Trekking is always a fun thing to choose, and it is fantastic when it comes to the Himalayas of Nepal. We need to be careful as sickness can be a problem sometimes. Here are some guidelines on staying healthy, consider the following advice, if you do get a sick consult with your assigned leader. The statement is written for our Nepal treks but applies almost equally for our India/Tibet and Bhutan treks.
Arrival:
If it comes to vacation, None of us like feeling tired or ill, traveling to a different time zone can be exciting, but due to the jetlag and everything makes us think the variation in how your body responds literally could be night and day. The most common symptoms of jet lag are sleepiness during the day and wakefulness during the night, headache, and stomach upset. There are things to prepare for time zone transitions; try to take it relaxed and calm and allow your body to fall into the current pattern.
Drinking water:
we are serious about hygiene on every trip. Clean drinking water, toilets are easily accessible in the developed countries, but we will not get such kind of privileged while trekking in the Himalayas. We will not be found luxuries While trekking in Nepal and Himalaya; however, there is a clean toilet in most of the Teahouse on the trek. Mineral water, boiled water, or water with Iodine is safe to drink while we are up in the Himalaya. Our team will take care of those essential, so there is nothing to worry about it.
Purifying Water:
There are lots of contaminated water we can found in the streams and rivers of Nepal, to achieve purely potable water, several technologies must combine in a sequence. We will not prefer you to drink water without high precautions up in the Himalaya. Only water made from clean snow is safe and has brought to heat, 5000m/16,404ft, is reliable to drink. Water only needs to purify at 75ºC/162ºF. At 5800m/19,000ft, water boils at around 81ºC/177ºF so all tea, coffee, and hot lemon, etc. is safe to drink. There are many different methods to purify water; in the lodges, boiled water usually is available, while camping, our crew members provide thermos of boiled water. Sometimes you may want to clean water yourself; the most convenient method is Iodine tablets. If you have a water filter, ask us if it is worthwhile to carry it.
Diarrhea:
Most of the developing countries’ common problem is diarrhea, especially India & Nepal. We might face this problem may be due to climate change or the food our body is not familiar with the chosen environment. Usually, when we get diarrhea, seeing a doctor is the first option, but while trekking, we will not find a doctor, so we need to follow the precaution. So, what recommended: is when we were not able to find the medical treatment, we will go with the available remedies for the procedure. First, we need to be clam because sometimes people cannot understand and choose to take pills at the first loose bowels. Instead, our team will support the individual to be hydrated and follow the guide’s remedies. Let us wait for a few days and see what happens. Unless it is particularly awful, there is no need to stop trekking; drinking lots of water and making our body hydrated is a good option. Only choose to eat when you are hungry and taking lots of light, and soupy food is the best part. Diarrhea is still becoming trouble for a few days, and You may seek some treatment. We advised being careful and informed of any history of stomach ulcers, gall bladder problems, previously perforated intestine, etc. where we will follow the recommended remedies by the expert.
Giardia:
Common in Nepal and Himalaya. It is usually from infected water, especially from Kathmandu and high mountain streams near where yaks graze. It generally takes 7-10 days to develop and does not come on suddenly. The classic symptoms are very sulfurous (rotten egg) smelling farts and burps. The other symptoms that make it easier to distinguish from different types of diarrhea are rumbling, churning, upset stomach, sometimes cramping and bloating, and no fever, chills, or nausea. In these last couple of years, giardia has also introduced different symptoms.
watery diarrhea:
Giardia can also be virtually symptomless, just occasional soft stools or constipation even and a vaguely upset stomach. Some forms your body will clear given a month or so, and several people have had it without realizing, however, if it is visible and a problem, two drugs are effective. Tiniba – this can be bought at all Nepalese pharmacies (without a prescription). The name of the active chemical is Tinidazole. The dose is 2 grams, i.e., 4 x 500 mg (milligrams)) all at once, then 24 hours later, the same dose, and 24 hours later, a third dose. It is perhaps better taken in the evening due to the usual side effects, a strong metallic taste in your mouth and nausea may cause slept off. This dose is about 90% effective – it may re-occur later. Do not mix with alcohol. Alternatively, take Flagyl/Metronidazole. The treatment is 250mg three times a day for 5 to 7 days. It is not allowed with alcohol. Note! DONT take Flagyl and Tiniba at the same time.
