Trekking the Annapurnas: Overcoming altitude sickness in Manang

This time last week I was on top of the world. At 5,416m, I had just achieved what I dramatically – at times – thought that I would die trying to do. I sipped the world’s most expensive cup of tea, had a worry about about the changeable weather and insisted we leave as quickly as possible and return to things that I had begun to convince myself only existed in dreams: hot water, clean hair and a life without thermal underwear.

In the ’70s, the Annapurna circuit was well-known as one of the best treks in the world. It formed a complete loop of the Annapurna mountains through isolated villages and every biosphere from sweltering subtropics to glacial peaks.

Nowadays, jeeps can rumble into the National Park as far as Manang on the east side and Muktinath on the west. This just leaves the stretch in the middle between these two towns that remain accessible only by foot. Between them lies a beast: Thorong La. At 5,416m above sea level, it boasts the title of the world’s highest pass.

That’s 5,416m.


The figure is burned into my consciousness. I made a habit of adding “AND SIXTEEN” whenever someone carelessly rounded the height to the nearest hundred.

At this altitude, everything is infinitely more difficult. Breath is short, steps are small, heads pound with pain. This is inconvenient because the tough terrain takes a clear head to navigate. It’s not a good time to encounter steep inclines, skinny paths thick with ice, mercurial weather, landslides, frostbite, yetis, etc.

With blissful ignorance, we estimated the journey from Manang to Muktinath would take four days. We withdrew enough cash to get us through, rented sleeping bags and dusted off our thermals. In a laughable display of naivety, I packed shampoo.

We took a bus to Besisahar at the edge of the National Park and boarded the first jeep to Chame. If there is one positive thing to be said for the jeep ride it’s that it was so unpleasant that, at my lowest point several days later, I still refused to turn back and repeat it. It made Bolivia’s Death Road look like a casual meander through gentle hills.

The journey took around seven hours. I sat alone in the front passenger seat, listening to the only song I have downloaded on my phone. It unwittingly provided a fitting soundtrack. Careering round a bend to certain death is a wonderful time for the words  “Hello darkness my old friend” to be sung into your ear in haunting harmony.

The ‘road’ is narrow and uneven. The jeep bounces along, thrown left here by a rock and right there by a pothole. You never feel like you make a great deal of contact with the ground.

A few hours in, I saw a sheer, featureless rock face ahead. Something unnerved me. I noticed a small thread winding across it. “That can’t be the road.”

Yet it was. As we rounded a corner and trundled through a stream – getting the tyres nice and wet and slippery – it became certain. We were heading up to cross the cliff face.

I have rarely felt sick with such fear. I turned in my seat and faced away from the edge. I brought my knees up to my chest and held myself in the foetal position as we passed painfully slowly along it. I was so scared that everything felt unreal. At one point, the jeep hit a rock and lurched. I can’t even remember which way it lurched – towards or away from the drop. I was so queasy with fear that direction no longer held any meaning. Everyone screamed. The driver wrenched the wheel and we stayed on the path.

That night in Chame, I celebrated the fact that I was still alive with a single beer and also a glass of ‘local wine’. ‘Is it made from grapes?’ I asked earnestly. The man just laughed. He brought a large tumbler of warm, colourless liquid to the table. I took a couple of sips and it reminded me of sake, but also chemistry lessons. I left the rest of it. Later as I stumbled to the wooden cabin that served as our room for the night, I realised that my head was foggy and my balance was off. The altitude had magnified the effect of the booze fivefold. Either that or I’d just ingested drain cleaner.

The next morning I emerged from my sleeping bag with an undeserved hangover. The solar showers barely ran they were so cold. The gas-powered shower promised better results and boiled me to a hearty forty seven degrees centigrade, the heat of which quickly dissipated as I dried off in the draughty stone cabin.

We were planning to catch an early jeep from Chame to Manang but they were in short supply. Instead, we hiked through thick pine forests lining rocky gorges. We filled our water bottles from crystal clear streams (and properly purified it with chlorine tablets – v. important). In the far distance, the sun beamed off snow-topped peaks, but they were so far away and we were warm and around us everything was green and I thought EVERYTHING WILL BE FINE.

Eventually we stopped for lunch. As we were leaving, resigned to walking the whole way to Manang, we saw a small wooden hut with ‘motorbike service’ scrawled on the side in black marker pen. Twenty minutes later two local Nepalis had turned up with motorbikes and were making space for us to get on.

“Do you have helmets?”

“Helmets not needed.”


We covered a two day trek in little under half an hour.

After a few precarious bends, the route opens up. The terrain changes rapidly. The peace of the pine forest disappears and is replaced by something altogether more sparse and inhospitable. The colours of the landscape are bleached and plantlife is scrubby and low. Pebbles become rocks and then boulders. Wooden chalets become squat stone huts.

