Day 01 Arrive in Chengdu (D)
Arrive in Chengdu, capital of province Sichuan, the home town of Panda. Picked up by the local guide at airport and transferred to hotel. 1N in 4*Yinhe Dynasty Hotel
Day 02 Chengdu - Wolong – Danba (B/L/D)
In the morning leave for Danba. We'll cross the Wolong Giant Panda Natural Reserve, where about 50 giant pandas are bred in a semi-natural environment. After lunch at Wolong, cross the foggy Balang Mountain (4,523 meters) and pass by the Siguniang Shan Mountain (four-girls mountain, highest peak 6250 m), late in the afternoon we reach Danba (1900 meters). 1N in 2*Danba Hotel
Day 03 Danba – Bamei (B/L/D)
The local people are called Jiarong (Gyarong) Tibetans. It is said that they are the descendants of the people of the ancient Xixia Kingdom, who merged with the local people after they fled from Gansu and settled here. Danba has long been acclaimed as the Kingdom of Thousands of Ancient Blockhouses. Visit the ancient block towers in Suopo. They were made of clay and block and look fine from outside with solid thick walls. Time permitting; visit the Jiaju Tibetan Hamlet. Jiaju, 10 kilometers away from the county city, is one of the rare places in China that has preserved complete Tibetan style residences. More than one hundred buildings keep the same architectural style with a complete and unique character of Jiarong Tibetan residences. Under the blue sky, the Tibetan residences decorated in red, white and black are strewed at random but also in order from the bottom to the middle slope of the valley. In the afternoon drive to Bamei. Pass by Donggu Scenery Spot (the Natural Bonsai Valley), which is situated at the Donggu Village 21 kilometers to the southwest of Danba County. In the valley, the clear Yak River flows through and numerous varieties of plants are well preserved and the lush and damp forests make it hard to view the sky. Strangely shaped peaks and giant stones form a forest of rocks; ravines stretch out in length and width here and there; and waterfalls flying down from the steep rock with thunder-like sounds. Many lakes and hot-water pools at the bottom of the valley create a world of steam. Too many wizardly sceneries to see, just like the fairyland on the earth. We reach Bamei in the late afternoon. 1N in simple Zhuoma guesthouse
Day 04 Bamei - Kasa Lake – Garze (B/L/D)
Drive to Garze, the real cultural and religious center for the Tibetans living in Sichuan. In Tibetan "Garze" means "white and beauty", named after the famous temple in the county. On the way have a rest by the Kasa Lake. Upon arrival, visit Garze monastery of yellow sect (Gelug). The temple was built in1552 by Juji Angwengpencuo the disciple of the Fifth Dalai Lama. 1N in 2*Golden Yak Hotel
Day 05 Garze - Yilhun Lhatso – Dege (B/L/D)
In the morning pass by Manigango to visit Xinlu Hai Lake (Yilhun Lhatso). Located at the foot of Chola Mountain in Dege County, Xinlu Hai Lake Scenic Spot is 98 kilometers from Garze County and 100 kilometers from Dege County. It is 4040 meters above the sea level, with an average depth of 10 meters and a maximum depth of 15 meters. There are plateau spruces, firs, Chinese weeping cypresses, azalea trees and meadows around the lake. It is also a preserve for wild animals like white-lipped deer. We walk on the left side of the lake to its top, the gate of a short valley where the melted snow and ice pour into the beautiful lake Yilhun Lhatso. After that we drive up to the Chola Pass (5,000 meters), get across the steep Chola Mountain, the highest peak of which is 5,650 meters. In the afternoon we visit the Dege Printing House which has always been well reputed as the “Cultural Treasury at the Foot of the Snow Mountain.” As the national leading protected entity of cultural relics, it is the biggest printing house in Tibetan area. 1N in 2*Chola Hotel
Day 06 Dege – Chamdo (B/L/D)
Drive across the Jinsha River (upper reaches of Yangtze) Bridge connecting Sichuan and Tibet heading for Chamdo. We will cross over no less than four passes: Khargang La (4,352 m), Lashi La (4,450 m), Jape La (4,680 m), and Tama La (4,511 m), with clutters of prayer flags waving in the wind on the peaks and friendly nomads waving at us from the grasslands. Straddling the Mekong river, Chamdo (3200 m) was the former capital of Kham in East-Tibetan area and has a rich history as one of the earliest centers of the Tibetan plateau and home of Kalden Jampaling, the great monastery founded between 1436-44 and developed through the centuries by successive Living Buddhas. 1N in 3*Chamdo Hotel
Day 07 Chamdo – Riwoche Jeep 105 km (B/L/D)
