Acute Mountain Sickness and Importance of Acclimatization

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We all want to enjoy the lovely nature and breathtaking views of Himalayas. While going to Himalayas, many of us take the high altitudes very lightly and always consider the brighter side of it i.e majestic vistas :). However, there is a darker side attached to the high altitudes as well. How many times have you been to high altitudes and either you or people around you complained that shortness of breath, nausea, headaches or vomiting etc? I am sure you must have encounter such uncommon situations while in the Himalayas especially at the high altitudes like regions of Manali – Leh Highway, Leh – Ladakh, Rohtang Pass, Spiti Valley in India to name a few. To be very frank, some people suffer mildly and some may not suffer altogether; consider your self very lucky in such a case. However, some persons suffer drastically and the effects can be seriously ugly from them.

Illness or sickness on Himalayan trips is very common especially if you are directly flying or driving to a higher altitude which almost certain the chances. Such Illness can spoil a much awaited relaxing holiday into something ugly and in some cases may have severe consequences too. Higher you go directly, higher will be the risks. Hence, its always better to know what the altitude sickness means and what we can do to prevent it. Further in the article, I try to lay out some important theory and facts about the mountain sickness and acclimatization which may help you be prepared for altitude changes and enjoy that ever awaited holiday of yours :).

Acclimatization and Acute Mountain Sickness (AMS)

Altitude can be categorized into the following scales —

  • High (8,000 – 12,000 feet [2,438 – 3,658 meters])
  • Very High (12,000 – 18,000 feet [3,658 – 5,487 meters])
  • Extremely High (18,000+ feet [5,500+ meters])

Generally, people can go up to 8000 feet without much problems of mountain sickness. As you start to increase altitude, the barometric pressure starts to decrease which reduces the Oxygen intake per breath. Now, in order to compensate for the less Oxygen intake, your body need to increase the breathing rate. Although the increased breathing rate does increase the Oxygen level in the blood but it does not take the Oxygen level to the same level as required by the body while you are at home doing some activity. By spending proper amount of time at such altitude your body will adapt to such changes in Oxygen levels and this process is called as acclimatization.Always keep in mind that different people will acclimatize at different rates. Hence, always try to avoid any sought of comparison and wait for the person suffering in the group better acclimatize.

Acute mountain sickness (AMS) is caused above the altitudes of 10,000 Feet or 3,048 Mtrs to majority of people. Higher is the elevation and rate of ascent, more will be the effects of AMS. Hence, do not try to directly go or stay at very high altitudes directly. When you sleep, the symptoms will get worse as our body respiration decrease while sleeping.

The best cure is either to acclimatize properly or descend. However, effects of mild AMS can be cured by taking some preventive AMS medicines like headache pain relief or Diamox with proper consultation and prescription with your doctor or physician prior to the start of the trip. Diamox is a sulfa drug and does have side effects including allergies. Hence, Diamox shall only be taken after proper prescription by your doctor or physician. Diamox can also be helpful in case a person suffer from periodic loss of breath, which especially occurs in the night while sleeping.

Incase, you feel the personal is suffering badly then ask him to walk in a straight line by placing toe to toe. If the person is not able to walk in a straight line i.e. he is suffering with ataxia. IMMEDIATELY DESCEND!!

Tips for Better Acclimatization

Below are few tips that will certainly help you in better acclimatization:

Increase the altitude gradually

The acclimatization rules states that after 10,000 feet we must stay overnight for every 1000 feet or 305 Mtrs of elevation in order to properly acclimatize our body. This schedule in between shall allow a complete day acclimatization rest after 3000 feet or 915 Mtrs with overnight stay at the same altitude. If you can adjust your plan to this rule then perhaps you will not suffer with mountain sickness. However, the ground reality is only few people stick to this schedule especially in India where leaves are hard to find from their work life :lol:.

Keep your body properly hydrated

Do take plenty of intake of water with ORS or fluids like milk tea, juice, soup (garlic one will do wonders). If possible, take ORS soluted water or ORS – L tetra packs with you to replenish the lost nutrients immediately. Also, garlic flavored water ( keep garlic in water bottles) will help much more than drinking plain water which shall be avoided. This will help keep the oxygen level to normal in the body. You should avoid too much black tea or coffee as well…

AVOID over hydration because as quoted by vistet linked here(post #12):-
Forcing children to drink when they are not thirsty : at best they will vomit ( which will force you to descend ) , at worst they´ll start to develop cerebral edema – either only from water intoxication , or as a mixed result from this and altitude sickness. See for example Peter Hackett ( Everest-climbing doctor and co-author of the CDC altitude advisory ) on this : ” Too much water is harmful and can dilute your body’s sodium levels (hyponatremia) causing weakness, confusion, seizures, and coma.”

Avoid sleeping at high altitudes

As sleeping decrease the respiratory drive of our body, it is recommended that one shall hike to high altitudes in the day but should always come back to by the evening to sleep at lower altitude.

Avoid over exertion

Do not over exert your body with any unnecessary physical activity which may lead you pump more breath.

Avoid tobacco and smoking and alcohol and other depressant drugs

Avoid tobacco and smoking and alcohol and other depressant drugs including, barbiturates, tranquilizers, and sleeping pills. These depressants further decrease the respiratory drive during sleep resulting in a worsening of the symptoms.

Keep your body warm

Keep your body warm with woolens and do not let it cool. Make sure your clothes are always dry.

Eat lots of Carbohydrates

Eat a high carbohydrate diet (more than 70% of your calories from carbohydrates) while at altitude.

Avoid sleep during the day

Try not to sleep during the day and keep yourself involved in some light activity during the day. Respiration decreases during sleep which further exacerbate the symptoms.

Sleep in upright position, if possible

Try to lay down or sleep by resting your back against the wall. If you cannot sleep in such mode then do not flatten your head on the bed rather place a bag below your head and then one or two pillows and then sleep in such a posture. It will help you keep your head much lighter.

Carry preventive medicines for AMS

Do take preventive AMS medicines along with you on the trip but only after consultation with your doctor or physician because the AMS medicines may lead to some side effects too. If you are not sure about any allergy with these medicines then try them one or two week before you plan the trip. Check to see if there are any allergic effects and decide.

