Is Your Next Vacation a High One?

I’m an altitude freak of nature, having been over 16,000 feet many times, with no ill effect. While my compatriots at Everest base camp in Tibet might be listless with no appetite, I would run around happily scarfing the meals they couldn’t touch. This is because, In 2012, the wonderful Dr. Javers discovered I’ve been living most of my adult life with sinuses almost completely blocked, so I'd adapted to low oxygen.?? ?It felt like the Grand Canyon after he fixed the problem.

?My niece is doing an "altitude trek" in February, so rather than send her a long email, I thought I’d post an article focusing on high altitude travel to developing countries, since often the two go hand in hand. ?

Over the past 30 years, since I said goodbye to the office, I’ve had the privilege of fueling my passion for adventure travel, working remotely from over 78 countries. Many of those travels have involved high altitude treks.

Four Key Things to Remember Before You Go

The four common denominators with most of these adventures is:

1. There’s usuallly a large support crew carrying your gear, kitchen and tenting equipment, whether it is Nepal, Bhutan, Peru or Kenya.? Although my last Patagonia trek was self-supported, there is a point where you might want to support the local economy by hiring a few people to take the weight off a bit (usually less than it’ll cost you for physio when you return).
2. There can be all kinds of safety, security and health implications from travelling to a developing economy where most of the people are much worse off than where you are travelling from.
3. Most people underestimate the effects of altitude.?? I was racing in 24-hour multi-sport event in the Rocky Mountains with a team from California, prepping for a 7-day race across New Zealand.? We’d been training for months. The tour leader, who was in superb shape, bailed out within the first five hours, so we were disqualified.?? The remaining two of us carried on, not out of any need to win the event, but because we’d downed at least 20,000 calories and neither of us wanted to up-size coming back home.?? It was only later I realized he was suffering from altitude sickness, since we were racing at around 9,000 feet and it didn’t occur to us in our training to do any altitude prep.
4. Being fit is no indicator of how you are going to react at the top. I've seen out of shape people literally being pushed and dragged up to a base camp with no issues and super-fit triathletes drop out 5,000 feet lower, even with acclimatization.

HAPE - High Altitude Pulmonary Edema

Whether you do high end excursions that carry portable oxygen chambers - or low budget ones where the accommodation might be a loft over a chicken coop, the concern for everyone is to prevent high-altitude pulmonary edema (HAPE).?

My husband encountered a couple at a small village in Pakistan who had been there a week. The guy was very ill, suffering from altitude sickness, and they were still at altitude waiting for it to get better! It won’t get better if you don't get to lower ground.?

I've never seen a severe case that requires a helicopter, but have had the privilege of very good advice from high altitude medical doctors, especially in Nepal, who publish excellent studies on the subject.

Here are some things to consider.

Take Dukarol at least two weeks prior to leaving

This is available in Canada over the counter and approved by the FDA but at this writing not available in the US, except by mail order.? It is a cholera drug that prevents or lessens travellers’ diarrhea.? Do a search on how to take it.

There was a big trek in Nepal where we had a large banquet before leaving and I was the only person not living next to the toilet for the next 24 hours.?

Dukarol is absolutely my go-to for travel anywhere where water quality may be an issue.

Print off extra copies of all your key documents, passports

Leave electronic copies with someone back home.? I know it is not cool to print stuff off anymore, but have you ever tried to board a flight with a dead phone or a stolen phone??? ??

My husband and I are lucky enough to have two passports in the event that war breaks out and we have to leave quickly.?? These days, no one needs to hold your passport unless it is a border check.?

Know where the closest embassy is and keep their number with you.

Put together a comprehensive travel medical kit

You are going to be in the middle of nowhere without access to a doctor and likely, even if you can find a pharmacy, they won’t have your fancy north American pills or recognize your prescription if you do an online appt.

If you’ve had any malady in the past 20 years (ladies think UTIs), get a prescription and fill it.? ?A “travel kit” is a perfectly reasonable excuse for your MD.

Besides all the things I’ll mention below, I like to take extra antibiotics, rehydration salts, water purifying pills (water bottles can be “fake” and filled with tap water).? ???Moleskin and small scissors because you’ll sweat bandages off.? Some of my friends take their own syringes and dental repair kits.? ?Be sure to take something to ease tooth pain.?

A good travel clinic can give you other current recommendations for your specific location and which vaccinations you need.?

Consider everything electronic or RFID open game

That guy at the airport with the bag nearby?? He’s probably scanning your credit cards or monitoring your text messages.? Become very smart about protecting your data from public WIFI networks and master this before you start your trip.?

Make sure you can shut everything off remotely if your phone is stolen – or have someone who can do this for you. If you don’t have an RFID protected wallet, lining it with aluminum foil does the trick just as well, although it can set of the security scan at airports, so consider packing some with you. ?

If you’re going to be doing these types of trips regularly, consider a backup well-protected travel phone with only the apps that you absolutely need to communicate or work while you’re on the road.?