In the morning visit Galden Jampaling monastery. In its earlier prime time there were more than 1000 monks in the monastery. In the afternoon drive over the Zholpel La pass (4688 m) to Riwoche (3810 m). Riwoche means in Tibetan „mountain”. 1N in simple Guesthouse
Day 08 Riwoche - Dengchen Jeep 185 km (B/L/D)
Drive on very bad road to Dengchen. Dengchen means in Tibetan „great terrace”. Dengchen is the center of the Boen-Religion, which is a primitive religion based on ancient witchcraft and the worship to god and ghost, and was spread through the whole Tibet before the Buddhism was introduced into Tibetan area. Here visit two monasteries: Tengchen and Ritro Lhakhang. 1N in simple Guesthouse
Day 09 Dengchen - Bachen – Sok Dzong Jeep 255 km (B/L/D)
After master Tsuri La Pass (4200 m) and Shel La Pass (4750 m) we arrive at Bachen, the “big Yak hair tents”. Continue to drive 30 km we reach Sok Dzong, Sok means in Tibetan “Mongolia”. At the junction of the Song Dynasty (960-1279) and Yuan Dynasty (1271-1368), 39 Hoer tribes of Mongolians migrated to the present day areas of Dengchen, Bachen and Sok Dzong; hence the name of "the Land of the 39 Tribes". Besides, the three counties are rich in Chinese caterpillar fungus. 1N in simple Guesthouse
Day10 Sok Dzong - Naqu Jeep 230 km (B/L/D)
Drive to the Sok Tsanden Zhol village, and visit the monastery of Nyimpa sect - Sok Tsanden Gompa. After that cross over two passes and reach the city of Shakchuka. Still just 100 km and two other passes have to be mastered before arrive at the today's destination Naqu. The northern route of Sichuan – Tibet Highway (Chengdu - Lhasa) and the Qinghai-Tibet Highway (Golmud – Lhasa) meet in Naqu. 1N in 2*Qiangtang Telecom Hotel
Day11 Naqu – Nam Tso Lake – Lhasa Jeep 480 km (B/L/D)
Drive on the vast Qiangtang Grassland for Nam Tso. Cross the 5,150 m Lhachen La Pass and reach the Namtso or Tengri Nor (“Heaven Lake” in Mongolian) along the newly paved way and set up camp at Tashi Dorie peninsula. Nam Tso, the biggest salty lake of Tibet, is 70 kilometers long from east to west and 30 kilometers wide from north to south, covering an area of 1,920 square kilometers with an altitude of 4,700 meters above sea level. It is said the holy lake and the holy mountain Nyenchentangla are a couple of lovers, who altogether guard the vast pasture and cattle. Take a walk on the peninsula and visit a small nun temple of Nyingma Sect. In the afternoon drive to Lhasa (3650 m), capital of Tibet Autonomous Region. The city is situated on the bank of the Kyichu River and has long been the "Holy Land" of Tibet. 3N in 3*Dhood Gu Hotel
Day12 Lhasa (B/L/D)
In the morning visit Potala, which was originally constructed in 637 by Songtsen Gampo, the first king of the united Tibet, and later expanded and served as the winter residence of the Dalai Lamas as well as the religious-political nexus of traditional Tibet. The crowds of pilgrims, innumerable magnificent murals, Buddhist statues, scriptures and rare treasures altogether creative a dense religious and art atmosphere that impresses every visitor. In the afternoon visit Jokhang monastery, the center of the Tibetan Buddhism and the sacred land of Buddhist followers where thousands of pilgrims come for worship everyday. The temple, built in 647, is the earliest wood-and-masonry structure still existing in Tibet. Walk on the Barkhor street surrounding Jokhang, a big free market with its prolific stalls for selling local specialties.
Day13 Lhasa (B/L/D)
In the morning visit Drepung monastery the sacred land of Gelug Sect., which was established in 1416 and the second, third and fourth Dalai Lama once resided in. In the afternoon visit Sera monastery, which was created in 1419 and has always been an important Buddhist seminary. As rose are planted everywhere in the monastery, it is also called “the court of wild rose”. Today still 200 lamas live in there.
Day14 Air Lhasa – Chengdu (B)
In the morning transfer to Gongga airport (100 km), fly to Chengdu (CA4402 1020/1210)- continue to kathmandu Airport
ACCESS (GETTING IN & OUT)
The Capital city Lhasa, is connected with Kathmandu by China Southwest Airlines. There are flights on Tuesdays from April 1st week to November last week, the flight of Saturdays are in operation from April First week to the last one of October and the flight of Thursdays is in operation from the first week of August to the last one of October. (However this flight operation schedule might be changed, please contact us for further information) Besides these, there are daily flight to Chengdu from Lhasa and twice a week flights to Beijing and through Chengdu Lhasa is connected with other major cities in China and Hong Kong.
