Medex Newsletter, 18
This is a bumper 26 page Newsletter with lots of contributions from all sorts of Medex Members. Annabel Nickol has written a lengthy section devoted to Medical Expeditions which has been very active. As you will read Medex members made up 10% of all the delegates at Hypoxia 2005 at Lake Louise in Canada. David Hillebrandt and Peter Barry have also been busy with the diploma and I have included the full text of David’s report on the Scottish winter component of the diploma. We are in the early stages of planning the research ethos of the 2008 West Nepal Expedition and details of this will appear in the next Newsletter.
We are missing out the Hyssington BBQ this year so we hope to see as many people as possible at the Langdale meet in October. Don’t forget to book early in order to guarantee that you get a meal. Booking details are included later in the Newsletter.
WORLD CONGRESS OF MOUNTAIN AND WILDERNESS MEDICINE:
Scotland, Sept 27-Oct 1st 2007. This is the next World Congress and is sponsored by both the International Society of Mountain Medicine (ISMM) and the Wilderness Medical Society (WMS). Brownie Schoene from the USA is the Co-Chair from the WMS (he is their past president). Charles Clarke will head up the organising from the UK side. Various Medex members, as well as other altitude buffs, will also be involved. It should be a great conference so put the dates in your diaries now!
Mountain Medicine Course, Plas y Brenin. Fri 2nd – Sun 4th December 2005
See the web site ‘courses’ for a provisional time table, and email email@example.com to register interest. More details to follow soon!
Altitude Symposium 30th November 2005, St. Catherine’s College, Oxford. Full details on the website. Organised by Medical Expeditions.
Royal Geographical Society: Tues 7th June 2005 7pm at Royal Geographical Society, Kensington Gore, London Road Surgery
The first ascent of Kangchenjunga- 50th Anniversary
With George Band, Joe Brown, Norman Hardie. Introduced by Richard Attenborough, closing tribute by Doug Scott. Further details should be on the RGS website when they update to the summer program http://www.rgs.org/category.php?Page=mainevents
Hyssington Summer BBQ
For years now we have had a July BBQ in Hyssington but this year we have decided to postpone it as we are deep in negotiations with our Swedish boat builder who is due to deliver in early July. At least we won’t clash with the Bletchington Ball.
Old Dungeon Ghyll in the English Lake District October 2005
October 15th - 16th 2005, Old Dungeon Ghyll Hotel, Lake District Weekend. This is the annual Medex event We normally arrive on the Friday night, spend Saturday on the hill with dinner in the evening. B&B accommodation can be booked direct with the Hotel (tel: 015394 37272) and camping is available nearby. If you want to attend the dinner on the Saturday evening this must be booked direct with Medex as places are limited. A cheque for £28 will secure your place for dinner, made payable to Medex and sent to the Pinfold, Hyssington, Montgomery, Powys SY15 6AY
Pay either by cheque or direct bank transfer into the Medex account: contact firstname.lastname@example.org for details. Unfortunately at present we do not accept credit cards. www.odg.co.uk/langdale
Bletchington Ball - Saturday 16th July 2005: Fancy some revelry in the countryside? Annabel and friends invite you to join them for the Bletchington Ball. Blechington is Annabel’s home village and is near Oxford. All are also welcome for Pimms at Vikki, Dan and Monty's from 6pm on Saturday, and for a BBQ brunch at Annabel's on Sunday.
Cost Ball £45 cheques payable to Bletchington sports and social club (social section) Pimms and BBQ... voluntary £5 cash... please RSVP to help us ensure there are enough sausages!
Send to Annabel Nickol, 4 Home Farm Cottages, Bletchington, Oxfordshire OX5 3DD by 30th June
B&B at the Black's Head Pub, tel Chris and Karen 01869 - 350315
Camping at Greenhill Farm, tel Paul 01869 - 350985 or 07811 - 457400
Contact Annabel on 01869 - 351841 or email@example.com
A further gentle reminder to all those who have not yet re-joined Medex. The last subscription period ended on 31st December 2003 and the new subscription period runs for four years and costs just £45. I have included at the end of this newsletter a list of all those who have already signed up and so, if your name is not on the list, your membership has expired. If you do wish to re-join then please drop us a line with a cheque or email us asking for the bank details for direct transfer.
