Pre-Trek Medical Checkup: What Your Doctor Needs to Know

Every year, trekkers with undiagnosed medical conditions arrive in Nepal's mountains and discover—sometimes dangerously—that their bodies react differently at altitude than expected. A previously stable heart arrhythmia becomes symptomatic at 4,000m. Well-controlled asthma flares in the cold, dry air above Namche Bazaar. Diabetes management becomes unpredictable when daily calorie expenditure doubles and carbohydrate intake changes completely.

The purpose of a pre-trek medical checkup isn't to find reasons you can't trek. Most people with well-managed chronic conditions can safely trek in Nepal with proper preparation. The purpose is to identify potential issues before they become emergencies, adjust medications for altitude, create contingency plans, and give you confidence that you've done everything medically reasonable to prepare.

This guide explains what to discuss with your doctor, which tests to request, how specific conditions interact with high altitude, and when you need a specialist rather than a general practitioner. Whether you're a healthy 25-year-old or a 65-year-old managing multiple conditions, this information helps you have the right conversation with your healthcare provider.

Table of Contents

1. Quick Medical Preparation Overview
2. Why a Pre-Trek Checkup Matters
3. When to Schedule Your Checkup
4. What to Tell Your Doctor
5. Recommended Tests and Assessments
6. Pre-Existing Conditions and High Altitude
7. Asthma and Trekking
8. Diabetes and Trekking
9. Heart Conditions and Trekking
10. Knee and Joint Problems
11. Mental Health Considerations
12. Medications to Discuss
13. Dental Checkup
14. Vision and Contact Lens Considerations
15. Travel Medicine Specialist vs GP
16. Medical Certificates for Agencies
17. Preparing Your Medical Emergency Plan
18. Frequently Asked Questions

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Quick Medical Preparation Overview

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Why a Pre-Trek Checkup Matters

The Altitude Factor

High-altitude trekking places unique demands on the body that no amount of gym fitness can fully simulate:

Cardiovascular system: Your heart rate increases by 10-20% at rest above 3,500m. Cardiac output increases to compensate for reduced oxygen. Blood pressure initially rises. Your heart works significantly harder than at sea level, even while sleeping.

Respiratory system: Breathing rate increases by 20-40% at altitude. The air above 3,500m is cold and dry, irritating airways. Oxygen saturation drops from 95-99% at sea level to 80-90% at 4,500m and 70-85% at 5,500m. Existing respiratory conditions are amplified.

Blood chemistry: Your body produces more red blood cells (polycythemia) to carry oxygen more efficiently, but this thickens the blood, increasing clotting risk. Blood pH changes as the body compensates for altitude-induced respiratory alkalosis.

Metabolic demands: High-altitude trekking burns 3,000-5,000 calories per day. Blood sugar management becomes more complex. Hydration needs increase by 50-100%. Electrolyte balance shifts.

Neurological effects: Altitude affects cognitive function, judgment, mood, and sleep quality. Pre-existing conditions affecting the nervous system may behave differently above 3,500m.

What a Checkup Catches

Real examples from Himalayan Rescue Association reports:

• A 48-year-old trekker discovered during a pre-trek ECG that they had an undiagnosed heart rhythm abnormality. With medication adjustment, they trekked safely. Without the ECG, the arrhythmia could have caused collapse at altitude.
• A 35-year-old with "mild" asthma found through spirometry testing that their lung function was more compromised than they realized. An adjusted inhaler regimen prevented a serious episode at 4,500m.
• A 55-year-old on blood pressure medication learned their dose needed adjustment for altitude. Without modification, the altitude-induced blood pressure increase plus their medication's limitations could have caused a hypertensive crisis.

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When to Schedule Your Checkup

Ideal Timeline: 6-8 Weeks Before Departure

This timeline allows for:

• Initial consultation and test ordering
• Test results review (1-2 weeks for blood work)
• Follow-up if any issues are discovered
• Medication adjustments with time to stabilize
• Vaccination appointments (coordinated with medical checkup)
• Dental checkup scheduling
• Eye exam if needed
• Prescription procurement (Diamox, emergency antibiotics, specialty medications)

Minimum Timeline: 2-3 Weeks Before Departure

If time is short, prioritize:

1. Blood pressure measurement
2. Basic blood work (CBC, metabolic panel)
3. ECG (if over 45 or any cardiac symptoms)
4. Medication review with doctor
5. Prescription for Diamox and emergency medications

Too Late? Day-Before Options

Even the day before departure, you can:

