La Doog: A Dangerous Condition Known As: AMS | HAPE | HACE

This morning’s Kuensel carried an article that deals with the increase in cases of, what the Bhutanese call, “La Doog”. It is timely. There is total lack of understanding surrounding this deathly condition.

I had requested the Bhutan Broadcasting Service (BBS) to do a series on the subject – they agreed but I could not find a person with the knowledge as well as the Dzongkha language skill to speak on the subject.

Bhutanese people think that since we are mountain people, we will not be affected by La Doog – WRONG. International trekkers think that they have trekked in alpine regions in their own countries and that they can handle Bhutan’s altitudes – WRONG!!  One of Switzerland’s highest peaks - the Matterhorn, is only 4,478 Mtrs. By comparison, our Bonte-La above Jumolhari Base Camp towards Soe Yaktsa stands at 4,980 Mtrs.

Bhutanese people’s understanding of La Doog is so poor that I dedicated ten articles to the subject of sickness brought on by high altitudes. Please read them all at:

https://yesheydorji.blogspot.com/search/label/Death%20By%20Ladoog

Classification of heights

Type of high altitude sicknesses and their symptoms

Death by Ladoog X

“Ladoog” is a deathly condition that can result in fatality. And yet, it is the most misunderstood of all maladies. It is a sickness brought on by high altitude. There is this totally uneducated belief that since we are mountain people, we cannot be affected by it. That is totally wrong – we can be and we have been. I am told that few deaths had occurred during the operation “Lower the Thorthormi Tso” few years back. I can tell you that those would have been caused by AMS – but blamed them on Ladoog – mountain poison.

Having come to know of a near death experience by a friend who had gone to Laya and who did not know that she was afflicted by AMS, I wrote a series of articles on the issue. Between 19th to 30th of October 2021, I wrote nine articles on the subject. I even requested the BBS to do a Dzongkha program on the subject because I notice that lot of Bhutanese go on pilgrimages to high altitude places and some deaths have occurred – I was witness to one in Singye Dzong. Despite my repeated requests to descend to a lower altitude, the group refused to do so - with the result that one group member died of AMS, on the third day. The Bhutan Broadcasting Service (BBS) agreed to air the program but there was no one to come on camera and speak authoritatively on the subject – I could not because my Dzongkha is not so good.

My series on Ladoog - Acute Mountain Sickness (AMS) – or simply altitude sickness was earlier categorized under “Health”. But because of its importance, I have this morning segregated it from “Health” and gave it a separate category – "Death by Ladoog". I did this because I want my readers to read the series and be better educated on what AMS is all about. I have also included exhaustive tips on how to prepare for high altitude treks.

I urge you to read, I repeat please read the series at:

https://yesheydorji.blogspot.com/search/label/Death%20By%20Ladoog

Know your Ladoog

I took the pain so that you may be better prepared to tackle Ladoog that can mean sure death - if you do not know what to do or how to tackle it. Ofcourse not all of us are susceptible to it – but a large number of us are.

ENJOY!!

AFTERTHOUGHT:

I hear that some pilgrimages are conducted by helicopter - say, for instance, to Nob Tsonapata to the north of Haa. This is terrible news particularly where people expect to spend days at the pilgrimage sites. Going by helicopter to high altitude sites and spending days there can be dangerous. The reason is that you gain height all of a sudden. For people who are susceptible to AMS, this is very dangerous and can be fatal. You must gain height gradually so that your body has the time to adjust to the changing barometric pressure.

Strangely the TCB - the regulatory authority - does not regulate trekking - they don't even know if the guides who are leading high altitude treks are qualified and knowledgeable on AMS related issues. TCB should regulate and also train trekking guides on AMS and on emergency evacuation procedures in cases of AMS.

Death By Ladoog IX: FINAL POST

LAYERING

In my rush to close the series of articles on Ladoog, I omitted to write on one important element: LAYERING.

The concept of layering is pretty simple but effective. What it means is that your trekking clothing is categorized into three categories: Base Layer, Mid Layer and Outer Layer.