Congratulations Nick and Amanda who sent in this note on 9/1/05. Just a short note to let you know that the new addition to the family arrived safely this morning weighing in at 7 pounds 7 ounces. I've just got back from the hospital and am pleased to report that Mother and baby (and Daddy) are all doing fine. I'm sure we’ll give you more details in due course including a name once we've agreed on one, but in the meantime I've attached a photo. Regards, Nick Brown.
Richard Parris has been working as a ship’s doctor in Antarctica and he and Liz are expecting a baby anytime around now!
Alex Horsley says: Had a baby four weeks ago and have just started a PhD in Edinburgh. Hence been a wee bit busy recently! Alex
Expedition Opportunities (Dr required)
Rob Conway writes, “I'm writing to you about our research project to Bolivia this summer looking at Coca tea and altitude sickness.
The project is to be run over the month of August in La Paz Bolivia, working with a team from St George's Hospital Medical school in London. We will be looking at the effects of coca tea on altitude sickness in healthy volunteers from the travelling and mountaineering community as well as some medical students! We really want to get team Dr on board with good experience. We were wondering if you could recommend us one, or Dr Jim Milledge (our patron), said that you may be able to send an email out to MEDEX members (of which I am one) advertising for one. They would have to pay for flights and insurance, but would be accommodated in Bolivia and get to do some good climbing as a perk! If so this would be incredibly helpful.
We have a website at http://www.wildmedics.sgul.ac.uk/bolivia.htm with more info”
Damian Bailey: taken up post of Professor of Physiology at South Glamorgan AND married all in one year
Michael Schupp: gained CCST in Anaesthesia… now off to Toronto to work for one year
Giorgos Tsianos: submitted PhD thesis, including chapter of data from the Chamlang 2003 expedition ~ ‘The hypoxic ventilatory response’
Sally and I have been Ski Touring in Austria with Carol Darwin, Michelle White and Annabel Nickol. Our best day was the ascent of the Piz Buin from the Wiesbadener Hut and a ski descent to Klosters.
This was sent in by Linda Sherpa who spends much of her time in Nepal where she is linked to a delightful bed and breakfast establishment called Hamro Ghar and now to a holiday let in Manang.
I am pleased to hear and read over here in Kathmandu of another Expedition Group visiting Nepal to experience the joys, dangers and experiences of the Khumbu and the mountaineering challenge of reaching the Everest Summit in the name of research. We know full well this knowledge eventually comes back to the 'mere mortals' who wish to go as high as possible within the capabilities of their own minds and bodies.
Living here it is impossible to know of real progressive developments politically as all the communication media are still censored. All our lives are filled with rumours and potential threats of more blockades and bandhas to the Kathmandu Valley. We just have to 'scurry on' regardless of outside valley tragedies with local lives.
Anomalies are many and the show of the rich and affluent in material wealth through vast lavish private homes and building continues despite rising costs, absorbing the rich agricultural land within the valley. Many local people are under tremendous pressure as they continue to migrate into Kathmandu or other towns to escape from the outer area situations, in total confusion of not knowing or understanding who their real and ruthless persecutors are as accusations with retributions come from both security, Maoists and possible bandits. Who knows?
I awoke this morning, wondering yet again how I should continue to write my news and decided on a positive approach as so many countries in the world seem to be surrounded by doom and gloom.
Latest of my missions is to promote Manang village (free from the civil war), what a wonderful place to live in and not just trek through on the circuit etc. The latest is you can now fly to Humbre and miss the 5/6 day walk in or you can helicopter to Thal and walk in 3 days to help acclimatisation. Anyway study the books take a look, do some research. It is a beautiful location with good trails and from airport to Manang, very safe trails either upper route or lower way.
There are many options for mountaineering, climbing and trekking to remote areas to local villages that are unspoilt. The Manang Youth Association are working to promote the area with sensitivity to all their culture and environment to preserve the best of their heritage.
Well, my contribution is an experiment with a local family i.e. to clean out deceased Grandmothers home in the back trails (streets) of the town/village and create a 'holiday let'. Without altering the style or original dwelling to retain its old world flat roofed charm we will create and modify with adaptations for a family or group to have a base for further adventures.
