Nepal Spirit

 

  • annapoorna-002
  • Destination: ,
  • Duration: 16 days
  • Departs: 27/04/2017
  • Arrives: 12/05/2017
  • Price: $2,695
  • Led by:
Day 01
Arrival at the Tribuwan International Airport in Kathmandu (1,345m).Overnight at a hotel
Day 02
Pre-trip meeting and sightseeing around the Kathmandu valley. Overnight at a hotel.
Day 03
Drive to Pokhara (900 m) by tourist bus – 7 hrs. Overnight at a hotel.
Day 04
Drive to Nayapul (1,010m) – 1 hr. Trek to Tikhedunga (1,570m) – 3 hrs.Overnight at a guesthouse.
Day 05
Trek to Ghorepani (2,840m) – 5 hrs. Overnight at a guesthouse.
Day 06
Hike up to Poon Hill (3,210m); and trek to Tadapani (2,610m).Overnight at a guesthouse.
Day 07
Trek to Chomrong (2,140m) – 5 hrs. Overnight at a guesthouse.
Day 08
Trek to Doban (2,500m) – 5.5 hrs. Overnight at a guesthouse.
Day 09
Trek to Deurali (3,200m) – 4 hrs. Overnight at a guesthouse.
Day 10
Trek to Annapurna Base Camp (4,130m) – 5 hrs. Overnight at a guesthouse.
Day 11
Trek back to Bamboo (2345m) – 6 hrs. Overnight at a guesthouse.
Day 12
Trek to Jhinu hot spring (1,780m) – 5 hrs. Overnight at a guesthouse.
Day 13
Trek to Nayapul (1,010 m) – 4.5 hrs. Drive to Pokhara – 1 hrs. Overnight at a hotel.
Day 14
Pokhara City tour. Overnight at a hotel.
Day 15
Drive back to Kathmandu (1,345m) and farewell dinner. Overnight at a hotel.
Day 16
Transfer to international airport for your final departure.

Overview

Annapurna Base Camp Trek combines some of the most spectacular mountain scenery, providing a fascinating insight into the modern hill life of Nepal. This is a unique trek along local trails, through forests, villages and terraced farmland treats you to unparalleled mountain scenery, surrounded by enormous glaciers giving you an inside experience into the Nepalese life and culture.
The trek to Annapurna base camp follows the Modi River and passes through dense stands of rhododendron and bamboo. By the time you reach the large rock over hanging, known as Hinku Cave, you will have noticed that the vegetation has thinned and the gorge narrowed to be only a few hundred meters wide.

Steep snow-clad ridges falling from Hiunchuli on the left and Machhapuchhre on the right from the entrance to the Sanctuary. As we pass through the “gate” and enter to the Sanctuary, you find yourself in a huge amphitheatre enclosed by a solid wall of snow capped peaks.
Annapurna base camp trek starts and ends in Pokhara or it can be tailored as part of the Annapurna Circuit or the Jomsom / Miktinath trek, by trekking from Tatopani through Ghorepani and Tadapani and joining the main Sanctuary trails at Chommrong.
Our Annapurna Base Camp group trek departs every week from Kathmandu, while private treks can be arranged at any time. View our selected departure dates here.

Trip details at a glance

PRICE $2195.00 per person

  • Best Season: February, March, April, May, June, September, October, November & December
  • Country Visited: Nepal
  • Trip Start: Kathmandu
  • Trip Ends: Kathmandu
  • Destination: Annapurna Base Camp
  • Trip Route: Ktm-Pokhara-Ghorepani-Poon Hill-Chomrong-Himalaya Hotel-Machhapuchere Base Camp – Annapurna Base Camp – Bamboo-Nayapul-Pokhara-Ktm
  • Trip Style: Lodge to Lodge Trekking
  • Activity: Sightseeing and Trekking
  • Max. Altitude:4,130 m /13546.4 ft
  • Activity Per Day: Approximately 5hrs walking per day
  • Trip Category: Annapurna Region

Trip Highlight

  • Sightseeing around Kathmandu and Pokhara
  • Impressive Sunrise and mountain views from Ghorepani and Poon Hill
  • Typical Gurung village along the trekking route
  • Fishtail (Machhapuchhre) Base Camp
  • Spectacular mountain and glacier views from Annapurna Base Camp
  • Natural Bath in hot spring at Jhinu

High Altitude Travel Notes

(Dr Jim Duff, 01/04/2008)
More useful information on these and other subjects can be found in my book ‘Pocket First Aid and Wilderness Medicine’, which can be obtained via www.treksafe.com.au .

As you ascend to altitudes above 2000m, your body has to acclimatize to the decreasing amount of oxygen available. If the ascent is too fast and/or the height gain too much, these acclimatization mechanisms do not have time to work, and symptoms and signs of altitude illness (also called high altitude illness) will appear.

Altitude illness becomes common above 2500m and presents in the following ways:

  • AMS (Acute Mountain Sickness): common but not life-threatening if dealt with correctly.
  • HACE (High Altitude Cerebral Edema): less common but life-threatening.
  • HAPE (High Altitude Pulmonary Edema): less common but life-threatening.

