Travel medical information

Dehydration

While trekking lower down in the valleys it is hot and you sweat a lot so it is important to replace the fluids you lose. At altitude the problem is worse, you are still sweating and the air is dry and thin meaning you must breathe a lot harder. With every breath you breath out water vapour. It is very important then to drink a lot. Dehydration make you feel tired and lethargic and can give you a headache. The symptoms are similar to AMS so the easiest way to avoid confusion is to always keep hydrated.
 
The basic rules are; drink as much and as often as you like, (that does not include alcohol!) even if it seems like a lot. This can include soups and lots of tea, but even with a lot of liquid food, you should drink a lot of water too. Many people find that with dinner they often drink more than a litre of water, catching up on what they should have drunk during the day. A great guideline is the expression: A happy mountaineer always pees clear!
 
The easiest way to check that you are not becoming dehydrated is to look at your urine; if it is very yellow or orange you should drink more, but if it is almost clear then you have been looking after yourself well. Using this as a guideline some trekkers find that, although they don't feel thirsty, their urine is definitely yellow. This means drink more, even if you have to consciously think about it.
 
 
The Khumbu Cough
If trekking for a prolonged period at altitude, especially in the Everest region: If you escape the Khumbu Cough you did very well. This is the perpetually running nose and a usually mild productive cough. It is caused by breathing excess quantities of dry cold air - so much that you partially injure your bronchi. A cold or infection is the normal cause of this but in this case the irritant is only air however your body reacts almost identically - quantities of clear or white goo. Get rid of it when you can, there is plenty more waiting to well up. Since there is no infection it is pointless taking antibiotics. Throat lozenges help so take plenty.
 
 
Bronchitis
An inflammation of the bronchi from an infection, ie identical to the Khumbu coughs but instead caused by an infection. Differentiating this from the Khumbu Cough is difficult, but you perhaps experienced a fever and/or some chills. The cough may be more productive. Since it can be a viral or a bacterial infection, taking antibiotics will not always help and is not particularly recommended. Best is some rest and a return to a lower altitude, eg Namche and see a doctor if it is particularly bad.
 
Pneumonia
This is an infection that causes fluid to build up in the lungs. It is rare but once HAPE was miss-diagnosed as pneumonia and since the treatment was antibiotics, rather than descent, most people died.
 
 
Cold/snow injuries

Snow Blindness
This is sunburn of the cornea. It is particularly painful, like hot sand in your eyes. It is entirely preventable by wearing sunglasses that block UV light. This precaution is most important while around snow, even on cloudy days, but altitude alone increases the concentration of UV light so while at higher altitudes also wear sunglasses. Porters often get snow blindness. If sunglasses are not available then cardboard shields shaped like glasses with two narrow slits for vision are easily made and are quite effective.
 
Frostbite
When flesh freezes solid the results are very serious and often amputation is necessary. Frostbite takes time to develop unless flesh is exposed to a vicious cold wind. First your fingers or toes feel numb, clumsy and lose power. If you can still vaguely wiggle them then warm them up now, they are on the verge of freezing. Rewarming is painful. When real deep freezing has occurred the flesh turns white or even blue and fingers or toes become wooden, incapable of movement. At this stage don't begin rewarming until in a position when refreezing cannot occur (even more damaging). Warm slowly and evenly. Blood temperature to 42?C is the optimum warming temperature and once defrosted promotes blood circulation. Blisters will probably form. See a doctor as soon as possible.
 
 
Bugs, blisters and skin problems
 
Fleas, bedbugs and scabies
These problem bugs are almost unknown on our treks. The trekking regions of Nepal are considerably cleaner than years ago.
 
Leeches
The monsoon terrorizer. You have to admire their skill in being able to put a sizeable hole in you completely painlessly. In damp forest they wave around waiting for you and are adept at penetrating socks and even boot eyelets. They should be removed by applying a lighted match or cigarette to the end still sticking out.
 