The house modernisation for your comfort - the large living area will have a stove with a chimney, for heat and cooking. Traditional furniture will be used (even electric lighting,) all wood, kitchen equipment provided and bring your own cook or have local staff. Food can be bought by your group as required from Kathmandu or bought locally.
A smaller room will be converted into a wash room and loo will be possibly on lower ground floor according to drains. But may be possible to have on first floor as well next to bedrooms!
There will be sleeping area for up to 6/8 pax. in the other room which may have wooden divisions or locally hand woven heavy curtain dividers. Just ideas as yet. We will be doing this in August/September for the new season all decorated and clean for your visit. It is a safe area for children with ponies galore for those who ride rather than walk and with so many places to go that are rich in History and flora and fauna. Himalayan Rescue provides the Hospital and Doctors.
The flat topped roofs give outside seating (no gardens) with splendid views of the local mountains for those just wanting a sun filled relaxing less energetic holiday. There is a very good ACP office, with loads of local information and a new museum has just been built and is well on the way to being finished which hopefully will be a weaving base with shop and coffee tea cafe.
What a wonderful out lying holiday centre without the 'resort mentality' developing around the major tourists centres.
Lots of life as the circuit trekkers plough through with fun filled noisy lodges around for a good music night out if required or a quite evening in with family or friends in your very own holiday Manangi Home.
I return to the UK on 20 April so comments welcome and reservations galore may be made; they are a lovely family and all monies to them – it’s just my idea! Regards to All
Linda M. Sherpa
Mark Howarth and co have been in Alaska and he has sent in this article.
The Tortoises go to Alaska
Most of the tortoise group from Kanchenjunga have kept in touch since 1998 and have been on various trips together. So it was that Gill Macquarie (aka Havely), Ian Baxter, David Geddes and myself, together with honorary tortoises Ian Arnold and Harry Burn teamed up with guide Dean James and his assistant Adrian. Our target was Mt Marcus Baker, a fairly small but remote peak in the Chugach range in Alaska. It had never been climbed by a Brit – and sadly I have to report that it still hasn’t.
We flew to Anchorage and the next morning on by two-seater ski plane onto the Knik glacier. It seemed bizarre to be in such a remote setting quite so soon after leaving home. It took all day to fly us in. We set up four tents on the glacier. The first few nights and mornings were about as cold as I could imagine. I slept in boots and two pairs of socks, balaclava and gloves and every layer you can think of in between – quite a squeeze to get into my sleeping bag! Supper was an instant meal heated up on a stove. I saved some hot water for washing up and went to use it a few minutes later – only to find it had not just cooled but had frozen solid. Toothpaste and sunscreen were useless without prolonged armpit treatment. Wet wipes seemed an obvious idea but you can begin to guess why they don’t work either.
For the first five days the sun shone fiercely through a clear blue sky making for very pleasant walking by mid-morning. We explored the glacier on snowshoes. Conditions were superb but the glacier is heavily crevassed and we sometimes had to make long detours. We climbed a couple of small but virgin peaks and had fantastic views of the massive Alaskan glaciers. Denali loomed large on the horizon despite being 150 miles away. But Marcus Baker looked impossible. Surrounded by massive crevasses and bergschrunds, I think it will be a while before it is climbed again. The afternoons were surprisingly warm up to about 7pm. so we were able to sit outside eating, drinking coffee and wondering why we had never thought of going to Alaska before. And eating ice-cream – here I feel I must share my recipe because I think it is really rather good!