If you think you or your ‘buddy’ are becoming ill, TELL YOUR LEADER IMMEDIATELY.

Warning: do not ascend with symptoms of altitude illness as this has led to many deaths from HAPE/HACE.

Acute Mountain Sickness (AMS)

A diagnosis of AMS is made when there has been a height gain in the last few days, AND:

  • The victim has a headache (typically throbbing, often worse when bending over or lying down)
  • PLUS there is one or more of the following symptoms:
    • Fatigue and weakness
    • Loss of appetite, or nausea, or vomiting
    • Dizziness, light headedness
    • Poor sleep, disturbed sleep, frequent waking, periodic breathing
HACE (High Altitude Cerebral Edema)

The important symptoms and signs are: severe headache, loss of physical coordination and a declining level of consciousness. This is a deadly condition and immediate descent is the treatment.

HAPE (High Altitude Pulmonary Edema)

The important sign is breathlessness. This is a deadly condition and immediate descent is the treatment. For more information on HACE and HAPE, see http://www.treksafe.com.au/medical/documents/altitudeillnessfordoctors_003.pdf.

Treatment of Mild AMS
  • Rest at the same (or lower) altitude until the symptoms clear (this will take a few hours to a few days)
  • Avoid unnecessary exertion
  • Keep warm, drink enough fluid to maintain hydration and occasional sugary drinks
  • Rest in a semi-reclining position if this is more comfortable
Medications for mild AMS
  • Treat headache with ibuprofen or paracetamol
  • Consider treating persistent nausea or vomiting with prochlorperazine (Stemetil) or other anti-vomiting medication
  • Consider starting acetazolamide (Diamox) 125 to 250 mg 12-hourly for the rest of the time at altitude

Hypothermia, dehydration and low blood sugar (due to not eating) share many symptoms and signs with AMS and may be present at the same time. So always re-warm, re-hydrate, resugar.

If the illness is more severe, DESCEND. Other specific treatments will be given by your leader/doctor.

Preventing Altitude Illness

Above 2000m, altitude illness (AMS, HACE and HAPE) is a possibility, and above 2500m it becomes common.

  • As a rough guide, above 2500m the maximum daily height gain between sleeping altitudes should not exceed 300m (slow acclimatizers) to 500m (fast acclimatizers), with a rest day every third day (or after every 1000m of ascent).

    Over 5000m, the daily height gain for the slow and fast acclimatizers is halved to 150m and 250 meters per day, respectively

  • If you must fly or drive rapidly to 2500m or higher, spend a minimum of two nights at your arrival altitude (or lower if possible) or until symptoms disappear, before ascending further. If ascending rapidly to 3000m or higher, consider using acetazolamide (Diamox)
  • Avoid overexertion and breathlessness while acclimatizing, especially if experiencing symptoms of AMS.
  • Drink enough liquid to keep your urine pale and plentiful
  • Avoid alcohol, excess caffeine, salt and protein
  • Warning: do not ascend with symptoms of AMS, consult your leader/doctor ADVENTURE TRAVEL ADVICE, including trekking.
    (Dr Jim Duff, 1/04/08)
Fitness and training

The fitter you are, the more you will enjoy your holiday. Plan your training well in advance and seek advice if you are not sure of what is expected of you. Lack of personal fitness can cause problems. Turning back may be difficult to arrange, and causing delays in bad weather can be especially dangerous.

Over-exertion is a risk factor for altitude illness. Nepal and Kilimanjaro trips involve strenuous days. On Kili, the summit day involves climbing 1200m (4000ft) and descending 2200m (7200ft). summit of Kilimanjaro, there is only 50% of the oxygen that is available at sea level. http://www.treksafe.com.au/medical/documents/altitudeillness.pdf for more information.

Pre-existing medical conditions

If you suffer from any of these medical conditions: asthma, high blood pressure/heart disease, diabetes, epilepsy or mental illness; please discuss it with your doctor before your trekking holiday or wilderness adventure holiday.

Visit http://www.treksafe.com.au/medical/notes_for_doctors_and_leaders.htm for more information on these conditions to aid your assessment and preparation. These notes are for medical practitioners.

Preventing problems THE BUDDY SYSTEM

Pairing up to keep an eye on each other makes early recognition of illness/problems easier. Buddies should voice their concerns to the leader/doctor as soon as possible.

Recognizing Someone Is Becoming Unwell

These signs and changes in behaviour are particularly important when they are ‘out of character’:

  • Loss of appetite, missing meals
  • Tiredness, lethargy; coming to camp late and last, going to bed early, being last to get out of bed.
  • Personality changes: anxiety, irritability, excitability, anger, aggression, complaining, social withdrawal, depression, loss of concentration, talking more/less.
  • Clumsiness, staggering, falling over, dropping things, inability to tie shoelaces or pack or carry one’s own bag.
  • Breathlessness, confusion, drowsiness
  • This can be memorized as: “Grumble, mumble, stumble, tumble”.
Sunburn, Blisters, Etc
  • Wear a wide brimmed hat to reduce the risk of sunburn and heat exhaustion. Cover up or protect noses, necks, ears, the backs of hands on walking poles, and backs of knees and calves.
  • Acetozolamide (Diamox) and doxycycline (an antibiotic often taken for malaria prevention) can cause a person to sunburn more easily (photosensitivity), so extra sun protection is needed.
  • Stop and treat blisters at the first sign of rubbing and apply blister dressing
  • Walking poles are very useful while trekking, practice with them pre-departure
  • Mittens are much warmer than finger gloves
Painkillers and Medications

If pain relief is needed at altitude, paracetamol is a safe option, while ibuprofen is better at treating the headache of acute mountain sickness. Neither drug will mask symptoms of altitude illness.