• Have a doctor review your medication list for altitude interactions
• Get prescriptions for Diamox and emergency antibiotics
• Discuss your specific chronic conditions and altitude management
• CIWEC Clinic in Kathmandu also provides pre-trek consultations

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What to Tell Your Doctor

Many general practitioners have limited knowledge of high-altitude medicine. Help your doctor help you by providing specific context:

Information to Bring

Trek details:

• Maximum altitude you'll reach (e.g., EBC at 5,364m, Thorong La at 5,416m)
• Trek duration (number of days)
• Daily altitude gain profile (your itinerary showing overnight elevations)
• Level of physical exertion (5-8 hours of trekking daily with elevation gain)
• Remoteness (days from nearest road/hospital at maximum altitude)
• Temperature range (potentially -10 to -20 degrees Celsius at high camps)

Your medical context:

• Complete medication list with dosages
• All diagnosed conditions (even "minor" ones)
• Previous altitude experience (if any) and any problems experienced
• Family history of heart disease, stroke, or blood clotting disorders
• Previous surgeries (especially cardiac, pulmonary, or orthopedic)
• Current fitness level and training history
• Allergies (medications, foods, environmental)
• Mental health conditions and medications

Questions to Ask Your Doctor

1. Are any of my current medications problematic at high altitude?
2. Should any medication dosages be adjusted for altitude?
3. Based on my health profile, are there specific altitude-related risks I should monitor?
4. What warning signs should prompt me to descend immediately?
5. Can you prescribe Diamox (acetazolamide) for altitude sickness prevention?
6. What emergency medications should I carry?
7. Do I need any specific tests before this trip?
8. Is there anything in my health history that makes high-altitude trekking inadvisable?

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Recommended Tests and Assessments

For All Trekkers Above 3,500m

Blood Pressure Measurement

• Purpose: Baseline measurement before altitude-induced changes
• What you need: Resting blood pressure below 140/90 mmHg for safe trekking. Higher readings require evaluation and possible medication adjustment.
• Note: Altitude typically increases blood pressure by 10-15 mmHg. If your baseline is already elevated, altitude may push it to concerning levels.
• Cost: Included in standard doctor visit

Basic Blood Work (Complete Blood Count + Metabolic Panel)

• Purpose: Baseline health assessment, identify anemia, blood sugar, kidney/liver function
• Key values:
  • Hemoglobin: Low hemoglobin (anemia) means less oxygen-carrying capacity—already compromised at altitude
  • Blood glucose (fasting): Baseline for diabetes monitoring
  • Kidney function (creatinine, BUN): Altitude and dehydration stress the kidneys
  • Liver function (ALT, AST): Baseline before potential Diamox use
  • Electrolytes: Baseline before altitude-induced changes
• Cost: $50-$150 (often covered by insurance as part of annual physical)

Urinalysis

• Purpose: Check for kidney issues, urinary tract infections, diabetes markers
• Cost: $20-$50 (usually included with blood work)

For Trekkers Over 45

Electrocardiogram (ECG/EKG)

• Purpose: Screen for undiagnosed heart rhythm abnormalities, conduction delays, or ischemic changes
• Why at 45+: Risk of undiagnosed cardiac issues increases significantly after 45. Altitude-induced cardiovascular stress can unmask hidden problems.
• What it reveals: Arrhythmias (atrial fibrillation, bundle branch blocks), signs of previous silent heart attack, ventricular hypertrophy
• Cost: $50-$200

Exercise Stress Test (Consider if risk factors present)

• Purpose: Assess cardiovascular function under exertion
• Recommended if: Family history of heart disease, chest pain with exertion, shortness of breath disproportionate to fitness level, known coronary artery disease
• Cost: $200-$500

For Trekkers with Respiratory Conditions

Spirometry (Lung Function Testing)

• Purpose: Objective measurement of lung capacity and airflow
• Recommended for: Asthma, COPD, history of smoking, any unexplained shortness of breath
• Key values: FEV1 (forced expiratory volume in 1 second) and FVC (forced vital capacity)
• Altitude relevance: If lung function is already reduced at sea level, altitude further compounds the limitation. Knowing your baseline helps predict altitude tolerance.
• Cost: $50-$200

Pulse Oximetry (Baseline)

• Purpose: Record your normal blood oxygen saturation at sea level
• Why useful: Knowing your baseline SpO2 helps you interpret altitude readings. If your sea-level SpO2 is 97%, and you read 82% at 4,500m, you know your body is within normal altitude adaptation range. Without a baseline, you can't assess what's normal for you.
• Cost: $0-$20 (most doctor's offices check this routinely)