The Friendship high way connects Lhasa with Kathmandu, the only overland route now in operation as the route from Golmud or Chengdu is very often prohibited for travelers.
VISA & PROCESS
All foreigners are required to have a valid China Visa with the permit for Tibet to enter Tibet. However, it is not as easy as it seems to travel and get the visa to Tibet. Entry point must have been mentioned at the visa and clients are not allowed to enter Tibet from other than the point mentioned in visa. So we recommend you to leave all these visa tension to your travel agent as there are lots of process to do to get the visa.
If you are traveling through Nepal Visa must be obtained in Kathmandu or if any travel operator is organizing the tour the local operator (We) can send the visa authorization to Chinese Embassy/ Consulate in their respective country through our counterpart in Lhasa. The authorization is the paper issued by the TIBET TOURISM BUREAU addressing the concerned Embassy to issue visa for the clients mentioned in the list. But min. no of PAX must be 5 on the list. PLEASE NOTE it is not possible to get the visa without joining the trip and the trip must have been organized by the travel agency.
Visa fee is changed every now and then by the authorities. Sometimes the fee is charged according to the Nationality of the clients and sometimes a flat rate is charged. However, expect to pay US$ 40-45 per person for the visa. Please contact us for further information, latest visa fee and regulation.
ENTRANCE & PERMITS
Entrance fees are charged in Each Monasteries in Tibet. Usually the fees is charged to your organizer and your organizer included this fee in their package cost. Normally travel agencies buy the entrance coupons from the monastery and distribute it to the clients return it back to the Monasteries while on sightseeing. The fee vary according to the monastery and the importance of the place (from US$ 4. (30 Yuan ) to US$ 8 (60 Yuan). Our prices include such fees.
There are entrance fees to Everest Areas and Kailash areas as well. Boating fee is charged while on a trip to Samye or road permit fee is charged for traveling outside Lhasa. You need to have Alien Travel Permit (ATP), Tibet permit and special permits to travel to Tibet except your visa. Tibet permit is issued by Tibet Tourism Bureau and Alien Travel Permit (ATP) or road permit is issued by Public Security Bureau (PSB). We arrange all these permits by ourselves leaving you free to travel. Except these army and culture permit is required to travel to Mt. Kailash area.
Chinese Yuan is used in Tibet. Big hotels accept major credit cards or you can exchange your money in any branch of Bank of China, located in Zhangmo, Shigatse, Lhasa and in Tsedang only. Currently the exchange rate is 01 US$ = 8 Yuan but the rate gates changed very often.
Chinese Standard Time (Beijing) is used in Tibet which is is 8 hours ahead (+) of GMT and 2 hours 15 minutes ahead of Nepal.
Warm clothing are always a must for the trip. For regular tours, light warm traveling clothing are required from June to October. Warm clothing are required for other months (including dusk mask) April, May and November. If you are going for trekking all trekking gears such as, down jacket, sleeping bags, shirts, comfortable walking shoes, long johns, trousers and skirts, sweaters, jackets, dust masks, shocks, sun hats, sun glasses, suntan lotion, utility knife, water bottles/ thermos, flashlights, water purifying tablets, first aid kit, toilet & tissue papers etc. are important through out the trip.
Traveling in Tibet involves high altitude & can be strenuous. Person having blood, lungs & heart problems should consult their doctor before taking any decision regarding trip though very few cases of altitude sickness have been reported. Simple headache, fever, loss of appetite or stomach disorder can happen before acclimatization. For your safety there will be oxygen bottles in or each vehicle.
The best time to visit Tibet is from June to October. Even though monsoon touches some part of Tibet in July and August it is next to nothing if compared to Nepal. If you wish to skip this period then September, October, and the first half of the November is perfect time to visit. This does not mean that in other season you can or visit Tibet. In fact You can visit Tibet from March Last week to November last week. The flight connection to & from Lhasa is started from April the first week to the last one of November and it is closed from December to March due to extreme low temperature which goes below -13 degree centigrade. So plan your journey from April to November last to have the perfect view and sightseeing.
In Lhasa various choices if hotels are available from 4 star Lhasa Hotel (Former Holiday Inn) to the local budget hotels But in other towns like Tsedang, Gyantse, Shigatse, Shegar, Zhangmo etc. there are 2-3 star hotel one at each towns charging US$ 45 to 65 per night for double room per night on room only basis. If you wish to skip these hotels there are no other choices but to stay in local BUDGET guest house, local lodges etc which you may not find as to your expectation. While traveling in Tibet please keep in mind that you are traveling in a very remote part of the world where you will have to cross more than 500mtr of passes on a dusty roads. So if possible it is suggested not to compromise on accommodation etc.