Fluids

Dehydration occurs at low altitude, where heat and humidity cause excessive sweating and is also common at high altitude due to exercising in cold dry air. Travellers need to drink enough fluid (as soups, beverages or water) to keep hydrated (you are hydrated if your urine is ‘pale and plentiful’. Infrequent small amounts of strong smelling, dark coloured urine means you are dehydrated)! Discipline yourself to stop and drink at least every hour.

Diarrhoea (And Food Poisoning)

Diarrhoea in developing countries has a greater than 50% incidence for first-time travellers staying for more than a short time. In these countries it is more likely to need antibiotic treatment than it is at home. Diarrhoea can vary from mild to severe; it can result in dehydration and salts loss with resulting depletion of energy and fitness. This can result in failure to complete your holiday, trek or to summit.

Reduce your risk of diarrhoea by frequent hand washing/drying and avoiding hand-to-mouth contact.

Porter Care

If you employ porters directly or indirectly through a company, you must take care of them. This means they should have adequate clothing, footwear, food and shelter. This is especially so above the tree line. The maximum legal load a trekking porter should carry varies from country to country: 20 kg on Kilimanjaro, 25 kg in Peru and 30 kg in Nepal.

Many trekkers take far too much ‘stuff’ with them and you should aim to travel light. If you want to take more, be prepared to hire another porter. If you are concerned for your porters speak out there and then!

More information about porters and their needs can be found on http://www.ippg.net/.

Altitude Illness: AMS, HACE and HAPE

Notes for doctors and trek/expedition leaders (Dr Jim Duff, 03/01/2007)

As you ascend to altitudes above 2000m, your body has to acclimatize to the decreasing amount of oxygen available. The three main acclimatization mechanisms are:

  • Deeper breathing and an increased respiratory rate (from 8 to12 breaths/min at rest at sea level to around 20 breaths/min at 6000m). This starts immediately on arrival at altitude.
  • Producing more urine. This starts within hours and takes a day or two. If this mechanism is not efficient, the characteristic puffiness of early AMS appears in the face, hands and feet. (water retention)
  • An increase in the number of red cells in the blood. This only begins after a week at high altitude.
  • If the ascent is too fast and/or the height gain too much, these mechanisms do not have time to work, and symptoms and signs of altitude illness (also called high altitude illness or altitude sickness) will appear.

Altitude illness becomes common above 2500m and presents in the following ways:

  • AMS (Acute Mountain Sickness): common but not life-threatening if dealt with correctly.
  • HACE (High Altitude Cerebral Edema): less common but life-threatening.
  • HAPE (High Altitude Pulmonary Edema): less common but life-threatening.

Depending on the altitude gain and speed of ascent, the incidence AMS ranges from 20 to 80%. HAPE is roughly twice as common as HACE and together they occur in approximately

1 to 2% of people going to high altitude. These three forms of altitude illness can vary from mild to severe, and may develop rapidly (over hours) or slowly (over days). HACE and HAPE can occur individually or together.

People often refuse to admit they have altitude illness and blame their symptoms on cold, heat, infection, alcohol, insomnia, exercise, unfitness or migraine, and risk death by continuing to ascend.

Warning: do not ascend with symptoms or signs of altitude illness, as this has led to many deaths from HAPE/HACE.

Risk Of Developing Altitude Illness

In any group there will be ‘fast’ and ‘slow’ acclimatizers needing different ascent rates. While a flexible schedule is always preferred, the fact is that many trekkers are on tight schedules (Often, but not always, members of commercial groups) leading to a higher incidence of altitude illness. Slow acclimatizers in these tight schedule situations are at extra risk, and prompt diagnosis and treatment becomes even more important.

However, even if a trekker has a flexible schedule, they may still feel pressurized to ascend with symptoms (by pride, peer pressure, rivalry, not wanting to appear weak, etc).

Interestingly, fit and impatient young people can be more at risk of altitude illness than unfit and patient older ones!

Flexible schedule Tight schedule
  • FAST ACCLIMATIZERS LOW RISK MEDIUM RISK
  • SLOW ACCLIMATIZERS MEDIUM RISK HIGH RISK
  • AMS (ACUTE MOUNTAIN SICKNESS)

AMS varies from mild to severe and the main symptoms are due to the accumulation of fluid in and around the brain. Typically, symptoms appear within 12 hours of the ascent. If the victim now rests at the same altitude, symptoms usually disappear quickly over several hours (but for ‘slow acclimatizers’ this can take up to 3 days!) and they are now acclimatized to this altitude. AMS may reappear as they ascend higher still, as acclimatization to the new altitude has to take place all over again.