Carry Small Oxygen Kit

If possible, you may also carry a oxygen cylinder to counter the AMS symptoms. It will certainly help as a supplement but do take proper consultation from your doctor for the intake amount of oxygen, before the trip.  Oxygen intake will help you incase of any emergency and will spare you more time to descend to lower altitudes as soon as possible.

A note from the pioneer, Vistet linked here at post #12: on oxygen cylinders:
Small tanks of even medical grade oxygen provides a false sense of security : they will at extreme best last for an hour or two. For the value of cheap , portable oxygen solutions see here, # 5 and #7 check here

Immediately descend, if symptoms increase

Last but not the least, if the AMS symptoms start to increase then you should consider immediate descend. This is the only cure in some conditions when the symptoms have reached moderate levels and are not decreasing.

Symptoms of Acute Mountain Sickness (AMS)

Below is the categorization of symptoms for different levels of Acute Mountain Sickness (AMS) along with indicative cure for it…

AMS Symptoms

AMS Level

Possible Cure

Headache, dizziness, fatigue, shortness of breath, loss of appetite, nausea, disturbed sleep, and a general feeling of malaise

Mild

Medication or Descend
Decreased coordination (ataxia), Severe headache (not relieved by medicine), other mild level symptoms with increased affect

Moderate

Advanced Medication or Descend  about 305-610 Mtrs
Inability to walk, decreasing mental status, and fluid build-up in the lungs

Severe

Immediate Descend about 610-1,220 Mtrs

Taking baby or kid to high altitude?

Many a times when you want to travel to high altitudes, you may likely to worry for your kid or baby or infant. Well, personally I suggest you travel with kid or infant atleast 12 months old. However, studies suggest its safe to travel with an infant more than 3 months old IFF he/she is not born prematurely or do not suffer from any illness. NEVER travel with a baby less than 3 months old While the above tips are helpful for kids or babies above 3 months old as well but there are other tips which need special attention for traveling with Kids and babies. I have tried to cover the details for traveling with babies or kids in the link below: Traveling to High Altitude with Kids or Babies

Thanks to Ram Kris for this awesome FAQs on AMS and Acclimatization

References

If you need more detailed information about Acute Mountain Sickness, then you may read the following links as well…

Please share your valuable comments on acclimatization and acute mountain sickness or if you like the article and it could be of some help for you too.

Having said all that, it is still recommended that you CONSULT A DOCTOR or PHYSICIAN before you make a trip to a high altitude region just to ensure everything is in right place. Again, these are just my suggestions based on my very limited or negligible knowledge of AMS or mountain sickness but I will definitely suggest you that you consult some physician or doctor before going on the trip because I am not any of them. For more details on the same you MUST READ the links mentioned in the references which explains it in better details

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199 Comments

  1. mamatha n on

    Hi Dheeraj,

    I am travelling by air to Leh this October 9th. What would be the expected minimum temperature that time? I get frequent colds because of sinusitis and I am worried it might worsen. I am also concerned about AMS. Let me know precautions and what I should be prepared with before travel?

    • Regarding AMS, I have explained in the article above and the tips you can follow over it. It will surely be cold up there and hence you need to go prepared with heavy woollens. Nights will be sub zero.

  2. Hi dheeraj,
    we are 3 planning to travel from srinagar on 4th sept to leh then manali.we have to reach manali by 11th sept.please plan our journey.we are from kerala.waiting for your valuable reply.

  3. Hi Dheeraj,
    I Will be visiting Leh-Nubra-Pangong in the next few days and have all the hotels booked but confused how to book the taxi. Can you pls suggest good taxi agents/driver contact details or one of your articles link on it ?
    Thanks

    • Pranay, for the leh – ladakh taxi union rate list 2016 – 17 including the contacts of some reliable taxi drivers within Leh – Ladakh, check the link here. You can get about 12-15% of discount by directly getting in touch with drivers and of course, talking in person rather on phone always help in bargaining more.

  4. AMS is NOT going to hit You! I traveled to Kaza last month and was psychologically inclined to fall sick due to AMS. I kept on thinking, I am unable to breathe and literally to get enough oxygen, I deliberately increased my breathing rate. Immediately, I was rushed to the hospital in Kaza , after my repeated complaints of being breathless.

    My oxygen level as checked was absolutely normal, if not better than normal. But due to excessive breathing and psychological inclination to believe that I was breathless, my blood pressure had shot up.

    The doctor immediately asked me if I had read about altitude sickness on Internet and whether I also had Diamox. The majority of cases, he received were due to READING about AMS online and the psychological effect. They weren’t really AMS cases.

    While thie above knowledge is good to have, I feel, the best is to simply enjoy the trip and the pollution-free freshness at altitudes and just completely forget about AMS.

    You are going to feel a little restless. Accept it! Nothing wrong with that. Short of breath is also Ok. Vomitting is Not OK; and, Severe headache is not Ok. Slight headache is Ok.

    My partner who was travelling with me was smoking cigarettes like a chimney in Kaza and he never took AMS seriously and he was completely fine.

    • Good to read it Chintan the insights from the doctor but that does not mean at all that one should not be worry about it. The whole reason which gave birth to Devil On Wheels was to spread practical information people for traveling to high altitude places which people lacks. Believe me, I have seen people vomit blood and have myself been to be admitted into hospital in Padum to save my life. When it hits, believe me, it looks like worst nightmare and biggest lesson if you survive it. I have done countless trips to high altitude places in last 7 years now and even I dont guarantee myself that I wont get hit again. So, to know about it and how to react is definitely worth to know than dying without knowing the reason why you did die. It is foolish to copy someone smoking cigarettes like chimney in high altitude and consider that it is OK. Even doctors can’t predict who gets hit with AMS and when. Some does cope with it well, some does fair job, some does not but comes alive like me and some die.

      The article is not to scare people or make them psychologically ill of AMS rather it will help you mitigate the chances of getting hit with AMS. People die every year of AMS while traveling to high altitude places.

      • Hi Dheeraj, Thanks for your reply. What you have provided in your article is real wealth of information and there is no question about its truthfulness. It is an amazing resource on AMS, however, I do feel, somewhere if you could have a section on “Psychological AMS”, it will help many travelers. Trust me, not only the doctor, the owner of the hotel where I stayed, he, too, commented in sarcasm, “I don’t know why but People want to fall sick here”.