For Trekkers with Diabetes

HbA1c Test

• Purpose: Measures average blood sugar over 2-3 months
• Target for trekking: HbA1c below 8% is generally considered safe for high-altitude trekking. Higher levels indicate less stable diabetes control, increasing altitude risks.
• Cost: $30-$80

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Pre-Existing Conditions and High Altitude

General Principles

Most chronic conditions do not prevent trekking in Nepal, but they require:

1. Stable management: Your condition should be well-controlled for at least 3-6 months before the trek
2. Medical awareness: Understanding how altitude affects your specific condition
3. Medication preparedness: Carrying adequate supplies plus backup
4. Contingency planning: Knowing when to descend and how to manage flare-ups
5. Communication: Your guide should know about your condition and emergency management

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Asthma and Trekking

How Altitude Affects Asthma

The relationship between asthma and altitude is complex and somewhat counterintuitive:

Potential benefits of altitude:

• Lower allergen concentrations above treeline (fewer molds, pollens, dust mites)
• Reduced air pollution compared to cities
• Some asthmatics experience improved symptoms at altitude

Challenges of altitude:

• Cold, dry air is a known asthma trigger for many people
• Increased breathing rate means more cold air exposure to airways
• Physical exertion at altitude significantly increases ventilation
• Reduced oxygen availability compounds airway restriction
• Dust on trails (especially during dry season) can trigger attacks
• Campfire smoke in tea houses irritates airways

Pre-Trek Preparation for Asthmatics

Medical review:

• Spirometry testing to establish baseline lung function
• Review and optimize medication regimen
• Ensure asthma is well-controlled (no recent hospitalizations or emergency visits)
• Peak flow meter practice (bring one on trek for monitoring)

Medication strategy:

• Preventive inhaler (e.g., fluticasone): Increase dose 1-2 weeks before trek if doctor recommends. Continue throughout trek and for 1 week after descent.
• Rescue inhaler (e.g., salbutamol/albuterol): Carry at least 2 inhalers. Keep one in your daypack pocket (accessible within 30 seconds) and one in your main pack as backup.
• Spacer device: Bring a collapsible spacer—inhaler effectiveness decreases significantly without one, especially in cold conditions when coordination is impaired.
• Oral steroids (prednisolone): Carry an emergency course prescribed by your doctor for severe attacks. Know when and how to use them.

Cold air management:

• Breathe through a buff/neck gaiter above 3,500m—this warms and humidifies air before it reaches your lungs
• Avoid mouth breathing during exertion when possible
• Walk slower to reduce ventilation rate
• Warm up gradually each morning before strenuous climbing

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Diabetes and Trekking

How Altitude Affects Diabetes Management

High-altitude trekking fundamentally changes the variables that control blood sugar:

Blood sugar goes unpredictable because:

• Daily calorie expenditure increases to 3,000-5,000 calories (from a typical 2,000-2,500)
• Carbohydrate intake composition changes dramatically (dal bhat, rice, noodles—high glycemic foods)
• Meal timing becomes irregular (early starts, late arrivals, variable lunch times)
• Altitude itself may affect insulin sensitivity (studies show mixed results, but many trekkers report more variable blood sugar)
• Stress, cold, and physical exertion all affect blood sugar
• Altitude sickness symptoms (nausea, loss of appetite) reduce food intake unpredictably
• Dehydration affects blood sugar readings

Type 1 Diabetes

Pre-trek requirements:

• HbA1c below 8% (ideally below 7.5%)
• Experienced in managing blood sugar during exercise
• Comfortable with carb counting and insulin adjustment
• Carry CGM (continuous glucose monitor) if available—invaluable at altitude

Medication and supply planning:

• Carry 150-200% of estimated insulin supply (cold can reduce potency, vials can break)
• Insulin must be kept from freezing (body-heat pocket, insulated case)
• Insulin sensitivity may change—carry faster and slower-acting options
• Glucagon emergency kit (train your guide to administer)
• Blood glucose meter with extra batteries (cold drains batteries)
• Extra test strips (altitude and cold can affect meter accuracy)
• Fast-acting sugar sources at all times (glucose tablets, juice boxes, candy)

Daily management on trek:

• Test blood sugar more frequently than normal (every 2-3 hours minimum)
• Reduce long-acting insulin by 10-20% initially (increased activity reduces requirements)
• Carry fast carbs in every pocket (hypoglycemia at 5,000m is extremely dangerous)
• Inform your guide about signs of hypoglycemia and how to help
• Always eat before and during trekking days

Type 2 Diabetes

Generally less complex than Type 1 at altitude, but:

• Medication review is essential—some oral diabetes medications interact with altitude or dehydration
• Metformin may increase lactic acid risk at altitude (discuss with doctor)
• Sulfonylureas increase hypoglycemia risk during heavy exercise
• Blood sugar monitoring remains important (every 4-6 hours)
• Carry all medications plus 50% extra supply

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Heart Conditions and Trekking

Conditions That Require Careful Assessment

Controlled Hypertension (High Blood Pressure):

• Generally compatible with trekking if well-controlled (below 140/90 at sea level)
• Altitude typically increases blood pressure by 10-15 mmHg
• Some blood pressure medications need adjustment (beta-blockers may impair altitude acclimatization; ACE inhibitors are generally well-tolerated)
• Monitor blood pressure on trek if possible (portable monitors are lightweight)
• Avoid altitude if blood pressure is uncontrolled at sea level

Previous Heart Attack (Myocardial Infarction):

• Trekking is possible if: cardiac rehabilitation is complete, exercise stress test is normal, cardiac function is preserved (ejection fraction above 40%), and at least 6-12 months have passed since the event
• Requires cardiology clearance specifically mentioning high-altitude tolerance
• Lower maximum altitude targets may be advisable (staying below 4,500m)
• Carry nitroglycerin and aspirin on trail

Arrhythmias (Irregular Heart Rhythms):

• Atrial fibrillation: Usually manageable at altitude with proper anticoagulation. Altitude and dehydration increase clotting risk—stay well-hydrated.
• Other arrhythmias: Require individual cardiology assessment. Some arrhythmias worsen with altitude-induced sympathetic activation.
• Pacemakers/defibrillators: Generally function normally at altitude. Inform your guide and carry device identification.

Heart Valve Disease:

• Mild valve disease (aortic stenosis, mitral regurgitation): Often compatible with moderate-altitude trekking below 4,500m
• Moderate to severe: Requires cardiology clearance and may be a contraindication for high-altitude trekking
• The reduced oxygen at altitude increases cardiac workload, which problematic valves may not tolerate

Coronary Artery Disease:

• If you've had stents or bypass surgery and are now stable: trekking may be possible with cardiology clearance and stress testing
• Carry nitroglycerin sublingual tablets
• Know the symptoms of acute coronary syndrome at altitude (may be masked by altitude sickness symptoms)
• Have a low threshold for descent if chest pain develops

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Knee and Joint Problems

Why Knees Are the Trekker's Nemesis

Nepal trekking involves thousands of meters of both ascent and descent. While ascending is cardiovascularly demanding, descending is mechanically brutal on knee joints. Each downhill step loads the knee with 3-5 times your body weight. Over a typical EBC trek day, you might take 20,000-30,000 steps, many of them on uneven, rocky terrain.

Pre-Existing Knee Conditions

Osteoarthritis:

• Mild to moderate arthritis is manageable with preparation
• See a physiotherapist for a knee-strengthening program 8-12 weeks before the trek
• Consider knee braces or compression sleeves (test before the trek)
• Anti-inflammatory medications (ibuprofen, naproxen): discuss regular use during trek
• Trekking poles are essential (not optional) for arthritic knees—they reduce knee load by 20-25%

Previous ACL/Meniscus Surgery:

• If fully rehabilitated (12+ months post-surgery), trekking is generally fine
• Ensure muscle strength symmetry between legs
• Wear a supportive knee brace on the affected knee
• Report any instability or pain to your guide immediately

Chronic Knee Pain:

• Get diagnosed before the trek. "My knee sometimes hurts" needs investigation.
• An MRI or orthopedic consultation may reveal treatable issues (meniscus tears, bursitis, patellofemoral syndrome)
• A 2-3 month targeted physiotherapy program can dramatically improve knee function for trekking

Hip, Ankle, and Back Problems

• Hip arthritis: Similar considerations to knee arthritis. Descents are the main challenge.
• Ankle instability: High-cut, well-fitted trekking boots provide support. Ankle bracing may help.
• Lower back problems: The weight of a daypack (5-10kg) combined with uneven terrain stresses the lumbar spine. Core strengthening and a well-fitted pack with hip belt transfer help.