Symptoms & signs

A diagnosis of AMS is made when there has been a height gain in the last few days, AND:

  • The victim has a headache (typically throbbing, often worse when bending over or lying down)
  • PLUS there is one or more of the following symptoms:
    • Fatigue and weakness
    • Loss of appetite, or nausea, or vomiting
    • Dizziness, light headedness
    • Poor sleep, disturbed sleep, frequent waking, periodic breathing

In AMS, the victim’s level of consciousness is normal.

Note: AMS and HACE are two extremes of the same condition and it can help to think of AMS as ‘mild HACE’.

Note: the only early signs of altitude illness in a young child (under 7 years old) may be an increased fussiness, crying, loss of interest and/or loss of appetite.

HACE (High Altitude Cerebral Edema)

HACE is the accumulation of fluid in and around the brain. The important symptoms and signs are: severe headache, loss of physical coordination and a declining level of consciousness.

Typically, symptoms and signs of AMS become worse and HACE develops (but HACE may come on so quickly that the AMS stage is not noticed). Also, HACE may develop in the later stages of HAPE.

Symptoms & signs

A diagnosis of HACE is made when there has been a height gain in the last few days, AND:

  • The victim has a severe headache (not relieved by ibuprofen, paracetamol or aspirin)
  • There is a loss of physical coordination (ataxia):
    • Clumsiness: the victim has difficulty (and often asks for help) with simple tasks such as tying their shoelaces or packing their bag. When examined they fail to do, or have difficulty doing (or refuse to do!) the finger-nose test
    • Staggering, falling over. When examined they fail to do, or have difficulty doing (or refuse to do) the heel-to-toe walking test or the standing test
  • Their level of consciousness is declining:
    • Early on, this presents as loss of mental abilities such as memory or mental arithmetic. When asked, the victim cannot do or have difficulty doing (or refuse to do) simple mental tests
    • Later on, they become confused, drowsy, semiconscious, unconscious (and will die if not treated urgently)
  • Other symptoms and signs that may appear:
    • Nausea and/or vomiting, which may be severe and persistent
    • Changes in behaviour (uncooperative, aggressive or apathetic, “Leave me alone”, etc)
    • Hallucinations, blurred or double vision, seeing haloes around objects, fits or localized stroke signs may all occur but are less common

Tests For Hace

Failure or difficulty doing any one of these tests means the victim has HACE. If the victim refuses to cooperate, assume they are suffering from HACE. If in doubt about the victim’s performance of the tests, compare with a healthy person. Be prepared to repeat these tests to monitor progress.

  • Finger-nose test. With eyes closed, the victim repeatedly and rapidly alternates between touching the tip of their nose with an index finger, then extending this arm to point into the distance (useful test if the victim is in a sleeping bag or cannot stand up).
  • Heel-to-toe walking test. The victim is asked to take 10 very small steps in a straight line, placing the heel of one foot in front of the toes of the other foot as they go. Reasonably flat ground is necessary and the victim should not be helped, but be prepared to catch the victim if they fall over! Excessive wobbling is difficulty (to do the test), falling over is failure.
  • Standing test. The victim stands, feet together and arms folded across their chest, and then closes their eyes (the victim should not be helped, but be prepared to catch the victim if they fall over! Excessive wobbling is difficulty (to do the test), falling over is failure.
  • Mental tests are used to assess level of consciousness. You must take into consideration pre-existing verbal/arithmetic skills and culture; it is a decline in ability over time that is significant. Examples of tests include: “Spell your name backwards”, “Take 3 from 50 and keep taking 3 from the result”, or ask their birth date, about recent news events, etc.
HAPE (High Altitude Pulmonary Edema)

HAPE is the accumulation of fluid in the lungs. The important sign is breathlessness. HAPE may appear on its own without any preceding symptoms of AMS (this happens in about 50% of cases) or it may develop at the same time as AMS or HACE. Severe cases of HAPE may result in the development of HACE in the later stages.

HAPE may develop very rapidly (in 1 to 2 hours) or very gradually over days. It often develops during or after the second night at a new altitude. HAPE can develop while descending from a higher altitude. It is the commonest cause of death due to altitude illness. HAPE is more likely to occur in people with colds or chest infections. It is easily mistaken for a chest infection/pneumonia. If you have the slightest doubt, treat for both.

Symptoms & signs

  • Reduced physical performance (tiredness, fatigue) and a dry cough are often the earliest signs of HAPE
  • Breathlessness:
    • Early stages: more breathless than usual with exercise, takes a little longer to get breath back after exercise
    • Later stages: marked breathlessness during exercise, takes longer to get breath back after exercise. This finally progresses to breathlessness at rest
    • At any stage, the victim may become breathless while lying flat and prefer to sleep propped up
  • Breathing rate at rest increases as HAPE progresses. (At sea level, resting breathing rate is 8 to 12 breaths/min at rest. At 6000m, normal acclimatized resting breathing rate is approximately 20 breaths/min)
  • A dry cough
  • As HAPE gets worse, the cough may start to bring up white frothy sputum. Later still, this frothy sputum may become bloodstained (pink or rust coloured): this is a serious sign
  • ‘Wet’ sounds (fine crackles) may be heard in the lungs when the victim breathes in deeply (place your ear on the bare skin of the victim’s back below the shoulder blades; compare with a healthy person)
  • Note: wet sounds may be difficult to hear (or absent), even in severe HAPE
  • As HAPE gets worse, lips, tongue or nails may become blue due to lack of oxygen in the blood
  • There may be: fever (up to 38.5ºC), a sense of inner cold, or pains in the chest or even upper belly
  • As HAPE worsens, the victim becomes confused, drowsy, semiconscious, unconscious (and will die if not treated urgently)
What Else Could It Be?