Melt half a bar of good dark chocolate in a little boiling water
Add a few spoonfuls of milk powder
Fill pan with snow and beat like crazy with a wooden spoon
But it was too good to last. We then had six days and seven nights of storm. Leaving the tent was only for the most essential of activities – performed in great haste! The wind was ferocious and the flapping of the tent canvas made sleep difficult. Snow piled up around the tents and David’s tent collapsed the first night leaving him and Harry to hastily beg space in the other tents. Occasionally there was a lull but only to tease and then it built up again. Cooking was hazardous and we nearly burnt the tent on a couple of occasions. As the snow built up and we neglected our digging the tent walls were splinted and the flapping ceased but one night the wind just howled over us. We later learnt that there had been a force 8 gale in Anchorage so we were probably not far off hurricane force. Then one magical morning we heard geese honking overhead. The wind had dropped a little and we ventured out with shovels. It felt a bit archaeological as we excavated cautiously. “Look! Here’s a tent, early 21st century design complete with cooking utensils and food remains.” We found just about everything after a few hours and all the time the sky was clearing and the wind dropping. Our spirits soared (it must be confessed they had sunk a little) It took me a day to recover my strength but there was still time for a superb final day on another unclimbed peak. One morning a Northern Wheatear flew into our camp looking very lost. He obligingly posed on a ski pole for photos and then in a tent before flying off to an uncertain future. Apart from him and the geese we saw no other life in the mountains.
Then back down to the valley one at a time in the Piper Cub and a taxi to Anchorage. Met some wonderful people there and made good friends. There are some good cycle trails to explore. The final day I arranged a kayaking trip which involved flying onto a glacial lake but sadly we had to abort this. After a series of minor mishaps, the final straw was when the float plane started sinking in the harbour! There are times when I favour life over death – and a bike ride to a cafe over a flight in a rust bucket.
As a final bonus the flight home took us right over our glacier and we could see exactly where we had been. The agony and the ecstasy. But isn’t it strange how quickly the agony fades but the ecstasy lives on? I can’t wait to go back to Alaska.
Greg Harris firstname.lastname@example.org sent in this. Hi Simon and Sally,
Medex Down Under continues to exist, albeit still sadly lacking in significant altitude or climbing partners...
A move from Melbourne to Darwin 12 months ago has given us much warmer weather, occasional cyclone threats and some raised eyebrows from some Medex members who had heard that we'd prefer the cold of Tasmania! Life is very comfortable in the 'Top End', although the spectre of Fellowship exams is looming and a return to the South is likely at the end of the year.
Expeditioning here has been more of the 4WD-type, with trips through Kakadu National Park, Katherine Gorge and right across the Kimberley region to Broome and back, an easy 4000 km round trip via some of the most spectacular and remote desert scenery in the world.
The cognitive data from Nepal has come together in a very interesting fashion; I've attached a copy of the abstract for the general interest of all. I hope to have something in submittable form by the end of the year. To have the opportunity to present it at Lake Louise was priceless, and the comments made by others about the lively and active Medex presence would have made all Medex members proud. I don't think any of us did anything to counteract that impression (I take no responsibility for any photographic evidence that may suggest otherwise), and Jim's dancing should spur us all on for the next Hypoxia meeting!
With kind regards to all Medex members (even Group 4), Greg Harris
John Sanders sent in a note from New Mexico where he has been living for the last 4 or 5 years. Dear Simon, I hope all is well with you two. Just to demonstrate that I read your e-mails I will respond to one. Update on outdoor activities for your letter.
Very good climbing and skiing season in New Mexico and Southwest Colorado. Nothing to shake the world but more an advertisement and inducement if people wish to visit and crash for a bit. Steve Archibald has been out once and is returning next winter. This year I soloed a big wall in Zion, and a few Scottish 4 and 5 routes in Colorado as well as climbing my best routes of the year Birdbrain Boulevard 1200 ft M6 WI5, an early repeat of Dukes of Hazard M6 WI6, and Seven Year Itch WI6 M6.
Alex Truesdell sent in a note from Washington DC: So, here's my news...on the research front I'm presenting the Makalu data for the last 2 times at the American College of Physicians Meeting in San Francisco and The American Thoracic Society International Meeting in San Diego--both in late Spring.
I graduate my residency (Internal Medicine) in June. I was selected for Special Forces following graduation--with a start date in 2006, so I'll kill the time in between at the Pentagon here in Washington, DC. After that I suppose I'll FINALLY return for Fellowship and complete my medical training. And that's that.
OK. Take care. Alex email@example.com
Jim Duff writes: Dear Simon, I am running a doctors' trek up Kili in July. It is a commercial venture (i.e. I get paid!) and I use World Expeditions as travel agent. It attempts to include 10 hours of talks, and instruction on the PAC and a little observational research.
Is a description and invite to go on the trip suitable for the NL?