        • Sure Chintan, I will add a paragraph about why not to take too much mental pressure about AMS and when to be really concerned & when not. Thanks again for highlighting it.

  5. Hi Dheeraj ,

    Thank You for the great work you are doing. It is helping us a lot.

    We are group of 14 people travelling to Leh . Below is the Itinerary that we are planning as of now .

    Day 1 : Chandigarh – Manali
    Day 2: Manali – Jispa
    Day 3: Jispa – Tsu Kar
    Day 4: Tsu kar – Tso Moriri – Leh
    Day 5: Leh Local Sightseeing
    Day 6: Leh to Pangong
    Day 7: Pangong To Leh
    Day 8 : Leh to Nubra
    Day 9 : Nubra to Leh
    Day 10 : Departure from Leh Airport.

    Do you think this plan is feasible and also let us know your recommendation ? What about AMS factor for the above route ?

  6. Hemant Saini on

    hello deeraj,

    we are 4 persons & planning for leh ladakh tour and plan is like that

    7th Aug chandigrah to manali(night stay)
    8th manali to jispa or sarchu(night stay)
    9th sarchu to leh(nightstay)
    10th leh to nubra leh(stay at leh)
    11th leh to pangong (night stay )
    12th Pangong to Tso moriri (night stay)
    13th Tso Moriri to Tso Kar to leh(night stay)
    14th Leh to Kargil(night stay)
    15th Kargil to srinagar(night stay)
    17th Flight out

    I have one day extra

    so pl. tell me is this plan ok..? or need some changes, if so guide me.
    also if you can suggest for accommodation at pangong & Tso moriri

    • Hi Hemant,

      You should plan it like below with one day extra:

      7th Aug chandigrah to manali(night stay)
      8th manali to jispa
      9th Jispa to Leh
      10th leh rest day
      11th leh to Nubra Valley
      12th Nubra Valley – Leh
      13th Leh – Pangong Tso
      – Extra day as Pangong Tso to Leh and then follow below
      14th Leh to Kargil(night stay)
      15th Kargil to srinagar(night stay)
      17th Flight out

  7. KARAN TALUJA on

    Hello Dheeraj

    I am travelling to Leh via Manali this weekend with my wife and a cousin . My Itenary is as following : –

    24 june ( friday ) – leave panipat/ Delhi late night
    25 june ( saturday ) – reach manali by 12-1 pm
    26 june ( sunday ) – leave manali early morning for jispa , reach jispa be eve ( IBEX OR PADMA )
    27 june ( monday ) – leave jispa early morning for leh , reach leh by eve .
    28 june ( tuesday ) – leh local sight seeing
    29 june ( wednesday ) – leh to nearby 1 day trip ( Bike Tour )
    30 june ( thursday ) – leh to nearby 1 day trips ( Bike Tour )
    01 july ( Friday ) – leh – khardunglan- leh ( Bike )
    02 july ( saturday ) – leh to pangong lake
    03 july ( sunday ) – pangong to tso morori
    04 july ( monday ) – tso morrori – manali
    05 july ( tuesday ) – manali – panipat
    06 july ( wednesday ) – extra day

    I HAVE ARRANGED PERMIT TO CROSS ROHTANG THROUGH A FRIEND IN MANALI , HE WILL GET THE PERMIT ON
    FRIDAY SO THAT WE CAN CROSS ROHTANG ON SUNDAY .

    HAVE BOOKED HOTEL REENAM IN LEH FOR 27 and 28 , HOTEL OMASILA FOR 29 and 30 .

    PLEASE SUGGEST HOTELS NEAR PANGONG AND TSO MORIRI . ALSO PLEASE SUGGEST HOW TO COVER HANLE .

  8. Abhinav Chauhan on

    Hi Dheeraj

    First up, thanks for an amazing write. Wish i had read this before my first ride as well:)

    Now, I do have a query as well – I understand the skepticism and concerns related with doing TsoMoriri enroute to Leh when coming from Manali. But, is it totally non-doable? Or are their ways, we can still accomplish it, probably stay a day extra at a halt on Manali-Leh highway to get acclimatized, or break up the ascents? A friend suggested staying additional day at Sarchu, however, i think Sarchu is almost at the same altitude as Tso Moriri and dont really think that should aid much. Help a brother out. Thanks!

    • You should not do Tso Moriri while going from Manali to Leh because you will not be acclimatized to sleep at such high altitude so early in the trip and may cause some ugly AMS issues for you. Highly not recommended, because any help if required will be very hard to find in case you get hit with AMS.

      • I am planning to travel to chandrataal around 20th June with parents.

        I want to do night stay in chandrataal becoz of high altitude. So is it possible to stay at some low altitude, start early morning and come back.

        The best solution i found out a stay in sissu. The height is 10000ft. and also 80 kms from Kunzum pas.

        If we start at 6 am in morning from sissu, we can reach chandrataal by 11 am and can leave at 3 pm to reach sissu by 7 pm. Is this feasible?

        • Hi Rahul,

          Both Sissu and Khoksar are the good options to stay before sleeping over at Chandratal. Since, the altitude is too high for Chandratal, you can never be acclimatized 100% to deal with it unless you travel from Shimla side and spend some days in Spiti.

  9. Hi Dheeraj,

    Let me be specific about my question rather explaining the whole plan for the trip.

    Manali – Leh – Srinagar

    Am leaving Manali by 5th June Morning and need to catch flight @ Srinagar on 12th June (2.40pm)

    Considering the travel from Manali to Leh & Leh to Srinagar, I will have to stay @ sarchu and kargil.

    The time ll be @ Leh would be from 6th Noon till 9th Night.
    But, I want to cover Pangong, Nubra and Lamayaru.

    What do u suggest ?

  10. Hi Dheeraj,

    Let me be specific about my question rather explaining the whole plan for the trip.

    Manali – Leh – Srinagar

    Am leaving Manali by 5th June Morning and need to catch flight @ Srinagar on 12th June (2.40pm)

    Considering the travel manali to Leh to and o Leh to Srinagar, I will have to stay @ sarchu and kargil.