If the illness comes on after 4 days at a new altitude and/or does not respond to descent, oxygen, dexamethasone and/or nifedipine, reconsider your diagnosis:

  • HACE may be difficult to distinguish from: migraine, meningitis, diabetic coma, CO poisoning
  • HAPE may be difficult to distinguish from: pneumonia, asthma, pulmonary embolus (a blood clot from a DVT), heart attack, hyperventilation (panic attack)
  • Hypothermia, dehydration or low blood sugar (due to not eating) share similar symptoms to altitude illness

Unless absolutely sure, treat as HACE or HAPE (or both) PLUS your alternative diagnosis.

Note: the basic treatment of all of these problems is roughly the same: re-warm, re-hydrate, ‘resugar’, re-oxygenate and descend.

Treatment Of Altitude Illness

If someone is ill at altitude after a recent height gain, carry out a full secondary survey (especially level of consciousness and breathing rate), a ‘Lake Louise Score’ and the tests/examination for HACE and HAPE.

Because the victims of altitude illness often fail to take care of themselves, they are likely to develop hypothermia, dehydration and/or low blood sugar (due to not eating).

There comes a point when it is vital that the leader/doctor/companion starts making decisions for the victim (e.g. ordering immediate descent), even if the victim disagrees.

General treatment of altitude illness

  • Descent is the treatment of altitude illness. Prompt descent will begin to reverse the symptoms. Descend immediately if symptoms are severe, even if it means at night or in bad weather. Resting at the same altitude is only acceptable if the victim has mild AMS and is improving with treatment
  • Oxygen: give oxygen, either as bottled oxygen or in a hyperbaric bag if the symptoms are severe and descent is not immediately possible (e.g. dangerous terrain or weather, not enough helpers to carry an unconscious victim, waiting for a helicopter) or the victim is too ill to move
  • Rest is recommended even for mild symptoms. With more serious illness, if at all possible avoid even the slightest exertion, as just walking a few steps may make symptoms worse or reappear; carry the victim or, as a minimum, assist them to walk and carry their rucksack
  • Keep the victim warm and hydrated, give occasional sugary drinks
  • Prop the victim up in a semi-reclining position, as lying flat can make them feel worse
  • If at any stage the victim has difficulty breathing, is turning blue or lapsing into unconsciousness, assist their breathing with mouth-to-mouth before they stop breathing.
Going Back Up Again?
  • Anyone seriously ill with HACE or HAPE needing oxygen, treatment in a hyperbaric bag or dexamethasone or nifedipine, should descend immediately after treatment. As, even if they feel completely recovered, symptoms may rapidly re-appear with even mild exertion or further ascent.
  • Cautious re-ascent may be considered once symptom-free for 4 weeks (ideally seek the advice of a doctor qualified in mountain medicine). Long haul jet flights should be avoided while symptomatic, unless oxygen is available
  • If re-ascent is unavoidable (e.g. driving out of Tibet over high passes), give:
    • Acetazolamide 250 mg 12-hourly
    • If the original problem was HACE, add dexamethasone (4 mg 12-hourly)
    • If the problem was HAPE, add modified release nifedipine (20 mg 12-hourly)
    • Give oxygen while crossing passes
  • If symptoms of AMS disappear and the person is feeling well (and has been off dexamethasone for at least 3 days), they may try re-ascending slowly while continuing to take acetazolamide. Otherwise, continue descending Acetazolamide (Diamox)

Acetazolamide increases the breathing rate at altitude and speeds up the acclimatization process. A dose takes 12 hours to become fully effective.

Acetazolamide does NOT mask the onset of AMS, HACE or HAPE. However, taking acetazolamide does not guarantee that altitude illness will not develop.

There are three situations where acetazolamide is useful:

1. Prevention of AMS

Acetazolamide reduces the incidence of AMS, however routine preventative use for all trekkers on all treks is NOT recommended. It is recommended for those who have a past history of altitude illness, or for everyone when rapid height gain is unavoidable, such as:

  • Any ascent to 5000m or more (e.g. Kilimanjaro 5895m) under 7 days: consider using 125 to 250 mg 12-hourly from the start of the ascent until back below 3000m
  • Flying or driving rapidly to altitude (e.g. Lhasa 3660m, Leh 3500m, Cuzco 3470m, La Paz 3880m, etc): consider using 125 mg 12-hourly, start 24 hours before flying and continue for 2 or 3 days after arrival or the rest of the time at altitude. This is especially useful if the traveller’s itinerary does not allow for 2-3 rest days on arrival at altitude.

