Flight to Leh - Diamox necessary?

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#1 Jul 9th, 2012, 12:52
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  • hikingaddict is offline
#1
After reading all of the threads about Leh, it seems everybody takes Diamox one day prior to departure. I've been to Rohtang Pass recently, stayed at Manali, and since I'm from Switzerland I have done a lot of hiking and experience with height (though it's usually below 3000 meters). I just don't want to take Diamox because of the side effects, I don't know if I can handle it (I don't know if I have these allergies which make it a no-go for me) and I actually want to know how good I can handle the height. Despite the fact that my trip will be 3-4 days at max, I don't mind if I'll be hampered for most of the time and all I can do is driving around with a cab and look at a few things here and there.

However, if it's a serious danger for my health (AMS and HAPE/HACE) if I don't take Diamox, I need to rethink this.

Therefore, my question is: is there ANYONE who flew into Leh (the bus trip through Manali is not an option since I only have an extended weekend) and who HASN'T taken Diamox at all?

Also, everybody talks about rest as soon as you get there, which is so odd because all flights go only in the morning, so you'll spend your first day doing nothing. Does rest mean "stay in bed and sleep for the whole day" or just "take it slowly and don't walk any stairs"? I don't get why sleeping would be good, because isn't it especially sleeping at high altitudes which is the most difficult and dangerous thing about altitude?
#2 Jul 10th, 2012, 03:55
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#2
Quote:
Originally Posted by hikingaddict View Post I've been to Rohtang Pass recently, stayed at Manali, and since I'm from Switzerland I have done a lot of hiking and experience with height.. [/b]
None of the above equals going to sleeping altitude 3500+ in a single day from below 2000.The closest in Switzerland I guess would be the hotel at the Gornergrat , nearly five hundred meters lower. Leh is lot more challenging to your system than a few hours at the Rohtang La.

Quote:
Originally Posted by hikingaddict View Post I just don't want to take Diamox because of the side effects, I don't know if I can handle it ..... I don't mind if I'll be hampered for most of the time
A lot of people make this choice , most cope somehow - but nearly all who get bad cases of altitude sickness also come from this group. Second worst scenario unmedicated is one or two days of a really bad hangover - including the nausea and in a few cases vomiting. Worst case is ending up in the hospital , hours to a day or two - where you will get hit with double doses of Diamox and steroids , on top of the oxygen.

Worst case of Diamox side effects is the parestesia in the hands and taste change : I find the parestesia **** annoying , but a lot better than the actual disease. Other side effects are very , very rare.

Quote:
Originally Posted by hikingaddict View Post Therefore, my question is: is there ANYONE who flew into Leh (the bus trip through Manali is not an option .. and who HASN'T taken Diamox at all?
The answer from the hospital would probably be : too many I have flown in twice without medicating , but I know my own response to altitude from a range of different situations , some of them worse - like the Manali-Leh road , which is a lot worse than flying in.

Quote:
Originally Posted by hikingaddict View Post Also, everybody talks about rest as soon as you get there, which is so odd because all flights go only in the morning, so you'll spend your first day doing nothing. Does rest mean "stay in bed and sleep for the whole day" or just "take it slowly and don't walk any stairs"? I don't get why sleeping would be good..
Resting and avoiding exertion is good ( graphically illustrated by the Yushu earthquake in 2010 , where they had to evac whole groups of rescue workers by air ) , lying down is no good , since it means lower lung function. First step in treating pulmonary edema is sitting up for example. Find a guesthouse with a nice garden and a view , prop up a chair , have tea ... maybe a short flat walk in the afternoon.
#3 Jul 10th, 2012, 13:49
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#3
Quote:
Originally Posted by hikingaddict View Post Therefore, my question is: is there ANYONE who flew into Leh (the bus trip through Manali is not an option since I only have an extended weekend) and who HASN'T taken Diamox at all?
We flew into Leh from Delhi in 2010 and we didn't take Diamox. When we landed at Leh airbase we felt bit uncomfortable for initial 10/15 mins (may be because of the chilling wind), but after that everything was fine. We were at our guesthouse till 3PM, then went to the main market and hiked up to the top of the Leh fort on the very same day. So basically we did things which should not be done. We didn't face any serious problem may be because we had previous experience in spending nights at 3500+ and we were fully aware about our abilities (and limitation).