    Thus I consider the time from 6th Noon till 9th Night @ Leh.
    But, I want to cover Pangong, Number and Lamayaru.

    What do u suggest ?

  11. Ankita shah on

    Hi, Dheeraj!
    I am Ankita and I am travelling with 3 of my friends to Leh. We are all 25. We will be leaving on 2nd June and the trip commences on 12 June.
    We are from Mumbai. We are taking a flight from Mumbai to Srinagar, followed by a road trip to Leh.
    Out itenary is as follows;
    1. Srinagar to sonemarg. Stay sonemarg
    2. Sonemarg to lemayuru. Stay Lemayuru
    3. Lemayuru to Leh. Stay Leh
    4. Leh acclimatisation
    5. Leh to Nubra. Stay hunder
    6. Hunder to Leh. Stay Leh
    7. Leh to pangong. Stay pangong
    8. Pangong to leh. Stay Leh
    9. Leh to Kargil. Stay Kargil
    10. Kargil to Srinagar. Stay Srinagar
    11. Fly out
    Please let me know if this itenary is relaxed and convenient. Also, I have been reading way too many articles on AMS and I am getting increasingly worried about it. None of us have been on an adventurous trip before this and never to this altitude. The amount of articles that I’ve been reading only state that it’s kind of scary. Just want to know if it’s actually that scary, and whether out itenary is good enough for us to comfortably enjoy the ascend. If there’s anything I need to change please do let me know. Also, please tell me it’s going to be fun cause now I’m only super worried about the altitude sickness.
    Thank you so much!

  12. Robin Bansal on

    hello sharma ji
    my father is 50 yrs old nd me 25 yrs
    we r going for amarnath yarta nd aftr that we”ll travel to leh ladak.plz plan a journey for us .its 27th yatra of my father nd mine is 7th.we r traveling by our own Alto.pls give ur suggestions.

  13. Robin Bansal on

    Hello Sharma ji
    Me nd Father in s going to Shri Amarnath Yatra.My father is going from last 26 yrs nd me started In 2010. This year we r going to Leh ladak By our on Alto. plz help me to make our tour by excellent Plaining.
    My father is 50 yrs old nd m 25. plz give ur suggestions.

  14. Thanks Dheeraj,

    Lot of information here. I am flying last week of June 2016 from delhi to Srinagar and then taking innova via Kargil Route to reach Leh-Nubra-Leh-Pangong-Leh-Tsomoriri-Serchu-Manali in order of visit day by day. Please advice if this is fine or do I need to tweak it a bit. Also, need your advise on,

    1. What all important stuff we need to carry for trip?
    2. My wife has very very mild asthma so planning to carry portable oxygen tank. Is it allowed on the flight?

    Thanks

  15. Sanjay Singh on

    Hi Dheeraj

    Tremendous effort by you & your team. Well done.
    I have a q.
    I am flying to Leh on0 3 May 16.
    Staying put on 3&4th May.
    Planning an overnight at Pangong on 06th May 16.
    Will it be okay?
    Regards

    Sanjay

    • Hi Dheeraj ,
      we are going to leh in june. we did not find any accomodation near tsomoriri . can you please help me out .

      • You can check the nice, preferred list of accommodation options in entire Leh – Ladakh (Leh, Nubra Valley, Pangong Tso, Tso Moriri) including moderate (cheap budget hotels as well) in the series of articles starting on the link here

  16. indrajit sanyal on

    sir
    I am reaching leh by flight on 10th Oct’16 & leaving leh by flight on 20th Oct’16 morning.
    we are 3,myself 48yrs my daughter 15yrs & my wife 47yrs. please suggest a programme and also teĺl me if the flights are cancelled frequently in this time at leh.
    regards.

    • Hello Indrajit ji,

      Ocotober is quite cold in Ladakh with lakes very cold especially at night and most of the hotels shutdown and restaurants closed. Can you make some other time up to September?

      • Indrajit Sanyal on

        Hello Dheeraj ji,
        Due to my daughters examination and my office I could not manage in that time. This the only time i can manage. I have visited ladakh in august earlier. this time i want to go and stay at Turtuk and Nubra for 3 days. and also in tso morriri and pangong if possible. please suggest.
        Thank you

        • I can only suggest, final call is yours. Nubra Valley is still fine but for Pangong Tso and Tso Moriri you will have to stay at Tangtse (34 KMs before Pangong tso) and Chumathang (about 85 KMs before Tso Moriri)

  17. Hi Dheeraj,

    We are planning to go from Manali to Leh to Manali on bikes. Here are the small details –
    Manali – Jispa – Pang – Leh – Pangong – Leh – Sarchu – Manali.
    On 25th Jun we will start. How will be the climatic condition at all these places? Will there be rain during travel period as we are starting towards the end of Jun? Is this the right plan?

    • PK, PLEASE do not stay at Pang while going to Leh as your body will not be acclimatized to sleep at that height while going to Leh. Also, I see there is no rest day in Leh and no visit to Nubra Valley. How many days do you have?

      • Thanks Dheeraj. We have one day to rest in Leh. ya… we r not covering nubra valley. our tour organizer has set it tHis way….first daystay at Manali. Next day Jispa. 3 day Pang 4 day Leh 5 day Leh n around 6th day pangong 7 day back to Leh 8 day Sarchu 9 day Manali

        • I will drop Pang from the plan and reach Leh directly as there is always a high chance of getting stuck with AMS in Pang or Sarchu while going to Leh from Manali. I will move Day 5 as Leh rest to Day 4. Day 5,6 I will make two day trip to Nubra Valley. Day 7 I will make one day trip to Pangong Tso and then I will start back to Sarchu on Day 8. OR I will stay at Pangong Tso and leave at 5 AM from Pangong Tso for Sarchu or Pang on Day 8

  18. Hi Dheeraj,

    Thanks for an excellent blog. It’s been a go-to site for me as we planned our Ladakh trip in June. We’ll be driving to Leh from Srinagar with a night halt at Kargil. We’ll reach Leh on Day 3 and leave for Pangong on Day 8 (with a full day of acclimatisation and trips to Nubra and Lamayuru in between). Given that Pangong is the highlight of our trip, we are planning to spend two nights at Pangong. Just wanted to check with you if altitude sickness will be a problem if we stay for two nights. What precautions can we take for that?