2. Treatment of altitude illness

If someone with mild AMS has a flexible schedule, the preferred option is to rest at the same altitude until symptoms disappear. This ideal approach is sometimes not possible on treks and the argument for prompt use of acetazolamide is stronger. In this situation, a person with persistent symptoms of mild AMS despite treatment should start acetazolamide (125 to 250 mg 12-hourly) as this offers the best chance to safely continue their trek (given that no-one should ascend with symptoms of altitude illness).

See treatment of more severe AMS, HAPE or HACE above.

3. Poor sleep, disturbed sleep or periodic breathing at altitude

Poor sleep is common at altitude; first, check warmth of sleeping bag, improve ground insulation, avoid caffeine, check peeing arrangement and offer reassurance to the anxious. A trial of acetazolamide is indicated for sleep disturbance at altitude, particularly if the insomnia is associated with periodic breathing. This is recognized by repeated cycles of normal or fast breathing followed by a long pause, then several gasping breaths. The sufferer often wakes feeling like they are suffocating. This can be frightening for the sufferer’s tent ‘buddy’!

In the morning the victim feels tired and unwell.

Acetazolamide is often called ‘the high altitude sleeping pill’ (125 mg one hour before going to bed. If the problem persists, increase the dose to 250 mg).

Acetazolamide: Allergy And Side Effects

The side effects of acetazolamide include allergy. Avoid it if there is a history of a severe allergic reaction to acetazolamide or sulfa containing medications (mainly the sulphonamidetype antibiotics such as co-trimoxazole, Septrin™, Bactrim™). Note that if the sulfa allergy is mild (rash, diarrhoea, etc), test doses of acetazolamide (125 mg 12-hourly for 2 days) may be tried well before departure (but do not attempt this if the sulfa allergy is severe!). Most people with mild sulfa allergy can take acetazolamide.

Common side effects of acetazolamide include:

  • Paraesthesiae (tingling) in lips, fingers, toes or other body parts and a metallic taste when drinking carbonated drinks are the most obvious. Both side effects are milder with lower doses and disappear on stopping the medication
  • Acetazolamide can cause photosensitivity (sunburn more easily) so use hats, gloves, sunscreen
  • Extra urine output. The effect of acetazolamide to increase urine output is mild (people pee more as part of the normal acclimatization process as they ascend)
  • Rarer side effects include: flushing, headache, dizziness, nausea, diarrhoea, tiredness

Note: the medication acetozolamide used for Acute Mountain Sickness has to be obtained from a doctor on prescription. As its use for AMS is not officially recognized, some doctors may be reluctant to prescribe it for you. Showing your doctor this handout may help.

Medications At Altitude
  • At altitude (above 2500m) some medications such as sedatives, strong painkillers, antihistamines and most sleeping tablets (except zopiclone and zolipidem) may depress breathing. This may make altitude illness more likely or more severe, especially at night. If you have to use any of these medications, consider giving acetozolamide (Diamox) 125 to 250 mg 12-hourly to stimulate breathing, and check the person frequently.
  • At altitude, antimalarial medications may cause nausea and psychotic episodes
  • Oral contraceptives (“the pill”) slightly increase the blood’s tendency to clot, so they should be avoided above 5000m
  • Aspirin and NSAIDs (non-steroidal anti-inflammatory drugs, e.g. ibuprofen) may cause bleeding in the eye (retina) at high altitude (over 5000m) especially if coughing is present.

Everest Base Camp

What immunizations will I need?

No vaccinations are compulsory in Himalaya, but we do recommend you are covered for diphtheria & TB, hepatitis A, hepatitis B, *malaria, typhoid, polio and tetanus.

We also recommend, a dental check-up prior to travelling and that you know your blood group in case of emergency.

If you have any pre-existing medical conditions which might affect you on tour, you make these known to your tour leader.

Can I obtain the visa for Nepal upon on arrival at the airport?

YES, you can obtain a visa easily upon your arrival at Tribhuwan International Airport in Kathmandu. Tourist Visa with Multiple Entry for 30 days can be obtained by paying US $ 40 or equivalent foreign currency. Similarly, Tourist Visa with Multiple Entry for 90 days can be obtained by paying US $ 100. Please bring 2 copies of passport size photos.

I would like to extend my holiday, any recommendations?

Yes, there are a plenty of options and choices to extend your holiday before or after your main trip.

Do you guys have a PAC Portable Altitude Chamber?

Yes, we do have PAC but we don’t use it for Everest Base camp trek since you only have to stay a night above 5000 meters. We will surely provide one if required.

What is the temperature rating of the sleeping bag that you lend to trekkers?

The temperature rating of the sleeping bags we provide are about -10 deg C, we can provide liner or extra blanket if the sleeping bag is not warm enough for you.

Will there be a place to store items/clothing not required for the trek?

The hotel in Kathmandu does provide the free storage services. So you can leave all your items that are not required for the trekking at your hotel.

Do you use yaks/porters on the trek or do we carry all of our own gear?

Whilst on the trek, our porter will take care of your luggage. All you need to carry is your small day bag for your personal belongings like camera, water bottle, sun cream etc only.

Can I add extra days to my trekking trip?

