Crag & Route Beta

Author	Advice for preparation to Everest B.C...
MattyB 10-Jan-2010 6:54:54 AM	Hi all Chockers! I'm 3 weeks away from a trip to Everest B.C. on the North side, via Tibet. Quite excited about the whole thing, should be a wicked trip! Train from Chengdu to Lhasa, and then 4WD to the B.C. I'm posting this mainly to find out about preparation for altitude related issues. Having never been up to 5000+metres elevation before, I'm hoping that I won't get struck by AMS on a more serious level, and thus spoiling or cutting short my dream trip. Interested in hearing opinions from people who have spent time at this altitude, and what do you think about nipping any issues in the bud by using Diamox? Or anything else that is de rigeur for minimising any high-altitude problems?? (I'm aware of the Viagra option, but I don't plan on shagging any yaks while I'm there... I'll probably get quite a rise from the north face of Everest anyway... : ) It's deep winter, so I'm taking full cold weather kit, picked myself up a nice MH Sub Zero downy for a bargain couple hundred AU bucks here in China, so that's coming along for the ride! Taking a sleeping bag for extra insurance too... Also, food/water issues in Tibet (taking my Steripen anyway), recommended painkillers (Ibuprofen??), or any other information I can glean from those in the know would be most appreciated! Cheers guys!
BoulderBaby 10-Jan-2010 7:42:15 AM	I work with a few mountaineers, and they've told me that they take it with them, and the times they've had to use it, it's been fine... sorry I can't be more help.
porkpie 10-Jan-2010 8:51:02 AM	If I where you I would carry Diamox (250 mg), Dexamethosone (2mg tablet or injection) for Cerebal Oedema, and Nifidipine (8mg from memory) (or Pulmonary Oedema. I am not a Dr but this is the advice I got from some UK mountaineering website and it seems consistant with other recommendations. If you need to use them these are the rough guidelines. Once you are better and at a lower altitude get of the drugs ASAP as these are high doses. DIAMOX • 125 mg twice a day DEXAMETHASONE • 8mg initially then, • 4mg every 6 hours NIFIDIPINE (ADALAT) • 20mg initially then, • 20mg every 6 hours I was able to buy these drugs (and many others) over the counter in Nepal and Pakistan (not sure on China). I would recommend carrying these 3 and maybe some broard range anti-biotics. I won't comment on taking Diamox as a preventative or waiting until you feel the effects - it would promote more debate than weather or not Arapiles should be retrobolted.
diddy 10-Jan-2010 9:49:04 AM	Some general advice (and no offence porkpie). Advice from fellow climbers can help you get an idea of other people's experience at altitude, and their experience of certain medications (whether they used it, whether they thought it necessary, etc). But please consult your doctor about the appropriate dosage before you head up there, and whether any particular medication is or is not appropriate for you. The internet is great for some things -- but you should trust a doctor for the final say on any medical advice.
porkpie 10-Jan-2010 10:14:58 AM	You are right Rudi - seek professional medical advice. Unfortunately here in Aus no doctor I spoke to would give you anything unless you are currently suffering an illness. It was very annoying telling my GP my plans and getting no good advice and I had bucklies of getting a script for any meds (remember these drugs are for heart conditions, swelling of the brain, etc - they are not specifically for altitude - try explaining that to a quack). Plus drugs cost bugger all overseas compared to here. Seek medical advice but if your Dr is unwilling to help (as in my experiences) I believe you have a responsibility to investigate further and procure the knowledge and medications that good save you if things get ugly. On a trip to Pakistan I saw a guy get very sick - stuck for a night at 6700m I was glad he had taken the intative and stocked up on drugs in Islamabad - of course he took them without the presence of a Dr - not ideal but better than the alternative...
hipster 10-Jan-2010 10:30:41 AM	MattyB, In my experience you can start to feel the effects of altitude around 3000m, especially if you normally live at sea level. Shortness of breath, lethargy, not that hungry..that kind of stuff. When going up above 3000m rough estimates are to sleep at 300m gains per sleep/day, allowing the oxygen demands of your body to adjust. Thus walking into a BC is always a good way to acclimatise. Sounds like you are going the express option and flying/driving, so will need to be super-cautious at first. The Dex and Nifidipine are taken once you develop symptoms, as opposed to Diamox, which when taken as a precautionary measure helps the body adjust to altitude..it does not mask any effects from altitude sickness. Taking Diamox definitely helped the members of an expedition to the Karakorum I went on last year. We begun taking it at 3000m, even though some of us weren't feeling any effects, and continued to take it until 4 days in at our highest altitude. Some strange side effects..I won't ruin all the fun..but you'll be feeling some strange pins and needles when you least expect it. Personally I found it helped, I never woke up at night gasping for air, which is quite a common as you body adjusts, and quite disconcerting at the time. Other members who hadn't taken Diamox before also found it really helped. We saw a Swiss lad with HAPE at 4000m, he descended to 3200m to recover, so don't think these illnesses only happen around 8000m. I'd be taking a broad spectrum antibiotic with you as well as pain relief. Ibuprofen, panadol and panadeine forte, just in case you get a toothache or abscess. Having these kept our cook in base camp, he'd developed an abscess in a molar. When you arrive in Tibet you can supplement your medical supplies with some of the cheaper ones available and offload them to porters/cooks/drivers/locals who always appreciate them. Ado
davidc 10-Jan-2010 10:53:49 AM	You can buy most meds in Lhasa the problem will be trying to communicate to get the right medication( I remember struggling for 20 mins trying to get nifidipine in Lhasa and then the guy behind the counter then telling me the slow release was better even though he never asked me what it was for). So it would be better to get them prior to leaving. Most doctors won't know a lot about higher altitude but I know some do, it can be a little hit and miss, but fairly easy for them to find out more. Remember the best treatment for AMS etc is to go down.