    • KK, not really, you should be acclimatized by then to the altitude and should not have much problem. Unless there is too much of a problem staying at Pangong Tso on first night, there isn’t much issue staying next night too. Keep your body hydrated well always.

  19. I want to share my experience with AMS prevention medicine called “Diamox”.
    When browsing on the internet i found multiple articles mentioning the use of Diamox for AMS preventition and hence i thought to use that during my trip to avoid any discomfort.
    Than i came across this article which mentions about the side effects of this medicine,since i never had reaction to any medicines in the past i took it casually.
    Two days before leaving for my trip i had an i feeling that i should atleast try this medicine once so i consumed one tablet and nothing happened for 2 days,on the morning of the my journey day i started some skin allergies with lot of itching.
    I was not sure that is because of medicine or something else and given the fact i won’t get adequate medical services once start from manali i got scared.
    Luckily i had a stop at chandigarh before continuing to Manali,i visited a skin doctor there and she confirmed it is because of medicine and prescribed me few more medications which helped me get cured in 2 days.

    In nutshell, i have described this incident in detail because i feel many of us think the same way and take medicines without considering much and when you are on a adventurous trip like Manali-Leh we should take all precautions.

    • Thanks a lot Rohit, this will surely help many. I wonder how a sulfa drug like this is being mentioned all over the internet in many article even I have read without any warning or issues related to it which can cause allergies. Great to know that all went well for you as you had a presence of mind to get it worked out else it could have been a nightmare trip with bare minimum medical facilities along the way. Thanks again for sharing it.

  20. Hi Dheeraj,

    Need your expert advice.. My father-in-law would be visiting kaza n spiti in the month of October (beginning). he is 70 years old n going in a group which would have 3 kids aging 10/ 3/3. Should they be carrying an oxygen cylinder with them…. is it required? If so, would it be available enroute Shimla ?? Whom can we contact in that case ? also please brief me as to what SHOULD BE THE STRENGTH OF THE CYLINDER REQUIRED IN CASE OF AN EMERGENCY??

    • Hi Juhi,

      It depends on person to person to take the children of such age group because AMS do not matter with respect to age or sex or any fitness level. It can happen to anyone of any age or sex or fitness I shall say :D… The issue with children is that they tend to exert the body considering it the same kind of place they belong to and this elevates the chances of getting struck with AMS. Secondly, they are not much expressive about their uneasy feelings, so it is parents who need to watch out and take care that the child is not suffering from uneasy feelings, headache or nausea and is behaving properly. With less than 3 year child, I think he/she will also be NOT able to convey the uneasiness she may feel. You have to be vigilant and if you notice any such feeling or he/she tells you about such a feeling then please do not ascend anywhere, either descend to lower altitude or stay at the same place to watch things overnight and if symptom increase then start descending immediately. Same is applicable for any adult as well. And yes, do keep the body adequately hydrated!!

      Best is that you guys carry a 2.5-3 Ltrs oxygen cylinder with you to help in case required. However, going by Shimla side will help everyone to be acclimatized but it will be great if you can carry it. Not sure if you will find it in Shimla.

  21. Hi Dheeraj !!!
    Quite useful article. My bro was planning to go to Leh-Ladakh via Srinagar route by road taking a halt at Kargil. The plan is to complete the journey in 10-11 days. He had these panic attacks (epileptic seizures) few months ago and currently its all under control. Will it be advisable for him to be a part of the trip to Leh/Ladakh considering the AMS and low oxygen levels. Also should we be consulting our family doctor before he goes.

    Kindly advise.

    Cheers!
    Viv

    • Viv, please consult a doctor because I do not know AMS impacts to panic attacks he had and if it is safe at all to under take this journey or not. Pleasse consult a doctor.

    • Hi viv,

      I want to know if ur brother visited leh and how was his trip? Was he comfortable there? M asking because m also a anxiety sufferer and want to enjoy leh views but m afraid of all these silly symptoms of panic like fast heart rate etc. thanx in adv.. Hope u reply..

  22. amrit nandra on

    Hi bro thnx for making dow, ur doing suprb jo,, acctly we 4 are plannig a trip On this 14th to kazza through shimla route, and thinking of coming back through kunzum., manali route, is it the right tim. To go? I mean kunzum pass rought is open or not? And cn we go by verna car?

  23. Abhijit Ghosh on

    Hi Dheeraj
    First of all many thanks for maintaining such a wonderful website which is helping all of us. We (family of three) are visiting Ladakh for 5 nights from 12th June to 16th June; and we have taken a package through Yatra. Please see the itinerary –
    1. Arrival at Leh from Delhi by flight on 12th Morning. Transfer to hotel; full day rest and acclimatize
    2. Full day sight seeing at Leh; return to hotel for overnight stay.
    3. Leh to Nubra via Khardung-la; Hunder Monastery, Sand dunes, Camel safari; overnight stay at Nubra.
    4. Nubra to Leh via Diksit; reach Leh by afternoon for overnight stay.
    5. Leh to Pangong via Changla Pass and back to Leh for overnight stay
    5. Leave Leh for Delhi on 17th morning

    Please let me know your opinion on this itinerary. Also please share your knowledge on such package tours.
    I am a bit worried regarding AMS since my wife has high BP (however she is presently fine with medication). As per package rule they will provide one oxygen cylinder per group (I think group here means maybe 7-10 people) Is there a need for me to carry a oxygen cylinder? I am not sure where and how to buy one….please suggest. If you can provide any other health related tips (I have read the page regarding AMS on this website) Also I am worried if Vodafone mobile connection will work there….if not then what is the solution…

    Any other general advice would be welcome.

    Regards

    Abhijit

    • 5 days are a bit less a time to visit Ladakh. Given the days plan looks OK. No idea about group but in Leh oxygen cylinders are available on rent. Only postpaid connection work over there where BSNL provide the maximum coverage.

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  25. Sandesh Satam on

    Hello Dheeraj,

    I am planning to visit Valley of Flowers, Uttarakhand in the month of Sept,

    Detailed Itinerary from Haridwar to Valley of Flowers and back to Haridwar.

