Dear Friend,

Please find below a set of instructions/advisory to prepare for your forthcoming tour in Ladakh or other high altitude destinations in India.

Since this is your first trip to a high altitude destination and you could be involved in short hikes / treks  as well, it is surely going to be a different experience and you need to plan before setting out on the tour.  You need to read the document thoroughly and let us know if you have any doubts/queries.

Ladakh is a very adventurous experience. Travelers and trekkers from around the world come to experience the thrill, chill and the mesmerizing/wild unique beauty of Ladakh.  Ladakh is also a journey of learning and understanding. You will get to explore several cultures, Ladakh lifestyle and cuisines. The learning experience is seriously amazing.  If you love adventure, there is no place like Ladakh. Just take care of the planning and you will be ready for it.

Things to carry & Packing List

1.1 Water

Water is the most essential thing while traveling in Ladakh, since dehydration can further complicate health issues at such a high altitude. So make sure you are carrying at least couple of liter of water per person all the time and drinking at regular intervals.

1.2 Medicines

Carry Diamox if you aren’t allergic to sulfur drugs (helps reduce some of the symptoms of AMS) and medicines for headache, fever, stomach ache, cold and cough syrup. Carry all your essential / personal medicines. You may not find those in Ladakh.

1.3 Sunscreen Lotion

UV rays at high altitude can be quite damaging to the skin, even during the harshest of winter, so don’t forget to carry a good quality sunscreen lotion eg. Sun Screen Lotion with rating of SPF40 or higher and apply it properly before going out in the sun.

1.4 Lip balm & moisturizer

Dry and cold weather of Ladakh will make your lips dry, which can get quite painful due to cracking and skin coming off, so make sure to carry a lip balm or Vaseline. Use moisturizer generously.

1.5 UV Sunglasses

As mentioned earlier, UV rays at high altitude can be quite damaging and this holds true for eyes as well. So having decent quality UV sunglasses  is quite essential, especially if you are traveling early in the season or during winter, when mountain passes have a lot of snow cover and sunlight reflecting from the snow can be even harsher!

1.6 Clothes

In Ladakh it is best to dress in layers, since majority of coldness is due to wind chill and temperatures can change rapidly depending on the place, time and weather. Hence dressing in layers will allow you to add/subtract layers as and when needed. So make sure apart from your regular cloths, you are also carrying a

Essential Packing

  • woolen gloves
  • cap (protect head and ears from cold winds)
  • Sun Glasses
  • Balaclava
  • Woolen Socks  
  • Sweater / fleece jacket
  • Thermal inners (especially if you are traveling in winter months)
  • Insulated Shoes (trekking shoes if you go hiking / trekking)

Additionally, for winter months (Sep – May)

  • Heavy down jacket / parka.
  • Rain cover / Breathable waterproof jacket and lowers.
  • Woolen Gloves and Inner
  • Woolen Cap
  • Hand and toe warmers (these also work to warm batteries)

1.7 Snacks

Carrying chocolates, biscuits and few hundred grams of almonds, raisins and cashews is a good idea, as these provide instant energy and easy snack and don’t take up too much space.

1.8 Chargers

Chargers for All Gadgets. 3 socket Belkin Surge Protector: While it is a little large in size, 3 socket Belkin Surge Protector will not only keep your gadgets protected from power surges, but will also allow you to charge multiple devices simultaneously and at the same time, provide the crucial cable length to safely place your gadgets in rooms with idiotic power socket locations (sadly enough, many hotels have this).

1.9 Photographic Equipment

Spare Battery : Carry at least one spare set of batteries required by your camera, since in cold environment, batteries can die quickly. If you are an avid smart phone user, then make sure you are carrying car charger or a power bank with at least 20,000-50,000mAH capacity to keep your mobile phone running throughout the day.

1.10 Wildlife Photography

Those interested or travelling for wildlife photography need to consider bringing a tripod for their cameras that can stay stable in windy conditions. For snow leopard photography, it is advisable to bring a long lens of at least 500mm focal length, as most of the sightings happen at a distance. 



1.1 Fitness

Before embarking on any kind of physically strenuous adventure it is imperative to be sure you are physically capable of completing the course without putting at risk your own or anyone else’s safety. 

1.2 Get Fit

Being physically fit is not regarded as a preventative factor by most experts in altitude physiology.  Even the most highly trained athletes may suffer the effects of altitude illness. Nevertheless, if you are physically fit you stand a better chance of being more resilient in the midst of any illness.  

1.3 Get Checked

A visit to a medical provider familiar with the demands of altitude travel is helpful before your trip, especially if you have ongoing medical conditions.   You should address any acute medical issues such as sinus infections, bronchitis, or chest pain with your doctor before you leave on your trip.  Individuals with Heart and Lung disease should be examined carefully as altitude places tremendous strain on the cardiovascular system.  Sleep disorders can also pose significant problems at altitude since sleep is significantly disrupted during the acclimatization process.  Musculoskeletal

Conditions can also present problems for traveling efficiently and performing effectively at altitude.  A clinician who knows your health conditions and understands the demands of altitude can help you prepare for your trip.  Medications useful to you at altitude as well as immunizations for travel to remote areas can also be provided at your pre-trip visit.   

Acute Mountain Sickness(AMS)

2.1 Acute Mountain Sickness (AMS)

Hikers, skiers, and adventurers who travel to high altitudes can sometimes develop acute mountain sickness (AMS). Other names for this condition are altitude sickness or high altitude pulmonary edema. It typically occurs at about 8,000 feet, or 2,400 meters, above sea level. Dizziness, nausea, headaches, and shortness of breath are a few symptoms of this condition. Most instances of altitude sickness are mild and heal quickly. In rare cases, altitude sickness can become severe and cause complications with the lungs or brain.

