Vertical Limit: What Middle-Aged Desis Ready to Take Off to the Himalayas Should Know About High-Altitude Trekking
- Empty nesters who packed kids off to college and looking for adventure should know that the expedition might appear deceptively safe. They need to be prepared to avoid dangers lurking at every turn.
As the altimeter began to register well beyond 13,000 feet in the Langtang National Park in Nepal, I hiked up just over 45 km mostly in silence, frequently in shock and awe at the unfolding peaks of the Langtang Himal range. Enlivened by moments of cheering and jubilation with my trek mates, it was particularly exhilarating when we reached Kyanjin Gompa at the very end of Langtang Valley, encircled by towering walls of snow, some 20,000 plus feet high, icy glacial lakes and meltwater forming the headwaters of the Langtang Khola.
Crossing the rubble of the original Langtang village destroyed in the 2015 Everest region avalanche and earthquake was deeply sobering. Our group felt not just the thinness of the air but the weight of collective loss as we trekked through the rebuilt village on the exact 9th anniversary of the disaster, mere moments after a memorial was inaugurated by the local army battalion.
The jubilation turned pensive, our minds grappling with the idea of sudden and catastrophic loss of life and destruction of an entire human habitat on one calamitous day when a great majority of villagers were gathered in their gumba for their weekly communal prayer.
This led us to thoughtful reflection and brought to the surface some observations that I found to be share-worthy.
Coincidentally approaching the half-century mark in my life, the deep thoughts that formed as I delved into the world of high-altitude trekking came full circle that day.
What keeps me and millions of humans coming back after the punishing toll of each trek and the risk to life?
The experience in its entirety, is a group of like-minded trekkers new and experienced, friends, and strangers coming together some six months before the journey, chronicling training updates and functional milestones in a group setting to motivate the rest. And finally meeting face-to-face before taking the first step on the trail armed with trekking poles and a backpack, there was quiet satisfaction after each successful day of climb and the final exhilaration on every summit.
Like the fired-up thoroughbreds that anxiously wait behind the closed gates at the Kentucky Derby, the adrenalin rush of all of those first moments unleashes an enormous high to an otherwise mundane life of work, kids, and chores.
That initial trip is like a gateway drug that opens the door to the pursuit of the endless high of each successive climb. And just like that, one is hooked.
High Altitude Trekking
High-altitude trekking might appear deceptively safe, becoming increasingly popular in the middle-aged Indian diaspora. The power of the mountains has taken hold, especially in momâs groups after packing the kids off to college.
After all, how hard can it be compared to successfully launching a couple of humans into the world, right? Or, so, we all think! Donât know what Kili, ABC, and EBC stand for? Better get hip with the lingo.
The addictive aspects of high-altitude trekking are often represented by the acronym SPACE. Expanded, it stands for the simplicity of each day, a purpose that is singular and fills one with adventure, in a communal setting that leads to extreme exercise and a surge of endorphins. In fact, many trekkers plan their next one before going home to avoid the post-trek blues, a real phenomenon seen all too frequently.
For those of us with an Indian background, the pull of the Himalayas is deeply tied into cultural identity with the concept of pilgrimage and seeking the divine, not just the challenge of their unparalleled might.
Rapidly becoming the number one group adventure travel activity in the empty nester Indian diaspora, the seeming familiarity with the location, the absence of true wild, and the overwhelming amount of constant information available at our fingertips through Google, even in the remotest of the Himalayas, has created an apparent sense of security. Additionally, at first glance, there seems to be no need to acquire new skills, just being able to put one foot in front of the other.
Bragging Rights
Our inherent cultural competitive nature further fuels the race for bragging rights, and like lemmings racing to the cliff’s edge, we all fly out to Nepal armed with our brand new, brand-name gear to conquer them all.
Our inherent cultural competitive nature further fuels the race for bragging rights, and like lemmings racing to the cliff’s edge, we all fly out to Nepal armed with our brand new, brand-name gear to conquer them all.
But as some have learned the hard way, there is a real propensity for high-altitude trekking to turn dangerous, coupled with no real certification to assess for readiness or lack thereof.
For most novices, preparation is a lot of trial and error, and tweaking individual training tactics from trip to trip by incorporating tried and tested protocols. Online resources, group leaders with prior experience, and friends are often the sources of information, sometimes misleading and incomplete.
Then there is the great distance and time difference that further complicate the picture, sometimes leading to dangerous shortcuts to acclimatization times and eliminating redundancies to maximize the experiences at the destination.
However, advantages do exist compared to my earlier hobbies of choice. The absence of speed and the presence of normal communication, combined with the human physical constraints to altitude and our bipedal mobility ensure a slow and steady ascent and leave plenty of time to evaluate for developing morbidity and mortality, providing the much-needed safety factor. If we can get out of our own way!
Having witnessed a few health emergencies and injuries on the trail, I analyzed the different factors in each circumstance. I found poor planning and dismissing good advice to be universally common almost every time.
Every expedition has some pregame rules. Some tours only allow participants who have had a certain amount of experience, both in terms of distance and altitude and expect medical and cardiac clearance while others perhaps rely on the honor system and expect a clean bill of health along with an honest functional capacity assessment from the participants.
Having received a few unsolicited gifts of inherited chronic medical conditions that limit my endurance and stamina, my pregame checklist might be slightly different than that of the average healthy 50-year-old.