Different type of transportation in Tibet are provided for separate purpose. For instance for Government employee, local perople, domestic traveler (Chinese) and International travelers.
In normal condition foreign traveler must travel on the vehicles specified for them. Mustly for this purpose 90`s model of Landcruisers of Japan made and Jeeps of China Made are used and there are quite good Hino buses for group travel and Nissan/Toyata Coasters for smaller groups Places where the buses and coasters can not reach 4WD jeeps/Landcruisers are used.
While planning your trip you have to keep in mind that the infrastructure in Tibet is limited to some extent and during the month of July, August, September & October Tibet sees quite a big no of tourist and it seems difficult to handle all the people with the limited infrastructure. So if planning the trip for this period you may have to book the trip much more in advance to get the best you want. If the booking came late you may have to compromise with something you may not like to.
High mountain altitude sickness in Himalaya
Travelers are drawn to high altitude places in ever increasing number- Nepal alone now receives more than Five hundred thousand trekkers from around the world every year. It can be easy to under-estimate the dangers of altitude illness; deaths from these conditions are all the more tragic because they are entirely preventable.
Mountain climbers, serious trekkers, romantics sauntering through the foothills of the Himalayas, native porters, skiers in North America and Europe, pilgrims to high altitude shrines, diplomats posted to La Paz or Lhasa, miners in South America, and Everest marathon runners have something in common: they are all exposed to the effects of high altitude, and may be at risk from a potentially fatal but eminently preventable problem: Acute Mountain Sickness, commonly referred to just as AMS.
AMS consists of headache plus any one of the following symptoms in different degrees: nausea tiredness, sleeplessness or dizziness, occurring at altitudes of around 8000 ft or higher where pathophysiological changes due to lack of oxygen may manifest. Another term, "altitude illness', is also widely used - an umbrella term that includes the benign acute mountain sickness and its two life-threatening complications, water accumulation in the brain (high altitude cerebral edema, HACE) or high altitude pulmonary edema (HAPE, water accumulation in the lungs). The latter two complications may follow AMS, especially when people continue to ascend in the face of increasing symptoms. In keeping with the Jesuit tradition of painstaking documentation, Father Joseph de Acosta, a sixteenth century Spanish Jesuit priest, is credited with having first described the effects of high altitude in humans. In vernacular Nepali, mountain sickness is called "Lake Lagne": in Sanskrit it is aptly called "damgiri" ("dam" means breathlessness and "giri" Means Mountain).
Those most at danger from complications are people who do not "listen to their body", and heed the early warning signals of AMS; they can go on to suffer from HAPE and HACE and may even die-a process that has been carefully documented in important autopsy studies performed by Walter Bond and John Dickinson during the Seventies in the old Patan hospital in Kathmandu.
Chronic mountain sickness is an entirely different condition, recognized by Carlos Monger Medrano in high altitude long-term residents of South America during the Twenties. Such maladaptation is seldom found in the Sherpas or Tibetans, possibly due to thousands of years of exposure to high altitude living. (South Americans populations are relative newcomers to high altitude.) The present discussion will be confined to acute exposure to altitude in short-term sojourners.
Acute Mountain Sickness (Ams)
If a participant on an Everest trek suffers from a mild headache and nausea at Namche Bazaar (12,300ft), he might take an aspirin and wait for these symptoms to go away; however if the symptoms progress to vomiting and a splitting headache, he must assume that he is suffering from AMS and make plans to descend. It is amazing how many people in this situation ignore the dangers and continue to ascend with their friends, trying to blame their symptoms on poor fitness or flu. For some people, it's the high investment of time, effort and money, for others perhaps it's peer pressure or reluctance to accept defeat. A further is that many in the burgeoning adventure travel industry are clueless about mountain sickness.
AMS may set in within hours to days of arrival at high altitude: the onset of symptoms is usually gradual, which is why it is so vital to watch out for early warnings: does a person feel excessively tired; is she the last one to drag herself in to camp?
What causes AMS?
AMS is caused by a lack of oxygen. Although the proportion of oxygen in the atmosphere always remains the same (21%), as we go higher the "driving pressure" decreases. The driving pressure depends directly on the barometric pressure, and forces oxygen from the atmosphere into the capillaries of the lungs. Reduced driving pressure results in decreased saturation of oxygen in the blood and throughout the tissues.
Just what causes some people to suffer from AMS but not others is largely unknown, but there are clear-cut and important preventive factors that are now well- established (see below). The exact mechanism (pathophysiology) of AMS has similarities to that of HACE.
High Altitude Cerebral Edema (HACE)
Our trekker in the above example would probably go on to suffer form HACE if he continue to ascend despite the headache and vomiting; the symptoms of HACE are an extension of those to AMS.