Holiday should never be about making it to the final point quickly. Along your trek we can add days at your request with additional costs to cover guides, porters, accommodation and food.

Where do we toilet along the trail? Is it similar to Kilimanjaro and just wherever we can find privacy?

At most cases you can use the toilet provided by the tea houses/lodges on the trail but normally in case of emergency, you just do toilet along the trail wherever you find privacy.

What opportunities will I have for shower along the trek?

In major places (Namche Bazar, Lukla), we arrange guesthouse with hot shower. And in the rest of the places, hotel water in bucket will be provided for shower; it would cost you extra about USD 3-4 per shower.

Do I need to tip my guide and porters? How much would that be?

This is a difficult thing to gauge. We have seen everything from USD 20 to USD 1000 per person for guides and porters. Tipping is not required, but a small gesture of thanks to your guides and local porters. The level of the tip should reflect the level of satisfaction from and personal involvement with your guide. However, we recommend you to spend minimum 10% of your total trip cost for tipping entire local staffs, the ratio of tipping guide and porter will be given to you at the pre-trip meeting in Kathmandu before starting the trek.

How much additional money do I need per day?

It depends on your spending habits. Generally, in Kathmandu, you can allocate USD 10 to USD 15 for a lunch and a dinner. USD 15 to USD 18 per person a day will be enough to buy bottles of water, chocolates, pay for the hot shower and a few drinks during the trekking.

Can I use credit cards in the places I visit in trekking?

In the cities, yes – to some extent. Once you are out of the cities, all you need is cash. Please change the currency in local Nepali Rupees before you go to the mountains.

Is there any communication while we are on trekking?

There are telephones in some villages along the trekking routes from which you can make international calls. All our guides are equipped with the local mobile phone. You may wish to pass the number of our guide to your family for the callback or you can make a call from the guide’s mobile and pay him directly for the international call too.

Can I charge my digital camera or other equipments on my trip?

These facilities will be available in most of the places in your hotel reception by paying some service charges. Remember to bring TWO and THREE pin travel adapters!

Do we book our own international flights to and from Nepal?

Yes, you need to book your own International flights.

Do you know about how many miles the trek is?

Total distance of the entire trek is about 75 miles.

What safety measures are in place? What safety equipment do your guides carry with them on trek to deal with sickness/accidents?

Our guides are well trained for the high altitude problems and first aid. They always carry the first aid kit bag during the trek. However we still recommend you to bring your personal first aid kit as well. All our guides carry the local mobile phones and SAT phones for the emergency.

Do your guides have trekking guide certificates from the Hotel Management and Tourism Centre? Have they received first aid training for high altitude?

Yes, they have all received 45-day training from the Hotel Management and Tourism Centre in Nepal. The guides have also received high altitude first aid training from KEEP (Kathmandu Environmental Education Project).

I am a Vegetarian, is that a Problem ?

No problem at all because the lodges mostly serve the vegetarian meals. We always recommend our clients to eat vegetarian meals to avoid the food poisoning, eating heavy meals and non- vegetarian meals at the high altitude is not really safe for the stomach.

What is the weather and temperature like in trekking?

Every trekking trip up the mighty Mt. Everest presents its own amazing, unforgettable moments that forever live on in the hearts and minds of those brave enough to make the climb. One of the most unpredictable elements of the Everest region is the weather. If you’re not properly prepared for the twists, turns and volatility of the conditions that can occur in this breathtaking region, you might find yourself in an uncomfortable and unpleasant situation.

Generally speaking, the nights are much cooler than the daytime hours in the Everest region. Many first-time trekkers are surprised to learn about the incredible range that may occur in a given day. During the day, the thermometer could reach temps as high as 25 degrees C, only to dip down as low as -20 degrees C in less than 24 hours. While there’s no way to know exactly what each day in the mountains will bring, the weather and temperature ranges tend to be somewhat predictable based on the month and season.

Spring – March / April / May / June
Spring is one of the best times of the year to visit the Everest region, although because of this, it can become somewhat crowded. One can meet many other Everest climbers during this season and base camp is full of tents. The beautiful clear blue sky can be seen and the many different species of flower are visible in the lower altitude.

During springtime, the average temperature is 17 degrees C with a maximum of 25 degrees C during sunny days and a minimum of -15 degrees C in the morning and at night for areas above 4000 meters.

July / August through Mid-September are Monsoon Season
This season is not really recommended to travel as it rains in the lower altitudes, below 3500 meters. In areas above 4000 meters, it rains sometimes and although it is also sometimes dry, very few people travel during this season. There are positives to trekking during the monsoon months, however. The excess rainfall can provide ample chance to see spectacular views of the waterfall and it’s also the best season to avoid the crowds. The maximum temperature during the monsoon season averages 25 degrees C during sunny days with a minimum -15 degrees C in the morning and night at areas above 4000 meters. The average temperature tends to hover around a comfortable 18 degrees C.

Autumn – End of September / October / November
Similar to springtime, autumn in the Everest region is also a crowded season, but it’s one of the best times to trek. While it lacks the beauty of flowers, the clear blue sky can be seen, affording incredible views from just about every angle.

