High Roads News Sticky , 2015

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LADAKHI INROADS :

Manali-Leh , April 22nd : Rohtang cleared up to Marhi , i.e. around 3000 meters .

Srinagar-Leh , April 18th : Zoji La cleared almost cleared now , from both sides. Borders Roads new goal to open within a week .Weather forecast coming days : mix of clouds , some more snow at the high end of the road, and later sunny .

NEPAL :
February 1st : heavy snowfall in Manang region , Jomosom airport closed.
No word on the Friendship Highway from Kathmandu to Lhasa.

PAKISTAN-XINJIANG/CHINA :

Khunjerab pass closed , opened last year in May.

SIKKIM-CHINA :

Nathu La closed for the winter.

HIMACHAL WEATHER ,
April 1st : more snowfall projected in the coming days
March 29th : ideal conditions for avalanches below the Rohtang La : recent snowfall near the top of the pass , turning in to sleet and rain lower down , and temperatures dancing just above and below the freezing point.
March 3rd : heavy snowfall in Manali , half meter at the Rothang La.
February 3rd : Kinnaur : heavy snowfall esp.at Sangla , also Kalpa , Rekong Peo etc along the the NH22/Hindustan Tibet road. One meter of snow at the Rohtang La.

Snowfall over Saach Pass January 13th

KASHMIR WEATHER ,
April 1st : Jammu-Srinagar road opens for one way traffic , schools to open tomorrow.
March 31st : Jhelum river in Srinagar receding in sunnier weather.
March 30th : snowfall all the way from the Zoji La down to Srinagar , more slides on the Jammu-Srinagar road.
March 28th : Jammu-Srinagar highway out again , in the “wettest March in one hundred years ” , according to Met Department . Jhelum river raising towards the danger mark.
March 7th : Srinagar-Jammu road cleared for one way traffic to Srinagar.
March 3rd : heavy snowfall takes out Jammu-Srinagar road and Srinagar airport.

February 2nd : heavy snowfall blocks Jammu-Srinagar road.
January 15th : First snowfall at Gulmarg , a few inches.

Jan 13th : Omar Abdullah “feels sorry” for skiers : Gulmarg slopes green , not white.

( All of 2014 – waiting in to May for fresh veggies in Leh , the flooding in Kashmir , and the late , late closure of Srinagar-Leh has been kicked in to oblivion. The photo comes from my Srinagar-Leh run in early December. Change on the way here , like a FGQ ( Frequently Gasped Questions ) and a timeline. )

Kathmandu Earthquake

Mounting death toll in the 7.8 earthquake , latest estimate around one thousand. Effects go way beyond the Kathmandu Valley , including eighteen dead climbers on Mt Everest . The epicenter of the second , smaller ( 6.6 ) quake close to the start of the Annapurna Circuit .

* Tribuhvan airport is out : first for repairs , and after that military aircrafts will have priority. Indian Air Force is sending in Hercules and C130 planes with rescue personell and supplies.

* Friendship Highway to Lhasa is out .

* no clear word on the Everest Base Camps , on both sides of the border. now would not be a good time.

Everest : The Hidden Story Behind The First Ascent

History. Change.

A few times it comes down to a few people . Or just one.

In 1993 a great anniversary reception was made , celebrating the first Everest ascent. All the expected persons were found on the stage , and given their due respect. And then the expedition doc Michael Ward touched a well hidden raw nerve , saying ( condensed version )

” we’ve been told that that we succeeded because of our outstanding British climbers , good leaders and strong organisation. Well , we had all of that on earlier expeditions , and we failed. Not once or twice , but eleven times. ”

He then named the final deciding factor in reaching the top : a better understanding of how the human body works , delivered by the physiologist Griffith Pugh , and taking the consequences from that .

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Pugh was what we’d today would call a boots and GoreTex doc, starting as a Army doc , training British soldiers in mountain warfare during WW2. Coming in to contact with the Everest effort he recognised that that climbers failed ( and ultimately often died ) from the same factors seen in the battlefield . They failed from being exhausted from dealing with cold conditions , and being starved on water , food and oxygen. Pugh then set out systematically to change all of that. He started with redesigning clothes : exchanging buttons for zippers. Introducing taffeta lining so that the anoraks would go down , and stay down , instead of hitching up from the backpack movement. New fabrics . Constructing new double walled tents , and having them tested first in wind tunnel labs , and then on the mountain. New sleeping bags that allowed turning in your sleep. The first inflatable ground pads for climbers.

Having dealt with cold , Pugh went on to food , and introduced the ration model we today still recognise not only from climbing expeditions but also from the International Space Station. One part very well calculated rations that will cover all the essential needs of the body – and one part personal favorites chosen by each member , the stuff that makes you want to go on.

Pughs first goal however was to end oxygen starvation , and making the climbers of the 50’s accept the use of oxygen was a long and bitter fight . It had already cost the first expedition leader his job , which didn’t mean that his successor Hunt was an enthusiast.