From fatigue, there is progression to lethargy and then to coma. Or there may be confusion and disorientation, A useful test is to see if the person can walk a straight line. If he walks like a drunk or is unsteady, it has to be assumed that he has life-threatening HACE and needs to descend promptly with assistance. This situation is serious enough to justify immediate helicopter evacuation.
HACE is probably caused by shifts of fluid into the tissues of the brain. Reduced oxygen levels cause swelling within the confines of the bony skull. The resulting rise in pressure may lead to lethargy and eventually coma.
High Altitude Pulmonary Edema (HAPE)
This disease may follow AMS, but often it may appear independently. The typical scenario would be a trekker who has no headache or nausea, but finds he has a harder time walking uphill, that he is out of breath on slight exertion compared with the initial days of the trek. There may be a nagging cough and he too may have ascribed these symptoms to a cold. He may be suffering from sub-clinical or early HAPE, a well-recognized entity. With further ascent this may progress to shortness of breath even at rest - descend is now obligatory, or the outcome may be fatal.
Low oxygen causes the pulmonary artery to narrow and this results in exudation of blood near the smaller branches of the lungs (the alveoli). If the exudation continues, blood may escape into the alveoli leading to a cough with watery, blood-tinged phlegm. Such exudation, or "water logging" of the lung tissue interferes further with oxygenation. A popular, compact device called a pulse oximeter can measure the oxygen level in the blood simply and rapidly, using a sensor attached to the index finger. It can be very helpful in confirming if HAPE is present.
What is acclimatization?
Acclimatization is a state of physiological "truce" between the body of a visitor and the hostile low-oxygen environment of high altitude. This truce permits the trekker of ascend gradually. (This is distinct from "adaptation" - permanent change to the organism, perhaps over thousands of years, perhaps even at a genetic or evolutionary level, to facilitate survival at altitude. Scientists are trying to decipher if the Sherpas or Tibetans have made such an adaptation.)
For acclimatization to take place the single most important step is hyperventilation- the trekker unconsciously breathes faster and more deeply than normal, even at rest, to make up for the lack of oxygen. However, hyperventilation also leads to loss of carbon dioxide from the blood, making the blood more alkaline, and it turn depressing ventilation. However, 48 to 72 hours after exposure to high altitude, the kidney comes to the rescue and begins to excrete alkali from the blood to restore a more balanced environment in which hyperventilation can continue unabated.
Preventing altitude illness
There is little doubt that altitude illness is one hundred percent a preventable illness. No one should die from it. For the past quarter of a century, one of the most important objectives of the Himalayan Rescue Association in Nepal has been to preach the gospel of prevention, from its aid posts in Pheriche (at around 14000ft in the Everest region) and Manang (at around 12000ft in the Annapurna region). There are four golden rules, plus some important general principles that should always be followed:
1. Understand and recognize the symptoms of AMS. Recent growth in adventure travel has made trekking at high altitude simpler and more accessible, with the result that more and more people who go trekking are ignorant of the basic facts of altitude illness.
2. Never ascend with obvious symptoms. Incredibly, I have known people who have hired a horse or a yak to go up higher when they were too sick to walk. This is courting disaster.
3. Descend if symptoms increase. It is amazing how striking and dramatic the relief may be with even a couple of hundred feet of descent. People with signs of HAPE or HACE have to descend.
4. Group members need to look out for one another
(Perhaps like the buddy system in SCUBA diving). This rule gets broken with unfailing regularity every trekking season in the Himalayas, because people are just too anxious to complete their trek, even if one of their party members is ill. A trekker with AMS, HAPE or HACE will want nothing more than to be left alone, unbothered, at the same Altitude- potentially a fatal option. There is no alternative but to bring the person Down to a lower altitude accompanied by a friend who speaks the same language.
Following a conservative rate of ascent
Going too high, too quickly, is the single most important cause of susceptibility to AMS. Beyond about 9000ft, the sleeping altitude should be no higher than about 1500ft from the previous night's altitude. The sleeping altitude, not the altitude achieved during the daytime, is what is important. Altitude sickness often manifests at night because during sleep the oxygen level in the blood may dip further. Many mountain climbers will have been to 14000ft or high in the Alps or in North America but few will have slept at the altitude. In the Himalayas, you don't have to be an experienced climber, or use crampons, to be able to "hang out" at 15000ft or higher for days: easy accessibility to these altitudes makes exposure to AMS also mush easier.
While ascending, every second or third day should be rest day for acclimatization. "Climb high and sleep low" is the dictum, but it is important not to exert oneself excessively in trying to fulfil this.