Jim Duff wrote an account of the Marchermo Porter Shelter in the last newsletter. He has now written a full account of the 2004 activities:
At 4400m, Machermo is ideally suited to serve porters and trekkers descending from the upper reaches of the valley (Gokyo-Ri 5483m) and the passes leading into it (Renzo La 5600m and Cho La 5420m). Since the spring season 2003 the post has opened each trekking season, for variable lengths of time.
Two major events occurred in 2004. First, Namgyal Sherpa started the building process by bringing in a team of 10 stone breakers paid for by CAN (Community Action Nepal). Second, IPPG (International Porters Protection Group) has engaged Chhewang Sherpa as full-time salaried manager for Machermo with an extensive job description. The salary has been guaranteed for the next three years by doctors who were on my trek last October.
In October I was able to visit Machermo briefly. I talked to Namgyal, observed the huge quarry of building stone and met Dr Louise Cook, the resident volunteer doc, and Chhewang. On the way down I met Tenzing Tashi Sherpa, chairman of the Kumbila Buffer Zone Committee (KBZC) for discussions including oversight of the construction costs and ownership/management of the project as a whole.
The management of the project:
A) The land will continue to belong to the National Park
B) The buildings will belong to the KBZC
C) The KBZC will arrange a roster of local lodge owners to manage the porter shelter
D) IPPG will organize and run the rescue post
E) KBZC and IPPG will consult each other on policy
F) CAN is responsible for building the structure and coordination with Namgyal and the KBZC via Ian Wall (CAN board member and IPPG-UK rep)
G) IPPG is responsible for fitting the buildings out
Ian Wall has been up to Machermo to check out building progress along with Chhewang and Govinda (CAN’s building supervisor). Building proper should start in March 2005 and it may be ready in October!
The post still runs from a room in Namgyal’s lodge and we are grateful to him for his support. It is equipped with a Portable Altitude Chamber (donated by the manufacturer CE Bartlett), an oxygen generator (IMEC), oxygen cylinders (seasonal rental, donor sought), a pulse oximeter (Bernhard Fassl), a stretcher (Skipton CRO UK), solar powered batteries (Jim’s Kili sponsors), a satellite phone (Island School, Hong Kong) and heaps of medication including Penthrox inhalers (Medical Developments International, Australia).
In 2004 the rescue post was staffed for four weeks in the pre-monsoon season and six weeks post-monsoon, with a steady flow of consultations punctuated by some serious problems needing prompt action and evacuation. It is always hard to say if lives were saved or not, but reading through the doctors’ log it makes me think that there must have been some close calls even with the doctor present.
Problems dealt with:
The most common problems treated were altitude illness, respiratory, gastro-intestinal, and trauma. Occasionally more serious or unusual problems were seen as described below.
Pre-monsoon March 29th to April 28th
Drs Alex McRae (Australia), John Banks (Australia), and Trish Batchelor (Australia)
· 71 patients seen (47 porters, 14 local Sherpas or guides, 10 trekkers)
· 8 porters had AMS
· 4 trekkers had AMS, 1 HAPE, and 1 HAPE and HACE
Post-monsoon October 1st to November 14th
Drs Louise Cook (UK), Andrew Kingsley (UK). Medical student Tom Martin (Australia)
· 126 patients seen (46 porters, 44 local Sherpas or guides, 36 trekkers)
· 16 porters were treated for Altitude Illness (13 had AMS, 2 HAPE, 1 HAPE & HACE)
· One porter was carried down with severe HACE after being paid off and abandoned by a trekking group
· 6 trekkers were treated for HACE and/or HAPE, 1 severe gastro-enteritis, 1 convulsions cause unknown. Of these 8 seriously ill trekkers, 5 were evacuated by helicopter, 3 were walked or carried down
Chhewang Sherpa has been praised by all who have worked with him. He is taking English language classes, first aid courses and is keen to improve his wilderness medical skills. Chhewang has been visiting all the porters in Machermo each evening to talk to them.
Next season there will be regular education lectures for porters and trekkers and we hope to have the Porter Shelter completed by October 2005.
A big thanks to Dr Trish Batchelor who worked hard to get the rescue post up and running while living in Kathmandu.
