Mountain Biking in Nepal

Health

Health and Vaccinations before your Trip

Ultimately it is your responsibility to ensure that you are fit enough to join an adventure holiday. In line with this, please complete the relevant section of our booking form fully and honestly. You should also have a thorough medical and dental check-up before the holiday. You may need specific vaccinations when visiting some remote areas and this is explained in the information that we send to you when you book. For recommended and compulsory health requirements, please talk to your doctor or visit a specialized travel medical clinic.

Personal First Aid Kit

Although every trip carries a medical kit, it is advisable to bring a supply of first aid items for your own personal use. Base this on the following list, plus any special medications you may require. Please note that this list is appropriate for a long trip in a remote location and at high altitude. For a week's short hike, antibiotics and multivitamins are not necessary.

• Insect repellent.
• Iodine tablets
• Antiseptic cream.
• Sunbloc SPF 30+.
• Throat lozenges or hard sweets.
• Decongestant
• Painkillers. Aspirin, Paracetamol etc.
• Anti-diarrhea (Diocalm or Immodium).
• Plasters (band-aids) and 'Second Skin' for blisters.
• Antibiotics. A broad-spectrum antibiotic (such as Ciproxin) suitable for a variety of infections. Please consult with your doctor.
• Re-hydration salts. (Gastrolyte).
• Dextrose glucose tablets.
• Multi-vitamin tablets.

Acute Mountain Sickness (AMS)

What is it?

Altitude sickness is the reaction of the body adjusting to decreasing amounts of oxygen. Normally, the higher the altitude, the less oxygen is available for the body to carry on normal functions.

Altitude sickness most commonly occurs from above 2800m/9,200ft but this is different for everyone - there is simply no way of knowing your own susceptibility prior to being at altitude thus it is vital you monitor your own health. Symptoms may be mild and subside/go away after a day's rest, or if it is ignored it could lead to death.

What are the symptoms of AMS?

Symptoms can appear within 1-2 hours although most often appear 6-10 hours after ascent and generally subside in 1-2 days as the body adjusts to altitude. They may reappear as you continue to go higher. Symptoms of AMS usually occur gradually and can be one or a combination of the following:

• Headache
• Difficulty sleeping
• Shortness of breath
• Loss of appetite
• Disturbed sleep or drowsiness
• Irritability
• Fatigue
• Nausea/vomiting
• Dizziness
• Rapid pulse
• Swelling of hands, feet & face

Symptoms generally associated with more severe acute mountain sickness include:

• Bluish discoloration of the skin (cyanosis)
• Chest tightness or congestion
• Confusion
• Cough
• Coughing up blood
• Decreased consciousness or withdrawal from social interaction
• Grey or pale complexion
• Inability to walk in a straight line, or to walk at all
• Shortness of breath at rest

At high altitude all people will experience some of the above symptoms in a mild form. If the body is unable to adjust to altitude these symptoms will persist and, if they are left untreated, altitude sickness may progress to High Altitude Cerebral Edema (HACE) or High Altitude Pulmonary Edema (HAPE). Edema means simply fluid accumulation in your interstitial body tissues. Both HACE and HAPE can be fatal if ignored.

What are the symptoms of HAPE (fluid in the lungs)?

• Breathlessness
• A dry cough, developing to a wet one with blood-tinged discharge or saliva
• Tightness in the chest & blueness/darkness of face, lips & tongue
• Low fever up to 38°C/100°F
• Severe fatigue, progressing to coma

What are the symptoms of HACE (fluid in the brain)?

• Severe headache symptoms not relieved by painkillers or lying down
• Confusion, disorientation & drowsiness
• Nausea/vomiting
• Loss of balance or coordination
• Blurred or double vision/retinal hemorrhage

How to prevent it?

Certain medical conditions (such as respiratory disease) or medications (such as sleeping pills) can increase the risk of altitude sickness - it is important that you inform your guide of any medical conditions or medications before ascending to altitude. You can help your body to acclimatise and avoid altitude sickness by:

• Avoiding alcohol, tobacco and substances that can interfere with good delivery of oxygen to the body or cause dehydration
• Eating small, frequent meals high in carbohydrates
• Drinking plenty of water – the test of sufficient amount of water intake is ability to urinate colorless urine
• Taking it easy or have a rest. Walk at a slower pace than you would at sea level and avoid over-exertion
• Climb the mountain gradually and stop for a day or two of rest for every 600m/2000ft above 2,400m/8000ft
• Sleep at a lower altitude when possible
• Learn how to recognize early symptoms of mountain sickness

What is the treatment?

Most travelers are able to successfully acclimatise by following the previously mentioned guidelines. However, there are instances where medical treatment is required. Ultimately, the best treatment for acute mountain sickness (AMS) is to descend to a lower altitude and rest. Early diagnosis is important. Acute mountain sickness is easier to treat in the early stages.

The guide we book for your party has training and experience in AMS symptoms recognition, prevention and treatment. The guide will monitor your all the time for symptoms and will pace you appropriately to minimize your exposure to AMS.

We ask you to cooperate with the guide by reporting any above described symptoms and allow your guide to undertake appropriate and timely action such as take a rest and have a drink or snack, help you to carry your day pack or change a pace, take extra day rest or descent if necessary.

Your Guide will carry some medications in First Aid Kit and may suggest medication such as Ibuprophen, Paracetamol, combination of them or specific AMS medication. Standard and effective medication for prevention of AMS is Acetazolamide (Diamox) and it may be given to help improve breathing and reduce mild symptoms. This drug can cause increased urination. Ensure you drink plenty of fluids and avoid alcohol when taking this drug.

With severe cases of AMS our guide will contact our office in Kathmandu and arrange your evacuation by helicopter. Before we accept you on the trek we will require that you purchase health and travel insurance including helicopter rescue and hospitalization.