?If you have bad knees, plan for trek back down

Even without a pack, the trek back down can be excruciating.?? The team will offer to cut you some poles, but why help defoliate the local forest when you can pack extendable trekking poles like these. Sadly, it can be hit and miss whether you can carry these onto a plane.?

Poles are also great for getting across streams, retrieving hats that fly off into unreachable bushes or protecting yourself against monkeys.

?Of course, take whatever knee supports you have, or some KT tape or ankle wrap. KT tape, done properly, can take a lot of strain off knees. Check out videos on Youtube. I just use one wrap, outside stretched to inside to stabilize my patella.

And don’t forget an anti-inflammatory (Naproxen).?? Extra strength 10% Diclofenac cream works wonders on aching joints.? Get a prescription for 100ML so you can carry it onboard.? ?

Cash is King

Of course you are going to alert your bank that you are going away. Even so, there's a good chance that at least one of your credit cards won't work fairly quickly. So take extra cards and extra cash. Split it up and challenge someone to find all the stashes before you leave. I have a couple of no fee low limit credit cards that I use so that if they are compromised, it isn't a big deal. I don't take my big limit cards and I usually ask my bank to lower my ATM withdrawal limit - if the area is fairly dicey.

You could get money from a bank, if one is open and they haven't run out of cash. There was a case recently where a bank teller was giving info on tourists getting large amounts of cash and those tourists were then being held up for that cash at gun point. So get your cash and get back to your hotel, preferably by pre-arranged taxi. And that nice ATM in the hotel is likely sending your information to North Korea.??

A stack of new USD dollars and fives works great for tips, buying those small trinkets, giving to the local school or orphanage with a donation box that you inevitably will pass by.?

On one trip, our group was held up by Maoists and we had to cobble together enough cash to pay a “ransom” to allow the crew to continue supporting us (some people didn’t have enough cash and now that I think of it, they still owe me money)!

We would have been stranded because our porters would have had to leave us there. This would have affected their ability to work - and could have impacted their villages.?? There was no ATM within 100 miles so that extra cash was put to good use. Happily, they gave us a receipt, so the next Maoists would let us pass, which I thought was very civilized.?

If you aren’t paying ransom for your crew, another need for cash is at the end of the trip. There’s usually an end of trek dinner where everyone chips in to give the staff a big tip and everyone acts surprised. If there are particular people you want to recognize, taking some envelopes that you can put cash in will make both of you feel good.? Write their name small so they can re-use the envelope.

That person who brought you your tea in the morning, the porter who hiked back 10 miles to retrieve your late luggage. Seriously. Learn their names and recognize their efforts.

Plan for altitude sickness

Diamox, or its equivalent, is a “take as needed” pill, not a “take before you need it” pill.? So many guides will tell you to start taking these drugs before you start the trek and all you do is end up with a bunch of dehydrated people constantly needing to pee, half of whom don’t need the pill at all.

Diamox is a diuretic and you take it to offset the build-up of water in your system.? No one knows in advance how they will react to altitude, even with proper acclimatation, which is why many don’t make the entire trek up.?

If you’re given the opportunity to take hikes to higher altitude during the day, even if you’re tired, slog up there instead of sitting back with that cold beer.? It’ll help you adapt easier.? And that alcohol isn’t going to do you any favors either, including the local moonshine you’ll be offered.

Make sure your insurance includes air evacuation services

If you do develop serious HAPE symptoms, you want to get to lower ground really fast - or into a portable oxygen tent.? Pay the extra money for insurance so you can do this.?

If your symptoms are severe, move lower, bail on the trip – your life may depend on it.

And on that note, we know that cellular networks are everywhere now, but hopefully on really remote treks, your guiding company has a sat phone and a way to keep it charged.

Consider getting a day pack with a bright inside colour

Black bags are great, but newer ones like this bag let you to see your stuff a lot easier, especially if it in the midst of a flight and you’re trying to find that protein bar you packed.??

As you can see in the photo, this particular bag has a support strap across the chest, which really eases the shoulder and back strain because as you're slogging up hill, even a 10 pound bag can feel heavy.

Fill up the extra room in your bags with stuff you can leave behind

Electronics, old tablets, phones, PCs (all reset of course), footwear, clothing – it will be much appreciated where you’re going.? Pens (or pencils and way to sharpen them) for kids.? Stickers are cute and kids love candy, but it isn’t really going to help them with their school work. ?Or ask your tour leader before you depart, since these kids likely see a group every day.

Some stuff you may not plan on leaving behind.?? If you lend something to someone, you may not get it back.? It won’t be stolen, it’ll just be considered a gift and who are you to argue.? I lost my super cool multi-Swiss knife lending it to my trekking guide and he was so thankful for the incredible present.