Amoebic Dysentery:
Occasionally, its onset is sudden and weakens a person severely, sometimes to the point of barely being able to lift oneself off the toilet. However, it usually comes on slowly, mild diarrhea that comes and goes, something that can almost, but not entirely, can be ignored. When it is most dangerous because the symptoms can eventually clear up, but your body is still infested and slowly damaged. If you suspect you have this, upon returning to Kathmandu, we will move forward with the bowel test. According to Dr. David Schlim of CIWEC clinic, Kathmandu, it causes perhaps 1% or less of all diarrhea cases in Nepal.
Travelers / Bacterial Diarrhea:
The onset often accompanied by fever, chills, and nausea; next is relatively sudden frequent watery diarrhea and often cramps. It can be by slightly different strains of bacteria that your body is adopted. This type of infection is usually the first to attack fresh from home arrivals to Nepal. There are two methods of treatment. Your body generally copes with foreign bacteria quite well, so it should clear up given plenty of time. However, the usual Nepalese version is more reliable than many, so particularly useful is to begin a short course of Norfloxacin, under the name Normaflox or Norbactin in Nepal. The dose is 400mg every 12 hours for three days. An often-recommended drug is Bactrim / Bactrim DS or Septra. There are now resistant strains, so they are not nearly as effective, and similarly, there is increasing resistance to Cipro, so another drug is becoming the standard treatment. See a doctor in Kathmandu.
Food Poisoning:
Food Poisoning comes on suddenly and severely, and common symptoms are vomiting and diarrhea. It happens about 4 to 8 hours after eating the contaminated food. Luckily, it usually lasts less than 24 hours, and recovery is quick, although you may feel weakened. There are no drugs that can help – the body just must eject all the contaminated food and rid itself of the poison. Rest and, once the first severe bout or two are over, drink plenty of fluids. Oral rehydration solutions are helpful.
Other Medical Problem
Dehydration:
While trekking lower down in the valleys, it is hot, and you sweat a lot, so it is essential 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 breathe out water vapor. It is crucial then to drink a lot. Dehydration makes you feel tired and lethargic and can give you a headache. The symptoms are like AMS, so the easiest way to avoid confusion is always to 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. We suggest the consist of soups and lots of tea, and much liquid food, you should include a lot of water too. Many people find that with dinner, they often drink more than a liter of water, catching up on what they should have drunk during the day. A great guideline is an 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 transparent, you have been looking after yourself well. Using this as a guideline, some trekkers find that, although they do not feel thirsty, their urine is yellow. Overall, it means trying to be hydrate even if you must think about it consciously.
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. It is the perpetually running nose and a usually mild productive cough caused by breathing excess quantities of dry cold air – so much that you partially injure your bronchi. A cold or infection is the usual 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 bring plenty.
Bronchitis:
Inflammation of the bronchi from an infection, i.e., identical to the Khumbu coughs but instead caused by a virus. Differentiating this from the Khumbu Cough is difficult, but you perhaps experienced a fever and some chills. The cough may be more productive. Since it can be a viral or bacterial infection, taking antibiotics will not always help and is not particularly recommended. Best is some rest and a return to a lower altitude, e.g., Namche, and see a doctor if it is particularly bad.
Pneumonia:
Pneumonia 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:
Snow Blindness is the 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 elevations, 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 useful.
Frostbite:
When flesh freezes solid, the results are severe, and often amputation is necessary. Frostbite takes time to develop unless pulp gets 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, do not begin rewarming until the refreezing cannot occur (even more damaging). Warm slowly and evenly. Blood temperature to 42ºC 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 must admire the skill in being able to put a sizeable hole in you entirely painlessly. In the damp forest, wave around waiting for you and are adept at penetrating socks and even boot eyelets. They can remove by applying a lighted match or cigarette to the end still sticking out.