Pre-Trek Joint Preparation

1. Physiotherapy assessment: 8-12 weeks before departure
2. Strengthening program: Focus on quadriceps, hamstrings, glutes, and core
3. Trekking pole technique: Learn proper pole use for descents
4. Footwear fitting: Professional boot fitting at an outdoor shop
5. Test everything: Complete several 4-6 hour training hikes on varied terrain wearing full gear

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Mental Health Considerations

Why Mental Health Matters at Altitude

High-altitude trekking affects mental health in ways many trekkers don't anticipate:

Altitude-related effects:

• Insomnia is nearly universal above 3,500m (affects mood, judgment, resilience)
• Cognitive function decreases (slower thinking, impaired decision-making)
• Irritability and emotional volatility increase
• Anxiety and claustrophobia can intensify in confined tea house rooms
• Depression symptoms may worsen due to isolation, physical exhaustion, and altitude effects

Situational stressors:

• Isolation from normal support networks
• Physical discomfort (cold, fatigue, digestive issues)
• Group dynamics and interpersonal stress
• Uncertainty about health and safety
• Cultural displacement and language barriers
• Performance pressure (especially on guided group treks)

Pre-Existing Mental Health Conditions

Depression:

• Stable, well-managed depression is compatible with trekking
• Altitude and exhaustion may temporarily worsen symptoms
• Continue medications throughout the trek (bring extra supply)
• SSRIs and SNRIs are generally safe at altitude
• Inform a trusted trekking companion about your condition and warning signs

Anxiety Disorders:

• High-altitude trekking can trigger anxiety, especially around health symptoms (is this headache altitude sickness?)
• Claustrophobia may be triggered by small tea house rooms, enclosed sleeping bags, and crowded dormitories
• Establish coping strategies with your therapist before the trek
• Benzodiazepines (if prescribed): use cautiously at altitude—they can suppress breathing

PTSD:

• Remote, unfamiliar, and physically stressful environments can trigger episodes
• Discuss your trek plans with your therapist
• Have a grounding strategy plan
• Inform your guide discreetly if you have known triggers

Medication Considerations:

• MAOIs: Potentially problematic at altitude (tyramine in fermented foods common in Nepal; interaction with certain altitude medications)
• Lithium: Requires careful hydration management—dehydration at altitude can quickly become dangerous
• Benzodiazepines: May suppress respiratory drive at altitude
• All psychotropic medications: Discuss altitude interactions with your prescribing doctor

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Medications to Discuss

Medications That May Need Adjustment at Altitude

| Medication Class | Altitude Concern | Action | |-----------------|-----------------|--------| | Beta-blockers | May impair acclimatization by limiting heart rate response | Discuss alternative with cardiologist | | ACE inhibitors | Generally safe; may help prevent altitude-related pulmonary edema | Continue, may be beneficial | | Diuretics | Dehydration risk amplified at altitude | Adjust dose, increase fluid intake | | Blood thinners (warfarin, DOACs) | Altitude increases clotting tendency; trauma risk on rough terrain | Continue, carry INR testing if on warfarin | | Insulin | Dosage changes due to altered activity and diet | Plan adjustment strategy with endocrinologist | | Oral diabetes medications | Metformin: lactic acidosis risk. Sulfonylureas: hypoglycemia risk | Review alternatives | | Corticosteroids | Used therapeutically for altitude sickness; may mask symptoms | Discuss with doctor | | Birth control pills | Slightly increased clotting risk at altitude; dehydration compounds this | Stay well-hydrated, consider alternatives for very high altitude | | Statins | Generally safe at altitude | Continue normally | | Thyroid medication | Generally safe at altitude | Continue normally |

Medications to Request Prescriptions For

Diamox (Acetazolamide):

• The primary altitude sickness prevention medication
• Typical dose: 125mg twice daily, starting 1 day before ascent above 3,000m
• Discuss with your doctor: side effects include tingling extremities, increased urination, and altered taste of carbonated beverages
• Contraindications: severe sulfa allergy, severe kidney disease

Emergency Antibiotics:

• Azithromycin (Zithromax): For severe traveler's diarrhea and respiratory infections
• Ciprofloxacin: Alternative antibiotic for GI infections
• Your doctor should provide clear instructions for when to self-treat

Emergency Medications (Condition-Specific):

• Prednisolone: Emergency course for severe altitude sickness or asthma
• Nifedipine: For high-altitude pulmonary edema (HAPE) emergency treatment
• Nitroglycerin: If you have coronary artery disease

