Ladakh - The Desert Beauty and Acclimatisation Woes

I have always wanted to visit Ladakh, but I was scared to do so. I have an altitude sickness problem. Besides, many years ago, the sister of a colleague passed away in Ladakh after arriving there with a severe cold. That incident kept Ladakh at a distance for me.

Ladakh is a high-altitude desert region in India, with most places well above 3,000 metres and many areas at elevations of 3,800 metres (about 12,500 feet) or more.

My friend from Germany told me that she was coming to Ladakh for a meditation camp. She asked if I would visit her there, as she had five days after the camp to travel around. I decided that perhaps it was finally time to visit Ladakh.

I had heard from close ones and friends that it takes at least two days to acclimatise to the low-oxygen environment at such high altitudes. During this period, one can experience headaches, nausea, vomiting and nose bleeding. The advice I received was that even if you feel perfectly fine, you should rest and avoid venturing out in the first couple of days.

So, I decided to arrive three days before my friend would be free from her camp. That would give me enough time to acclimatise.

In retrospect, I think the first mistake I made was landing in Ladakh on an empty stomach. I had not eaten since 5:30 in the morning and had only had a cup of tea. I landed at 10:30 am and had asked the place where I was staying to keep breakfast for me. I finally had breakfast close to noon. Looking back, that was probably not the best way to begin the trip.

By evening, I was throwing up. My altitude sickness initially manifested itself as the acidity that I generally suffer from at high altitudes, compounded by motion sickness.

I could not keep even a morsel of food or a sip of water down the entire evening. In any other place, I would perhaps not have been too worried, because I knew that I would probably feel better the next day. But not being able to drink water at high altitude, where hydration is particularly important, seemed risky.

The lady at the place where I was staying suggested that I visit Sonam Norboo Memorial Hospital, the major government hospital in Leh.

I went there. The doctors asked me to take medication for nausea and Diamox (acetazolamide) for altitude sickness. However, these medicines were to be taken after food, and I was unable to eat anything. They also suggested three injections, which I refused.

I returned to the hotel.

The next morning, my condition was worse. The lady at the homestay insisted that I go to the emergency department and take oxygen.

I went back to the hospital. Since I was alone, it was exhausting to stand in queues, fill out forms and deal with all the formalities. As luck would have it, I realised that someone we knew was acquainted with a doctor associated with the hospital.

The doctor told me to get admitted and take the injections I had refused the previous day. She arrived at the hospital in the evening, and I must say she was God-sent. I followed her advice over the next two days.

I was finally back on my feet.

I was first admitted to the general ward and was later shifted to the tourist ward, where you hear all kinds of stories from fellow travellers.

There was one lady who had travelled from Srinagar the previous evening because her son's wedding was to take place the following day. She said that she had a cold when she left Srinagar and knew that she might face problems. By the time she reached Leh, she was having difficulty breathing. The hospital advised her to take as much oxygen as she needed and then leave for the wedding, making arrangements to have oxygen available there as well. Another boy they discovered had dengue when he arrived. Another foreigner had water in his lungs and was waiting to travel back home. These do subside but unfortunately the low oxygen makes it longer and difficult to heal. 

Those first three days were filled with oxygen masks, saline, nausea medication and injections.

Fortunately, the next five days were filled with the breathtaking beauty of Ladakh.

My friend and me had the most beautiful drive to Nubra Valley, passing through the stark, dramatic landscape of the Khardung La region. This is where the beauty of Ladakh's brown and purple mountains becomes truly mesmerising.

Then there was Sangam - the spectacular meeting point of the Indus and Zanskar rivers (photo above).

And then came Pangong Lake, at an altitude of around 14,000 feet. The lake was breathtaking, with its waters changing between shades of blue and green and glittering in the sunlight.

We visited many Buddhist monasteries such as Diskit and Thiksay, saw stupas and stopped at a gurdwara on the way back. The day before our trip to Nubra, we had a hot one-and-a-half-hour drive to Alchi Monastery. The lunch there is said to be very good, but unfortunately we missed it as the restaurant was closed for some work.

Our trip ended with a visit to the school associated with the movie 3 Idiots, where we got to take a photograph wearing the traditional Ladakhi dress.

And for a pure vegetarian like me, Ladakh offered a surprisingly wide variety of food. There was authentic Ladakhi cuisine such as thukpa, noodles, tasty momos.There were also good Punjabi and other Indian options. And yes, we even found a place serving dosas! Besides, my doctor friend got us tasty Ladakhi bread for breakfast eaten with dollops of butter and honey. She also made apricot dessert that was so yummy. Apricots are in plenty in Ladakh.

It was a beautiful trip - one that began with pain and ended with joy.

So, how will I prepare myself next time the Ladakhi mountains call me?

1. Discuss Diamox with my doctor before the trip.
   I was advised that Diamox (acetazolamide) can be started before arriving at high altitude and continued for a few days after arrival. I had gone on a high-altitude trek in Uttarakhand in 2024, but I had not been advised to take Diamox then, so I had skipped it this time as well. Next time, I will discuss it with my doctor and take Diamox well before the journey.
2. Carry a pulse oximeter.
   It is a tiny instrument that allows you to check your blood oxygen saturation and pulse rate.
3. Take symptoms seriously.
   If oxygen saturation is very low or I develop significant headache, nausea, vomiting or breathing difficulty, I will not wait it out. I will seek medical help immediately.
4. Check the availability of oxygen where I am staying.
   It is worth asking the hotel or homestay beforehand whether oxygen is available in an emergency. Some hotels may have oxygen cylinders or concentrators. However, if someone is severely breathless or deteriorating, medical care is far more important than relying on equipment at a hotel.
5. Eat and rest properly before the trip.
   If I have a bad cold, fever or significant fatigue before travelling, I would seriously consider postponing the trip. High altitude can magnify problems that might otherwise seem manageable.
6. Take the first couple of days slowly.
   Follow the rules - No excursions immediately after landing. I would give my body time to understand where it is!
7. Carry my regular medication and speak to my doctor beforehand.
   Any existing health issue should be discussed with a doctor before travelling to high altitude. 

I am also sharing the image of the health advisory that was given to us with the permit that we had to get for travelling to Nubra and Pangong. For Indians, the permit can be obtained online. Foreigners need to visit the relevant office in Leh, and it can take quite a while if there is a queue.

Despite the difficult beginning, Ladakh has left me wanting more.

I hope to make one more trip to those mountains - this time better prepared, better rested and with all the necessary precautions.

And hopefully, the next time, the acclimatisation will be much kinder to me!