MattyB 10-Jan-2010 4:37:58 PM	Thanks for the advice, great information! I forgot to mention, I am going to see the expat doctor here in Chengdu (he's a Taswegian, poor guy... : ) before I hit the pharmacy counter. Hopefully I can get what I need down here in the lowlands... But comforting to know it's available in Lhasa! hipster, I am catching the train up to Lhasa, it's a 48 hour trip. It's supposedly 'pressurised', but from what I can glean off the Internet, with the connecting doors between carriages, it is not *really* that pressurised...! Not quite ideal, but better than flying.... And the drive between Lhasa and Everest is taking 5-6 days, so we're not banging up to 5000 super quickly. And Arapiles should be retrobolted Frankenstein-style, and I'd also love to climb Uluru on 26th January and take a dump on the top. GO nuclear power! Oops. Wrong threads... : p No controversy here... Thanks again for the advice...! : )
muddy 10-Jan-2010 10:25:58 PM	I made the drive to BC from Lhasa about 10 years ago. Those days you could only fly into Lhasa (from Chengers) so we spent a week there (~3000m) acclimatizing. By the time you get to BC you will have crossed a couple of 5000m passes but (presumably) you will be sleeping lower, so yeah, the drive does acclimatize you a little . We didnt take anything special for the altitude, but give the chinese brandy a miss - a hangover at 5000m sucks. We stayed at the monastery at rongbuk, even brushing your teeth at that height makes you breathless if you havent walked in. Take a supply of cough serum\lozenges...the thin air is really dry, and if you are going in winter it will be seriously cold. I was there in September and was wearing a full length hand made thick woolly tibetan coat ontop of all the normal piles and thermals. But hey, the view of everest along the rongbuk on a clear day is simply superb.
Romfrantic 11-Jan-2010 9:55:28 AM	what about blood thinners like low-dose aspirin (e.g. Cartia etc)....anybody got any advice or experience with that?
MattyB 11-Jan-2010 10:29:13 PM	Yeah, that baijiu Chinese liquor is one small step removed from paint thinner, quite seriously... I'll be staying well away from that!! : O Blood thinners, however, interesting question... I know already that you're not supposed to take aspirin with Diamox... I have everything sorted clothing-wise, except a pant dilemma. I'm wearing Icebreaker 200 long john thermals, thin Berghaus nylon pants (uninsulated), and I wanted to get a third layer for the top. I left my outer layer back in Aus (stupidly, my lovely MH Compressor pants... : ) I also carry a backup, cheap lightweight pair of nylon rainpants for a foul-weather shell. My only two options I found in the limited market I looked at today, is- a *Gortex* (I use the term loosely) Shelled, two-layered lightly insulated (fleece lining), heavy duty (reinforced heels, knees, butt) pant, with inner gaiters, boot zips etc.... Or- a pure insulating layer, a thicker down pant with no bells or whistles. Just insulation. Both the same price. What do you reckon for -20C-ish?? I'm attracted to the heavy duty pants for their robustness for future cold weather climbing/trekking use, but will they be warm enough over what I'm already wearing? Or is a simple insulating layer a better idea (like my MH Compressors sitting back home, getting jealous)?? : /
ban3 13-Jan-2010 7:38:36 PM	Dude i wish u best of luck i was planning on doing that Trip next year. Are you taking lots of pics? love to see what im in for.....good luck again
One Day Hero 15-Jan-2010 2:12:22 AM	Why are you posting stuff about a train and 4wd tour on a climbing forum? Know why it's called a "base camp"? Cause that's where you go to start the trip! Everything leading up to the base camp, i.e. your whole trip, is the annoying stuff which has to be done in order to get to the actual trip............if someone went on a climbing trip and only managed to do the bit which you're doing, they would consider it an utter failure! Good luck solving the pants dilema, I'm glad its not me making that call. However, I find that the pussmaster 3000, ultralined spooftex pants are top notch for sitting around on flat terrain, while ordering cups of tea from the sherpas. Anyway, have a nice time, don't forget to take lots of drugs :)
MattyB 15-Jan-2010 6:31:53 AM	Mate, that is exactly the sort of comment that I was expecting from some of the narrow-minded people that seem to criticise any post on the forum that doesn't meet their misguided and naive ideas of what is 'valid' to post in the 'General' section on a climbing forum. Do you have any idea of the amount of people in the climbing community with excellent and positive contributions to make, that I know who totally avoid Chockstone because of people who behave like you??? Sheesh. Get out of the sandbox, pack up your toys, and grow the f*%k up. I have lurked on this forum for a while now, and every time I go to post something, I hesitate. Because I know some imbecile has to pull out his little kiddy magnifying glass, and flame up everything that's said - outside of some vague and subjective parameters set, by who....? By you??? I didn't say I was going for a trip to Paris, and what cosmetic shops I should visit when I am there.... I didn't ask for advice about a trip to the frikking Maldives and what colour budgie smugglers should I take as I sit on