Day 5 (November 16, 2013) - Dole (4110m) to Machhermo (4410m)

I passed a shivering night, squirming from my right side, to left side, twisting around again to generate heat. Exhausted by the time my alarm sounded, I slowly unzipped myself from the relative warmth of my sleeping bag, putting on my trekking clothes stiff from the cold.  Our breakfast of pancakes with honey and jam worked its wonder, and we were off, shouldering our packs in the early morning sunlight. As we left, a girl about our age was sitting in a composed silence in the sun. I greeted her, and she responded, nearly in tears that she had a raging headache and was unsure if she would be able to continue. My heart went out to her, as we headed towards the steep hill out of the valley. 

Pancake, honey, tea, Diamox. Breakfast of champions.

On the Camino, time walking in solitude was part of the spiritual and mental exploration of the Way. Even though I am walking always within sight of Em and Bishnu, we are often silent. Em and I breathing hard, our bodies toiling to adapt to the thinner air and demanding terrain, there is not breath enough to hold a conversation. Even to think too hard, on any particular subject, seems to sap our bodies of energy. At times, it is enough to concentrate completely on climbing this hill, or maneuvering around that bend, our minds relinquishing control to the all consuming act of physical movement. 

Amazingly, despite our slow - deliberately slow - progress, porters fly past us carrying unbelievable burdens. From kerosene, The North Face duffels of gear, to beer, and toilet paper, porters flow past us in tennis shoes and old Adidas jackets. Em and I are constantly gaping at each other, as we sidestep to allow these superhuman Nepalese (who are all smaller than me) surge past us.

We can no longer see Everest from our, but we are now witnessing other Himalayan giants. Today, Cho Oyo, the 6th tallest mountain in the world looms before us. I feel a slight pounding in my temples, as a miniature headache wraps itself around my head. We move slowly upward and forward, and four hours later we are standing above the valley village of Machhermo. 

View of the moraine valley running through Machhermo.

After a lunch of fried rice, we set out to gaze at a moraine of the Ngozumpa Glacier that runs through the village and to find the International Porter Protection Group (IPPG) and Rescue Center that has an outpost here. 

A helicopter evacuation of an injured porter. 

Staffed by four international doctors, this post of IPPG is designed for the welfare of trekking porters, and also guides and trekkers. Founded in 1997 when a porter developed Acute Mountain Sickness crossing Cho La pass, was subsequently paid off and then sent down the mountain alone, only to die 30 hours later as a result of his sickness, the IPPG is dedicated to spreading awareness of the hardships of porters and provide them with free healthcare at their outposts. A non profit, IPPG depends on donations, and also charges trekkers a fee for medical consultation. We joined a gaggle of other trekkers for the free daily briefing on altitude sickness. Very ignorantly, I hadn't properly educated myself on altitude sickness prior to our trek, so needless to say, I learned a lot. 

In summary:

- A person's ability to acclimatize is genetic. Some people are fast, others slow. Additionally, some people are capped at a certain elevation, at any given time, and will become sick if they go beyond it.

- Normal indications that you are at high elevations are breathlessness, high heart rate (100 bmp is normal), vivid dreams, swollen face and hands, and fatigue.

- Signs of Acute Mountain Sickness (AMS) are headache, loss of appetite/nausea, fatigue, trouble sleeping. Remedy is to stop ascending, and allow your body to acclimatize. 

- Signs of High Altitude Cerebral Edema (HACE) are disorientation, stumbling, severe headache. Only remedy is immediate descent. 

- Signs of High Altitude Pulmonary Edema (HAPE) are difficulty breathing, severe headache, can't breath lying down. Only remedy is immediate descent. 

- AMS can progress to HACE or HAPE, or both, and can be lethal

- At sea level, hypothetically, you have 100% oxygen in the air. At Machhermo, using this logic, you have 57%. On top of Gokyo Ri (where we will go) it is 51%. On top of Everest, 33%.

- Above 2,500 - 3,000m, a person should only ascend 300 - 400m for where they will sleep the next night. A person can ascend more on a day hike, but shouldn't sleep higher than 300 - 400m higher than they did the previous night. 

At the end of the brief, the team of doctors took our blood oxygen and heart rate readings. At sea level, a healthy persons blood oxygen level is around 98%. In Machhermo, my reading was 85% (in the middle of the normal range) and my heart rate was 90. Emily's blood oxygen was 89% and her heart rate was 69 (what a beast). 

Puffy, high elevation face!

Educated, informed, and now especially wary of any headaches, we returned as dusk fell to our lodge. A hot dinner of vegetable noodle soup called thukpa, and an early bedtime was in order. It seems the higher we get, the more lethargic and tired we become, craving long hours in our sleeping bags. I decided to up my warm game for sleep, and am now wearing my fleece jacket, puffy jacket, ear warmers, hat, thick gloves, long underwear, rain pants and two pairs of socks. Hopefully that does the trick tonight, and I can fall into a deep sleep. Tomorrow, we will lay our eyes on the brilliant green of the lakes around Gokyo, and marvel at our planet's beauty.