The trekker should not be in a hurry in the mountains. The itinerary should be planned so that there are enough "leeway days" in case more time is needed to acclimatize. Trying to do a high-altitude two-week trek in one week is always fraught with problems.
Avoiding of excessive exertion in the initial days
Excessive physical exertion at high altitude makes one more susceptible to AMS. It is important to take it easy at high altitude, especially in the initial days. People who are very fit for example marathon runners or those who carry very heavy backpacks seem more vulnerable to AMS than others, probably because they push themselves harder. I once looked after a trekker who felt he could not break his morning jogging sessions despite a strenuous trek day ahead, even at 4000m! The feeling of" man against nature" may be stronger in this fitter group.
Jim, a rock star, decided to "whoop it up" with four bottles of beer, on arrival at 3500meters in the Everest region. He felt ill with severe AMS and needed to be helicopter out two days later. He had been warned not to drink alcohol on the trek, especially while ascending. Alcohol may dehydrate the trekker but more importantly it depresses breathing or ventilation. Sleeping pills may have a similar effect.
Maintaining adequate hydration
Adequate amounts of fluid (about 3 liters a day) are necessary in the mountains:- dehydration mimics altitude sickness and may even predispose to it. On the other hand excessive water drinking should also be avoided as this may lead to electrolyte imbalances.
Maintaining a high carbohydrate diet
A high carbohydrate diet aids ventilation and efficient use of oxygen. The good news is that - in many high altitude places - there is not much alternative: rice, potatoes and other strach-laden foodstuffs tend to be the staple, with not much else to choose from.
Drug prevention (prophylaxis)
Diamox (actazolamide) may be necessary for people going on rescue missions at high altitude or flying in to high altitude cities like La Paz or Lhasa. People with sulpha allergy should not take diamox, the primary drug for prevention, and further details are given below. A second drug, dexamethasone (see below) should also be carried, particularly if the destination is remote: this can be life saving if HACE supervenes.
Wherever, possible this has to be attempted. There is really no magic altitude to descend, but the sick patient may suddenly feel something lift and feel hungry. This is the altitude to which the body is adjusted. Patients with HAPE need to descend slowly and with assistance: excessive exertion even during descent may increase the blood flow to the lungs and exacerbate the problem.
Lack of oxygen at altitude is the chief reason why people suffer from altitude sickness, so breathing supplemental oxygen is obviously going to make a difference. But oxygen is a hard commodity to come by in the mountain - cylinders of oxygen are not easily portable. When oxygen available in AMS settings, it should be used.
Acetazolamide (diamox): This is the most tried and tested drug for altitude sickness prevention and treatment. Unlike dexamethasone this drug does not mask the symptoms but actually treats the problem. It seems to works by increasing the amount of alkali (bicarbonate) excreted in the urine, making the blood more acidic. Acidifying the blood drives the ventilation, which is the cornerstone of acclimatization.
For prevention, 125 mg twice daily starting the evening before and continuing for three days once the highest altitude is reached, is effective. A recent article in the British Medical Journal suggested taking a higher dosage -- 750mg daily. Our experience in the Indian subcontinent has consistently been that 250 mg per day has been rewarding, while excessive dosage may just increase the side effects.
Side effects of diamox are: an uncomfortable tingling of the fingers, toes and face (called "jhum jhum" in Nepali); carbonated drinks tasting flat; excessive urination; and rarely, blurring of vision. In most of the treks in Nepal, gradual ascent is possible and prophylaxis tends to be discouraged. Certainly if trekkers develop headache and nausea or the other symptoms of AMS, then treatment with diamox is fine. The treatment dosage is 250 mg twice a day for about three days.
Dexamethasone: This steroid drug can be life saving in people with HACE, and works by decreasing swelling and reducing the pressure in the bony skull. The dosage is 4 mg three times per day, and obvious improvement usually occurs within about six hours. Like the hyperbaric bag (See below), this drug "buys time" especially at night when it may be problematic to descend. Descent should be carried out the next day. It is unwise to ascend while taking dexamethasone: unlike diamox this drug only masks the symptoms.
Dexamethasone can be highly effective: many people who are lethargic or even in coma will improve significantly after tablets or an injection, and may even be able to descend with assistance. Many pilgrims at the annual festival at Gosainkunda lake in Nepal suffer from HACE following a rapid rate of ascent, and respond remarkably well to dexamethasone. Mountain climbers also sometimes carry this drug to prevent or treat AMS. It needs to be used cautiously, however, because it can cause stomach irritation, euphoria or depression.
It may be a good idea to pack this drug for a high altitude trek for emergency usage in the event of HACE In people allergic to sulpha drugs (and therefore unable to take diamox) dexamethasone can also be used for prevention: 4 mg twice a day for about three days may be sufficient.
