Expedition Preparation: International Trip Logistics & Lead Times

I have come to the conclusion that planning an international climbing trip is a lot like planning a wedding. They are completely different events but many of the same rules apply. Both include similar lead time planning, the same dress rehearsals, and the same feelings of being overwhelmed by all of the details. (so many!)

Don't believe me? Let me explain it this way. The internet is full of wedding timetable calendars to help the bride plan the big day. These guides provide a high level outline of how early you should complete key events. These outlines suggest that you should have your caterers & florists confirmed 9 - 12 months in advance, your guest list 6 months in advance, your dress 3 months in advance, and so on. A major climbing expedition is the same. Your trip should be booked 12 - 9 months in advance, your travel insurance booked within 21 days after that, your gear confirmed and ready at least one month before departure, and so on. The same rules apply.

The only thing still missing is this same treatment for major international climbing adventures. I wish someone had outlined this for me when this adventure started! Here is my high level outline of what it really takes, and how long it takes, to prepare for an international climbing adventure.

I am currently at the ~60 day mark before the big day. This list below may tweaked as we get closer but here is the plan so far. It's quite a list!

• As Soon As You Know You Want to Climb 'X' Mountain
• Mountain Selection: Research Past Trips - Ex. Blogs, YouTube, Summitpost.com, etc
• Guide Service - Selection: Select Your Guide Service - Interview as Many as You Can
• Trip Itinerary - Selection: Confirm Your Trip Selection, Preferred Itinerary Options, and Cost Tolerance(s). 
• Travel Insurance - Selection: Confirm Your Travel Insurance Selection & Options (Ex. Travelex)

• 12 - 9 Months Before Departure
• Guide Service - Trip Booking: Book Your Trip with Your Selected Guide Service (yay!)
• Submit All Requirements Paperwork & Passport Photo Copies
• Travel Insurance - Trip Cost: Purchase within 21 Days of Trip Purchase - Expedition Cost
• Training - Outline: Initial Outline of Physical Training Schedule
• Gear - Initial List: Initial Outline of Required Additional Gear Purchases (Ex. Double Plastic Boots)

• 6 - 9 Months Before Departure
• Airfare / Travel Agent - Initial: Establish Relationship with Travel Agent, if Using, for Airfare Booking
• Physician / General Practitioner - Initial: Review Your Trip, Vaccine, Medications, and Physicians Clearance Letter Requirements with Your Physician. Most Guide Services Require a Physicians Letter.
• Training - Start: Start Your Training! (Ex. Stair Climbing, Hiking, Snow Camping, etc)
• Gear - Start Purchasing: Start Purchasing Your Gear. This Advance Lead Time Spreads the $$$ Pain and Supports Inventory Availability.

• 3 - 6 Months Before Departure
• Airfare / Travel Agent - Purchase: Confirm Purchase of Airfare Booking - Layover Hotels Too if Needed
• Travel Insurance - Airfare: Update Existing Travel Insurance to Include Airfare Cost
• Guide Service - Air Travel Details: Share Your Air Travel Details with Your Guide Service
• Physician / General Practitioner - Medications: Confirm Your Required Medication Selection(s) & Prepare to Fill Prescriptions ~30 Prior to Departure
• Vaccinations & Travel Medicine: Make An Appointment With a Travel Medicine Professional. Plan to Start Required Vaccines Before the Three Month Mark.
• Training - Continue & Ramp-Up: Check in on Your Training Progress. Need to Change Anything? Do it Now.
• Gear - Final Purchase List Confirmed: Your Complete Gear List Should be Finalized & Purchases On Their Way.

• 90 Days Before Departure: 
• Physician / General Practitioner: Confirm Physician Readiness to Write Required Prescriptions & Sign-Off on the Physician Release at ~30 Days Prior to Departure. 
• Vaccinations & Travel Medicine: Confirm Final Vaccine Schedules. Complete Before the ~30 Days Prior to Departure Milestone.
• Training - Continue & Ramp-Up: Check in on Your Training Progress. Add as Much Activity Specific Training as Possible w/ Your Actual Gear. (Ex. Boot Break-In)
• Gear - Break-In: New Boots? Awesome! Start Breaking Them In! New Jacket? Cool! Take it Snow Camping! Use that Stuff to Make Sure it Works as Expected.

• 30 Days Before Departure:
• Physician / General Practitioner: Confirm Receipt of Physician Release & Fill Prescriptions.
• Training - Finishing Touches: Are you Ready? Are you Sure? You Should Be.
• Gear - Practice Packing: Practice Pack All of That Gear & Weigh It. Carefully Consider Applicable Weight Restrictions. (Ex. 15kg for Flights to Lukla) Make Any Final Purchases Now.

• One Week Before Departure:
• Final Packing: Pack That Bag. It's Time to Go! Batteries? Chargers? PLB Configurations? All Done and Ready.

Missing anything? I'd love to hear from you in the comments.