Climbers had two reasons for their resistance . One was tradition , seeing the use of oxygen as cheating. The other reason came from bad experience. The first oxygen rigs were basically bomb plane equipment ripped out from the cockpit , giving the flow rates that had proven to work well for pilots sitting in a chair. Climbers rightfully bitterly complained over the result : heavy equipment meaning more work with little relief from the extra oxygen. Lighter kits and more than double flow rates made a dramatic change , both in how climbers performed and in accepting the idea.

Having calculated and changing the rations of food and oxygen Pugh went on to the fluid rations. The British rations were extremely low , around a half liter per day. Pugh came up with what was called “copious ” drinking at that time. The problem came from the storm kitchens used at the time : Pugh introduced new kitchens and carrying enough fuel to smelt snow and ice efficiently.

This last part came to be the least understod of the changes Pugh introduced. It’s not even clear that Pugh made any connection between dehydration and altitude sickness – a common idea that many have tried to prove , with miserable results.

The fluid rations that took Hillary and Tenzing to the top …this is the part where many will start to guess wildly , starting from 5-6 liters per day . Actually it was 3-4 liters , and this is still the the recommendation from for example the Himalyan Rescue Association , after three decades of experience of running the Pheriche first aid clinic enroute to Everest. It also comes with a warning of the risks of binging on water. The Everest success led to a tradition of stressing fluid intake , taking it to another extreme. Today we know both that you can’t perform well on low, low water rations – and that the other extreme is at least as harmful : there are well documented deaths after extreme water intake , at all altitudes. This is slowly getting acknowledged despite the high water intake theory has been a pet project for a long time : last year British National Health Service finally gave up their recommendation that all visitors at any altitude , any degree of activity should drink almost the double ration of Hillary and Tenzing ( 4-6 liters ) , and halfheartedly replaced it with ” plenty of fluids”.

( This is lightly polished version of an evening talk at the SECMOL school , involving a bucket of water going round and nearly half being thrown out the door : ” this is not the Middle Way ” . A lot came from Pughs recently published biography , Everest – The First Ascent . State of the art on info fluid balance at altitude can be found in the evidence based guidelines from WMS at http://korta.nu/wem under ” other options” . )

BAI Award 2014 : Soroche Pills

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This years Bad Altitude Info Award goes to Crespal Labs in Peru , for their suggestion to medicate against altitude sickness at Macchu Pichu – which will be the lowest point reached by 99% of Andean tourists . MP peak is at 2400 meters , i.e. similar to cabin pressure on airplanes , and a thousand meters lower than Cusco. The hotels in Aguas Calientes are several hundred meters lower.

Soroche Pills are often described as a local product , with hints on herbal medicine : Incan tradition vs Bad Pharma . This pans out badly when you look at the components :

ASA , i.e. Aspirin
Caffeine
Salophene

Salophene , which has been discontinued on the rest of the planet for many decades , metabolises in to more ASA and paracetamol/acetaminophen. It was marketed by the German pharmaceutical firm. Bayer in the early 20th century.

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Later Bayer became the image of not only bad but Evil Pharma with another discontinued product : Zyklon B.

This years runner up for rubbish non-commercial info is the Norwegian independent drug info site Relis.no , intended as a guide for prescribing doctors. Their posts on AMS prevention ( høydesyke ) contains repeated mentions of up to five times higher acetazolamide doses than present guidelines – and points to an article from the Norwegian Medical Society journal as source , which says the opposite.

Worlds Highest Cable Car

Up , up and away : grand day out starting from Lijiang in Yunnan at 2400 meters , taking the cable car to 4506 meters , topped by stair excercises up to 4680.

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4506

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4680

This is the highest running cable car in the world at the moment : the Meridian cable car reached 4700+ meters , but stopped operating in 2008. Second highest would be the Lina Rioja down to La Paz from El Alto @ 4061 meters.

Honorable mentions below 4000 meters :
* the Quito TeleferiQo claims to go up to 3945 meters , starting from 3117 , which checks out on Google Earth
* the Gulmarg gondola makes two different claims on their official homepage : 3747 meters ( around thirty meters lower than the the Aiguille du Midi in Chamonix ) and 3979 meters . The later is clearly an exaggeration , Google Earth places it a few meters below the Quito Teleferiqo. A second level of exaggeration is often found on Indian websites , giving not the altitude of the cable car station but the top of the mountain , starting from 4200 meters.

* The Aiguille di Midi in the Mont Blanc massif at 3842 meters

* Yunnan holds another cabe car going from Kangding at 2600 meters , reaching .. have to check that with a GPS next time around.

