A road trip to Leh is often categorized as an adventure because of the challenges it presents. Apart from the wonderful vistas that you get to see, there is also the excitement of driving through inhospitable terrains and dangerous roads but there is one thing about this journey that most people tend to overlook, mostly because they have little knowledge about it, that is Acute Mountain Sickness [AMS], also known as High altitude sickness. If you are planning a trip to Leh, here are a few tips on how to deal with acute mountain sickness in Ladakh.
Acute Mountain Sickness is caused by exposure to lower percentage of oxygen at high altitudes. While our body tries to adjust to the sudden increase in height, some of the initial symptoms that one can suffer from are high body temperature, severe headache, chest pain, vomiting, lack of sleep, fatigue and nausea. These symptoms gradually subside after a couple of days at high altitude but sometimes it can even lead to high altitude pulmonary edema, which is the worst condition of AMS and can be fatal. Please note that I used the word “sudden” here but it is not always applicable. Some time will suffer AMS when the increase in altitude is in a matter of a few hours or a day but some people may suffer it for first few days even if the gain in altitude is gradual. At what height a person will suffer from mountain sickness and for how long differs for every individual but it is safe to assume that if you have never been to a high altitude place like Ladakh, you are bound to feel a few symptoms of AMS in first few days.
The first time I visited Leh, I knew what AMS meant and that I may feel symptoms of it but had no idea what those symptoms were. When I first suffered from AMS, which was during our night stay at Pang, It took me quite some time to realize what It actually was. My body temperature shot up, letting me in to believe that I was suffering from fever. I had severe headache, could not get myself to eat or drink anything and my chest felt as if it was being crushed from both sides. Entire night at Pang was spent tossing and tumbling and even next day was no better. Until we finally arrived in Leh, my entire body felt like it was hit by a train. It was quite surprising for me because I visit hill stations quite often and have never felt AMS before. What I didn’t know back then that apart from the height, the reason I suffered from AMS that night was because of the sudden increase in altitude. In just a couple of days, we gained from 227 meters in Delhi to over 4000 meters at Pang and it was for the first time in my life that I was at such high altitude so there was no way that I was going to get away with it without suffering from AMS at all. An even more surprising fact is that I only felt AMS during my first trip to Ladakh. I have never felt any symptoms at all in any of my later trips.
So what really causes AMS? As I mentioned above in this post, Acute Mountain Sickness is a direct result of exposure to lower percentage of oxygen at high altitudes. As altitude increases, level of Oxygen present in the air starts to get lower. In order to accommodate for low oxygen per breath, our body increases the breathing rate and this is the reason why we start to huff and puff so easily in mountain regions. The process of a human body getting accustomed to low oxygen and adapting to the new environment is called acclimatization. When there is ample time for this process and our body is not undergoing a stress, there will not be any symptoms at all however, as it happens in case of a trip to Ladakh, the gain in altitude continues to happen over a period of 3-4 days and at a faster rate than our bodies can adapt to it and this is what eventually leads to acute mountain sickness.
Depending on the symptoms, Altitude sickness can be of three types.
- Acute Mountain Sickness (AMS): AMS is the mildest, most common type of altitude sickness. caused by reduced air pressure and lower oxygen levels. Symptoms include difficulty in sleeping, dizziness, fatigue, headache, loss of appetite, nausea or vomiting, rapid heart rate, and shortness of breath.
- High-Altitude Pulmonary Edema (HAPE): HAPE is a more serious condition of altitude sickness, symptoms include shortness of breath (even while resting), persistent coughing, exercise intolerance, coughing up pink, frothy spit (indication of fluid in the lungs).
- High-Altitude Cerebral Edema (HACE): HACE, another and even more serious condition of altitude sickness, causes difficulty when walking, severe lethargy and a loss of focus. HACE and HAPE are rare and if not treated on time can be even fatal.
There is really no certain way of telling or predicting the altitude that will lead to AMS as it differs from person to person. I have known people who felt the symptoms even at Manali and people who did not suffer from AMS at all anywhere during their trip to Ladakh. It can however be assumed that for most of the people, it is the height of 10,000 ft or above that can lead to altitude sickness.Once it happens, only two things will help. The first is to give your body ample time to adapt and for the symptoms to subside. If this however doesn’t help, the only other way is to get to a lower altitude as fast as you can. Apart from these two, below are a few other tips that can help with acute mountain sickness in Ladakh. Where will you suffer from AMS can differ for each person but your most chances of suffering from AMS are at Pang, Tanglang La, Tso Moriri, Pangong Tso and Changtang. Please be advised that these places are located at highest altitude in this region where most people feel the symptoms but you may suffer from AMS at other places too. Before I continue any further in this article, I would once again like to mention that I am not a medical person and these are just some general tips. Best thing would be to consult a doctor and take their advice.
Symptoms of Acute Mountain Sickness: While AMS falls under the category of nonspecific symptoms, in most cases they are the same of that of high fever. Your body temperature will suddenly rise followed by fatigue and headache. Some of the other symptoms are being unable to sleep, being unable to eat or drink, vomiting, nausea, loss of appetite and difficulty in breathing. These symptoms, ranging from mild to life-threatening, will also depend on the speed of your climb and how hard you exert yourself. Some of the severe symptoms, affecting nervous system, lungs, muscles, and heart are blue color to the skin, gray or pale complexion, chest tightness or congestion, confusion, coughing up blood, decreased consciousness, withdrawal from social interaction, shortness of breath even while resting or unable to walk at all. Severe cases may result in death due to lung problems or brain swelling, called cerebral edema.