    Day 0
    Saturday 29th of August 2015
    Reporting at Haridwar

    Day 1
    Sunday 30th of August 2015
    Haridwar to Govindghat.
    Distance 300 Kilometers,

    Day 2
    Monday 31st of August 2015
    Govindghat and Ghangaria.

    Day 3
    Tuesday 1st of September 2015
    Ghangaria to Valley of Flowers to Ghangaria.
    Distance 12 Kilometers (6 kilometers one side)

    Day 4
    Wednesday 2nd of September 2015
    Ghangaria to Valley of Flowers to Ghangaria.
    Distance 18 Kilometers (9kilometers one side),

    Day 5
    Thursday 3rd of September 2015
    Ghangaria to Hemkund Sahib to Ghangaria.
    Distance 12 Kilometers (6 kilometers one side),
    Time 8-9 Hours by trekking.

    Day 6
    Friday 4th of September 2015
    Ghangaria to Govindghat to Badrinath to Mana and back to Govindghat.
    Distance 20+20 Kilometers by Road and 13 Kilometers by trek,
    Two hours by road and 6-7 Hours by trekking.

    Day 7
    Saturday 5th of September 2015
    Govindghat to Haridwar
    Distance 300 Kilometers,
    Time 10-12 Hours by road
    Altitude loss (From 5500 ft to 1100 ft)

    I like to know about chances of AMS and what kind of precautions I should follow.

    Thanks!
    ~Sandesh

  26. Hi Dheeraj,
    I am planning trip to Srinagar – Leh – Manali (thanks to your guidance that its best to travel via Srinagar)
    Dates: 28th August to 8th Sept (12 days trip)
    below are the trip details, I want to know the chances of AMS for normal people and a senior citizen

    Day 0 (28th August) – Arrive at Srinagar and spend the day resting or local site seeing

    Day 1 (29th August): Srinagar – Sonamarg – Zojila Pass – Drass – Kargil
    Visit: Great vistas of Drass Valley with views of Tiger Hill, Kargil War Memorial
    • Enjoy the vistas en-route especially the lush green Minamarg Meadows
    • Have late brunch meal at Drass
    • Overnight stay at Kargil

    Day 2 (30th August) : Kargil – Lamayuru – Leh
    Visit: Rock Carved Mulbekh Maitrey, Lamayuru Monastery, Lunar Landscapes
    • Hit the roads by 6:00 AM
    • On the way to Leh you can also see Gurudwara Pather Sahib, Magnetic Hills, Confluence at Nimmu
    • Overnight at Leh

    Day 3 (31st August) : Leh Local
    Visit: Leh Main Market, Leh Palace or just rest
    Stay @ Leh

    Day 4 (1st September) : Leh – Khardung La – Diskit
    Visit: Khardung la , highest motorable road (as claimed), Diskit Monastery, which has 106 Feet tall Buddha statue, Go for Camel Safari over Hunder Sand Dunes in the evening
    • Hit the roads by 6.30 AM
    • Head for Nubra Valley and stay overnight at Hunder / Diskit
    • On the way enjoy a cup of Tea at Highest Motorable Pass (as claimed) Khardung La
    • Diskit has monasteries with tallest lord Buddha statue
    • Hunder has sand dunes and double humped bacterian camel safari

    Day 5 (2nd September) : Diskit – Sumur – Panamik – Sumur – Khardung La – Leh
    Visit: Hot water springs @ Panamik
    • Hit the roads by 6.30 AM
    • Overnight at Leh

    Day 6 (3rd September) : Leh – Hemis Monastery – Chang La Pass – Pangong Tso Lake
    Visit: Hemis Monastery,
    Pangong Tso: One of the largest salt water lakes in the world which is 1/3rd in India and rest in Tibet
    • Hit the roads by 6.00 AM
    • Witness the the largest monastic institution in Ladakh – Hemis Monastery
    • Dash for a day trip to Pangong Tso to experience the blue hues
    • Overnight at Pangong Tso

    Day 7 (4th September) : Pangong Tso Lake – Thicksey Monastery – Shey Palace – Leh
    Visit: Shey Palace, Thicksey Monastery,
    Pangong Tso: One of the largest salt water lakes in the world which is 1/3rd in India and rest in Tibet
    • Wakeup witnessing the beauty of Pangong Tso lake
    • Travel to Thicksey Monastery and Shey Palace
    • Back to Leh

    Day 8 (5th September): Leh – Tso Moriri via Chumathang
    Visit: Kiagar Tso, a small lake on the way to Tso Moriri,
    Tso Moriri , high altitude salt water lake changes colors many times a day
    • Hit the roads by 6.00 AM
    • Kiagar Tso, a small lake on the way to Tso Moriri,
    • Cover Korzok Monastery and Hot springs at Chumathang
    • Explore Something Unexplored at Tso Moriri or Rest before the next long day
    • Overnight at Tso Moriri

    Day 9 (6th September) : Tso Moriri – Tso Kar – Moore Plains – Sarchu – Jispa
    Visit (en route): Tso Kar, Moore Plains, Pang, Lachulung la @ 16616 ft, Nakee la @ 15547 ft, Gata Loops
    • Early morning we leave from Tso Moriri for TsoKar

    Day 10 (7th September) : Jispa – Manali
    Visit (en route): Rohtang Pass @ 13,054 ft
    Travel time: 5-6 hrs odd
    Stay @ Manali at 6,730 ft

    Day 11 (8th September) : checkout from Hotel and tour ends.

    is this good? let me know if i need to make any changes in the trip plan

  27. Devdatt Pandya on

    Hi Dhiraj,
    First of all many congratulations for DOW, you are doing a super job.

    We are travelling to Leh-Ladakh from 4th June to 11th June. On our 7th day we are visiting Pangong Lake.

    As per our itinerary its a DAY Excursion. I wish to spend a night at Pangong Lake, Please let me know how safe is it ? (from the weather point of view)

    Thanks
    Devdatt

    • Devdatt, are you talking about 7th June or 7th day that is 10th June? If 10th June, then it shall be OK to spend night at Pangong Tso. But, take a call if you all were able to sleep well in all previous 3-4 nights. Weather will be cold at night though.