Base Layer: generally thermal with good wicking properties

Mid Layer: of much thicker material – mostly Fleece

Outer Layer: heaviest of the three categories/layers – most often Down

When trekking, you wear the clothing in order of the above. At extreme altitudes, generally you start with all the three layers on. As you progress on your trek, your body begins to heat up and you feel hotter than warm. So the first layer that comes off is – the outer layer. Further up, the heat and the sweating gets even hotter – at this point your mid layer comes off … so you are now left with the base layer. As a rule, you should always keep the mid layer on – because it is not good to expose your body to the elements – the base layer is very thin, and most often soaked with sweat. You do not want to expose your wet clothing to the chilly wind.

After the summit or the high pass, you begin to descend or your trail is over a flat, level ground. Your body begins to cool off – at this point the reverse order is implemented. You put on the mid layer. As your body cools off even more, you resort to putting on the final, outer layer.

It is at the camp that you really need to put on warmer clothing since inactivity means you will feel the cold even more severely.

........................... End of Series

Death By Ladoog VIII

UPON RETURN FROM THE TREK

If you are reading this – it can only mean that you have survived the trek and that you are hail and hearty. CONGRATULATIONS! I have no doubt that you are in agreement with me that our alpine regions are truly awesome and breathe taking.

Post trek, there is nothing much to be done – but to clean and pack away your trekking gear – until they are needed for your next trek whenever that is likely to be. But there are still few tips I need to give you – before I finally close this series of blog, after this post.

THE CORRECT WAY OF WASHING/PACKING A SLEEPING BAG

You must wash and dry your sleeping bag after a trek. You can either do it at home or give it to a dry cleaner. If you are washing it at home – you can either do it with hands or you can do it in a washing machine. If you are washing it in a washing machine – make sure that you are using a “FRONT-LOADER” washing machine. YOU MUST NOT USE A “TOP-LOADER” – or your bag will be shredded to smithereens!

Thereafter dry out the bag – make sure that it is absolutely bone dry before you pack it away. If it is not, you run the risk of mildew formation, which would ruin the bag forever.

Same thing with the tent – make sure it is bone dry before packing it away.

Metal tent stakes or pegs: they have to be cleaned of earth – with water and oiled before packing away. This will prevent the formation of rust.

FINAL IMPORTANT TIP

When stuffing sleeping bags or down jackets into their holders, NEVER stuff them by folding or rolling them. Stuff them freely by disorganized pushing them into the sack. You don’t want “Memory” to form on the bag or the jacket.

How to pack sleeping bags correctly without running the risk of "Memory"

Trekking is a healthy lifestyle – ENJOY!

Death By Ladoog VII

ON THE TREK

We are now packed and ready to go on the trek.

Before undertaking the trek, there are two important things that need to be ascertained:

1.  Medical history of the persons going on the trek

2.  Have they been to altitudes above 8,000 ft., before in their lives.

I organize high-end treks and I follow the following rules:

AAA.  I employ experienced guides at close to 3 times the going rates for trekking guides. The guide needs to have good trekking experience – but above all he has to be a person with uncommon common sense. He has to be capable of thinking fast – and logically - in emergency situations.

BBB.  I am not convinced by trekkers from outside when they tell me that they have done many treks in their lives. That may be so but conditions are different all the time – altitudinal variations are different. Don’t forget the highest altitude in Switzerland is only 4,600 Mtrs. So when a Swiss trekker tells you that he has been to the highest altitude in Switzerland – you can tell him that is child’s play.

CCC.  I always make sure that trekkers arriving Bhutan get 3 days of lolling around at Thimphu or Paro – for acclimatization. If I am able to, I try and convince them to complete their tours to other cultural sites before embarking on the trek – so that their bodies have more number of days to get used to the changed atmospheric pressure of Bhutan. A human body can adapt - but it needs time.

DDD.  Before starting for the trek, I unfailingly take them for a test run. They have a choice – Taktsang or Chele-La. I make them trek either of these two sites before beginning the actual trek. If someone is affected at these altitudes, he/she will NOT BE GOING on the trek.

PEP TALK

Just before the trek starts, I give a little pep talk that set out the rules to follow on the trek:

AAA.  The Guide is the ultimate authority on the trek. He has the final say – the support team including the trekkers, has to listen to him and heed his decision.

BBB.  The Guide sets the pace of the trek. It has to be understood that you are not on a competition – you are here to have an enjoyable experience – not to outpace someone. You must take easy and even paced short steps – NO RUSH. The rule is that you should not tire yourself out. DO NOT get into a situation that causes you to do hard breathing.