Nifedipine: This drug is generally used to treat high blood pressure, but also seems able to decrease the narrowing in the pulmonary artery caused by low oxygen levels, thereby improving oxygen transfer. It can therefore be used to treat HAPE, though unfortunately its effectiveness is not anywhere as dramatic that of dexamethasone in HACE. The dosage is 20 mg of long acting nifedipine, six hourly.
It can cause sudden lowering of blood pressure so the patient has to be warned to get up slowly from a sitting or reclining position. It has also been used in the same dosage to prevent HAPE in people with a past history of this disease.
The hyperbaric bag
This is a simple, effective device, made of airtight nylon; it is about 7 feet long ad looks like a long duffel bag. With the patient inside, the bag is inflated with a foot pump until it becomes like a large sausage-shaped balloon. There is a one-way valve to avoid carbon dioxide build up inside, and it has transparent panels to assist communication with its occupant.
The pressure insde the bag is 2 p.s.i,. so the effect is about the same as bringing the patient down a couple of thousand feet. For both HACE and HAPE (but especially, in our experience, for HACE) the changes are usually dramatic within an hour. However there may be a "rebound" tow or three hours after therapy and the patient may need to get in the bag again. Just like the dexamethasone, this bag only helps to "buy tome". Descent is still mandatory as soon as possible.
Other problems at altitude:-
An abnormal breathing pattern whilst asleep is a common occurrence at high altitude: short spells of an increased breathing rate alternate with brief periods when breathing slows down seems to stop the medical term for this is "Cheyne Stokes" respiration. It is only a problem if it makes the suffers wake up repeatedly, breathless, anxious and unable to sleep. An effective remedy is Diamox 125 mg before dinner, which counteracts the low oxygen dips during sleep that trigger the problem. Sleeping pills should be avoided.
Upper respiratory tract infections and symptoms
Many people develop a persistent, bothersome cough and cold-like symptoms in the cold dry air of high altitude. An antihistamine at night like Benadryl 25 mg may help suppress the cough. Antibiotics are sometimes useful, but keeping the head and face covered and breathing through a silk or wool scarf to humidify the air may also help. many studies have shown that upper respiratory tract infections can predispose to AMS.
There may be swelling around the eyes, fingers, ankles at high altitude, but this may not indicate AMS per se unless accompanied by the symptoms of AMS. These symptoms without AMS usually require no treatment.
High altitude syncope (fainting): This is well known but harmless problem, in which fainting occurs suddenly, usually shortly after arrival. Simple measures like keeping the individual in a reclining position and raising the legs is helpful.
Travelers with pre-existing health problems; children, and birth control pills
High blood pressure: Blood pressure initially increases at high altitude due to the initial stress of low oxygen triggering neurohumoral changes. However people who suffer from high blood pressure can go up to high altitude as long as this is well controlled and they continue to take their medication.
Coronary heart disease: People with a history of heart attack (moycardial infarction) and even those with coronary artery bypass grafts or angioplasty but with no angina, can trek up to high altitude provided they are fit and able to walk rigorously at low altitude. The high altitude does not seem to add any extra burden to the heart.
Epilepsy: Although seizures may be provoked by altitude there is no convincing evidence that it is unsafe for well-controlled epileptics travelling to travel to high altitude, though such people should always take their anti seizure medications conscientiously.
Migraine: Sufferers may possibly have more attacks in the mountains and this may sometimes be difficult to distinguish from AMS. In doubt it is best to descend.
Lung disease: Also noteworthy is the limited observation that bronchial asthma does not seem to get exacerbated at high altitude due to the cold and exercise. However it is prudent for asthmatics to carry inhalers and other medications. Obviously people with chronic obstructive lung disease may be more short of breath and travel at high altitude would be inadvisable.
Neck surgery and radiotherapy: People with treated cancers like lymphoma or tumors in the neck who have had extensive surgery or radiation treatment may be especially prone to AMS because of damage to the carotid bodies - tiny organs within the carotid arteries that sense oxygen and aid ventilation.
Diabetes: Diabetics on insulin should have a reliable glucometer to check their blood glucose regularly, but high altitude does not seem to cause additional risks.
Corneal surgery: people who have had non laser surgery (radial keratotomy) to correct their short sightedness may run into problems at high altitude due to swelling of their cornea caused by the low oxygen. Such people should carry corrective lenses as well if travelling to high altitude.
Pregnancy: Pregnant women should not sleep higher than 12000ft as this may endanger the fetus; a further problem is that high altitude places are generally remote, making emergencies more difficult to deal with.
Children: Children do not suffer any more from the effect of altitude than adults. However, it is important that a child should be able to communicate any symptoms to responsible adult, so that prompt descent can be arranged. It may therefore be dangerous to take children to high altitude that is not yet old enough to do this.