  28. hi dheeraj
    firstly let me say u r doing a wonderful thing by sharing all ur inputs…wanted ur guidance….m planning a 15 to 20 day trip to leh via manali route from jalandhar n coming back via srinagar route in june…with my 6 yr old kiddo…have been to leh six yrs back via sri nagar route…so wanted to explore the other end..!
    could u please guide me as to where we should stop in route via manali for better acclamatization for my kiddo(who is going fr d first time)….
    thanks a ton

    • Navneet, Firstly, I will suggest you that please plan it in other direction as going via Srinagar – Leh Highway will be much much easier on your body and help you acclimatize to the high altitude of Manali – Leh Highway. Also, it allows you to enjoy the beauty of Manali – Leh by splitting the journey almost evenly in two days which is very difficult in the other direction. Thirdly, it will allow you to fit Tso Moriri lake into the itinerary in better way. You can read more reasons on the link here

      You will still be exploring the other end as well but with ease and less chances of getting hit with AMS. You can check a 15-20 day travel plan for Ladakh + Zanskar as below. To make it more relaxing, you can remove the Zanskar (Day 4 to Day 7)

      Day 1 | Delhi – Jammu / Patnitop
      — Overnight at Jammu or Patnitop

      Day 2 | Jammu / Patnitop – Srinagar
      — Enjoy walk around Dal lake and may be Shikara ride as well
      — If you have time then check out, floating market, Shalimar Garden.
      — Overnight at Srinagar

      Day 3 | Sonamarg – Zozi La – Drass – Kargil
      — Enjoy the vistas enroute
      — Have late drunch meal at Drass is you are a vegetarian as sometimes it gets difficult to find veg. food at Kargil
      — Overnight at Kargil

      Day 4 | Kargil – Padum (Zanskar Valley)
      — Head straight to Padum

      Day 5 | Padum Local Sightseeing
      — Enjoy Zangla, Stongde, Karsha

      Day 6 | Padum – Zongkhul Monastery – Penzi La Pass – Rangdum
      — Start back and stay at Rangdum

      Day 7 | Rangdum – Panikhar – Sankoo – Kargil
      — Checkout rock carved statue at Khartse Khar

      Day 8 | Kargil – Lamayuru – Leh
      — Cover Mulbekh Maitrey, Lamayuru Moanstery, Lunar Landscapes
      — On the way you can also see Gurudwara Pather Sahib, Magnetic Hills, Confluence at Nimmu
      — Overnight at Leh

      Day 9 | Leh Local Sightseeing + Inner Line Permits
      — To know the about the places to visit check the link: Travel Guide for Local Sightseeing of Leh Town in Ladakh
      — For more details on inner line permits process and to download application form read the link here
      — Overnight at Leh

      Day 10 | Leh – Khardung La – Diskit – Hunder – Turtuk
      — Head for Nubra Valley and stay overnight at Turtuk
      — On the way enjoy a cup of soup at Highest Motorable Pass (as claimed) Khardung La
      — enjoy the culture in the Turtuk Village
      — do mention Turtuk on the permits

      Day 11 | Turtuk – Hunder
      — Spend whole day at Turtuk and reach Hunder by evening
      — Overnight at Hunder

      Day 12 | Hunder – Deskit – Sumur – Panamik – Sumur – Khardung La – Leh
      — Diskit has monasteries with tallest lord Buddha statue and Hunder has sand dunes and bacterian camel safari
      — Enjoy drive upto Panamik, visit Yarab Tso Lake and back Leh
      — Sumur has a famous monastery to check out and Panamik has hot water springs
      — Overnight at Leh

      Day 13 | Leh – Hemis Monastery – Pangong Tso Lake
      — Cover either of Hemis, Thicksey and Shey on the go towards Pangong Tso
      — Overnight at Pangong Tso (Spangmik or Lukung)
       
      Day 14 | Pangong Tso Lake – Thicksey Monastery – Shey Palace – Leh
      — Cover either of Hemis, Thicksey and Shey on return to Leh
      — Overnight at Leh

      Day 15 | Rest day at Leh to enjoy local culture and some shopping OR Monastery tour OR You can do tour to Sham Valley
      — Monastery tour may include Hemis, Thicksey, Stakna and Shey monasteries.
      — Sham Valley include Alchi, Likir, Basgo Palace, Magnetic Hills, Confluence at Nimmu, Gurudwara Pather Sahib
      — Overnight at Leh

      Day 16 | Leh – Tso Moriri via Chumathang
      — Cover Karzok Monastery
      — Overnight at Karzok or Tso Moriri
       
      Day 17 | Tso Moriri – Tso Kar – Debring (Manali – Leh Highway starts) – Moore Plains – Pang / Sarchu
      — Try to start early in the day so that you reach Sarchu where the accommodation options are better than Pang
      — Overnight at Sarchu or Pang
       
      Day 18 | Pang / Sarchu – Baralacha La – Jispa
      — On the way cover Suraj Tal, Deepak Tal which are on the road sides only
      — Overnight at Jispa

      Day 19 | Jispa – Keylong – Rohtang Pass – Manali
      — On the way cover Suraj Tal, Deepak Tal which are on the road sides only
      — Overnight at Manali

      Day 20 | Manali – Delhi
      — Return home

  29. Abhishek Kumar on

    Hi Dheeraj,

    I am also planning a trip to Leh with my family (5 adults and 1 child of around 6-7 years) in June 2015. I have been to the forums and read through the various articles about planning a Leh trip (Noida > Srinagar > Leh > Manali > Noida).

    I am planning to go on a trip for around 10-12 days and wanted to know from you whether this time would be good to plan this trip and also can you also let me know whether 10-12 days would be sufficient for this trip.

    Let me know.

    Thanks and Regards,
    Abhishek Kumar

      • Abhishek Kumar on

        Hi Dheeraj,

        First of all, thanks a lot for replying to my query. I must also thank you for the wonderful work that you are doing by keeping such a forum running online which provides ample reading material and serves as a ready reckoner for many people like me who loves to travel and read about it.

