read the comments in Jamie McGuinness' sharing of my Part 1 note. There are quite a few interesting views which I like to highlight but best you hear it straight yourselves. Love the one by Judy Smith ... heheh.

Acclimatisation needs time and if the itinerary allows for sufficient time for acclimatisation, this is the best prevention against AMS. Different people acclimatise at different rate; some faster, some slower, some earlier, some later. The bigger the group, the safer will be the margin if the itinerary is stretched longer. The group always travels at the speed of the slowest person so the itinerary needs to be designed to allow for this. For organized groups, even if 1 person is down, everyone is affected so itinerary cannot be “anyhow anyhow”. If it’s just a small group of personal friends, fine ... if you understand each other well and willing to take a risk with AMS in trekking fast. Even then it’s prudent to stick to the recommended bare minimum.

As recommended by Jamie McGuinness , the suggested itinerary can be:

day suggested altitude itinerary 0 below 2000m arrive Kathmandu 1 2-3000m trek Phakding 2650m 2 2-3000m trek Namche 3450m 3 3000m Namche rest 3450m 4 3300m Namche rest 3450m 5 3600m trek Tyangboche 3860m 6 3900m trek Pangboche 3840m 7 3900m trek Dingboche 4350m 8 4200m Dingboche rest 4350m 9 4500m trek Thuklha 4600m / Chukhung 4750m 10 4800m trek Lobuche 4940m 11 4800m trek Gorak Shep 5150m via Everest BC 12 5100m trek Pheriche via Kala Pattar 13 trek Namche 14 trek Lukla 15 fly Kathmandu

You can see that it’s a 16D trip but with 14D actual hiking. As mentioned earlier, keep the city sightseeing for your next Nepal trip. Those on tight schedule can take out one of the walking days but for some groups, this may not work well.

Please go buy Jamie McGuinness’ Trekking in the Everest Region guidebook. There are tonnes of information listing many ulu no-footprint no-tourist places along the Everest trail which can keep you busy for easily over 20 days. Guaranteed to be a “no-regret” buy if you really want to get the most out of your trip. See Everest slow and steady, then your trek will truly be memorable. Not least with sufficient acclimatisation, your brain functions more clearly and will remember more of those little things.

IMHO based on past experiences, I do agree with the suggested itinerary By Jamie. In the earlier 1998 EBC trek I mentioned earlier, we were on a 18D trip with 13D hiking days. Out of 17 persons, only 7 were relatively unaffected by the time we reached Lobuche (4900m). At the end of the day, 1 member chose to stay at Lobuche while another just stopped short at the big rocks below Kala Pattar after he started experiencing hallucination (he saw one extra leg or two in front of him ... :-) ) . The next morning only 4 were brave enough to go EBC, with the rest of the team opted to take it easy and rest in camp (it was a freaking cold camping trek). This was the first Himalayan trek for everyone and it was indeed a (very) humbling experience and instilled in most of us an unequivocal respect for the mountain. We can see that even 13D is not enough for a big group and we could have done better if we just have one extra day on the trail. And if it’s 15D walking days, that would be even more ideal.

It is also true that there are those rare cases whereby a person may not acclimatise well above 4500m even if given time deemed sufficient for the average hiker. Probably 1 out of 100 persons. I have this client who joined me for Kilimanjaro in 2000. The year before, he took the trip on his own and opted for the 7D Western Breach Route. True to case he developed serious altitude sickness at the crater camp and had to be carried down the next morning. Not giving up on his Kili dream, he was brave enough to join me the next year. We had a 4D Mt Meru (4565m) climb program for acclimatisation first before attempting Kili via 7D Machame with a day’s rest in between. Meru was a horrid wet, and muddy climb with no good view on summit day and after the exhausting hike, the team decided to change to 6D Marangu route instead. With the Meru climb, we were quite hopefully that this client will make it for Kili summit since he has quite a few extra days of acclimatisation compared to his previous attempt. Well, all went well until the last stop at Kibo Hut (4700m) at midnight when we woke up for the summit attempt. This client at last moment decided not to go ahead as he was feeling not too good and not confident of ascending another 1200m to the top without getting into trouble later. We respected his decision and although disappointed, he was glad that he made a 2nd attempt. It was brave of him to recognise & acknowledge the poor acclimatisation ability of his body.

On a 2nd EBC group trek, we have one lady developing AMS symptoms around dinner time on the same day of arrival at Namche. That’s just the 2nd day of the trek and at an altitude of around 3500. We happened to have bottled oxygen with us on our trek and this was administered to her. By next morning she was totally well and raring to go. You would be worried and expect her to develop the AMS symptoms again as we went higher, but surprisingly it went well for her all the way as we continued on to Gokyo lakes and then all the way to Kala Pattar and EBC. Another lady only developed symptoms at Gokyo but she also recovered by the next day. In case you’re wondering, it was a 25D trip with 21D actual hiking days.

The above cases are, to me, good examples of different people reacting to altitude differently, some of them in extreme ways, and trek leaders need to be able to watch out for those who acclimatise slower. Trek leaders should have objective means (ie. pulse oximeter) of ascertaining altitude sickness and remedial means (ie. medications, bottled oxygen etc.). If you go for a cheap package, please expect none of these and join at your own risk.