CCC.  Stay with the group – do not stray - do not lag too far behind or go ahead too far. In the wilderness, you can get lost within a blink of an eye.

DDD.  Protect or shield the important points from where heat escape: head, mouth, nose, ears, fingers and legs.

EEE.  Start your trek early – on my own treks, I have always insisted that we leave the camp by 7.00 AM latest - breakfast should have been done and camp collapsed and we are on the road by then.

The reasons I insist on early trek are:

AAA.  There is no sun boring down you neck – so the trek is easier and there is not much sweating. A good bit of the trek would have been covered under favorable conditions.

BBB.  Starting early means YOU DO NOT HAVE TO RUSH. It also means, most importantly, arriving at your next campsite early. Arriving early means you have ample time to do what needs to be done – locate a good camping ground, set up camp, gather wood for the evening campfire, search out water source – all without scampering. If you start late, you arrive late – leaving you with precious little time to do what needs to be done, with care.

CCC.  Towards the end of the day’s trek, let the support team and the pack ponies go ahead of you. This way when you arrive the camp, everything would have been set up and hot steaming tea and snacks would be waiting for you. One of the most irritating things is to have to wait around for the camp to be set up.

WHAT TO DO AT THE CAMP SITE

TENTS

The guide has to inspect every tent that has been pitched. He has to make sure that the tents are pitched in the right way – a slack tent is trouble – the tent’s outer shell has to be drawn tight so that rain water or snow has no chance of gathering atop it.

Cabela's Extreme Weather Tent - the tent of my choice - I take this on my treks. From the tent spikes you will realize that this tent is designed for serious stuff.

The guide has to make occasional inspections in the night - to ensure that the ponies have not stumbled over the tent's stay wires and slackened the tents. My above tents have no stay wires - so there is no danger of ponies tripping over them.

GROUND SHEETS

The ground sheets on which the tents sit must be of good, thick quality so that there is no seepage of moisture into the tent from the soggy ground underneath. The ground sheets I use are imported from Malaysia and they weigh over 5 KGs. each - heavy certainly, but your tent floor will remain bone dry through out the trek. A wet tent floor means BrrrrrrrrrrrR!

Make sure that the edges of the ground sheets are folded up slightly – so that in the event of surface water running around the tent – it does not run over the ground sheet and wet the tent’s floor. This will be trouble.

DRINKING WATER

If you are the type who needs intake of water in the middle of the night or early in the morning, make sure that there is free-flowing water available to you. Remember that at high altitudes, the water freezes, turning into lumps of ice – not good for drinking. What I have done is that I take my drinking water to bed with me – inside my sleeping bag. That way the water will remain liquid. The trick is to use hot water bags – that will keep you warm, while at the same time keeping the water liquid and drinkable.

TREKKING BOOTS

My experience has been that you cannot leave your boots outside – they freeze turning into hard lumps. So make sure that you protect your boots, so that they are supple and pliable when you want to wear them on, the next morning.

WATER FOR COOKING

I have been to some seriously high altitude locations where every morning you find that the water has frozen inside the Jerri can – meaning no water for brewing the morning tea or cooking your breakfast. Thus I have always required my trekking support team to heat pots of water before going to bed and keeping the heated water inside their tent. This way when they wake up in the morning, they have liquid water to brew morning tea and cook breakfast. They do not have to wait for the water to defrost. You have to plan in a way that there is no delay in starting a new day.

BATTERIES

The efficiency of the batteries inside your camera and lamps drops to about 40% at high altitudes – due to cold. Thus make sure that your batteries are protected and kept warn. I generally wear them around my body – in the night I take them to bed – inside my sleeping bag.

Calculate your battery power requirement – then multiply by 2. Carry more batteries then you need – remember you may have to extend your trek for unforeseen reasons – and remember that battery efficiency drops dramatically at high altitudes.

HYDERATION

Trekking means you loose lots of body moisture. Make sure that you replenish loss of body moisture - by drinking water at regular intervals. Hydration also helps your organs to function well and it helps you to get your required quota of sound and restful sleep.

ALCOHOL

Absolutely a NO NO NO NO NO. You must stop the intake of alcohol on the day you start your trek. You must also make it absolutely clear to your support team that CONSUMPTION OF ALCOHOL ON THE TREK WILL NOT BE TOLERATED!