Expedition Preparation: Vaccines & Medications

I have noticed over the past weeks and months that there is a wealth of online information on certain areas of Himalayan travel. Every blog and every guide service has multiple posts dedicated to gear and training. (I will too very soon!) These are important but only a part of the overall preparation scope.

You know what these sites don't seem to spend time on? The required vaccines and medications. I can only imagine that this is either glossed over or ignored due to their overall lack of shininess. No one wants to include the potential side effects of dexamethasone and whether or not to get the rabies shot in their summit fantasies. And, while I completely understand this impulse, this remains an overlooked but highly critical part of expedition preparation.

Not My Actual Pill Bottles - Too Few

Your required vaccines and medications are a very important topic - no one wants typhoid - requiring a great deal of upfront planning, risk analysis, and significant financial investment. This is top of mind as I will be journeying to get my second of three Hepatitis A/B vaccines this afternoon. We also filled most of our required medications a little over a week ago - the pile is impressive! (not my actual pill bottles)

NOTE: These information is provided to represent my experience alone and not intended as a source of medical advice. Always consult your physician to access your individual medical needs.

There are three primary sources of information in determining what vaccines are required for international travel. The first source to consult is the CDC Travel section. This amazing resource is a great first step in determining your traveler profile, destination, and overall risk profile for disease exposure. A traveler to the rural interior of Brazil will have very different needs from a traveler to the high altitude areas of Nepal. This resource will provide you with a list of Recommended and Optional (Some Travelers) vaccinations for most world destinations and excellent guidance on general travel health considerations.

So Shiny and Pointy

The second resource is your local Travel Physician Clinic and/or a qualified General Practitioner. We are lucky in the Seattle to have access to the Travel Clinic at the University of Washington. Most other major metropolitan areas and/or medical schools should have similar resources. We worked with the University of Washington to schedule a consultation with a Physician experienced in both travel medicine and high altitude preventative and acute care. We were pleasantly surprised to learn that our physician had previously been to over 18,000 ft. and was very versed in AMS related regimens.

The third resource is your guide service. International Mountain Guides maintains a high level list of recommended vaccines and medications within their larger expedition form packet. (see section 5 - Physician's Certificate) Most larger guide services seem to provide similar conversation starting points for physicians. Your guides can also provide you with an excellent resource on their own preparation approaches, client stories, and expedition specific advice.

So, where did all of these bring us you ask? Our final list of vaccines and medications are noted below with a brief description of each. The total cost of these items, over and above our expedition cost, is expected to be $700. Note that this amount does not count the potential rabies vaccination we may also elect to receive. This vaccination, addressing a low risk but very serious and fatal disease, would add an additional $1,300 to the existing $700 total.

I am sharing these here to emphasize the reality of the risks and medical preparation requirement, in practical, financial, and emotional fronts, of a climb over 5,500 meters / 18,000 ft. This is an amazingly serious adventure but also impressively serious business.

• Vaccinations:
• Routine Childhood / Maintenance Vaccines: Polio, MMR, TDap, Flu, etc.
• Hepatitis A & B - Twinrix: The Twinrix hepatitis A / B combination vaccine is administered over a period of one month in three doses. This vaccine is administered in your upper arm. The CDC notes an expected > 98% protection against both types of hepatitis one month after the third dosage. We elected for the accelerated option in the interest of time. Cost: $105 /per Dose - $315 Total

• Medications:
• Azithromycin / Zithromax: Zithromax is a general purpose antibiotic used to combat a range of conditions from respiratory infections to general bacterial gastrointestinal distress. (Ex. travelers diarrhea)
• Ciprofloxacin: This is a much more powerful bacteria fighting antibiotic. This is used only in more serious situations as this drug can have a powerful negative side effect on the strength of tendons.  This is obviously not desired on a highly physical adventure.
• Tinidazole: The intended purpose of this antibiotic is in response to an infection of Giardia or Beaver Fever. Isn't that a fun thought in rural facilities?
• Advair HFA: This is a steroid inhaler intended for the purposes of combating the 'Khumbu Cough' or respiratory irritation, accompanied by cough, brought on by exertion in cold and dry air. 
• Acetazolamide / Diamox: This drug is the first of three in the arsenal against AMS - Acute Mountain Sickness. This condition can start in some individuals at quite low attitudes and can present itself as nausea, headache, disorientation, and/or swelling of the brain and/or heart. This condition can be fatal. Diamox works as a preventative by acidifying the blood, which causes an increase in respiration and arterial oxygenation and thus aids acclimatization.
• Dexamethasone: This is the second of three in the arsenal against AMS. This particular medication is focused on the treatment and stabilization of symptoms of HACE - High Altitude Cerebral Edema. We clearly hope not to need this medication - at all.
• Nifedical: This is the third in the arsenal against AMS. This particular medication is focused on the treatment and stabilization of the symptoms of HAPE - High Altitude Pulmonary Edema. This we also do not want to need - at all.

I hope this was helpful to you. I promise a more fun and lighthearted post for our next visit. In the meantime, happy medication reading!

NOTE: These information is provided to represent my experience alone and not intended as a source of medical advice. Always consult your physician to access your individual medical needs.