In addition to ramping up my exercise and fitness regimen, I also focus on sport-specific strengthening to selectively and repetitively train muscles, joints and body parts that strain the most in trekking, under the watchful supervision of my trainer and a physical therapist when needed, and medical supervision of my primary care physician.
Training Benchmarks
As a musculoskeletal doctor, I rely on a few training benchmarks that are vital, but not necessarily all-encompassing. The ability to participate in a physical activity that generates 10 to 14 METS for at least 30 minutes, to have a VO2 max of 35 or above, and to complete a 12/3/30 treadmill workout with relative ease are some popular fitness parameters. The ability to run up and down 4 flights of stairs in 60 seconds or less is a good initial indicator of cardiac readiness. Healthy runners that regularly clock a 10-minute mile or under, feel free to skip this portion of advice.
For the rest of us, reaching that potential may include getting full cardiac workout and a complete physical with blood work, including a treadmill stress test, so donât neglect it!
It is often not the absence of medical knowledge, but the presence of an overwhelming amount of complacency and hesitancy that seem to get high-altitude trekkers into trouble.
Make sure hemoglobin levels are optimal, as are calcium, vitamin D, and B vitamins, along with standard basic screens. Chronic medical conditions should be tightly and optimally controlled with contingencies discussed with treating physicians for necessary adjustments with high altitude and extreme physical exertion.
One activity I highly recommend is doing a trek rehearsal similar to a wedding rehearsal. Take an extended weekend trip to the nearest geographic location that simulates your far-away foreign high-altitude travel and test drive the effect of medications, practice with the gear & equipment, and evaluate your overall body response to the conditions so that you can troubleshoot safely at home.
Strategize and have solutions to overcome the lack of creature comforts and changes to body functions like sleep deprivation and bowel irregularities, both of which can slam the brakes on the otherwise unstoppable.
Known Your Capacity
Get to know your exercise capacity at a deeper level. Can you tell how fast your heart is beating without looking at your smart device or taking your pulse? Can you identify what your body feels like when you are exerting yourself at 60-70% of your max heart rate without looking at a device? Do you know how your body functions with a pulse ox of 85%?
Reacquaint yourself with your inner workings and learn to self-identify moments when you are redlining your physical limits. Get comfortable knowing your functional baseline under those conditions. Then learn strategies to recover and repeat.
Learn and master breathing strategies like pranayama and box breathing to reduce the workload of the heart and lungs at peak exertion, and facilitate increased athletic performance and endurance.
Familiarize yourself with techniques to release and recover from stiff and sore muscles well in advance of your trip. Epsom salt soaks, magnesium supplements, biofeedback, progressive relaxation, guided meditation, and yoga nidra are widely employed, with a lot of online resources to learn and master.
Myofascial release, kinesiology taping, knee and ankle bracing, and cramp release are incredibly useful and best practiced to perfection during the training period.
Pacing oneself and focusing on the entire of journey including the descent and equipping oneself with appropriately functioning equipment are paramount. Nothing stops you in your tracks like blisters from ill-fitting trekking shoes. Overworked and exhausted muscles can quickly fatigue during the equally grueling descent leading to injuries.
Utilize all of these strategies on your practice weekend getaway and incorporate them into daily training for several weeks leading up to your travel.
Did the chilly mountain air at 10,000 feet take your breath away and leave you gasping? It might not all be from the grand vistas and panoramic views, you may have bronchospasm triggered by the dry cold air combined with all the exertion. A condition that narrows the airways and is usually previously unrecognized at home altitude in many of us.
Imagine finding out about this on the other side of the planet, halfway through your once-in-a-lifetime trek. Identifying such deal breakers close to home allows for strategies to overcome almost all of them. For those with environmental allergies, it is imperative to research the local allergens. âKhumbu coughâ is an unwelcome souvenir that almost all the trekkers returning from EBC bring back home.
Ignore Chest Thumpers
Lastly, donât assume you are alone in your misery. Donât be intimidated by the overflowing adrenaline around you. Ladies, if you are in a coed group, donât let all that machismo and chest-thumping scare you. Those strutting around seemingly unaffected may be secretly suffering the most! Recognize your symptoms and confidently seek help. Know that everyone is sore, stiff, and physically strained in some kind of way.
Do not deprive yourself of life-saving treatments due to fear and hesitation about the potential side effects of prescription medicine. Whatever they may be, in the grand scheme of things, they are infinitely more innocuous than developing AMS, HAPE, or HACE! Do remember that steroids are magic life savers not just at sea level, but also up in the skies and everywhere in between!
Upon expertly equipping yourself, having gained physical prowess and mental fortitude, leisurely enjoy each step of the journey as if it is your last. Fill your lungs with the rarefied mountain air, capture the otherworldly beauty in your mindâs eye, and become one with nature. That is the real reward! Appreciate the SPACE each high-altitude trek offers and savor the experience. Slow and steady truly wins this race!
Conquer the mountains within, so your journey several kilometers above sea level is successful and as memorable as the mighty mountains you climb! A truly transformative Himalaya yatra for both the body and mind when done correctly.
Happy and healthy trekking and hope to cross trails with you in the future.
Suneetha Budampati, MD, aka Soni, lives in Great Falls, Virginia. She is a board-certified interventional spine and pain management doctor. An advocate for functional health and quality of life above all else, she encourages safe participation in outdoor activities and sports of all kinds. She is a certified scuba diver, licensed motorcyclist, and a high-altitude trekking enthusiast with a particular affinity for the Himalayas.