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Dental Checkup

Why Dental Health Matters on Trek

A dental emergency on a Nepal trek is disproportionately miserable:

• No dentists on trail. The nearest dental care is in Kathmandu or Pokhara.
• Altitude increases dental pain. Changes in atmospheric pressure can cause trapped gas in dental cavities or beneath fillings to expand, causing severe pain (barodontalgia). This is the same phenomenon pilots experience.
• Cold aggravates sensitivity. Exposed dentin, worn fillings, and cracked teeth become acutely painful in below-freezing temperatures.
• Limited treatment options. You can carry emergency dental cement and painkillers, but proper treatment requires a dentist. Dental pain severe enough to prevent eating or sleeping may force trek abandonment.

Pre-Trek Dental Preparation

Schedule a dental checkup 4-8 weeks before departure:

• Tell your dentist you'll be trekking at high altitude in remote conditions
• Request X-rays to identify any developing problems
• Complete any pending treatment (fillings, crowns, root canals)
• Address any sensitivity, loose fillings, or cracked teeth
• Discuss wisdom teeth if they're partially erupted

Dental emergency kit for the trail:

• Temporary dental cement (Dentemp or similar)
• Oil of cloves (eugenol)—natural dental pain relief
• Dental wax (for broken brackets or sharp edges)
• Ibuprofen/acetaminophen for dental pain
• Your dentist's email for remote consultation if WiFi is available

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Vision and Contact Lens Considerations

Contact Lenses at Altitude

Contact lens wearers face specific challenges at high altitude:

Dry eye problems:

• Air above 3,000m is significantly drier than lowland environments
• Wind at altitude further increases tear evaporation
• Contact lenses can become uncomfortable or unwearable
• UV exposure at altitude is intense and can irritate lens-wearing eyes

Corneal swelling:

• Altitude causes mild corneal edema (swelling) in some people
• This changes your lens prescription slightly and can make contacts uncomfortable
• Rigid gas-permeable lenses are more affected than soft lenses
• Extended-wear soft lenses tend to perform better at altitude than daily disposables (more oxygen transmission)

Recommendations for contact lens wearers:

• Primary: Bring prescription sunglasses as your main eye protection at altitude (eliminates lens hassle entirely)
• Backup: Carry daily disposable contact lenses (fresh lens each day reduces infection risk in dusty, non-sterile conditions)
• Emergency: Bring backup prescription glasses in a hard case
• Drops: Preservative-free lubricating eye drops—carry 3-4 vials in your daypack
• Hygiene: Hand sanitizer before handling lenses. Never use tea house water for lens care. Carry individual saline solution packets.
• Night: Always remove contacts before sleeping. Altitude-related corneal swelling is worse at night.

UV Protection

UV radiation increases by approximately 10-12% for every 1,000m of altitude gain. At 5,000m, UV exposure is roughly 50-60% higher than at sea level. Snow and ice reflect up to 80% of UV, creating exposure from below as well as above.

Requirements:

• Category 3-4 sunglasses with side shields (minimum requirement above 3,500m)
• Glacier glasses for snow-covered terrain above 4,500m
• Backup pair of sunglasses (losing your only pair above snowline risks snow blindness)
• See an optometrist before the trek if you need prescription sunglasses

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Travel Medicine Specialist vs GP

When a GP Is Sufficient

A general practitioner can handle your pre-trek checkup if:

• You're under 45 with no chronic conditions
• Your trek stays below 4,500m
• You have previous altitude experience without problems
• You need only basic tests (blood pressure, blood work) and vaccinations
• Your GP is receptive to your altitude-specific questions

When You Need a Specialist

Travel Medicine Specialist:

• Specializes in altitude medicine, tropical diseases, and expedition health
• Familiar with Nepal-specific health risks
• Can prescribe and advise on altitude medications (Diamox, dexamethasone, nifedipine)
• Available through travel clinics (see our vaccination guide for clinic listings)

Cardiologist (if applicable):

• Any known heart condition
• Abnormal ECG findings
• Family history of sudden cardiac death during exercise
• Significant risk factors (heavy smoking history, severe hypertension, diabetes)

Pulmonologist (if applicable):

• Moderate to severe asthma
• COPD
• History of pneumothorax
• Any condition requiring supplemental oxygen at sea level

Orthopedic Specialist/Physiotherapist (if applicable):

• Previous knee or hip surgery
• Chronic joint pain
• Recent injury
• Significant arthritis