the beach, and work on my tan. I didn't spam the forum trying to sell my Goretex ShamWOW!... I was (humbly) asking my climbing peers for some advice about altitude and extreme cold weather preparation, something I have not personally ever experienced before. But if my peers all behaved like you, well I'd rather not bother climbing at all. A death by HAPE would be infinitely more preferable then drowning in your 3 paragraphs of useless, vitriolic crap. FYI, I have already had a personal email from someone in the medical profession who took his valuable time to provide me with the accurate information I was after to hopefully have a safe and enjoyable trip to the highest region on the planet. If your head is even higher up than my plans, up in the bloody clouds, that's your problem - but don't anonymously hide behind a keyboard and inflict it on the rest of the people that are sensible, mature, and don't have some bitter axe to grind in the public domain. I've dreamt since I was a little bloke to see Everest, to understand the feeling of sitting at base camp, and knowing you have yet another monumental challenge ahead of you. Regardless of it's validity (by your words) as a 'Climbing Trip'... The whole reason I started climbing in the first place was after reading Lincoln Hall's inspirational 'White Limbo' about Aussies on Everest North Face in 1984. The journey through China, being in Tibet, the photos of the Potala Palace, the Base Camp maladies... It stirred my lifelong interest also in Tibetan Buddhism. I've gratefully shaken the hands of Lincoln, and Tim Macartney Snape, both heroes of mine since I was 14. Why gratefully?? Because they contributed positively to the myriad paths my life has taken. And I thanked them personally for being totally inspirational to me - a virtual stranger, in ways they could never imagine.... I didn't criticise their personal choices, I didn't lambaste their technical abilities or potential logistic failings. I politely thanked them for their innocent and unknowing contributions to my life. You know what makes me climb? It's not the rock, it's not the ego, it's the community and the people that I get to meet when I do it. Art does not exist in a vacuum, and neither does the feeling of conquering a millenium-old piece of cold and emotionless rock. It is a feeling to be shared amongst your peers and your friends. Behaviour like yours is antithetical to the climber's ethos, I don't care what grade you have climbed or if you've free soloed Mons Olympus with a broken arm, and in your undies. Personally, I don't actually want to climb the world's highest piece of rock and ice, I'm not interested in alpine slogging and becoming a statistic just to achieve another statistic. I'm much happier tooling around Mt Piddo on some nice, challenging 18. But I've spent a whole life following my dreams, following my own Mount Everest, through thick and thin. I get paid to play guitar for a living, I get to travel the world as a result, and I climb and live life the way I want to when I I'm not doing that.
MattyB 15-Jan-2010 6:32:12 AM	I honestly hope you can say the same for yourself, that you follow your dreams to the letter, like I have done my whole life. Otherwise, stop behaving like a puerile idiot, go and take some ritalin yourself, and think for a second - like an adult does, before you press the 'reply' button on this forum. My old man used to say the classic cliche "If you don't have anything positive to say, then shut the f*%k up." Did yours?? Why waste your time saying negative things, are you trying to impress your wittle fwends by being the biggest bully in the schoolyard? Or do you not have anything of worth to actually offer?? I consider my upcoming Tibet trip to be a dream actually realised, and not a failure, in ANY sense of the word. Failure is when you set a personal goal, and do not achieve it because of factors that are within your control. If I come down with AMS, so be it - at least I was exploring my personal limits. By posting on Chocky, asking for information on how best to prepare myself, from people with far more knowledge and experience at altitude than me, I am trying to minimise my chances of a failure caused by my own ignorance. There's a famous Frank Zappa quote about hydrogen that applies directly to you. If you don't know what it is, don't worry - you never will. Good luck, and a big thank you to all of the Chockstone people that have thus far helped my inquiries, this is most probably the last time I bother to post anything in this forum. Shame, really.... I think I have a lot of positive contributions to offer, if I couldn't be bothered wasting my time fending off useless faff from strangers, like I have just done. Oh - that is - unless you can come up with some literate, relevant response to mine, One Day Hero? A response that doesn't involve a banal criticism about me offering my 'life's story and nobody cares blahdy blah blah'. I highly doubt it though.... Have a nice time, and try drugs sometime, they might make you a nicer person... :)
porkpie 15-Jan-2010 8:33:05 AM	Well said mate. I hope you continue to post in the future - maybe if we all post on subjects that aren't 'exciting' for ODH he will get bored of Chockie and go and harrass others (I recommend religious forums or maybe AM radio talkback shows). Enjoy your trip and I hope you don't get sick.