Death By Ladoog VI

PACKING YOUR TREKKING CLOTHING/GEAR FOR THE TREK

It is now time to start packing for the trek.

You have to be imaginative about your requirements. Too many items would mean extra load that you do not need – too less could mean insufficient gear to keep you warm and toasty during the trek. Typically, my packing list would run as follows:

TENT:

Sleeping tent with moisture proof thick plastic groundsheet – my choice is Cabela’s

Sleeping Tent for the support team

Kitchen Tent

BED/SLEEPING KOT

Collapsible, low-lying, sturdy camp kot (something like GO-KOT Camping Cot).

SLEEPTING MAT

Inflatable - light and well insulated to prevent moisture from seeping in from below the ground. Therm-A-Rest brand is a good choice.

SLEEPING BAG

Most people mistakenly prefer sleeping bags that are suited for extreme high altitudes – say for -40 Deg. days. I, on the other hand, have a different idea. I choose my bags rated for a maximum of -0 Deg. days. My logic is that we would be gaining height gradually and thus we do not need bags that are rated for extreme weather at the beginning of the journey. Thus, my bags are rated at -0. Extreme weather bags that are rated at over -40 Deg. are very expensive. I buy -0 Deg. bags which are affordable. Then, to compensate as we climb higher and face colder conditions, I carry four numbers of fleece blankets. As it gets colder as we climb higher, I keep adding layers of blankets over the sleeping bag.

Buying bags that are rated for very high altitudes has another problem – they cannot be used for low altitude camping trips. This means you have to buy additional bags for low altitude trips. This is a waste of money. My choice of bag is Marmot for the -0 and Feathered Friends – for the extreme altitudes – I have one that is rated at -60.

SLEEPING BAG LINER

You need to use bag liners – so that you do not soil the interior of the bag. Also should the duration of your trek be long, you can wash the liner. They have to be of silk material.

PILLOWS

I pack four down pillows by Feathered Friends of USA. They are highly packable and soft like the belly of a nun.

LAMPS

You need a headlamp for yourself and each of the team members, and a tent lamp and a kitchen lamp. They have to be of high lumens. Do not make the mistake of getting the solar-charged variety – go for battery-powered variety. Buy high power rechargeable batteries – and carry good number of extra batteries on the trip. You will never face a situation of darkness or lightlessness. I prefer TheSeige by StreamLight of USA, rated at 540 lumens.

CLOTHING

On a trek, you do not carry too much clothing – just the bare minimum. But what you carry has to be top class of dependable quality made by proven industry leaders with long history of producing technical clothing. My preferred brand is Patagonia of USA. I suggest the following items:

List of Clothing I carry on my treks to the extreme regions

CARE TO BE TAKEN

When beginning the trek, pack one extra Base Layer Thermal in your rucksack, including a face towel. The reason is that you do not want wet clothing against your skin – that is dangerous! As you trudge up the mountain side in the mid-day heat, you will begin to sweat profusely resulting in sweat-soaked base layer against your skin. Do not allow wet thermal to cling to your skin –immediately remove the wet thermal with that of a dry one.

TREKKING BOOTS

This is one of the most important items that deserves very, very careful consideration. Unfortunately, my experience is that there is utter misconception among the Bhutanese trekkers about what level of boots you need on your trek.

The technically sound trekking boots come in three levels – Light, Medium and Heavy. Somehow the tendency to believe is that heavy trekking boots are the best for you – WRONG!

You have to remember that the Westerners set the standards. What is to be remembered is that trekking in the West is different than in Bhutan. There they have to carry the load on their own backs. In Bhutan, we use ponies to carry our loads.

Because they have to carry the loads on their backs, they decide on their boots – based on how much load they would be carrying. Thus the theory in the West is that – heavier the load you have to carry, heavier the boot type you need.

In Bhutan that theory does not apply – because there is no load on our backs when we are trekking – other then 2-3 Kgs. in a smallish rucksack. Thus at most, Bhutanese people should opt for light to medium weight boots. But make sure that the sole is of a good quality – my choice is Vibram brand. Your boots also has to be waterproof (Gore-Tex) and ankle height – so that you can prevent ankle twist as you go down hill over pebble-ridden trail.