All this takes money and we need about £20,000 (US$40,000) to complete the buildings. It costs around £3,000 (US$6,000) p.a. to run the rescue post, some of which is generated by charges for treatment (porters free, locals 20 Rs, trekkers US$), the balance being donated. All our donors are listed on the IPPG website and we are very grateful to them on behalf of the porters. If you have any queries or suggestions please email or ring me. Dr Jim Duff, IPPG International Coordinator firstname.lastname@example.org Ph +44 (0)1229 586225
Jim Milledge has sent in his account of a meeting and a mountain in Iran
Mount Damavand (5671m) Sept. 24th 2004
“Summit gp” Our group in the summit. Mummified ?goat on rock
“Nearing summit” Our guide followed by me, then Bruno
“Iranian girls” We met a friendly group of Iranian students on their way down, who had climbed the peak the previous day.
“Damavand2”, view of Mt Damavand from a village on the road approaching the peak
“Dama view S” Looking back to the South over grey brown ranges.
The annual meeting of the UIAA Medical Commission was held this year in Tehran. David Hillebrandt and I went representing the BMC. The committee meeting was followed, as usual, by a one day conference on mountain medicine. Dr Jalal Shahbazi, one of the Iranian members, was the main organiser and our host. He had suggested we might like to climb this mountain, the highest in Iran, after the conference. Four overseas members of the Commission decided to do so, Bruno Durrer (51) from Switzerland, Dominique Jean (49) from France, Silvia Frrandis (34) from Spain and myself (74) (David decided to go rock climbing). Jalal came with us and a friend of his, Mohamed was our guide and organised the trip. Two other Iranian friends came along too Mahanfar and Assad. I had got the impression from an e-mail from Jalal that we would take 4 days for the trip which fitted with my researches on the web of trekking companies’ itineraries. But when we met in Tehran and discussed plans it seemed that it was usual for Iranians to do it in just two days! This goes against our own teaching, that to avoid acute mountain sickness (AMS) one should ascend slowly and acclimatise. It might also explain the reported high incidence of AMS on Damavand of 60% (Ziaee et al. 2003, Wilder. & Environ. Med. 14, 214-9). So we agreed that we would go along with local custom and see how it went.
Friday Sept 23rd.
The eight of us left our hotel in Tehran about 6.30 on a beautiful morning in two cars and headed north on good roads. It took some time to get out of the sprawling city into the hilly countryside. September is the end of the dry season and so the country was pretty barren. We saw just one flock of sheep and what they could find to eat was not clear. Jalal told us that in a couple of weeks time, rain in the valleys and snow higher up would start. After crossing a pass where in winter there is downhill skiing, we traversed a number of valleys and reached our first stop, Ploor (2100m). Here, just outside the village, the Mountaineering Federation of Iran had almost completed a large building for an outdoor pursuits centre. We left the cars here to go on by pickup truck. After a cup of tea (Iranian, without milk) we piled into the truck and set off. We soon left the tarmac road for a bumpy dirt side road heading for our mountain. After about 20 Km we pulled up at Goosftand (2900m) where, at the end of the road, there was a car park and small mosque. A very chatty chap engaged us in quite good English. He ran the local mule train and was used by trekking companies to take their baggage up to the refuge, Baragh-e-sevvom (4150m). We declined his offer to transport our packs and set off for the refuge at about12.15.
The path was obvious, a stony, dusty track through the sparse vegetation of these middle slopes. At this height it was still quite green but as we climbed up, the plants thinned out, until a little above the refuge they give way to a landscape of pure rock, stone and sand. We applied sun screen and going up the south side of this extinct volcano, we had the sun warm on our backs. There was a sharp breeze blowing behind us so we kept nice and cool. As we gained height, the views behind us opened up, with range upon range of brown mountains running up to around 4000m. There was an emerald lake to the west, and altogether it was a very pleasant walk to the refuge which we reached in just over 4 hours, which is about guide-book time.