The average temperature during the fall is 15 degrees C with a maximum temp of 20 degrees C during sunny days and a minimum of -10 degrees C in the morning and at night, for areas above 4000 meters altitude.

Regardless of time of year, trekkers should always plan accordingly and bring clothing for both cooler and warmer temps. Layering is always recommended, as are pants that can double as shorts. For a full list of clothing and materials to bring to account for various temperatures and weather changes that can occur in the Everest region, visitors should work closely with their travel provider. This will ensure that the adventure will be enjoyable no matter what the weather and that every possible scenario will be accounted for ahead of time.

What is the best season for this trekking?

Our trekking season extends from mid- September to May. From early September the monsoonal rains decrease. By end of September through to December the weather is usually stable with mild to warm days, cold nights. February, March, April, May, October, November, December are the best time to do Everest base camp trek.

What mode of transportation do you use?

Depending on the nature of the travel, the transportation to and from the destination varies from domestic flights to vehicular transportation to even piggyback rides on mules and yaks. We provide you only those options which enhance your local experience while allowing you to travel comfortably and efficiently. We use private tourist vehicles for sightseeing, city tours and pickups. Depending on the group size we use cars, minibus, vans or alternatively 4WD SUVs, more manoeuvrable in travelling along the narrow and bumpy roads of Nepal. All the vehicles are usually air-conditioned unless we are travelling in cooler areas.
For domestic flights (Kathmandu – Lukla – Kathmandu), we use Tara Air, Agni Air -popular domestic airlines.

Is water provided and is there still water available at higher altitudes? Is it filtered/boiled? Readily available?

Bottled water is easily available at the lodges and tea houses. You can buy bottled water at the cost of USD 2 at lower elevations to USD 4 to higher elevation per litre. You can also drink the normal tap or spring water if you bring the purifying aid with you.

Is the food in mountain prepared to international standard in terms of safety?

YES, the food is very safe during the trekking and we recommend you to eat the vegetarian and local food. Please follow the suggestion of our guide on the trek.

What sort of food can I expect in trekking?

Most teahouses (lodges) in Everest Base Camp trails cook a delicious range of mostly vegetarian fare. Pasta, tuna bakes, noodles, potatoes, eggs, daal bhat(rice and lentils), bread, soup, fresh vegetables (variety depends on the season) and even some desserts like apple pies, pancakes, and some interesting attempts at custard. You will find a lot of garlic on the menu because it assists with acclimatization – eat some every day. In many larger villages you may find some meat items on the menu. You can always get hot chocolate, tea, and hot lemon drinks, as well as soft drinks, and treats like chocolate and crisps. Each day dinner and breakfast will be at a lodge you’ll stay at while lunch will be taken on the way to destination.

When I pay the remainder of the money on arrival in Kathmandu, how do you take that money? US cash or credit card?

You can clear the remainder of the money upon your arrival in Kathmandu or even before you arrive in Kathmandu. You can use USD cash, American Express, Travellers Cheque, Master or Visa cards for the payment options. There will be 4% bank levy when paying by credit cards.

Is this a guaranteed departure even if I am alone stating in the request trip?

YES all our trips are guaranteed to run. We never cancel the trip due to not having enough participants, we can arrange the trip for one person as well.

Is there a possibility of getting separate rooms for the Kathmandu portion of the trip? If so how much extra will this cost?

Yes! We can surely book separate rooms in Kathmandu for your portion of the trip. During the trek we will try our best but normally the lodges have twin sharing and dormitory styled room instead of a single room. The lodges will provide a private room for one person when the room is free and additional cost is not required.

The additional cost is USD 70 per person for booking a single room in Kathmandu for four nights when booking for groups of two or more than two people.

What sort of accommodation can I expect in Kathmandu and in trekking?

We use standard rooms at three star hotels in Kathmandu with breakfast included. Along the trekking routes, teahouses/lodges generally provide basic clean facilities with a mattress and a quilt or blanket. We can also offer you sleeping bags if needed (to be returned after the trip) but it is a good idea to always have your own sleeping equipment. The lodges in trekking routes usually provide single and double rooms, or occasionally a dormitory. At times when possible, dining will be around a bon fire. In tea houses, food will be prepared in the kitchen which you should not enter without permission. The toilet in tea houses provides essential and basic facilities and is always outside the room.

Will somebody come to pick me up at the airport upon my arrival?

Yes, our airport representative will be there to greet you at the airport. Upon arrival, you will be transferred to your hotel by our tourist vehicle.

What type of shape do I need to be in, is this trip for me?

Everest base camp standard trek is suitable for average people who are moderately fit, thus no previous experience is required. Some physical fitness programs such as running, swimming, hiking is recommended before you embark on your journey. Whilst on the trek, it is common to experience some discomfort before being fully acclimatized.

To prepare for a strenuous trek you should begin training at least two to three months before your departure. As a guideline, an hour of aerobic exercise three to four times per week would be considered a minimum requirement. The best preparation is bushwalking involving relatively steep ascents and descents. If you can manage a couple of valley floor to ridgeline ascents per comfortable and able to enjoy the trek to the fullest.

What is the success rate for your trips?

We have up to 98% success rate for our Everest treks.