2.2 High Altitude Cerebral Edema (HACE)

One would probably go on to suffer from HACE if he continues to ascend despite the headache and vomiting; the symptoms of HACE are an extension of those to AMS. From fatigue, there is progression to lethargy and then to coma. Or there may be confusion and disorientation, a useful test is to see if the person can walk a straight line. If he walks like a drunk or is unsteady, it has to be assumed that he has life-threatening HACE and needs to descend promptly with assistance. This situation is serious enough to justify immediate evacuation. HACE is probably caused by shifts of fluid into the tissues of the brain. Reduced oxygen levels cause swelling within the confines of the bony skull. The resulting rise in pressure may lead to lethargy and eventually coma. 

There are lots of articles on AMS, it’s symptoms, preventions and cure. Please be sufficiently informed about AMS & HACE before you embark on a trek.

2.3 Preventing AMS

There is little doubt that altitude illness is one hundred percent a preventable illness. There are four golden rules, plus some important general principles that should always be followed: 

  • Understand and recognize the symptoms of AMS. Recent growth in adventure travel has made trekking at high altitude simpler and more accessible, with the result that more and more people who go trekking are ignorant of the basic facts of altitude illness.
  • Never ascend with obvious symptoms. Incredibly, I have known people who have hired a horse or a yak to go up higher when they were too sick to walk. This is courting disaster.

Descend if symptoms increase. It is amazing how striking and dramatic the relief may be with even a couple of hundred feet of descent. People with signs of HAPE or HACE have to descend.

The way to prevent altitude sickness is to give the body enough time to get used to the rarefied air. A slow and steady ascent is vital. Adequate hydration is also helpful. The body is constantly losing fluid from the lungs and the skin in the high, dry environment. Drink enough fluid  to maintain a clear and abundant urine output. 

The drug of choice for altitude is Acetazolamide (Diamox), a sulpha drug. It hastens acclimatization, increases breathing, and reduces alkalinity and diuretic fluids. The usual regimen is 125 to 250 mg twice a day, starting 48 hours before arriving at high altitude, and continuing through the first 48 hours at altitude.

Almost all altitude problems can be avoided if symptoms are recognized and acted upon. The warning signs are headache, lack of appetite, nausea, feeling of tiredness, and sometimes vomiting. This stage of mild mountain sickness can be treated with aspirin or Diamox. Remember, Diamox accelerates acclimatization. It does not cure anything. If you have headache with any of the above symptoms, even after taking Diamox, it means your acclimatization is not complete and you must descend. "Under no circumstances should you climb higher if your symptoms still persists." Those most at danger from complications are people who do not "listen to their body", and heed the early warning signals of AMS.

Some links on AMS and its symptoms:

2.4 Stay Hydrated

Dehydration decreases the body’s ability to acclimatize to high altitude.  Unfortunately, many travelers arrive at their destination dehydrated after long plane-flights, bus trips, or automobile journeys.  Excessive caffeine and alcohol ingestion are common during travel and produce a general state of low blood volume.   Even before your trip begins, drinking 2-3 liters of water per day can prepare your body for arrival at higher elevations.  Keep a 1 liter water bottle with you when traveling and drink as regularly as is feasible, given your mode of transportation.  Reducing caffeine and alcohol consumption before your trip will also decrease your chances of arriving at altitude in a dehydrated state.

2.5 Get Medication

You should be sure to have an adequate supply of your regular medications when you begin your trip.  While most travelers choose to acclimatize to altitude naturally, many people choose to take prescription medications that help the body adjust to high altitudes, such as acetazolamide (Diamox) and dexamethasone.  Others suggest supplements such as gingko balboa may be helpful (Please consult your physician on all medication).  Altitude medications are highly recommended for rapid travel (i.e. by plane) to very high altitude (3500m-5500m/ 11,483 – 18,045 ft).

2.6 Get Rest

Arriving tired and dehydrated at altitude creates room for altitude illness to.   Many travelers find medications such as Zolpidem (Ambien) helpful if they struggle to sleep while traveling to the start of their trip.  Alternatively, plan a rest day or two once you arrive at your destination.

2.7 Get Information

The best treatment for altitude illnesses is to avoid getting sick in the first place.  While there is no flawless way to prevent altitude sickness, most experts agree that knowledgeable travelers are less likely to experience serious conditions such as HAPE and HACE.  You should know the symptoms, ascent guidelines, and treatment methods for altitude illnesses.   You can also carry with you small books on mountain first aid that have excellent sections on altitude illnesses.  Most individuals who have problems at altitude lack basic knowledge about high-altitude regions, ignore/rationalize away obvious symptoms, or fail to provide the proper treatments for party members

2.8 Avoid

Avoid anything which will slow down breathing, such as:

  • Alcohol
  • Sleeping pills
  • Narcotic pain medication
  • Tobacco
Please insure yourself against sickness, accident, evacuation, hospitalization and the like, as you would normally do before embarking on a wilderness vacation.
We do not insure our clients ourselves and we accept no responsibility for damages or expenses which may arise from mishaps to persons on trips.
Actually you will be safer on your trek in the Indian Himalayas than on the roads of many parts of the world, but insurance does not cost much and is a worthwhile precaution. Coverage should include air flights, including charters.