The refuge was on the only flat patch on a rocky ridge. It was built in concrete and consisted of just a dormitory of two tier bunks. There was no living/dining room or kitchen and the guardian had a tent in a sort of yard. There were a few small dome tents and sites for more. We were at the very end of the season but in July and August it must be a very busy place as we were told that each year about 10,000 people climb Damavand and this is the most popular route. After a rest we went for an evening walk up the ridge above the refuge and saw the sun set as we returned. The guardian allowed us to use his tent with its carpeted floor as a mess tent and we had our supper there. After dark the temperature dropped to well below freezing as the night was clear and the stars brilliant. Some of our party slept in the tent while some used the dormitory. There were about 15 other climbers sleeping there as well and some of these were up at 3.00am to set off. Also there were no mattresses, just the slatted boards of the bunks, so with that and the altitude we did not have the best of nights.
Jalal woke us at 4.30 with tea and after breakfast of Iranian, naan bread (unleavened) and goat’s cheese we were off just after 5.00. We were expecting it to be cold and it was but there no wind at the start and it was not hard to keep warm walking slowly up the path again. However, I was glad of my down jacket, balaclava and mitts. The sun rose over ridges to the east and it was a gloriously fine day. The path wound up over the ridge and back again and the angle steepened but only occasionally did one have to use hands and scramble. There were long ribbon patches of snow left from the previous spring even on this south facing side but the path avoided these. We began to feel the altitude as we topped the 5000m contour and took more frequent stops. We were clearly not acclimatised. I was the weakest link and eventually our guide took my pack on top of his. The last 2-300m was less steep and it was here we began to see and smell the sulphur fumes. The first fumes were coming from a small cave. It seems that when the sun has warmed up the permafrost sufficiently, the sulphur fumes (sulphur dioxide) begin to come off with a hissing sound. The fumes are grey-black and if you are caught down-wind near a fumarole they produce a choking sensation which is nasty and even frightening. You want to hurry past but the altitude reduces one to a slow plod!
At about 12.30 we reached the summit in just over the 6 hour guide-book time which, considering our un-acclimatised state, we were quite pleased with. The summit is a collection of standing rocks surrounding a sandy patch. To the west is the remains of the crater with bits of the rim missing. There was quite a lot of snow on the inside of this depression. Mohamed called us round to see a strange and rather moving sight. In a cleft in the rock facing the crater and north facing, was a group of what I took to be sheep at first, but on closer inspection may have been some sort of small deer. There were about a dozen, mostly fawns with one or two adults all huddled together facing out towards us and the crater. They must have been caught in bad weather up here, taken refuge in this cleft, huddled together for warmth and died of cold. The altitude and north-facing aspect meant that they were permanently deep-frozen. We had no idea how long they had been there.
About 1.30 we started down. We went quite quickly but the path required constant vigilance because the gravel underfoot could be like ball bearings and we all took slips and tumbles. Some of the low bushes were very prickly and especially as it got darker there was the likelihood of putting out a hand onto these in saving a fall. Not a good idea! We got to the refuge at about 3.00 in good order. None of us had any headache or other altitude symptoms. Over tea and soup we debated whether to spend a second night there or to press on down to spend the night in the Federation building at Ploor. Although we were quite tired the prospect of better sleeping at lower altitude and on mattresses made us decide to get on down. So we set off at 4.30. The path now seemed even more tricky and falls more frequent. I found my knees getting very weary. There was no pain but the constant need to walk with bent knees was causing fatigue. My knees were telling me that if I didn’t give them a rest they would just give way! I needed to stop and rest every 15 minutes. The sun set in a red ball at about 6.00 and by 6.30 it was dark. But the moon was about three quarters and gave a good light and we had head torches. Jalal, Bruno and I brought up the rear and for the last 20 minutes Bruno kindly took my pack. We arrived about 7.0 at the car park where we found the others in the mule man’s tent. We had more tea while we waited for the transport down to Ploor. There we washed, or in a few cases showered, in cold water, had some supper and flopped onto comfy mattresses and fluffy blankets. The end of a wonderful long day.
After a leisurely start we had a fine breakfast of yoghourt, naan bread, goats cheese, honey, jam, tea or coffee. We then set off in two cars for a village about 20 km away where there was a hot spring. It was another perfect sunny day but not too hot at this altitude. There they had built baths in cubicles with the piped thermal water running in and out of each bath. Bruno and I shared one and Dominique and Silvia one next door. We could communicate via the hole where the pipe ran. We stripped and showered (pour-over style) then into the tank-like bath to soak and relax for half an hour by which time we were ready to get out and cool off. This was perfect treatment for our muscles after yesterday. The drive back to Tehran took about 3 hours and we were back at our hotel by mid-afternoon.