Contraception: Oral contraceptive pills may predispose to abnormal blood clotting (thrombosis) at high altitude. the hypoxia (low oxygen), the excessive red blood cells (polycythemia) in the blood, and the possible dehydration in this environment may already be other predisposing factors for thrombosis. Hence it if best to use other forms of contraception at high altitude.
Other disease risks
Many high altitude destinations are in developing countries, so it is important to be up to date with vaccinations against disease like typhoid and hepatitis, to know about travelers' diarrhoea and its treatment, and to understand the other precautions described elsewhere in this book. Malaria is not a risk at altitude - transmission does not take place above 2000 meters.
Conditions that mimic altitude sickness
Improving medical facilities in countries such as Nepal have made it much easier to distinguish between altitude illness and conditions that can produce similar symptoms, such as bleeding in the brain (subarachnoid hemorrhage), strokes, dehydration and blood viscosity related problems like venous thrombosis.
Most of the problems of high altitude are totally preventable. With careful precautions, your experience in the mountains should be safe and rewarding.
FAQ for Tibet
What statue of person is called "foreign tourist"?
"Foreign tourist" here refers to the person who doesn't hold Chinese ID card. For Taiwan people who have "TaiboZheng" still need to get permit for traveling in Tibet. Hongkong and Macao people now are in freely need of permit.
Is independent tour allowed in Tibet?
Independent tour is prohibited in Tibet. You should take part in an organized group or have the local travel operator to arrange for you.
What is the best season for tour in Tibet?
Generally speaking, from April to October is the best season for Tibet tour. However, having a winter tour can be pleasant ifyou don't mind the cold weather. You can avoid the tourist crowds, and economical accommodations and transportation are more available.
What are some popular places in Tibet?
Lhasa, Tsedang, Gyantse, Shigatse, Tingri, Zhangmu etc. are the most popular places in Tibet, for both normal and trekking itineraries. For expedition, Mt. Everest and Mt. Kailish are the most exciting and accessible areas.
How to enter Tibet?
By air, there are several routes are available now: Beijing-Lhasa, Shanghai-Lhasa, Chengdu -Lhasa,Xi'an-Lhasa, Xining-Lhasa, Guangzhou-Lhasa, Chongqing-Lhasa, Kathmandu-Lhasa. By land, the possible routes are: Qinghai-Lhasa, Sichuan-Lhasa, Yunnan-Lhasa and Kathmandu-Lhasa. However,land transportation takes much longer time, and can be very tough, especially the Sichuan-Lhasa route.
Can I travel in Tibet by bus? I really can't afford the car.
Yes, but very limited, only Golmud (ofQinghai Province)-Lhasa. And this route is subject to change,not always available.
Other than Chinese currency, what else currency is acceptable in Tibet?
USS is acceptable only in a very limited range, e.g. tips. However, for convenience, Chinese currency is the best choice. Ifyou want to change USS to Chinese currency in Tibet, you can change in Lhasa Hotel or the Bank of China in Lhasa.
Can I draw cash from the local banks in Tibet?
Yes, but only the Bank of China in Lhasa has this function. However, the ATM there doesn't always work properly. So we suggestyou to bring some cash with you.
What should I keep in mind when I contact with the Tibetans?
Tibetan people are very kind and hospitable, you can feel free to talk with them. But there are some rulers you should go by:
- Do not photo them without permission, please show the respect to them!
- Do not talk about the sensitive topics like political or t religious matters!
- Do not eat dog, donkey or horse in Tibet!
What can I do with Tibetan beggars?
Religious beggars are an accepted part of society in Tibet. Giving money or food to a pilgrim is considered an act of merit. Donations of five fen to two jiao (Chinese currency) are appropriate. Please note: if the beggars are the old men and women who dress in shredded, bulky clothes, while the younger ones may have a monkey on a chain, it's a spectacle of great interest to the Tibetans.These beggars are professionals, having less meritorious intentions than religious pilgrims. Just wave them off as the locals do if you don't want give anything.
What medicines should I bring for the high elevation?
Try to bring the following medicines that will be very useful during your travel: cold and flu tablets, throat lozenges, nasal decongestant, Aspirin, Multivitamins. Or you can ask your local doctor for suggestions.
What should I bring for the plateau weather?
Tibet's high altitude and the atmosphere allow the sun's solar radiation to strike the earth with unusual intensity. It's very easy to get sun-burnt there. Sunscreen of high sun protection factor,quality sunglasses and a wide-brimmed hat are good means of protection. Calamine lotion is good for mild sun-burnt. Those with fair complexions should bring reflective sunscreen with them. Apply the sunscreen to your nose and lips as well.