Slow gain in altitude: Time is the key to altitude sickness, both before and after you start feeling the symptoms. As a rule of the thumb, stop for a day or two of rest for every 2,000 feet (600 meters) of climb above 8,000 feet (2,400 meters). You really got to give your body ample time to acclimatize and need to plan your journey in a way that the altitude gain happens gradually. As compared to Manali Leh highway, Srinagar to Leh route is at a lower altitude and the ascent is gradual. You slowly get to high altitude as you travel across the highway and your body adapts better. Highest point of Srinagar-Leh highway is at Fotu La Pass at a height of 13,479ft whereas Manali – Leh Highway’s highest point is 17,585ft at Tanglang La pass. Within a matter of 2 days, you reach from a height of 2000 mtrs at Manali to 5300 mtrs at Tanglang La, almost three times more. Hence, It is advised that you reach Leh from Srinagar and return to Manali. If you have to take the Manali-Leh highway, then it is best to spend a night in Jispa and then start really early the next day to continue all the way to Leh without breaking the journey anywhere. However if you must break, then preferred choice of night stay should be Sarchu and not Pang.
If you are experiencing symptoms of mild AMS, the first step is to rest at the same altitude. Usually symptoms resolve with rest and painkillers (paracetamol or ibuprofen) within 24 hours. If symptoms do not resolve or if symptoms become worse, move down (descend). It is common that even a short descent and rest will improve symptoms significantly. It may still be possible to climb up again (re-ascend) if you have recovered and your schedule allows for this.
Avoid Smoking & Alcohol consumption: I know, this is easier said than done but it definitely helps. Even at several of the high altitude passes, you will find boards put up by Indian Army advising people not to smoke at such heights.
Avoid turning the heater on: If traveling in a Car, you will be tempted to turn on the car heater in the cold atmosphere of Ladakh. Avoid doing so or even if you did turn on the heater, do not keep it at full blower of full heat. In the closed atmosphere of a Car, using a heater at its full capacity may trigger the symptoms of AMS.
Sleeping Habits: While you need to ensure that your body is getting proper sleep, there are several things that you need to avoid. First and the foremost is to avoid spending a night at a place where you are already suffering from AMS. If you start feeling the symptoms, then break the journey immediately rather than continuing to an even higher place. Ensure that you are sleeping with you head on a pillow and not without it.
Eating & Drinking Habits: Keep yourself hydrated. Drink a lot of water and ensure that your diet has lot of carbohydrates in it.
Do not exert yourself: Keep your body relaxed, try to walk slowly and do not exert yourself with any unnecessary activities that will leave you panting for breath.
Medicines: There are several medicines available in the market for high altitude sickness. What they do is make your body breath faster than the usual rate and hence try to compensate for the low amount of oxygen but please note that even the medicine is a precautionary measure and not a cure. These medicines are useless once you start feeling the symptoms and should be taken as a precaution to avoid symptoms. Acetazolamide, also known as Diamox, is the preferred medicine. It helps your body get used to higher altitudes more quickly, and reduces minor symptoms. It should be taken the day before you climb, and then for the next 1 to 2 days. It is highly advised to consult your doctor before taking Diamox as it has several side effects like nausea, drowsiness, tingling like sensation in the body and frequent urination. PLEASE CONSULT YOUR DOCTOR BEFORE TAKING THE MEDICINE, specially if you are allergic to something. For more information on Diamox, please Google it.
If you are at risk for a low red blood cell count (anemia), ask your provider if an iron supplement is right for you. Anemia lowers the amount of oxygen in your blood. This makes you more likely to have mountain sickness.
Traveling to Ladakh with children: Are you planning to take an infant or a young child to Ladakh? How an adult deals with Ladakh in an entirely different story than how a child will react or respond to it. Please take a look at the article below for more information on the precautions you must observe while traveling to Ladakh with children.
Once again, the only sure-shot cure of AMS is to get to a lower altitude. From my own experience, I could barely stand or ride my motorcycle when at Pang and Tanglang La but as I got closer to Leh which is comparatively at a lower altitude I was feeling fine. Same thing happened at Pangong. I could barely get myself to sleep that night but next day at Leh there were no symptoms at all. Disprin and Aspirin can help with headaches. Do not take combiflam as you are not really suffering from fever and body-ache will only go once you get to a lower altitude. An oxygen tank can help as well if you continue to have breathing problem. If your condition worsens, please rush to a hospital. If you are a heart patient, It is best to avoid this journey and not take the risk.
If you are flying to Leh, please spend a couple of days within the town before visiting Nubra Valley and Pangong Lake. Do not travel to Tso Moriri while on your way to Leh from Manali as the altitude gets even higher than Pang. Reach Leh, spend some time there, give your body time to adapt and then you can go to visit Tso Moriri.
PLEASE NOTE THAT I AM NOT A DOCTOR AND HAVE NO MEDICAL KNOWLEDGE AND EXPERIENCE. Everything I have written here is from a traveler’s perspective, based completely on my own personal experience. Do not take just my word in terms of the medicines I have mentioned. If you have a medical history, have a heart condition, suffer from Asthma, are allergic to some medicine, please visit your doctor before visiting Leh.