Fitness & Acclimatisation

The myth is that the fitter you are, the better you will fare at altitude. Well the general consensus is that fitness plays little part in the acclimatisation process. In fact studies have shown that the fitter the hikers, the higher tendency it is for them to develop symptoms of AMS. The fit person may be more used to pushing his/her body (breathing hard) and may not recognize that being winded is not as much from aerobic exercise as from lack of atmospheric oxygen. In general this tends to hold true and should be kept in mind by the trek leader.

However it is also true that the fitter the hiker, and assuming that the rate of acclimatisation is the same for another team member who’s not as fit, the better he will cope with the demand of thin air compared to his less-fit teammate as the group makes its way higher up on the trail. Being fit means that your body generally will be able to cope with the demand of altitude better, but this is subject to your body being able to acclimatise well. If your body is that of slow acclimatisers, then being super fit may backfires on you; it is not uncommon to see not-so-fit but better-acclimatising teammates doing better than marathoners or triathletes on the EBC trek.

Back in our 1998 EBC hike, incidentally the 2 fittest team members are among the 3 guys who reached both KP and EBC in admirable peak-top physical condition as active as lively monkeys. Well, they are the exception rather than the rule. The 4th member (a lady) is more slow but really steady ... haha certainly more human than monkey ;-)

It is good to pay attention to be as highly conditioned in fitness as possible before your big trek. There’s simply no harm in being highly fit and THE thing to remember is not to be gungho and dash up as if the EBC is a mountain race. As the saying goes, “heroes die young”, especially on the mountains. Keep your ego in check and enjoy the scenery instead. Otherwise you’ll be the first one to be lying flat on your teahouse bed and missing out on the fun & laughter. So much for heroics.

Having said the above, we need to remember still that more important is the itinerary. That is the real deciding factor. Get the itinerary duration right and everything else will just follow-up nicely. Altitude sickness may not even be a concern at all.

No lesson is as insightful and enlightening as a bad episode experienced first hand. In Chinese we call it 刻苦铭心. However this is a stupid way of learning a lesson. Unfortunately, we still have a bundle of people who don’t wise up till they have had a bad experience themselves. As the saying goes, “The wise stands on the shoulders of giants so that they can see further" and we should learn from the experiences of others before us.

Helicopter Evacuations & Moral Hazards

The heli-evac of 9 out of 20 persons from just a single trekking group is big news. Especially to seasoned professional expedition organizers. It’s a strong bet that none of these established adventure companies ever need to call upon a heli-evac unless it’s an unfortunate case of broken leg or life-threatening AMS or snowstorm which prevents safe trekking out.

What is at stake here is the possible abuse of helicopter evacuation services. In recent years, there has been a rise of insurance scams for helicopter rescue of trekkers in Nepal.

“Hey, things are not right here, let’s call in the helicopter. Anyway we’ve bought travel insurance and it’s a waste not to use it. Ohh man, I’ve never sit in a helicopter before ... let’s do it !

So what’s ails the trekker? Diarrhea. Hell man, diarrhea is not a life-threatening situation and you don’t suka suka call for airlift just because your legs goes weak after a few visits to the toilet. In almost every organised group trek, it’s almost guaranteed to find at least one trekker with a bad case of diarrhea. If everyone were to call for heli-evac when they have a bad case of diarrhea, what will be the implications? Well for one, the insurance companies are going to jump and premiums are going be be hiked up (no pun intended). If the trek leader doesn’t even know what to do in cases of diarrhea and take the easy way out by calling for heli-evac just because the Sirdar advised him to, why the hell is he there in the first place? As entertainment? To win the popularity poll?

More serious than abuse is claims of scamming of insurance monies by the trek operators and helicopter service providers. Read more below:

• High flying: helicopter rescue in Nepal investigated
• Insurance scams hit helicopter rescue | Nation | Nepali Times

So ask yourself if you wish to contribute to such possible insurance scams.

Parting Note

There’s no shortage of information on the net on dealing with all kinds of scenarios when on the trek. There’s little excuse to say you don’t know. By signing up with a commercial operator, basically it’s like you’re transferring the research & tedious arrangements to him. It is also expected of him to then provide you with the necessary information you need to know to prepare yourself for your trek of a lifetime. However you still need to do some homework.

• Please part with a few more dollars and sign up with an experienced and established adventure travel agent. Avoid those basement-bargain trip organisers. The differences can be startling.
• Please squeeze out more days for your holiday. This will save you literally lots of headaches. And probably a lifetime of regret as well.
• Please don’t be lazy, go do your homework and read more about the hazards of travelling to high altitude!
• Please pack your own medical kit with AMS medicine and learn how to use them. Get the excellent pocket guide “A Comprehensive Guide to Wilderness & Travel Medicine” by Eric Weiss as handy reading reference.
• Please train hard for your trek. A little bit of suffering at home will make your suffering on the trek more pleasurable.
• Please equip yourself well in terms of clothing & hiking gear. High end branded gear is good to have but more important is gear which are functional, and this can just cost a fraction of those ‘atas’ brands without compromising much in terms of performance. You really don’t need expedition grade gear for your trek. You’re welcomed to visit my gear store for further discussions.

Instant info is at your fingertips ... just Google or Youtube anything you want to know !