Whatever I have shared above is just my personal experience (to answer your question) and is not recommended as people react differently in high altitude places. It's your call regarding Daimox as you know your body best. One thing I can assure you, being at a high altitude place for 3/4 hrs and spending night over there are totally different, so think twice before taking final decision.
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#4 Jul 11th, 2012, 16:46
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#4
I am no doctor but have gone thru numerous posts on AMS before we travelled to Ladakh a month back. We did take Diamox. But, keeping our family physician informed our entire family took one dia mox about 7/10 days before journey for testing for allergy(it is a sulfa drug basically). Since we did not experience any adverse reaction, we started taking half a Diamox twice a day from three days prior to landing at Leh. We did flew in and out of Leh. My wife felt sick when we got stuck in a snow storm at Khardungla pass, the highest motorable road in the world at an altitude of 18,380 ft or so. Also, all of us felt variable degree of uneasiness while spending night at Tso Moriri (owing to altitude plus sub zero temperature).

If you are allergic to Diamox, you can go in for a homeopathy medicine called Coca 30 and start taking 3/4 globules twice daily from six days prior to landing at Leh. One family travelling with us did that and did not have major problems.

I do not think previous experience etc. really counts - precautionery medicine plus rest for two days upon reaching Leh, are musts.

Plus, any suggestion from vistet should be taken almost blindly. He is far too knowledgable in this part of the world and the associated issues/problems.
#5 Jul 12th, 2012, 18:58
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For myself its a no brainer, I sleep so much better with diamox that I now always take it. That said for years I didnt and regularly flew into Leh and had no problems save the usual weakness. Vistet is right in that the people who get AMS on the flights arrival are those who didnt take diamox, thge contrary is that a lot of people dont and survive. Unless there is a medical reason not to take it the side effects are at most mildly unpleasant and a lot better than the nausea that is mild AMS.

On a side comment and with no desire to start trolling, can I point out that homeopathy is now widely discredited. The UK national health service no longer provides it and I am not aware of any double blind testing that shows it as having any better effect than a placebo. See wikipedia for a start and read further to decide for yourself. For me its diamox or nothing
#6 Jul 12th, 2012, 19:01
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#6
I just met a few guys who flew in , walked around for 2 hours and then one of them was hospitalized other had a few symptoms. This is two from a group of 4. So its anyone's luck. If you give it a miss , do not stress yourself on the day you arrive.
#7 Jul 14th, 2012, 16:34
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#7
Quote:
Originally Posted by rickom View Post .. a few guys who flew in , walked around for 2 hours and then one of them was hospitalized other had a few symptoms.... If you give it a miss , do not stress yourself on the day you arrive.
The vital difference of a few hundred meters higher , and a lot of work immediately after arriving : after the Yushu earthquake in 2010 massive amounts of military and rescue workers were flown in ... and quickly became both useless and critically ill :

Quote:

A high incidence of acute altitude illness occurred in the
unacclimatized rescuers. About 80% of these, who were
from sea level or lowlands, developed acute mountain
sickness (AMS)..
To ‘‘rescue the rescuers’’ was a main task of the
Qinghai and Tibetan rescue teams.
( Mountain Rescue: The Highest Earthquake , Tianyi Wu in HAM&B



There even was a few deaths. Most striking example was the complete group of 300+ persons from Guangdong that had to be evaced by air.
#8 Jul 14th, 2012, 21:39
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#8
I have been in Leh area for years, and have seen hundreds of visitors fly in without diamox, and dozens fly in after starting diamox. I have never had AMS in dozens of times flying in to Leh without diamox, and the majority who fly in do not get altitude sickness, which is why anecdotal evidence from a few people is *worthless*.

I haven't kept data, but what I see is that about 1 or 2 people out of 10 (flying in to Leh) get AMS if they are not on diamox. If you have more than a week in Ladakh then you can choose to risk spending the first day or two miserable with AMS. If you have a short visit and you happen to be one of those who gets AMS, you will have ruined most of your visit. Almost nobody who is on diamox gets AMS, though it can happen (I have seen one case). You invite more chance of AMS if you excercise that first day just because you think you feel fine.

I have seen many cases of AMS. I speak from personal experience.