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Medical Certificates for Agencies

When Agencies Require Medical Clearance

Some trekking agencies, particularly for peak climbing permits (Island Peak, Mera Peak) and demanding routes, require a medical certificate. This is also increasingly common for:

• Trekkers over 65
• Treks above 5,500m
• Peak climbing expeditions
• Extended treks (more than 21 days)

What the Certificate Should State

A medical certificate for Nepal trekking should include:

• Your full name matching your passport
• Doctor's name, qualification, and practice address
• Date of examination
• Statement: "[Patient name] has been examined and is medically fit for high-altitude trekking up to [maximum altitude] meters"
• Any conditions noted with confirmation of stable management
• Doctor's signature and clinic stamp

Getting the Certificate

• Most GPs will provide this after a basic examination
• Travel medicine specialists include this as part of their consultation
• Cost: $25-$75 for the certificate itself (on top of consultation fees)
• Some agencies provide a specific form for your doctor to complete

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Preparing Your Medical Emergency Plan

Create a Personal Medical Information Card

Carry a waterproof card in your daypack with:

Side 1:

• Full name and date of birth
• Nationality and passport number
• Blood type (if known)
• Allergies (medications, foods, insect stings)
• Current medications with dosages
• Chronic conditions

Side 2:

• Emergency contact name and phone number
• Travel insurance policy number and emergency phone number
• Embassy contact information
• Travel clinic/home doctor contact
• Known medical history relevant to emergency treatment

Share Information with Your Guide

Before the trek begins, share with your guide:

• Your medical conditions (be honest—this information saves lives)
• Your medications and what they're for
• Warning signs specific to your conditions
• What to do if you become incapacitated
• Where your emergency medications are located in your pack

Emergency Evacuation Understanding

Know before your trek:

• How helicopter evacuation works (insurance activation, landing zone locations)
• Which villages have health posts along your route
• Your insurance company's emergency number (saved in your phone and written on your medical card)
• The general descent time from your maximum altitude to road access

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Frequently Asked Questions

1. Do I need a medical checkup if I'm young and healthy?

If you're under 35, exercise regularly, have no chronic conditions, and are trekking below 4,500m, a comprehensive checkup is less critical but still recommended. At minimum, check that your blood pressure is normal and you're up to date on vaccinations. For treks above 4,500m (EBC, Annapurna Circuit high sections, Manaslu), a basic checkup with blood work is recommended regardless of age. Young, fit people still get altitude sickness, and undiagnosed conditions exist in all age groups.

2. Can I trek with controlled high blood pressure?

Yes, in most cases. Controlled hypertension (consistently below 140/90 with medication) is generally compatible with high-altitude trekking. Important steps: (1) Get a pre-trek blood pressure review, (2) Discuss medication adjustments (some antihypertensives work differently at altitude), (3) Monitor blood pressure on trek if possible, (4) Stay well-hydrated (dehydration raises blood pressure), (5) Know warning signs of hypertensive emergency (severe headache, vision changes, chest pain). See the Heart Conditions section above for more detail.

3. Is trekking safe with Type 1 diabetes?

Yes, with thorough preparation. Many Type 1 diabetics have successfully completed Everest Base Camp, the Annapurna Circuit, and even summit expeditions. Key requirements: stable HbA1c (below 8%), experience managing blood sugar during exercise, adequate insulin and testing supplies (carry 150-200% of estimated needs), CGM device if available, guide awareness and basic diabetes emergency training, and readily accessible fast-acting sugar at all times. See the Diabetes section above for comprehensive guidance.

4. My doctor doesn't know anything about altitude medicine. What should I do?

This is common—most GPs don't encounter altitude medicine regularly. Options: (1) Book a consultation with a travel medicine specialist (they specialize in this), (2) Provide your GP with altitude medicine resources (the Wilderness Medical Society publishes clinical practice guidelines for altitude), (3) Visit CIWEC Clinic in Kathmandu for a pre-trek altitude consultation after arrival, (4) Use telemedicine services specializing in adventure travel medicine. Don't skip the medical assessment because your GP seems uninformed—find a provider who understands the specific demands.

5. I wear glasses/contacts. Any special considerations?

Yes. Contact lens wearers should bring prescription sunglasses as their primary eye protection at altitude (dry air makes contacts uncomfortable), carry daily disposable lenses as backup, bring preservative-free eye drops, and carry backup glasses in a hard case. All trekkers need Category 3-4 UV-protective sunglasses (essential above 3,500m). Glacier glasses with side shields are necessary for snow-covered terrain. See the Vision section above for complete guidance.

