Motorcycling to Ladakh : Part 3 : The Rider

Avoiding it – The usual thumb rule used by most mountaineers is to drink about 8-10 glasses of water a day when you’re riding. The colour of your urine or rather the lack of colour there is a useful indicator of your level of hydration. Clear urine means a hydrated body. But in your enthusiasm to stay hydrated, avoid over-hydration as that will encourage water-retention in your body cells and would also accelerate the onset of AMS.

Avoiding it – Dress in enough layers to keep warm in the coldest weather you’ll encounter, eat well and keep hydrated. Warm clothes, hot food and adequate fluids will see you ‘breeze’ through the coldest of winters.

Avoiding it – Use good gloves double layer of socks inside thick leather shoes and keep your nose and cheeks covered by wearing a balaclava in freezing conditions. In case your fingers or toes freeze or go feelingless, warm them at a safe distance from a fire or dip them in water not exceeding 45 deg C. Keep wiggling your toes inside the shoes and fingers moving to encourage blood circulation.

Avoiding it – So overdress while standing and never forget to have a top layer of windproof/rainproof clothing for your Ladakh sojourn.

Avoiding it – Keep your limbs covered and use sunscreen on exposed skin to avoid sun-burns and wear a cap when not wearing your helmet to avoid sun-stroke. The intense sun heats up your head and the body’s temperature control goes haywire. If affected, you’ll feel thirsty, dizzy, possibly high temperature and unduly fatigued. To affect a cure, get out of the sun, rest under shade, drink plenty of fluids and avoid exposure to the sun for a day or two.

Avoiding it – While such aches and pains will remain a reality on this ride and cannot be completely eliminated, proper riding posture, using your legs to cushion the shocks, proper working suspension, a good seat, frequent rest during long riding stages and good physical fitness levels can make a big difference towards lesser pains and aches.

Avoiding it – Remedies include long underwear made of absorbent fabrics like cotton, liberal use of some antiseptic ointment on the skin folds, avoiding garments that have thick seamlines which will form pressure points on your skin, good personal hygiene of the crotch area specially and frequent ‘bum-off-the-saddle’ stops will help avoid this problem.

This sickness, aptly termed ‘Acute Mountain Sickness’, usually affects us at altitudes higher than 2500 mtrs (8000 ft) above mean sea level (AMSL). Our first feel of reduced oxygen in the air is by getting breathless during activities that would be commonplace to us at home. The body strives to adapt and so our breathing patterns change along with other physiological changes. We breathe deeper and quicker, we urinate more frequently and the fluid/electrolyte balance of our blood changes. Whenever the oxygen balance of the body is upset i.e. you cannot replace as much oxygen through breathing as you consume, an oxygen debt occurs (called Hypoxia) and you enter the AMS zone. In fact our body has a certain ‘tolerance range’ for lowered oxygen levels and as long as your gain in altitude lies within this ‘tolerance range’ you shall be fine. In fact, acclimatization is a process of extending this tolerance range further towards lower levels of available oxygen. To avoid AMS completely, you need to limit your daily gain in altitude to where it remains within your tolerance range. Usually this amounts to about 1500 ft (500 meters) in vertical height as ‘sleeping’ altitude. Sleeping implies that even if you exceed a gain of 1,500 ft during your day travel, you should not sleep at a place that’s higher than 1500ft from the place you slept the previous night.

As motorcyclists who can cover lots of distance (both horizontal and vertical) during a riding day, that’s usually far from what we do. We typically end up way higher than the ideal at night, especially on routes like Manali – Leh. So AMS expectedly affects most of us, a lucky few escaping due to some unknown physiological advantage or previous exposure to that altitude say within the last few months. The accompanying chart details the symptoms of AMS and its two more serious and at times fatal iterations vis a vis High Altitude Cerebral Edema (HACE) and High Altitude Pulmonary Edema (HAPE).

Both HACE and HAPE are the most severe forms of AMS and need emergency descent to lower altitudes in sync with proper medical attention. Fortunately, this would be a rare occurrence for motorcyclists even on the Manali – Leh route as long as the riders’:

• Don’t get adventurous enough to stay the night on top of high passes and descend as low as practical for the night e.g. Bharatpur,
  Sarchu, Pang etc.
• Refrain from smoking, consuming alcohol (the latter reduces breath-rate and so worsens hypoxia), taking sleeping pills and narcotics.
• Exert only as much as is necessary
• Remain hydrated and eat light food

It is the best to acclimatize naturally even if it means an extra day in the itinerary. My old favorite method for the Manali – Leh route is to ride to Rohtang Top the day after arriving in Manali, spend the entire day lazing around above 12,000 ft, keep myself hydrated with soups, tea and water and return to Manali for the night. Leaving for Leh the following morning, I have rarely faced anything more than mild AMS during my night stay at Sarchu. For those who insist on accelerated acclimatization, Diamox (Acetazolamide) is the usual recommended though with its own disadvantages.

• It’s a Sulfonamide salt and those allergic to Sulphur should not use it.
• Numbness and tingling in extremities (hands & feet) and the edges of the lips
• Carbonated soft drinks play havoc with the taste buds. It’s like drinking liquid electricity!
• Ringing in the ears and/or tinnitus is also pretty common as is blurring of vision.
• Diamox is a mild diuretic and so you’ll lose more water through frequent urination, thus increasing the risk of dehydration.

The usual recommended dosage for adults is about 125mg twice a day (12 hrs between doses). The same dosage can be started a day before gaining altitude as a preventive. BUT REMEMBER THAT EVEN IF YOU’RE ON DIAMOX, A RAPID ASCENT (>2,500 FT sleeping altitude) COULD STILL LEAD TO SEVERE AMS.

The other drug commonly discussed and used for AMS is Decadron (Dexamethasone). This is a steroid used primarily to treat swelling of the brain tissue. While Diamox treats the ‘problem of AMS’, this just treats the symptoms. It does not help in acclimatization and can in fact mask the symptoms of AMS. This masking can bring about a false sense of security and the rider would continue higher even when not fit for altitude gain. Decadron is NOT A SUBSTITUTE FOR DIAMOX. It is meant to treat HACE and that is where it should be used. And certainly not without proper medical direction.

All said and done, there are 3 golden rules for avoiding, managing and treating AMS that mountaineers follow unquestioningly. And we motorcyclists can certainly take this leaf out of their books. The 3 rules are:
1. If you feel unwell at altitude, assume it is AMS unless categorically proven otherwise
2. Never, never continue to ascend with symptoms of AMS
3. If your AMS symptoms get worse with time, descend at once.