Death By Ladoog V

PLANNING AND PREPARING FOR THE TREK

We now understand the perils of AMS and how to prepare for and avoid it. I have also walked you through when to go, for what. It is now time to deal with the real deal – preparing for the trek and actually heading for it. But first let us begin the process of planning for the trek.

The process of preparing for the trek involves the following:

1.  Deciding on a contractor to provide pack ponies (transport) for the trek;

2.  Number of pack ponies/ridding ponies;

3.  Deciding on whether Yaks or Mules;

4.  Decide on the type of food to pack – based on duration and

     the highest point to which you are expected to climb to;

5.  Assess food and ration requirements based on number of people and duration of trek;

6.  Trekking support team; and

7.  Check the weather forecast.

TRANSPORTATION CONTRACTOR

It is preferable that you opt for a contractor who is also the owner and driver of the ponies. They care for the animals better – thus there is less risk of ponies going missing or careless accidents.

If possible, choose a younger person – but there is no substitute for experience. However, in situations where strength is called for – younger guys perform better. But in terms of getting out of sticky situations – experience is called for.

NUMBER OF PACK PONIES

It will be determined by the number of days and number of people in the trekking group. This can be worked out a few days before the start of the trek when you begin to start packing your stuff.

TAKE CARE that you do not overload the ponies – that is a bad idea. Keep them springy and agile – with reasonable load. This way, you can avoid accidents that can be costly.

My pack ponies on the trek between Rigona to Nob Tsonapata, from Sinchuloompa. Generally this route is out of bounds for trekkers - but I brought to bear some muscle power to allow me to take this route :)-

As a rule, I always insist on taking along a ridding pony for every 4 trekkers and an additional un-laden pony for every 6 trekkers. The ridding pony will be required in case you have accidents on the trek – or should a trekker fall ill. The extra un-laden pony is for the same reason – in the event of unforeseen accidents. It is less expensive to pay for additional transport than be stranded in the wilderness for want of it.

YAKS OR MULES?

For me this has always been a simple and straightforward decision – mules. Yaks are a moody lot, with unpredictable mannerisms. And they are terribly stubborn! They spook easily and can scamper off in all directions offloading their baggage all over the places and at times off the cliff into the ravines.

AMOUNT AND TYPE OF FOOD TO PACK

AMOUNT: This will depend on the duration and difficulty of the trek. I have one thumb rule: I pack X2 times the food needed. One is never sure what will happen in the high altitude wilderness – you could be stranded for all sorts of reasons and for days. Thus I always take food twice the amount that is needed. Your chances of survival are so much better if you have nourishment to sustain you.

Don’t be penny wise but pound-foolish.

TYPE: The general rule is that you pack food that are rich in carbohydrates that provide calories needed to give you energy. Examples are oat bran and good old white rice - and ofcourse energy bars - if they are available.

TREKKING SUPPORT TEAM

Select wisely. They have to be young and enthusiastic and hard working. Lazy bums should be shunned like as if they were lepers.

The support team can be either your weakest or strongest link.

Unfortunately, 99.9% of trekkers pay scant attention to their support team. This is absolutely the wrong approach. I have always believed that on a trek to the high altitude regions, your support team must perform with the utmost efficiency – thus they are more important than you.

If they fail, you have not a rat’s ass of a chance at success. If you fail, they are around to deliver you to safety and on the road to recovery.

If they freeze to death, you are a dead meat alongside them.

Therefore, one of the rules I have followed all my trekking life is that they wear the same brand of clothing I wear, same trekking boots I wear. Carry the same lighting system and even the sleeping bags they sleep in are technically as efficient as mine.

In fact, my pony man in Haa – Aap Semba - wears the same trekking boots I wear – worth Nu.23,000.00 for the pair. I bought it for him – on the condition that I am allowed to deduct the cost from trekking service that he would provide me sometime in the future. To date that future never came. But hopefully one day it will. If not, it will be my gift to him for the efficient service he had always rendered to me.

WEATHER FORECAST

Although not always reliable, it is a good idea to look at the weather forecast and plan your trek on days when the weather is predicted to be good and fair.

