Bus to ladakh - has

#1 May 1st, 2017, 21:08
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#1
Hello,
I am planning to go to Ladakh in June. I am concerned about altitudine sickness. If i go by bus to leh through Manali i know i will have to go as high as 5000 snd despite reaching that altitudine gradually i am not sure i will be able to take it. My question is: is there another way to reach leh by bus without going as high?
By bus should be safer than flying as your body has time to adjust but 5000 is a lot. Can you help me? Thanks.
Lorenza
#2 May 1st, 2017, 21:18
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#2
You could take a bus from Manali to Keylong & spend 2-3 days there acclimatising, then continue by bus to Leh, buses don't run every day from Manali so you need to check which days???
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#3 May 1st, 2017, 23:25
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An option could be train to Jammu and then by bus / cab to Leh via Srinagar. If you plan to do this check the situation in Srinagar before going.

Tourists going by flight usually stay a couple of days in Leh to get used to the altitude. However the flight costs are high during the season time.
#4 May 2nd, 2017, 17:14
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#4
Quote:
Originally Posted by kullukid View Post ... bus to Leh, buses don't run every day from Manali so you need to check which days???
HRTC buses run every day in the open period ( started running up to Keylong a few days ago , updates on my blog below ) , the posh HPTDC run every second or third day from july to first week September.

The best fast option for acclimatization is Srinagar-Leh , with a layover in Kargil @ 2693 meters. State J&KSTRC buses stop overnight in Kargil , shared cabs do a nonstop run - youŽll arrive late evening/night , miss some spectacular sights and most of the acclimatization advantage. Sleeping altitude at 2000+ is what really matters.

Second best option is the flyin, since you wont spend any time higher than Leh. Medicating in advance with Diamox/acetazolamide and sleeping lower than Leh first night(s) ( Alchi , Ule Tokpo - four hundred meters lower ) makes a difference.

Worst is Manali-Leh : there is always some risk that youŽll spend a night more than a thousand meters higher than Leh in Pang - IŽve been thru it twice over the years. Manali-Leh pointers here : http://korta.nu/sleepless

There is a fourth option , later in the season and taking a lot more time : go from Shimla to Spiti via Kinnaur , and connect with the Manali-Leh road on the north side of the Rohtang . This gives you a lot of time to acclimatize between 2100ish meters at Shimla and Kaza at 3660 , and a lot of intersting stuff on the way . Worth an extra week .
#5 May 2nd, 2017, 20:47
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#5
I would be leaving from Dharamshala. Can i still do srinagar-leh with stop over in kargil from here? My objective is to avoid going as high as 5000 as in the manali leh route.
Would i miss a lot of the amazing landscape?
The fourth option you describe sounds interesting and i could use the extra week as not pushed for time but you say later meaning July? Also i would have to reach spiti from dharamsala but i have heard altitude is a very big problem gor this journey.
Thanks
#6 May 2nd, 2017, 21:33
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#6
You will have to reach Pathankot from Dharamshala and from there take a train to Jammu. Then bus to Srinagar and then another bus to Leh. If you want you could go to Manali from Leh by road.
#7 May 3rd, 2017, 02:51
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Originally Posted by lorebeck View Post Also i would have to reach spiti from dharamsala but i have heard altitude is a very big problem gor this journey.
Thanks
You have two key starting points going to Spiti : the already mentioned NH22/Hindustan-Tibet road following the Sutlej river first , and from Manali. The later runs first up to the Rohtang La @ 3987 meters , turns east at Grampho (3300-ish ) , Batal 4000 , crosses Kunzum La at 4500 , then Kaza 3660.
#8 May 4th, 2017, 23:03
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#8
"The best fast option for acclimatization is Srinagar-Leh , with a layover in Kargil @ 2693 meters. State J&KSTRC buses stop overnight in Kargil , shared cabs do a nonstop run - youŽll arrive late evening/night , miss some spectacular sights and most of the acclimatization advantage. Sleeping altitude at 2000+ is what really matters."
Vistet: if i choose this option how high does the route takes me? If with this option i do not go above 3600 it seems the best. Second question: can i take this route from Dharamshala? Thanks
#9 May 6th, 2017, 16:36
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#9
Srinagar-Leh touches 4108 meters at the Fotu La .



The low route here is Srinagar-Leh , the high one Manali-Leh.

You are probably ovestressing max altitudes now. Health guidelines only talk about sleeping altitudes , two simple points mostly for added comfort would be

1) don't spend any time first day at 4000+ ( like for example flying in to Yading . )
2) don't spend any time second day at 5000+

With a night in Kargil first you are unlikely to have any real issues in Leh . Diamox starting the night in Kargil can be a comfort factor , but is outside guidelines . I've done flyins to Leh with and without Diamox , and nights in Kargil with and without : I slept a lot better with , but wasn't concerned even in Leh without. Hangover country. YMMV

If you do follow 1+2 and sleep in Kargil you are actually beyond safety guidelines : astronomers working at the Chajnantor Observatory are for example -grudgingly - allowed to drive straight up to the Observatory at 5000+ meters after a single night of acclimatization in San Pedro de Atacama , 2400-ish . After arrival they are placed in a artificial environment , slightly lower than Leh.
#10 May 7th, 2017, 01:01
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I did Vistet's suggestion. Looking back at it I wished I had sprung for a jeep so that I could stop off and see the sights. I was too newbie and cheap at that time..
#11 May 7th, 2017, 22:14
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Ok. Thanks a million. This site is amazing really. I will inquire about costs. I think i will have to do Dharamshala - Jammu by bus Jammu - shrinagar shared taxi And then bus to leh.unless there is a direct bus dharamsala shrinagar which i doubt. I will use Diamox And sleep at kargill. I have already been as high as 3500 in Nepal- poon hill but the idea of going higher terrifies me really. I will also consider the flight. Thanks
#12 May 7th, 2017, 22:20
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#12
You could go full circle once you've acclimatised in Leh it should be fine for you to go back in the Manali direction, it's a stunning route & the highest bits have the most spectacular views.