        Now, the situation is that the plan for this trip would be executed starting around 6th June 2015 and would end by 14th or 15th June 2015 due to some other official commitments. Do you still think that it would be good time to travel during this time?

        Also, I am following the common itinerary provided by you and it seems to just suite my need to plan the trip. Can you let me know which pitstops to take during this journey (hotels, guest houses etc.)? Also, an indication of expenses that would be incurred on an average so that we can plan to carry that amount of cash with us?

        Let me know if we can talk offline while I attempt this trip (if I need any help from you)?

        Thanks and Regards,
        Abhishek Kumar

        • 9-10 days are always quite short to travel for Ladakh trip. The only option in case is that you fly to Leh which will be costly. Manali – Leh Highway is yet to open and will open between 15-20 June. So, you cannot follow the common itinerary.

        • Abhishek Kumar on

          Hi Dheeraj,

          In that case, do you think that it is ok if we return back the same way i.e. Noida > Jammu > Srinagar > Kargil > Leh > Kargil > Srinagar > Jammu > Noida.

          We can extend this trip by around 2 days i.e. start on 4th/5th June and then return by 15th June 2015.

          The tentative itinerary that I have in mind is as follows:

          Day 1: Noida > Jammu (overnight stay at Jammu)
          Day 2: Jammu > Srinagar (overnight stay at Srinagar)
          Day 3: Srinagar > Sonmarg > Drass > Kargil (overnight stay at Kargil)
          Day 4: Kargil > Leh ( rest for the day at Leh in the hotel and get acclimatized)
          Day 5: Rest Day at Leh (roam around in Leh/Local Sightseeing)
          Day 6: Leh > Nubra Valley > Leh (overnight stay at Leh). Do you think that we should stay at Nubra Valley? Also, do you think we should take a taxi so that we can enjoy at the fullest?
          Day 7: Leh > Pangong Tso (Pangong Lake) > Leh (overnight stay at Leh). Do you think we should stay at Pangong Tso? Atleast one of the above stay if we can?
          Day 8: Leh > Drass (overnight stay at Drass)
          Day 9: Drass > Srinagar (overnight stay at Srinagar)
          Day 10: Srinagar > Jammu (overnight stay at Jammu)
          Day 11: Jammu > Noida (Trip Finishes!!! :))

          I guess I am being a little pushy here but I really want to do this trip.

          Thanks and Regards,
          Abhishek Kumar

        • Hi Abhishek,

          I am not convinced 100% that you are not even spending any day in Pangong Tso, Nubra Valley and then following the same route of Srinagar to return back as well. Such kind of trips are made once in a while for majority of us, I will strongly suggest that in case you really want to enjoy then at least try to post pone the trip by couple of weeks and add at least the charm of Manali – Leh Highway. This will give you an additional day as well and you can use that additional day in night stay at Nubra Valley.

          Regards
          Dheeraj

        • Abhishek Kumar on

          Dheeraj Ji,

          If you can please look up my plan that I shared with you yesterday and let me know if this would work, that would be super awesome.

          Thanks in advance.

          Thanks and Regards,
          Abhishek Kumar

  30. Hi Dheeraj, I am planning a 5 day trip to Ladakh. I am planning to cover Leh and surrounding area (Sham Valley) by renting a bike. Then Nubra and Pangong Lake by car. The plan to spend night in Nubra and Pangong which means effectively I am left with one day to either acclimatize or cover Sham valley. So I have two options and need your help to pick a viable one.

    1. I am reaching first day at 9:00AM by Air. Can I go out to Sham Valley same day or do I stay at hotel to acclimatize?
    2. If I stay at Hotel, I will have to cut down Pangong stay as I want to cover Sham valley on bike (kinda dream 🙂 )

    So, is first option feasible?

    Thanks!

    • Hi Ravi,

      1. You have to stay at hotel for rest and acclimatization only. Day 2 you can try out Sham Valley if you are able to sleep well else skip it and rest for local sightseeing only.
      2. Then next two days you go over to Nubra Valley and on 5th day do day trip to Pangong Tso.

      Regards
      Dheeraj

      • Thanks Dheeraj for the response.
        Your website is THE “travel to himalayas guide” and I am sure there are hundreds of folks out there who are benefiting from this website and your experienced advice. So thanks again for being there with your guidance 🙂

        Two more queries:
        1. Can I find shared taxi for Pangong Tso and Nubra valley from Leh? We are just two people so might end up paying a lot in Taxi fares if we travel alone.
        2. I am planning a trip to Chandratal in early June. We can also get shared taxi from Manali to Chandratal?

        Thanks & Regards
        Ravi

        • Thank you Ravi 🙂 🙂 !!

          Regarding your queries:

          1. You will be able to find the shared taxi without much fuss at all. There are lots of flyers which people put at cafes, dine-ins, restaurants, travel agent desks/shops/whiteboards wanting to share the taxis for different trips within Ladakh. Even travel agent organize such shared taxis trip as well but charge a little higher about Rs 200-300 more than it would ideally cost. So, in worst case you can always go back to them and book a seat for yourself.

          2. Very difficult that road to Chandratal will open in early June. Shared taxi to Chandratal will not be possible but you can use shared taxi to Kaza and get down to trek to Chandratal from diversion point. Read: Chandratal Lake | Cheapest Ways To Travel There

          Regards
          Dheeraj

  31. First of all thank you very much for this informative post. I have a daughter who suffers from heart problem like hypoplastic left heart syndrome by birth. She is now 7 years old and doing well. She has undergone two corrective surgeries last one being Bidirectional Glenn Shunt. She is scheduled to undergo the third (last one) in the series called Fontain procedure.

    We were wondering if it is possible for us to do this trip to Leh via self drive on Srinagar Leh route?

    In the past we have been to following places with our daughter –
    Dhanaulti, Srinagar, Pahalgam, Aru, Gulmarg, and Sonmarg. So I would say she has been to 9200 ft in height so far. During all these trips she was just fine and did not face any difficulty breathing or any problem related to altitude.

    • Abhy, I Will suggest that you please consult your doctor for the same and they will be able to advice you better in this case. Technically, high altitude is considered above 10000 Feet, so, I would suggest to consult the doctor as I will not be the right person. May be get in touch with someone who has experience of high altitude as well.

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