Once we stopped, we also noticed the cold. For the first time since arriving in Nepal, we shivered. In our room, I felt a rush of relief to see a plump duvet on the bed. I got underneath it and refused to get out until dinnertime when we sat in the ‘heated’ dining room and in our hats and fleeces cradling hot cups of tea and digging into plates of food that was mainly cheese.

I started to feel poorly. I had a headache. I could barely muster the energy to speak over dinner. I felt irritated to the point of cold-blooded murder by the sound of a man slurping tea behind me. All I wanted to do was to get back under the duvet. I blamed tiredness.

The next morning, I convinced myself I was feeling slightly better. It was still freezing but the cold shower I’d insisted on spurred me into some sort of adrenaline frenzy. I wanted to get moving. I wanted to distract myself from how cold and bleak everything felt. We decided to head up on an ‘acclimatisation walk’ to see a cave and a glacier high up in the mountains.

I had a headache as we set off but it didn’t alarm me. I get headaches all the time. I get headaches from things I eat, I get headaches from not eating. I get headaches when my clothes are too tight, I get headaches when my feet are too hot. A lot of the times I get headaches because I’m thinking about not getting a headache.

As we ascended, I assumed my head was throbbing because I was hungry, I was cold, my hat was too small, my tea hadn’t been strong enough, I’d eaten too much cheese. It couldn’t possibly be the altitude.

The ground was soft and coated in patches of unmelted snow and fallen pine needs. The path took us steeply upwards through a clearing that exposed the ruins of an abandoned village. A family of musk deer was grazing. I felt awful but I was too cold and doing exercise and this was entirely expected.

Everything changed when we were about two thirds of the way up. I’d begun to stop making the effort to speak because it was too difficult. I just wanted to shut down until the walk was over.

I sat down on a stone plinth surrounding a large white stupa and took an orange from my bag. I remember eating it and thinking: “This tastes like vodka. Why does my orange taste like vodka?” I then remember deciding that I needed to nap. I really very much wanted to nap. I’ve never wanted to nap more. Despite the chilly temperatures, I began looking around for a comfy spot. The drowsiness was overwhelming. Weakly I asked if we could head back.

As soon as I got a few hundred metres from the village I knew that I was going to be sick. I got back to the room and relief made me cry which only intensified the pain in my head. This triggered an overwhelming wave of nausea and an afternoon of vomiting. At one point, in my desperation, I asked for a garlic soup which I’d been told was ‘very good’ for altitude sickness. I took one tiny sip and the overpowering reek of garlic turned me upside down. My stomach redoubled its efforts to empty itself. Garlic soup is a terrible idea for altitude sickness. Garlic soup is a terrible idea for anything.

Despite taking copious painkillers, nothing released the vice-like pressure in my head and I continued to be sick until it got dark. I woke up the next morning still feeling too wobbly to walk. I considered trying to retreat to a lower altitude, but the thought of moving my body anywhere caused me to shed a few pathetic tears. I spent another day under the thick duvet, trying morsel by morsel, sip by sip to keep down food and water. By evening, I felt marginally better.

The next day, we made up our minds to abandon the trek and take a jeep back. I felt truly miserable and I spent several hours using the patchy WiFi to message anyone who would listen to tell them just how miserable I felt. Heavy with a sense of failure, we took a stroll around Manang, watched some goats sparring in the street and longingly followed a helicopter as it landed, dropped off some cargo and took to the skies again.

We walked ten minutes or so down to the icy lake just on the outskirts of Manang. I watched in disbelief as skinny children played in the crystal water as if it was the Carribean.

Finally, because I’m a fan of an educational talk, we attended a session hosted by The Himalayan Rescue Association. Every day at three o’clock they put on a free talk about mountain safety. A large part of it is taken up with discussion of the dangers of Acute Mountain Sickness (AMS) and its more severe forms: HACE and HAPE.

The talk confirmed what I already knew: that I probably shouldn’t have done that hike on my first day, and that even if I did, I should have turned back a lot sooner. But it also left me feeling like maybe, potentially, hopefully I could make the trek after all. All I needed to do was take it slowly and wait to acclimatise at each stage before going any higher. “No one who has attended our talks has ever died of AMS,” the doctor boasted.

He also said that no-one should be looking at mountains and wondering why they were putting themselves through this terrible experience (exactly what I had been doing for several days). You should be thinking ‘Ooh, what’s over there?”

And that’s how I wanted to feel. I spoke to the doctor afterwards and bought some medication for altitude sickness.

The next morning, I woke up and made a decision I thought I might come to regret: let’s do it, let’s continue. We’d made it through the first hurdle, albeit an unexpected one. Now it was time to meet the real challenge: onwards and upwards. The peak of the trek – five thousand, four hundred AND SIXTEEN metres – was over 1,500m higher than the point where a few days ago I’d felt compelled to find a nice tree to curl up into a coma under. As we set off, I genuinely didn’t believe that I’d ever acclimatise enough to make it up there.


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