widewetandslippery 15-Jan-2010 8:41:30 AM	mattyb maybe you should take a leaf out of your favourite monkey in an orange dress book and show some tolerance. Remember its ok to have the piss taken out of you as its going to come out anyway. I've been thinking of going to the Capertee Campground. What drugs should I take?
dhunchak 15-Jan-2010 3:02:47 PM	Hope this helps... Diamox (aka acetazolamide) is a diuretic that works by inhibiting cabonic anhydrase. In short, it prevents your kidneys from reabsorbing bicarbonate which makes your blood more acidic. This assists your breathing centre to keep you breathing while you are asleep by compensating for respiratory alkalosis, and helps prevent cheyne-stokes respirations - thought to be the cause of pulmonary and cerebral oedema. If this is true and I believe it is, you would want to take it as prophylaxis to prevent AMS. It is also used as a treatment for AMS says the internet, but I don't know anything about that; seems like you can use it pre and post. I would also like to recommend that the only reliable treatment for AMS is to descend in elevation and acclimatize. Fit young males are MOST susceptible to AMS, so don't let ego get in the way, take lots of time and don't spend your trip puking and not eating like I did. An Aussie recently died of cerebral oedema 2wks after descending, so don't push it too hard, you may not be able to recover. Now that all that negative nancy bullshit is out of the way, have a great trip! The Himalayas are arguably the most beautiful mountain range in the world (my opinion). Very jealous...
JohnK 15-Jan-2010 3:42:58 PM	My 2 cents worth - second everything everyone has said about Diamox. The advice we were given on my trip was to start taking it 1-2 days before your trip actaully starts at altitude - so start taking it when your train ride starts - I dont think you can OD on Diamox. The only person that bailed at our trip was the person that did not take Diamox. The cold, dry air as well is a serious issue - take a scraf, bandena etc and keep it wrapped around your mouth to encourage moist warm air going down your throat. Up in those areas it's very dusty so minimise the dust your breath with the same set up. As others have said prepare for the worse and take a good cough medicine and good throat lollies. Suggest you also take some good heavy duty anti-biotics in your kit. You will have an amazing time and post some photos when you get back! John K..
vwills 15-Jan-2010 4:42:56 PM	I have never taken Diamox when going to altitude, but thats because if I can control my acclimatisation schedule I know what works for me. I would consider Diamox if I had to fly/ ascend to above 3500m from sea level, and did not have the opportunity of spending a few nights between 3000-3400m. Above this I would not sleep more than 600m higher every 2nd day. You can go as high as you like during the day as long as you descend to sleep. Could Diamox cause harm? Unlikely if you are not allergic to it. Its very important to stay well hydrated whether you are taking it or not. The important thing with alltitude is that it is normal to feel pretty bad at times and not take it as a sign of personal weakness, give your body time to undergo its adaption process. Aspirin works well for AMS headaches with the potential useful side effect of being an anti platelet agent (and thus reducing your risk of thrombosis). Trials have demonstrated efficacy for headache prevention but I tend not to take it prophylactically as a headache is a good sign that you should not sleep any higher. The number needed to treat to prevent stroke/ DVT etc is too large to be feasibly tested- ie the benefit is quite small. Acute mountain sickness in itself isnt dangerous and usually improves providing you dont ascend. So dont panic if you get a headache. HAPE and HACE are serious and the most important management is DESCENT. Nifedipine, dexamethasone, frusemide, gammow bags and oxygen are adjuncts that should be available on large mountaineering expeditions but not included in a personal first aid kit to Everest BC. There is an excellent review article on altitude medicine in the British Medical Journal about 2003 that is woth checking out if you want to read more. . Most doctors who are interested in travel medicine and or Wilderness medicine in Australia should be able to give you quite appropriate advice about altitude and be prepared to prescribe Diamox and I would have thought proper preparation for China should entail a visit to at least talk about vaccinations. Sounds like its too late for that! Have fun.

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