The morning dawned cloudy but not overcast.  Just cloudy enough to add a bit of drama and features to the sky for photography yet also be a nice morning.  It was a bit cold when I awoke, repeating my morning routine of quietly dressing and slipping out, trying to not wake Lance.  Our lodge was situated at the far end of Dingboche, when we arrived we walk through the whole village to reach the lodge.  This morning I wandered down towards the trail back to Tengboche.  I didn’t go back through the village but took one of the paths on the hillside above, heading towards the 2 chortens we had passed coming into Dingboche.  It was there I met the Australian trekker pictured in my previous posting.  He had been coming to Nepal yearly since the 80’s, trekking the throughout the Himalayas.

After spending some time photographing the early morning, it was back to the Peak 38 for packing and breakfast.  Today’s hike would take about 5 hours, climbing from Dingboche at 14,300 ft. to Lobuche at 16,200 ft.  The trail would entail 2 steep climbs, the first right off the bat as we would climb above the village onto a tundra like plateau above, the second the very steep climb through Thokla Pass, the site of multiple memorials to dead climbers including Scott Fischer’s memorial.  After we had the standard morning fare of either eggs & toast or muesli and porridge it was onward.  The trail to Lobuche climbs steeply out of Dingboche but isn’t too long before leveling out into a very gradual ascent on a tundra covered plateau above the village.  As we hiked along the plateau we would occasionally pass other trekkers, Sherpas and area residents, and several stone houses.  It took about 2 hours to reach the Yak Lodge at Thokla, at 15,100 ft., where we stopped for a snack and tea.

As this point we were all feeling some effects from the altitude, some beginning to get some AMS (acute mountain sickness) to varying degrees despite being on Diamox.  AMS is funny; there is no real way to reasonably predict who will get it, other than once you have had it you are more prone to developing it in the future.  The symptoms range from a mild headache to more severe debilitating ones such as nausea, vomiting, and a severe headache.  Fitness is not a factor, everyone in our group was reasonably fit and we ranged from no AMS to a few with pretty severe symptoms as we got higher.  At this point I was feeling good, a bit winded from the altitude but otherwise fine.

As we had our respite, the skies began to cloud and become more ominous.  We had been lucky so far, the only really rain to contend with was after we had already reached Khumjung and was touring the school and clinic.  The trail gods must have been smiling on us, with many threatening skies but very little rain.  After resting and warming up with hot tea, it was time for the second climb of the day, the ascent to Thokla Pass.  The trail took an abrupt upturn and was rocky and tortuous, lending to the fact that all of us suffered on the arduous climb to some extent.  The top was a welcome sight and, as I crested the summit, I was somewhat taken aback by the sheer number of various-sized monuments scattered throughout the pass.  We took another break in the pass, a time for a group photo and for everyone to rest of explore the monuments.  After a bit, it was onto Lobuche, with the rest of the trail fairly flat as it followed the Khumbu Valley next to the tail of the Khumbu Glacier although, with so much debris brought down by the glacial movement, it was virtually impossible to see the ice yet.

As we continue deeper in the mountains, the peaks began to loom even more impressively.  There was the pyramidal shape of Pumo Ri on the left, standing at 23,494 ft. and we began to get glimpses of Nuptse on the right, standing at 25,772 ft. above sea level.  We reached Lobuche at lunch.  Lobuche is mainly a collection of lodge for trekkers it is too high for any agricultural  One of the interesting things was that we had continued cell phone coverage on the trip.  In fact, this was the first year that there was cell coverage all the way to EBC.  At the Eco Lodge it was time to shed the pack, have some tea, and wait for lunch with today’s lunch consisting of veggie pizza.  Most of us were quite hungry and anticipating lunch but a few were fairly ill and weren’t very hungry.  Ultimately about a third of the group would get AMS and/or gastroenteritis on the trip.  After lunch it was an afternoon to relax as tomorrow would be a long day, leaving before breakfast on our EBC day.

Lance and I went to our room to relax and read when he looked out the window and said “that guy doesn’t look too good.”  I looked out and saw a man being assisted by two others up the steps of the lodge next to use and sitting down outside.  I went to check on him and a found a mid-20 year old Russian there with 2 friends.  He was sitting in a tripod position, breathing very rapidly, with cyanotic lips.  They were on their way down, trying to get him lower and didn’t have a lodge there so I took him back to ours.  Once there we checked his pulse-ox (the amount of oxygen in one’s blood) and he was 56%.  In comparison, ours had ranged from 78-85% when we checked them earlier and normal not at elevation is above 95%.  He was clearly in pulmonary edema, a more serious, life-threatening form of altitude illness where the capillaries in lungs start to leak fluid into the lung tissue.

We treated him with the bronchodilator albuterol, started him on oxygen, and gave him verapamil, a calcium-channel blocker the helps with pulmonary edema.  He didn’t look ill enough to require a helicopter evacuation but he likely couldn’t continue to walk much further.  The cost of hiring a horse was 8000 rupee (a little over $100) but the cost of hiring 2 Sherpas was quite a bit less, only 2000 rupee, so rather than pay for a horse they hired the Sherpas.  We learned later on our way down that they went to the Himalayan Rescue Association clinic in Periche where he was still quite ill and the physician wanted to helicopter him out but the Russians didn’t want to pay for a helicopter so they compromised and paid for a horse instead.  Quite different situation from the US or Europe where they would just chopper you down and deal with the bill afterwards.  While treating him, we found out that he had been feeling badly 2 nights before when they were in Lobuche on the way up but continued up anyway, not recognizing how ill he was.  They went to EBC and then spent the night in Gorek Shep at 17,000 ft.  By the morning he was so ill they basically had to carry him down the next day.  He was lucky he wasn’t the second death at Gorek Shep that week, the first being the 23 year old girl I mentioned earlier.  One of the things I noticed is the number of people who going trekking at elevation in the Himalayas that don’t learn about altitude illness, how to recognize it, and how to treat it.

That night I took a small dose of Diamox, 62.5 mg, to help me sleep.  I had been having restless sleep for the past few nights and wanted to get a good night sleep before the hard, long day coming tomorrow.  The prophylactic dose for AMS is 125-250 mg twice daily, but a small dose can help you sleep better at night.  Above 10,000 ft. people start to have Cheyne-Stokes breathing, also known as periodic, breathing while they sleep.  This is basically increasingly rapid respirations interspersed by periods of apnea, or lack of breathing.  In some people apneic episodes of a minute have been observed.  Diamox works by causing a relative acidosis in one’s blood.  To compensate for this acidosis, your respiratory center is stimulated to increase ventilations and blow off more CO2 thus decreasing the acidosis caused by the Diamox.  The main side effects are parasthesias, or tingling of the hands and feet, increased urination, and your beer and sodas taste flat since it inhibits the enzyme that allows us to perceive the carbonation.  With a low dose for sleep you avoid the side effects while still getting more restful sleep.  The next day was the culmination of a long-time dream, to see Everest Base Camp and view Mount Everest up close, with my own eyes.