SNIPPET: This Aap Semba of Haa is so efficient and hard working and ever ready to please - that on one of our treks together - this time for photographing the rare and endemic White Poppy (Meconopsis superb) only found in the North of Haa - he suggested as follows:

"Dasho where is the need for you to put yourself through such gruelling hardship - why don't you sit by the fire and in the comfort of your tent. I will go and gather up all the flower you need. You can do your photography - no need for you to venture out in this terrible weather."

Ofcourse he does not understand that the flower is so rare that he should not uproot them.

Death By Ladoog IV

DECIDING ON THE TIME/MONTH OF TREK

Once you decide that you want to go on a high altitude trek, the first thing you do is decide when you want to go. As a rule this is determined by the purpose behind the trek. The purpose could be any of the following:

1.  Tourism

2.  Landscape photography

3.  Bird Photography

4.  Botany

5.  Pilgrimage

TOURISM

Under this, I would include trekkers – those people who love trekking in the mountains. I would choose mid October to mid December, and late March to early May. Ofcourse the duration of the trek is also a factor, including the highest point that the trek will attain.

LANDSCAPE PHOTOGRAPHY

Here too I would choose the above months. The reason is that these months will be that time of the year when the skies will be clear, there will be no rains and there is less likelihood of being snowed in.

However, if the trek is likely to touch over 5,000 Mtrs. you will have to begin the trek during mid September so that you cross the highest point before the heavy snow starts. Once again the duration of the trek is a factor that must be kept in mind. Regardless, what is important is that you plan in such a way that you pass the highest point in your trek, before the onset of the big snows.

View from Bonte-La Pass at 4,980 Mtrs. One has to scale this high pass to get to Soe Yaktsa from Jangothang. You can see the tip of Jichu Drake on the left.

BIRD PHOTOGRAPHY

Not many people go to high altitudes for bird photography. One reason is that the birds migrate to lower altitudes during the cold months. However there are bird species that live only at high altitudes – such as the Bja Oro (Common Raven – Bhutan’s National Bird) or the Lammergeier. In Bhutan I have spotted and photographed these two birds in Gangkhar Puensoom and Lingzhi. Thus October and March should be the months of choice. Both these places are likely to be open during these months. I have done Lingzshi in February!

BOTANY

This requires that that alpine flowers are in bloom. So June – August are the most likely months – in terms of productivity. But I can tell you it will be WET and SOGGY. Pack a bloody good ground sheet and make sure your rain gear is top notch!

PILGRIMAGE

Here too I would choose the months between October to November and March to May. The reason is that these months will be that time of the year when the skies will be clear, there will be no rains and there is less likelihood of being snowed in.

No reason why your quest for Nirvana should not be an experience in blissful enjoyment.

But one thing you have to keep in mind – DESPITE YOUR BEST PLANNING AND FACTORING IN ALL PROBABILITIES, you can never be sure.

In nature, be prepared for the unexpected!

Death By Ladoog III

DETERMINATION OF THE HIGHEST POINT ON YOUR TREK

First and foremost, when planning a trip to high altitudes you need to ascertain:

What is the highest altitude that you will attain on the trip?

This is important so that you know that you are, or are not going to, scale beyond 8,000 ft. altitude. If your trip is going to be lower than 8,000 ft., there is not much to worry – but if it is going to be over 8,000 ft. you need to be concerned.

Grading/Classification of Heights

Graphics by High Uinta Pack Goats

The threshold of 8,000 ft. is the point beyond which it is said that most will begin to experience AMS, if someone is susceptible.

The other thing you need to know is on which day of the trek the highest point, or the threshold of 8,000ft. will be attained.

If it is on the first or second day – you need to be seriously worried. The reason is that you are obviously going to gain height too soon, too quickly. This is not good – you are not giving your body the time needed to adjust with the changed barometric pressure around you.

If you must still continue with the trek, you should rest at the highest point for a few days – to allow your body to make the adjustments. If you feel OK at the highest point after the rest, then it is certain that you have most likely overcome the threat of AMS. You can continue. However, if there are signs of AMS, then you should descend – down to a lower height and take a few days rest and reattempt the trek. Or terminate the trip entirely, if you feel unsure.

If the highest point is gained on the 3rd or 4th day – the worry is less because it is then obvious that your climb has been gradual and that you had sufficient days on the trek to enable your body to make readjustments to the thinner air around you, as you gain height.