6. Do I need a specific fitness test for Nepal trekking?

There's no standard "trek fitness test," but a practical assessment is valuable: (1) Can you walk uphill for 4-6 hours with a 5-10kg daypack? (2) Can you climb 500-800m of elevation gain in a day? (3) Can you do this on consecutive days without excessive fatigue? If yes, you're likely fit enough for most Nepal treks. If you're unsure, a physiotherapy or sports medicine consultation can assess your cardiovascular fitness, joint function, and overall trekking readiness. See our fitness requirements guide for training plans.

7. Should I get a medical checkup if I've trekked before without problems?

Previous high-altitude experience without problems is reassuring but doesn't guarantee future success. If conditions have changed since your last trek (new medications, new diagnosis, significant aging, weight gain, reduced fitness), a fresh assessment is appropriate. If you're under 50, trekked within the past 2 years, and nothing has changed medically, a brief GP consultation reviewing any medication changes is sufficient.

8. What's the maximum age for Nepal trekking?

There is no official maximum age. Trekkers in their 70s and even 80s have completed Everest Base Camp. Age itself isn't the limitation—fitness, health conditions, and determination matter more. However, the risk of undiagnosed cardiac and vascular conditions increases significantly with age. Trekkers over 60 should have a comprehensive checkup including ECG, blood work, and ideally an exercise stress test. Agencies may request medical certificates for trekkers over 65. Realistic fitness assessment and willingness to adjust plans (shorter days, more rest days, lower maximum altitude) make age-appropriate trekking safe and enjoyable.

9. Can I take Diamox if I have a sulfa allergy?

This is a common concern because Diamox (acetazolamide) is a sulfonamide derivative. However, cross-reactivity between sulfonamide antibiotics (like sulfamethoxazole) and non-antibiotic sulfonamides (like Diamox) is extremely rare—estimated at well below 2%. Most allergists and altitude medicine specialists consider Diamox safe for patients with sulfa antibiotic allergy. However, if you've had a severe allergic reaction (anaphylaxis) to any sulfonamide, discuss alternatives with your doctor. Non-pharmaceutical altitude prevention (proper acclimatization, hydration, gradual ascent) remains effective.

10. What should I do about existing knee problems before the trek?

Start a physiotherapy program 8-12 weeks before departure focusing on: quadriceps strengthening (the single most protective factor for knees), hamstring strengthening, hip/glute strengthening (hip weakness causes knee strain), core stability, and balance training. Get properly fitted trekking boots and practice with trekking poles (they reduce knee load by 20-25% on descents). If you have significant knee arthritis or previous surgery, get an orthopedic assessment to confirm trekking is appropriate and discuss anti-inflammatory medication strategies.

11. Is it safe to trek while taking blood thinners?

Yes, with precautions. Blood thinners (warfarin, apixaban, rivarelbaan, dabigatran) don't prevent trekking, but they require awareness: (1) Altitude naturally increases blood viscosity—your anticoagulation is actually beneficial, (2) Bleeding risk from falls on rough terrain is the main concern—trek carefully and use trekking poles for stability, (3) If on warfarin, altitude and dietary changes may affect INR—consider carrying a portable INR testing device, (4) Carry extra medication supply, (5) Inform your guide about your anticoagulation and what to do if significant bleeding occurs, (6) Ensure your travel insurance covers pre-existing conditions.

12. Do trekking agencies in Nepal verify medical certificates?

Verification depth varies by agency. Budget agencies may accept any signed doctor's letter without scrutiny. Premium agencies may require specific forms, detailed medical history, and sometimes contact your doctor directly. Peak climbing operators (Island Peak, Mera Peak) are most thorough, as their liability exposure is higher. Regardless of agency requirements, the medical checkup is for your safety, not bureaucratic compliance. An honest assessment serves your interests far more than a rubber-stamped clearance.

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Related Guides

• Acclimatization Guide for Nepal Trekking: Understanding altitude adaptation and preventing sickness
• Vaccinations for Nepal Trekking: Complete vaccination preparation guide
• HAPE & HACE Emergency Guide: Recognizing and responding to severe altitude illness

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This guide is for informational purposes only and does not constitute medical advice. Every individual's medical situation is unique. Consult with a qualified healthcare professional for personalized medical guidance before undertaking high-altitude trekking. Last reviewed: February 2026.