Blisters
Since you spend most of your time walking, blisters are really worth avoiding. First use boots that have been worn in if possible. Test your boots by carrying a pack up and down hills - along level ground there is far less stress on your feet.
 
Normally you can feel a blister developing - some rubbing, or a hot spot, or a localised pain. Stop and investigate, even if it occurs during the first 5 minutes, or just in sight of the top of the hill; immediate action is best. The trick is to detect the symptoms before the blister develops. Put tape on or investigate what may causing the problem.
 
Blister Treatment - If you develop a blister then there are several approaches. If it is not painful then perhaps surround it (not cover it) with some light padding, eg moleskin, and see how it feels. If it is painful and causing problems then pierce it - clean the skin and sterilise the needle; holding the needle slightly above a candle or match flame for a second or two is effective. Do not cut away the blister skin until after a few days when it is dried out and no more use for protecting the delicate skin underneath. You can put protective tape over the top with some cotton wool to protect the blister, and some people even put the tape straight over the blister, with no protection.
 
If you have had a previous history of blisters or think that you are likely to get them take preventative action first! Use moleskin, a strong waterproof zinc-oxide tape or similar, and tape up troublesome areas first. Tape before you take your first step and be religious about checking, and replacing, the tape.
Vaginal infections
 
If you have experienced these before then it is very worthwhile taking along the medication just in case.

 
Precautions and Inoculations discussion
This information is given in good faith but with No responsibility. This was written for our Nepal treks but applies almost equally for our Tibet/Bhutan and India treks.
 
 
Precautions
Anyone with heart, lung and blood pressure abnormalities or a continuing medical condition should have a check-up and get a medical opinion before setting off.
 
Older people
Many recently-retired people have made it to the top of Kala Pattar (5554m/18,222ft) so age need not be a barrier. The older you are, the more important prior fitness preparation is.
 
Younger children
Caution should be exercised when taking children trekking. Younger people can be slower to adapt to altitude, and very young children have difficulty in communicating exactly how they feel. No studies have been undertaken so cautious doctors recommend the safe maximum for pre-teenage children is 3000m/9843ft. However a number of young children have made it to the top of Kala Pattar - 5560m. Trekking with children can be very rewarding and bring you closer to the locals. You share a common bond for there are few people without children in Nepal. Little legs are easily carried by a porter when tired, and Sherpanis are good babysitters.
 
Teenagers
There is no evidence to suggest that teenagers adapt slower to altitude than adults. However they do appear to be more at risk. This is likely to be because of competitiveness and a will not to give in, and also because some school groups treat the trek as an outward bound exercise, with everyone carrying their own backpack. School groups should allow an extra day or two over the most conservative itineraries and be particularly watchful.
 
Asthma
This is no reason to avoid trekking. Except in polluted Kathmandu there are fewer irritants in the air so most asthmatics actually feel better while trekking. Look after your medication - wear your inhaler on a chain around your neck or keep it in a pocket. There is still the normal risk of a serious attack so brief your companions on what to do.
 
 
Diabetes
If it is well-controlled diabetes is no reason to avoid trekking. You cannot afford to lose the medication so keep it with you at all times and warn you friends on the procedures in case there's an emergency. Your increased energy expenditure will change carbohydrate and insulin levels so it's very important to monitor your glucose levels frequently and carefully and to keep blood sugar levels well controlled.
 
 
High blood pressure (hypertension)
Blood pressure will fluctuate more and be higher than usual while on a trek. You should seek the advice of a doctor who is aware of the history of your condition.
 
 
Previous heart attacks
Studies have yet to be conducted but it is likely that the level of exertion required on a trek is more significant than the altitude factor. Seek the advice of your doctor.
 
 
Epilepsy
There is a moderately increased risk of a seizure at altitude, but is not a reason to stop you trekking. Your companions must be briefed on all the relevant procedures.
 