Vistet is the god of advice on this. He is a medical professional and avid traveller and keeps up on the information. Click through to his blog http://vistet.wordpress.com/.
Last edited by NonIndianResident; Jul 14th, 2012 at 21:44.. Reason: Vistet, I can't see your blog link in your signature today!
#9 Jul 14th, 2012, 22:11
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#9
Altitude advice
If you are planning to visit Ladakh, please be aware that its altitude (3500m / 11,500 feet) presents a serious health issue for a significant minority of visitors.

Low risk of AMS (safest)
Fly to Leh while starting diamox (acetamozolamide) one day before arrival and continuing for two days after arrival. Also rest the first day; and do not go higher such as Pangong or Khardong-La in the first two days.
Go by road from Srinagar, stopping overnight in Sonamarg or Kargil on the way.
Go by road from Manali, stopping for two nights in Kelong on the way.

Medium risk of AMS (in my experience maybe 1 or 2 in 10 will get it)
Fly in to Leh without diamox, and rest for two days on arrival. Do not go higher for two days after you feel fine.
Go by road from Srinagar without stopping overnight in Sonamarg or Kargil.
Go by road from Manali, stopping only one night in Kelong.

High risk of AMS and medium risk of something more serious
Fly into Leh without diamox and then exercise the first day, or proceed higher within two days (eg Pangong Lake, Chang-La or Khardong-La)
Go by road from Manali without staying overnight in Kelong. Staying overnight in Sarchu or Pang are more dangerous than going straight on through to Leh in one exhausting day.

Note:
If you have any blood, lung or heart problems, ask your doctor if you should visit Ladakh. There may be serious additional risks.
Start diamox before arriving at altitude and continue for two or three days after reaching the highest point. It takes 12 to 24 hours to take effect, so it's not very useful as treatment after you get AMS.
Diamox is a sulfa drug and some people are allergic, so talk to your doctor first. If you are not allergic, the side effects and risks from diamox are minor.
Alchi and Uletokpo are nice places with hotels and resorts quite a bit lower than Leh, about 1.5 hours away, so you can go direct to them from the airport if you want a pleasant place to do your first two days of resting and light walking.
If anyone in your group has AMS (headache or vomiting or just feeling bad) do NOT take them higher, such as to Pangong Lake, over Chang-La, over Khardong-La (or any pass to Nubra). If you do so they could get a much more serious problem.
Diamox does not "mask" AMS syptoms, it actually tricks your body into breathing a little faster, thus helping you acclimatise faster. If you get a headache from AMS, take a headache pill of your choice and try to breathe a little more while still resting.
Drink enough water, since Leh is a high desert with dry air, and dehydration is possible. However over-hydration does not prevent AMS or other altitude sickness, and extreme over-hydration is dangerous too. Moderation is the key!
Last edited by NonIndianResident; Jul 14th, 2012 at 23:36..
#10 Jul 16th, 2012, 11:22
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#10
Wow. Thank you all for your answers. (Even though it's not the answers I hoped to get ;-)). That was extremely helpful, clarifying and since essentially everyone here is on the same page, there is no doubt that Diamox is almost a must if you don't want to get into trouble...
#11 Jul 16th, 2012, 14:54
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Wish I had this advice when I travelled to Leh. My spouse wasn't bothered a bit, go figure. Yeah, I stopped overnight in Kargil and immediately set about exploring when in Leh and there was no Oxygen bar then even though I dreamed of such..
#12 Jul 18th, 2012, 00:12
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#12
Lost track of this thread ... best post on the subject for years in # 9 : short , systematic and covering all important points. Including the comment on anecdoctal evidence.

One factor to be added , IMHO : all overnight stops in Sarchu and Pang are not planned , and even a few Lahaulis get sick from doing a 1200 meter hike in sleeping elevation . I have made two forced night halts in Pang , and this is not unique. This leads to the question whether to medicate in advance , or keep medication at hand until the road goes out...Im leaning to the former ,after my last experience.

( And yes , all the positive comments... thanks )
#13 Jul 19th, 2012, 14:49
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#13
Im bookmarking this thread as a quick practical answer to OPs question.

Good medical sources on the subject :

International Society for Mountain Medicine

CDC altitude advisory

Wilderness Medical Society evidence based guidelines
#14 Jul 19th, 2012, 15:03
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#14
Wow, thank you for these links, they are very helpful - not just for the Leh issue, but hiking in general. Awesome!
#15 Jul 19th, 2012, 19:10
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#15
Excellent clear and concise advice in this thread!

This thread is now a sticky.











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