Death By Ladoog I

It would be incorrect to say that the incidences of death by Ladoog is a modern phenomena. I can say it with certainty that it would have happened in the past but remained unreported or, the cause is bound to have been misinterpreted or misunderstood, which is still the case.

Ladoog in Bhutanese literally translates to “mountain poison”, or sickness of the mountains. Most Bhutanese believe or are told that it is caused by the release of strong or pungent smell by the medicinal herbs/trees that grow at high altitudes.

This is a total misconception.

People have also irresponsibly propagated the idea that Ladoog can be cured by chocolates and wheat Sampa diced with sugar.

This is yet another total nonsense. Sugar provides instantaneous but temporary energy – thus misleading people that they have the energy to climb.

Even educated people believe that the Ladoog can be cured by Diamox or that simulation by Gamow Bags will cure altitude related sicknesses. While I agree that Diamox can help accelerate acclimatization at high altitudes, it is NOT A CURE. The Gamow Bag mimics a lower altitude by increasing air pressure around the affected person put inside the Bag. In fact I advise trekkers destined for high altitudes that they should not take the tablet because in my view taking this tablet can result in a false sense of safety. Not many can afford Gamow Bags.

One must know that Ladoog can be fatal. It can kill within hours.

Last week a friend faced a near death Ladoog experience in Laya, unknowingly. My instinct nudged me to call her and find out how she was doing since I hadn’t spoken to her in a year or so, only to find that she was returning from a trip to Laya at an altitude of 3,800 Mtrs. or nearly 12,500 ft. When she recounted her experience to me over phone, I realized that she was clueless about what Ladoog was all about. She had no idea that she was hit by Ladoog. Fortunately, she was lucky that she had an uncommon instinct that told her that something was seriously wrong. She descended to Punakha – and spared her parents the painful experience of having to go through the motions of her last rites.

This article is the result of my conversation with that friend and how utterly ignorant people are about Ladoog and its consequences.

“Ladoog” I believe is a collective term used by the Bhutanese to describe the following three different forms of altitude related sicknesses:

Acute Mountain Sickness (AMS)

High Altitude Pulmonary Edema (HAPE)

High Altitude Cerebral Edema (HACE)

All the above three can result in fatalities. That is as certain as night and day. There is absolutely no cure.

Symptoms of different types of AMS

A person will begin to experience the above conditions once he or she crosses the threshold of 8,000 ft. altitude. The barometric pressure at high altitudes causes the conditions described above. Higher one climbs, thinner the air gets, resulting in lesser supply of oxygen than that which people are generally used to.

The other reason why people get hit by the above conditions is because they gain height too quickly – before the body is able to adjust to the barometric pressure of the location at which they are. That is the reason why I insist that trekking groups coming from low lying areas and landing in Paro should acclimatize for atleast 3 days – either in Paro or in Thimphu - before they are allowed to undertake a trek.

The human body must be allowed to acclimatize with the changing barometric pressure around them. This means gaining height must be done gradually.

There are so many misconceptions surrounding altitude related sicknesses – I believe that the BBS should do a program in all the national languages – to educate the people on AMS related matters – how to prevent them, how to prepare for and how to avoid them. This has become important in recent times since I notice that people have taken to trekking to high altitude pilgrimage sites. BBS would be doing a service to the nation and in the process avoid preventable deaths. This has become an URGENCY.

I suggest that the tour operators who are conducting these pilgrimage tours should be required to be TCB certified operators with proper grounding in the knowledge related to AMS. The pilgrims should be made aware of the AMS related matters – so that they can make informed choices.

I have already seen 3 altitude related deaths – one in Jele Dzong in Paro, one in Singye Dzong in Lhuentse and one in Nagchung-La Pass in Merak. The girl who died in Singye Dzong was on a pilgrimage along with 16 other women. Despite my repeated requests to the group to descend to a lower altitude, the young girl succumbed to the condition – she was only 28 years old.

It was sad and such a waste of precious life.