 
Pregnancy
Complications are common, especially in the first pregnancy. Sometimes sophisticated care is needed so it's probably not a good idea to go trekking while pregnant. The effects of reduced oxygen at high altitude on the foetus have not yet been studied.
 
 
Past history of chest infections
If you are prone to these bring the medicine you are normally prescribed (usually Augmentin or Roxi-something), and at least 2 full courses of it. If you are ascending to high altitude for only a short time in the Everest region you may want to take it prophylactically, since your chances of picking one up are high.
 
 
Immunisations
The most accurate immunisation advice for visiting Nepal can be found on the Web - CIWEC Clinic's page. They are Kathmandu's most professional medical clinic. It is worth reading very carefully and printing this advice out, plus what follows, before getting your shots. American doctors (perhaps to avoid getting sued) tend to jab far more needles than is useful. The best people to consult about the vaccinations currently recommended are clinics specialising in travel medicine. They will have access to more up-to-date information than a normal general practitioner.
 
Hepatitis A
Usually passed on in contaminated water; immunisation is considered a must by most doctors unless you have had hepatitis A before. The vaccine is Havrix and a full course will give up to ten years protection.

Hepatitis B
This disease is avoidable since, like AIDS, it's passed by unsafe sex or contaminated blood products. A vaccine is available.

Meningitis
Occasional cases of meningococcal meningitis occur in Nepal. It is an often fatal disease but the vaccine is safe and effective and should be obtained.
 
Cholera
The World Health Organisation no longer recommend this vaccination. It is only partially effective and often causes a reaction. The risk of travellers acquiring cholera in Nepal is extremely low.
 
Typhoid
is prevalent in Nepal. There are now a variety of vaccines and one should be obtained.
 
Tetanus-Diptheria
This vaccine is recommended if you have not had a booster in the last 10 years. Many doctors advise a tetanus booster every time you intend to travel for any length of time.
 
Polio
If you escaped immunisation as a child a series of vaccinations is recommended. If you have not had a booster as an adult, one may be required. Check with your doctor.

Measles, mumps and rubella
If you did not have these diseases (or the vaccinations) as a child you may need a vaccination.
 
Japanese Encephalitis B
This disease is transmitted by mosquitoes and there have been sporadic outbreaks in the Terai (lowland Nepal) and India. Western doctors based in Kathmandu suggest the vaccination only for people working in the Terai for extended periods. In other words you DON'T need this vaccination.
 
Rabies
This deadly virus is transmitted by the bite of an infected animal, usually a monkey or dog. The risk of being bitten is minimal but it has happened. A vaccination is available but even if you've had it you'll then need a follow-up course of two further injections. If you've not been vaccinated and are unlucky enough to be bitten, a series of injections is available only from the CIWEC clinic in Kathmandu and should be started within a week or so of being bitten.
 
Malaria
Carried only by the lowland Anopheles mosquito, malaria exists in the Terai in Nepal (ie below 1000m/3281ft), and across much of the rest of rural Asia. There's no risk in Kathmandu or while trekking and the risk in Pokhara appears to be theoretical only. If visiting Chitwan April to October then you can consider taking tablets to protect against malaria. The actual risk, especially since you are there for a short time, is minimal, and the side effects of some drugs less than minimal.
 
Whether you are or are not taking anti-malarials, the first line of protection, is to avoid being bitten. The Anopheles mosquito is active only between early evening and dawn so you should cover up well between these times and use mosquito repellent on any exposed skin. All the better lodges at Chitwan spray the whole compound regularly with mosquito killing chemicals.
 
I am always staggered by the number of people taking anti-malarial medication who shouldn't be. The side effects of some of the stronger drugs can be quite nasty, so especially if you are going climbing or trekking, you shouldn't be taking them. Ask your doctor about this.
 
If you are behind on any of the immunisations listed above, they can be safely obtained at clinics in Kathmandu.
 
Medical insurance
A combined travel/medical insurance policy is a sensible choice for any traveller and a requirement for most tours, please take this insurance in your home country.