Anything you really need, wear it onto the plane or put it in your carry on

You don’t want hiking boots showing up the day you arrive back so if it won't fit in your carry on luggage, wear them.??I don't know how many times we've arrived and someone's bags haven't made it. You can pretty much cobble together everything you need, but footwear is crucial.

Hopefully you’ve broken in those hiking boots or shoes on a few local hills. I've been on treks where we've stopped so that one of the people could buy their shoes on the way. She lasted two days and had to be limped back to a bus.

Airtags are amazing, but it can be somewhat depressing to see where your bag actually is.? There are also some wonderful bag courier services, if you want to be super-sure. I used one of these once going to Bangalore because I was doing a side trip to South Africa, and it was a seamless wonderful experience.

I'd rather look like the Stay Puffed Marshmallow Man to make sure I have all the clothes that I need, rather than a sleek fashionista without my luggage.

Women – Consider Wearing Skirts

I strongly recommend women wear hiking skirts and leave the Dr. Livingston long pants to the guys.? You are going to pee a lot. Need I say more.?

Take wipes and steal some of Rover's poop bags and if you want to leave the environment pristine.

Assume someone "official" is going to rifle through all your stuff

Many times, any number of people will have the opportunity to look through your bags. We’ve often arrived home, opened our bags, and found things missing. So, hide that Airtag and use locks to zip valuables inside pockets.? Cash doesn’t buzz so carry it on you through airports.?

We were coming out of Nepal after one trip and the guy on the baggage security chose a few items as gifts for his wife from my husband’s carry-on bag.? You going to argue with airport security? Ever seen a Nepal prison? Me neither.

Leave all your valuables, rings and jewelry back home unless you’re travelling with armed guards, which is sadly getting more common.

Plan for your first night's sleep

You’ve just spent up to 30 hours getting to your destination. You’re probably wired from too much coffee, and you are (of course) way too smart to drink alcohol on a plane.??

My friend Shelley, who has guided hundreds of trips to developing countries and countless high treks, advises taking two melatonin pills and a Gravol pill.? I’ve been doing this for years and it is the best way to get a great first night sleep to help that immune system do its work and help reset you to local time.? The melatonin puts you to sleep and the Gravol keeps you asleep.?

And to feel really secure, I use a portable door lock or pack a small rubber door stop to wedge under the door. I also bring cable locks to secure cupboard doors or to secure locked luggage to non-movable furniture when I’m sleeping.? Room safes are rarely secure.? These added steps just make my room more of an effort to steal from than the next room.

Keep viruses at bay

Even if you've hosed down your airplane seat with sanitizer, the odds that you’ve breathed in a virus are pretty high.? Consider using saline nose rinses before, during and after travel to kill those viruses before they become nasty (use bottled water for the nasal rinse).?? I also take some (prescription only) Pulmicort.? There’s a good chance you can reduce the symptoms dramatically by introducing salt into your sinuses. The Pulmicort helps drain it out even more.?

I also bring Vitamin C packets and oregano oil and mix 3gs of C with a dropper of oregano oil, which is a potent antiviral and a shock to the system if you've never tasted oregano oil.?

Assume you can’t buy anything when you get there

Extra reading glasses, sunglasses, extra hats may be available, but assume not.? If it is going to be rainy consider waterproof Gore-Tex socks and also sock liners to keep those blisters at bay. ?

On that note, don’t forget earplugs, eye mask (sorry, Wirecutter, this is my current favorite) and bring two of everything.? Earplugs especially have a way of going missing and those monkeys howling might not be the way you want to wake up at 4 AM.

Bring a headlamp, a cashmere hat and sweater to help you keep warm at altitude (and on the plane sometimes), a small power cord extender with whatever adapter you need to plug it into and a couple of extra power backup chargers (carry these on – you may not be able to put them into checked bags).? Extra batteries if you don’t do rechargeables.?

And of course, bug spray, Afterbite, Benedryl spray and sunscreen sticks.

Donkeys can kill

So can yaks.??

Stay on the inside of the track when pack animals are coming along the trail.? We’ve had more than one near fatal accident from a pack animal/yak/donkey stepping casually over to try to knock the person over the cliff. If they can get you, they will.? One tried to squeeze me off a suspension bridge.

These aren’t your North American cows that you can slap, and they’ll move. These are hard core survival beasts not interested in sharing their space with you.? Better a bit muddy from being crushed into the bank than falling 1,000 feet.

I'm sure they are very nice but that glint in their eye before they casually push you over suggests they have another agenda.

?Oh, and if you encounter a pack of dogs, pretend you are picking up a rock to throw. They will usually scatter like flies.? If they don’t scatter, bring out those hiking poles, and consider finding a real rock if you haven’t brought bear spray!?

Duct tape.?? Never leave home without it

You can use it to splint a broken leg, tape a muffler back on, make a truck door stay closed, fix hiking boots, create a clothesline, or fix a hole in a tent. ??

Take an extra roll to leave behind. You will be a superstar.

And most of all, have fun, Teri!