There is a Tibetan saying that goes something like;

"It's not the destination but the journey which matters."
#13 May 8th, 2017, 05:47
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#13
post #4 by vistet must not go without a strong voice against:

Any recommendation to apply Diamox in a preventive way is to be regarded as highly critical and next to criminal. Diamox must be used only in a case of emergency! Even superficial research will explain why.

The best advice can only be "climb high, sleep low" - the most effective way to acclimatize is an active one. To REALLY get adjusted takes weeks and some effort. Anything else is just makebelieve.
#14 May 9th, 2017, 00:45
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#14
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Originally Posted by Hochwieskopf View Post Any recommendation to apply Diamox in a preventive way is to be regarded as highly critical and next to criminal... Even superficial research will explain why.
"Superficial research " will show that consensus in specialist and national health guidelines disagree with the above , and recommend Diamox/acetazolamide in a lot less extreme situations. CDC for example says that preventive medication with first nights at 2750 meters ( a hairs breadth under Kargil ) is "benificial and should be considered " and "strongly recommended " on first nights at 3500+ meters ( i.e. Leh ) YouŽll get similar recommendations from the International Society for Mountain Medicine ( ismm.org ) , Himalyan Rescue Association @ himalayanrescue.org , and the evidence based guidelines from Wilderness Medical Society :

Quote:
Acetazolamide

Multiple trials have established a role for acetazolamide in prevention of AMS.15, 16, 17, 18 The recommended adult dose for prophylaxis is 125 mg twice daily ..

For those who find the medicalese in the above sources heavy a recommended read is this interview with David Shlim. Shlim is a veteran of the Himalyan Rescue Association , followed by fifteen years as head of the CIWEC clinic in Nepal , and now president of the International Society for Travel Medicine (istm.org ) - and he describes Diamox prevention as "enormously safe" :

Quote:
Consider Taking Diamox
“Depending on your itinerary, Diamox is like an insurance policy for your trip,
With a good itinerary ( see the " sleepless" link ) you will end up second night in Leh , which is manageable for most. Or , as already pointed out , in worst case more than a thousand meters higher : I have been thru that twice over the years, and I carried someone from the vehicle both times.

Quote:
Originally Posted by Hochwieskopf View Post Diamox must be used only in a case of emergency!
Guidelines today stress that the first hand choice in actually treating AMS is dexamethasone , and acetazolamide is only a complement.
Last edited by vistet; May 9th, 2017 at 05:24..
#15 May 11th, 2017, 00:55
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#15
I've done some research (ie reading on scientific, government, and mountaineering websites), and all the reputable sources I've seen say that Diamox takes some time to start working, so if one is going to take it, it should be started 24 to 48 hours before arrival at high altitude. For that reason it is not so effective if started after AMS symptoms begin. Doctors at Leh hospital see hundreds of AMS cases each year, and they always give oxygen, and in many cases, dexamethasone and diamox.

I am eager to hear if the latest recommendations have changed, and because I am currently in Ladakh and have very poor internet, I would appreciate it if you would post links to some articles explaining why you believe diamox as a prophylaxis is so bad.

(Personally I never take diamox when flying in to Leh, and have never had AMS, but I have seen enough visitors with AMS ranging from mild to severe, that I like to keep myself well informed.)

The Centers for Disease Control:
Quote:
... travelers increasingly fly to a number of cities where they risk altitude illness, including Cusco, Peru (11,150 ft, 3,400 m); Lhasa, Tibet (12,000 ft, 3,660 m); and La Paz, Bolivia (12,400 ft, 3,780 m). Tourists who fly from a low altitude to any of these destinations should consider taking acetazolamide to help prevent altitude illness.

... Inducing healthy people to breathe more was postulated to improve acclimatization to altitude, and in an article published in 1968, acetazolamide was shown to prevent altitude illness. To this day, acetazolamide remains the best drug to prevent altitude illness.
WebMD says
Quote:
Acetazolamide is used to prevent and reduce the symptoms of altitude sickness. This medication can decrease headache, tiredness, nausea, dizziness, and shortness of breath that can occur when you climb quickly to high altitudes (generally above 10,000 feet/3,048 meters). It is particularly useful in situations when you cannot make a slow ascent. The best ways to prevent altitude sickness are climbing slowly, stopping for 24 hours during the climb to allow the body to adjust to the new height, and taking it easy the first 1 to 2 days.
The National Health Service says it's not licensed for preventing altitude sickness in the UK [maybe because there's no place high enough in the UK?] but then the NHS proceeds to actually recommend it for that use anyway:
Quote:
Research has shown that acetazolamide (Diamox, which is licensed to treat glaucoma) can help prevent symptoms of altitude sickness.... In the UK, acetazolamide is not licensed for preventing (or treating) altitude sickness. However, it may sometimes be considered for 'off-label' use to prevent altitude sickness in people who may be at risk of developing it. ... To prevent altitude sickness, the recommended dose of acetazolamide is usually 125mg or 250mg twice a day. You should begin taking the medication one to two days before you start to ascend and continue to take it while ascending.
Other medical, government, and mountaineering websites that I've seen have similar advice, and I haven't seen strong advice against it. Please post some links.

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