Higher Learning , For Free

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High Altitude Medicine & Biology , the best perk of working at a university hospital , is running a short period of free online access right now. This is a gold mine for everyone who is interested in hard data based articles on high altitude physiology and  medicine :
* Horrendous fail rates on Kilimanjaro , way outside all guidelines in Prevalence of Acute Mountain Sickness among Finnish Trekkers on Mount Kilimanjaro, Tanzania  

* Report from the first run on the Beijing-Lhasa railway ( first train in world with onboard oxygen generators ) , and how effective this is in preventing altitude sickness

* The article the Finns , and everyone on fast , fixed itineraries should have read first : Altitude Preexposure Recommendations for Inducing Acclimatization

 

On top of this is there is a lot of medical history , with still highly relevant results. There is a whole issue dedicated to the 50 year anniversary of the Silver Hut expedition , still a benchmark in the effects of extreme acclimatization : five months spent at 5800 meters , followed by bringing down more physiological data from up to 7400 meters. Those who still believe that it’s essential to push large volumes of fluids will struggle with the fact that that Milledge and the other members managed well on around three liters of fluids per day , including climbing up to 7000+ meters.
One of the results of going thru this issue that I’ve just dived in to the man and explanation of why the Hillary/Tenzing ascent succeeded , after seven British fails in a row : Griffith Pugh , the picture perfect mad scientist and genius that that pushed a kicking and screaming climbing fraternity in to a physiological approach to climbing : using oxygen , planning nutrition, designing tents and more.

Gentiana , Snake Bladders & Sulphur : Bad Altitude Info Award 2013

Best contender so far  this year : the Tibet and Lhasa Health & Safety section on Lonely Planet , about the (perceived ) dangers of Diamox treatment : 

“the use (of) Diamox is controversial. It can reduce symtoms , but may also mask warning signs. Severe and fatal cases of AMS has occured in people taking this drug.”
The advice seems well researched at a first glance , correct doses are given and there are a number of sources at the end of the document.

It has a number of serious problems though , starting with
fake sources
LP lists a number of sources / suggested reading … which all are very solid , and all say the opposite of what LP claims .

*Pollards classic High  Altitude Medicine Handbook , a given in my backpack since many years : 

” there is no evidence ” that Diamox has a masking effect. Feeling better with Diamox comes from the increased ventilation made possible by Diamox.  

*Richard Dawoods Travellers Health. Dawood worked three seasons with The Himalyan Rescue Association clinic in Periche  and one one can safely assume he agrees with their position on Diamox/acetazolamide : “the most tried and tested drug both for altitude sickness treatment and prevention… unlike dexamethason this drug does not mask the symtoms but actually treats the problem” 

The main reason Dawood would agree on this is that he is the author  , the AMS section in his book and on the HRA site are identical…

*Pocket First Aid & Wilderness Medicine , by Duff and Gormly : ” Azetazolamide increases the breathing rate at altitude and speeds up the acclimatization process… Acetazolamide does not mask the onset of AMS , HAPE and HACE”

 

* Last but in no way least : CDC , which are responsible for the national health guidelines in the US. CDC has consistently pushed for better/wider acceptance of preventive medication with Diamox in their altitude advisory ( shortlink : http://korta.nu/cdcalt ) . This year they published a separate Cusco advisory . Cusco is lower than Lhasa , and wording is more direct now : everyone travelling to Cusco should be prepared to prevent or treat altitude sickness with Diamox. 

 

DEAD TREE DEPENDENCY 

Finding today anything written that can’t point to  a single online resource gives a weird 90’s feeling. And the resources have been out there for a looong time : the High Altitude Medicine Guide and the Himalyan Rescue Association sites were both up in ’95 , soon followed by the International Society for Mountain Medicine and CDC . Any  of these sites will for example point out that the most efficient medication is oxygen , which never comes up at LP. This could be an atavism going back to first printed Tibet LP guides , saying that the effect from oxygen is “mainly  psychological” (!)

TRADITIONAL , TIBETAN OR WESTERN

 

LP brings up a number of alternative medications. First up is Rhodiola , which is called a Tibetan herbal medicine. Reading this as a uniqe local tradition is definitely off the mark : Rhodiola grows over wide areas over the world  , including Russia , Sweden and China . The search for a  medical use of Rhodiola started in the classical  Greek period, re-surfaced with Carl von Linné and … Josef Stalin, the later being the main reason westerners today are aware of Rhodiola.  The fuzzy wording “recommended by locals” leaves no clue if this is to be seen as a part of the Tibetan medical tradition , or if this is a word on the street thing , like the infamous soroche.  pills in South America. 

The entusiasm for non-proven medication is not limited to Rhodiola : the proposed medication list also includes Gentiana against AMS , which will  baffle …, basically everyone , including doctors and herbalists. To top it off the litteral Snake oil cures comes up : the classic Chinese cure of dried snake gall bladders against pneumonia (!) is mentioned.

 

Extra points for bringing up “Sulphur allergy ” ( Sulphur is an essential trace element , used in the body) . The mixup here is with sulfonamides , where allergic reactions are  in no way is certain between the antibiotic sulfonamides ( “sulfa” ) and the non-antibiotic group , like one of the worlds most common prescription medications , the diuretic furosemide.