Manali - Leh highway, how to avoid AMS?

YOGESH

Big Salute to you

I am From medical profession

In spite of that UR thread will help me a lot

All this acclimatisation & AMS we had read for our first year only which was washed

& You had freshened my brain fantastically

I also just wanted to thank the major contributors to this thread for a wealth of information which my girlfriend and I can use to increase our knowledge before embarking on our planned trip from Manali to Leh in August this year. I'm sure that all of this will ease her mind as to the dangers and the necessary precautions.
Thank you

High quality stuff everyone - compulsory reading for any ladakh visitor. 2 points
1/ last time i tried I could not get diamox in leh - it may have changed but it might be a precaution to buy it in Delhi - easily available
2/ hate to differ from Vistet who knows more than I do, and I empathise i have no medical knowledge, but on a personal and anecdotal note as someone who treks at 4500 meters+ every year i find that 4-5 litres a day really helps at that altitude - the rule of 'if you have a headache have a 1/2 litre of water' works. it might be that i am dehydrating with the exercise rather than altitude and need more water just as i would at sea level.

In a real life trekking situation we would probably agree a lot more than it may have seemed here : I suspect we both first would ask where the guy with headache slept last , look for a water bottle and a way down next. Exclude dehydration first , then move down if it pesists.

As you start to mention , input is only half the equation , and output is dependent on the situation and person.

My take on all this would be to drink normally , but I may have a somewhat different slant on normal. In my own case I would expect basic fluid loss , at rest , to be in the order of 2,5 + liters :

*acceptable urine output : 0.5-1 ml per kilo and hour
*"invisible" losses (breathing , feaces , perspiration ) some 30+ ml/hour

This is normal at rest. Add a pack and a track ( i.e. work ) : increase losses. Add hyperventilation : more losses. Add breathing through your mouth : increase again.

On top of that you have high altitude diuresis : peeing a lot is a major acclimatization factor. You get higher hemoglobin concentration before any new ones have gone through the whole production process, and the shift in acid balance is also done by bicarbonate secretion via the urine.

I have no problem seeing losses double under these conditions - which is a dramatically different situation from me sitting on a Leh bound jeep at rest , not to mention someone weighing 60 kilos.

I keep track on how much I drink , and as for the output ... don´t worry , no beakers involved , but I keep track on how often , and more importantly , the color. I try to go for a mildly pickled at the pub effect to be on the safe side , and drink more if it start to look more concentrated.

If you want to assess dehydration in someone else , look for the dehydration test on my blog.

Yogesh

thanx a ton.. required this knowledge..

planning leh in july..

will keep in touch

Hi,Yogesh
We plan to visit Leh/Ladakh in sept. end. I have already posted a thread in the other place. We plan to start from Manali on 30th. & to come back from Leh on 14th of October.
U have lots of experience & u've visited the place in September also. Would u pl. advice & draw some tour plan?

Since you are posting in this thread : the most important factor is to make your first night after Manali in Keylong. More tweaks here : http://korta.nu/sleepless

Thanx Vistet - we also plan to stay at Keylong but tell me one thing - the next journey to Leh in a day - will there be any trouble?

Sleeping altitudes is what really matters , once you´ve had a first night around three thousand you can handle a lot on the road as long as you don´t get stuck up there. Going from under 3100 to 3500 is a comfort, not safety , issue (unless you feel sick when setting out , highly unlikely) . And if you feel under the weather after the first night in Leh you can have the next night at 3100 , either in Alchi or Saspol . Alchi is worth visiting in it´s own right.

Note: The Road to Ladakh from from Srinagar is MUCH lower than the Manali-Leh road, and almost nobody has altitude problems on it. Many or most people have headaches and maybe vomiting at least, on the Manali road. I have been to Ladakh many many times.

Normal sleeping altitude : 2700 meters in kargil ' Worst alternative ; Drass , 3300. To be compared with sleeping altitudes up to 4510 meters on Manali-Leh .

Depending mainly on if you stay away from sleeping at The Vomit Hilton or Pang, and if you've had nights(s) t Keylong or other places 3000-ish. I came in to the Army first aid post at Pang this time with 82 % oxygen saturation around two weeks ago ... I was helping the sick one. Had an interesting discussion on the subject with the medic , while my fellow passenger was put on oxygen.

I am plannning to drive from either Srinagar to Leh or from Manali to leh. I would like to know that for a person who suffered a cardiac arrest 2 years back, which is a better route for acclimatizing and what are additional precautions to take for driving to leh

Srinagar-Leh is the best option to acclimatize , you can have a night in Kargil ( near cabin pressure on an airplane) , and another night lower than Leh on the way ( http://korta.nu/chilling ) . The heart (glad they got you going again ) is not a main problem for most , but your pulse will be higher , which means poorer circulation of the heart muscle . This , and lower oxygen content in the blood are main risk factors for myocardial ischemia , the clasic heart attack. That´s principles , only your doc can tell you if it´s relevant in your case : see your doc , maybe do a run on the test cycle with an ECG to put that concern to rest.

You may already be taking some medication to prevent thrombosis ,if not you could discuss this also with your doc as the blood gets thicker at altitude . My own take is that I take pediatric doses of ASA (DIspril etc. ) on travel days , when I cant move my legs freely for many hours.

um ! o.k

I have planned to go to North Sikkim on coming October. I live in Kolkata. In my touring party, there are people of age of 60-65 years. We will be going to places like Lachen, Youmthang, Gurudongmar lake which are at height of 17000 ft. So will these be a problem for them ? Looking forward for your kind help and suggestions.