Once you reach the highest point and if you should begin to experience AMS symptoms, you should immediately DESCEND to a lower height. But at this point the important thing is to decide:

Which direction is the more effectual way of making a quicker descend – backwards or foreword?

It is not necessary that you should descend through the same route that you took to arrive at the high point. It is possible that going forward may be the more efficient route. In other words, the descend to a lower height may be attained faster by going forward – may be the trail downhill on the other side is much more steeper – meaning that you will descend faster.

The IMPORTANT thing to remember is that you NEED TO DESCEND IMMEDIATELY.

The following are the golden rules when trekking in high altitudes:

Do not gain more than 1,000 ft. each day.

For every 3,000 ft. height gained, give yourself a day of rest before going up further.

"Climb High but Sleep Low". This is the maxim used by high altitude trekkers. You can climb more than 1,000 feet in a day - as long as you come back down and sleep at a lower altitude.

If you begin to show symptoms of AMS, don't go higher until symptoms decrease:

"Don't go up until symptoms go down".

Death By Ladoog II

I am truly concerned by the Bhutanese people’s poor knowledge, or total lack of it, related to Ladoog. Thus I am going to do a series of blogs on matters related to the subject. It is hoped that in so doing, that atleast some of the Bhutanese people will benefit from the transmission of my personal experience and expertise of nearly 7 years of continuous trekking the extreme high altitude regions of Bhutan.

In my 6-years assignment for the government to photograph the high peaks and lakes of Bhutan, I have trekked to almost all the high peaks of Bhutan. One of my treks was for a total of 43 days, without a break. I have trekked over the Gosoong in Singye Dzong, summating over a Pass that is over 5,000 Mtrs. or 16,500 ft. I have climbed to almost the summit of Masagung (7,194 Mtrs.) – when my Bjop horseman from Soe Yaktsa pleaded:

“Dasho – please let me know when you are done – I am feeling so cold I cannot stand it any more” – promptly sticking his head into a hole in the ground to shield himself from the vapor freezing chilly wind battering the mountain side, as I proceeded to plod up the frigid face of Mt. Masagung.

I have trekked to Chundugung, Gonzola, Doklam Plateau, Sinchu Loompa, Chundu Laatso and Nob Tshonapata, in the north of Haa.

Singye Dzong, Terda Lhatso, Gosoong, Tsokar and Tsona in Lhuentse areas of the East.

Sangyegung, Jumokoongkhar and Nagchung-La in Merak, Trashigang.

Juele-La, Dhur Tsachu, and three thirds the height of the great Gangkhar Puensoom at 7,570 Mtrs., in Central Bhutan.

Masagang, Tarigung, Gung-La Karchung, Keche-La, Gungchen Taag, Jumolhari, Jichu Drake, Ngele-La, Bontey-La, Lingzhi Dzong, Tserimgung, Lunana, Gungchen Singye – traipsing shores of Lugo Tso, Rapsthreng Tso and Thorthorme Tso in Lunana and Tsophu Tso in Jangothang in Western Bhutan.

Two trips to Phangu – one of them by helicopter – Bhutan’s richest Cordyceps growing area above Thanza, in Lunana regions of Western Bhutan.

All my above jaunts into the frigid regions of Bhutan’s alpine regions should tell you that I am qualified to speak on matters related to AMS.

Beginning from my next post, I am going to tell of some measures I take to battle the frigid weather conditions and traversing the perilous trek routes – to get to where I want to go – at the bases and above the waist lines of the virginal snow capped peaks and frozen lakes of the country’s extreme North.

For additional reading, try the following:

https://yesheydorji.blogspot.com/2012/10/lingzhi-yugyal-dzong-bhutans-remotest.html

For proof of the pudding, the following are three pages from hundreds of pages of notes taken down in minute detail, during my many treks. These ones on show are from my trek to Signye Dzong - in November of 2006.

Notings of my trek to Singye Dzong in winter of 2006

Over a dozen note books containing details of my many treks to the frigid regions of Bhutan

Imagine, no one dares to go to Singye Dzong in November - except this mad photographer. But clear blue skies, a trillion shimmering stars in the night sky and, frozen, wilting grass blades laden with ice and brooks lined with sparkling frozen banks - they make for great photography!

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.