Blisters:
Since you spend most of your time walking, blisters are worth avoiding. First, use boots that have worn in if possible. Test your shoes by carrying a pack up and down hills – along level ground, and there is far less stress on your feet. Usually, you can feel a blister developing – some rubbing, or a hot spot, or localized 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 cause 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, e.g., moleskin, and see how it feels. If it is painful and causing problems, then pierce it – clean the skin and sterilize it; holding the needle slightly above a candle or match flame for a second or two is adequate. Do not cut away the blistered skin until after a few days when dried out and no more used to protect the delicate skin underneath. Put protective tape over the top with some cotton wool to protect the blister. 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 to take preventative action first! Use moleskin, a durable waterproof zinc-oxide tape or similar, and tape up troublesome areas first—tape before you make 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. It was written for our Nepal treks but applied 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 is not a barrier. The earlier you are, the more crucial prior fitness preparation is.
Younger children: Caution should be applied when taking children trekking. Younger people can be slower to adapt to altitude, and young children have difficulty in communicating exactly how they feel. No studies have undertaken, so doctors recommend the safe maximum for pre-teenage children is 3000m/9843ft. However, several young children have made it to the top of Kala Pattar – 5560m. Trekking with children can be 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. It is likely because of competitiveness, and a will not give in, and some school groups treat the trek as an outward-bound exercise, with everyone carrying their backpack. School groups should allow an extra day or two over the most conservative itineraries and be particularly watchful.
Asthma:
Asthma cannot be a reason to say no to the trekking. Except in polluted Kathmandu, there are fewer air irritants, so most asthmatics 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 a reasonable risk of a severe 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 always keep it with you and warn you, friends, on the procedures in case there is an emergency. Your increased energy expenditure will change carbohydrate and insulin levels, so it is imperative 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 conduct, but the level of activity 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 it is not a reason to stop you trekking. Your companions must brief on all the relevant procedures.
Pregnancy:
Complications are common, especially in the first pregnancy. Sometimes sophisticated care is needed, so it is probably not a good idea to go trekking while pregnant. The effects of reduced oxygen at high altitudes on the fetus have not yet studied.
History of chest infections: If you are prone to these, bring the medicine you usually prescribed (usually Augmentin or Roxi-something), and at least two full courses. 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.
Immunizations:
The most accurate immunization advice for visiting Nepal can found on the Web – CIWEC Clinics 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 specializing in travel medicine. They will have access to more up-to-date information than a standard general practitioner.
Hepatitis A:
Usually passed on in contaminated water; immunization 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 of protection.
Hepatitis B:
This disease is avoidable since, like AIDS, 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 obtain.
Cholera:
The World Health Organization no longer recommends this vaccination. It is only partially effective and often causes a reaction. The risk of travelers acquiring cholera in Nepal is shallow.
Typhoid:
is prevalent in Nepal. There are now a variety of vaccines, and one should obtain.
Tetanus-Diptheria: This vaccine recommended if you have not had a booster in the last ten years. Many doctors advise a tetanus booster every time you intend to travel for any length of time.
Polio:
If you escaped immunization as a child, a series of vaccinations 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 might need treatment.
Japanese Encephalitis B:
Mosquitoes transmit this disease, 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 DONT need this vaccination.
Rabies:
This deadly virus we got by the bite of an infected animal like monkey or dog. The risk of being bitten is minimal, but it has happened. A vaccination is available, but even if you have had it, you will then need a follow-up course of two further injections. If you have not been vaccinated and are unlucky enough to be bitten, a series of vaccinations is available only from the CIWEC clinic in Kathmandu. It should start within a week or so of being bitten.
Malaria:
Carried only by the lowland Anopheles mosquito, disease exists in the Terai in Nepal (i.e., below 1000m/3281ft), and across much of the rest of rural Asia. There is no risk in Kathmandu or while trekking, and Pokhara’s uncertainty appears to be only theoretical. 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 the minimum. Whether you are or are not taking antimalarials, the first line of protection is to avoid biting. 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 antimalarial medication who should not be. The side effects of some of the more potent drugs can be quite nasty, so especially if you are going climbing or trekking, you should not be taking them. Ask your doctor about this.
If you are behind on any of the immunizations listed above, they can safely obtain at clinics in Kathmandu.
Medical insurance:
A combined travel/medical insurance policy is a sensible choice for any traveler and a requirement for most tours, please take this insurance in your home country.