Jim Milledge, Rickmansworth 30-09-04
Mountain Medicine Diploma
David Hillebrandt wrote a report on the Scottish Winter component of the Diploma course 2005. I have included an edited version of it below to give people an idea of what goes on. UK UIAA DIPLOMA MOUNTAIN MEDICINE
Dates: Eve Sun 27 Feb – eve Sat 5 March 2004.
Venue:Isles of Glencoe Hotel, Glencoe.
Course Organiser: Dr David Hillebrandt.
Course Director: Nick Banks IFMGA.
Instructors/Guides: Mal Creasey, Steve Hartland, Graham McMahon, Chris Smith, Al Richards (4 days).
Faculty Members: David Hillebrandt, Brian Tregaskis, Jon Dalimore, Juergen Rayner-Klein, Nigel Hart.
Observer: John Ellerton (IKAR England & Wales)
Past Diplomats: Jon Naylor dropped in for one night.
Delegates: Jan Richards, Niall van Someren, Stewart Letch, Isabel Syndikus, Mike Freeman, Ian Buck-Barrett, Ann Radford, Simon Jones, John Higgie, Mike Rodger, David Keitz, Helen Jenkin, Bill Young, Anja Kuttler, Harvey Pinn, Mourne Piennaar, Paul Sydney, Alexandra Koukoutsi, Rajiv Joshi, Alexander Martin-Bates, Jonjo Knott. (21).
An intense six days using the experience of the 2003 Pilot Course and 2004 full course to teach and assess winter mountain skills in the unique Scottish conditions. Incorporating some relevant talks on mountain trauma theory.
Although “crowded” in terms of winter climbers Glencoe does lend itself to this type of course. It has good hotel facilities, equipment shops where equipment can be hired, and pubs. Travel to Bridge of Orchy and Fort William is easy. There are a variety of walks and climbs and conditions are as reliable as anywhere in Scotland. One can use up lift facilities at Aonach Mor on some days. There is excellent navigation country on Rannoch Moor at the end of Glencoe or across the Coran Ferry.
We now have good contacts with Davy Gunn of the Glencoe MRT who does excellent presentations on the realities of mountain rescue in the Highlands. Hamish MacInnes demonstrated his Mark 7 stretcher. Brain Tregaskis (faculty) has an amazing network of local contacts which enabled us to have Hamish as an evening speaker and also to get reductions on the Aonach Moor gondola.
Venue Excellent, Brilliant. Jagged Globe, a commercial expedition company, run winter courses in Glencoe and have negotiated cheap rates with a hotel chain in the area. Several of our members work with Jagged Globe as advisors, trainers and on research projects. They arranged our accommodation with no booking charge at the Isles of Glencoe Hotel.
The programme has to remain fairly flexible to fit in with weather and conditions but also has to accommodate visiting speakers and RNAS SAR Flight.
The Sunday eve start enables people to climb on Sunday if they wish before the course. Some people may want to employ one of the guides that day for a personal introduction. People do not arrive until late so any preparatory work is impossible on the Sunday but it does ensure that people are ready for the hill early on Monday
The programme that eventually evolved for this year was:
Mon: Shakedown day on Mamores with basic snow craft. Eve talk from Davy Gunn on “realities of Scottish MR”.
Tues: Aonach Moor rope work on cornice then avalanche scenario en route down with help of Ski area personnel and medical student “dummies” arranged by Brian Tregaskis.
Evening talk: Brian Tregaskis on Work of Locharber MRT and Davy Gunn on
“Scottish avalanche search and rescue”
Wed: One half of course climbing other half navigation with accident scenario on descent at end of day arranged by Brian Tregaskis with help for Juergen and Nigel.
Eve: Hamish MacInnes on his Mark 7 stretcher then Jon Ellerton on IKAR/ISMM/UIAA roles.
Thurs: 0830 Helicopter use and briefing by Mike Rodger,
1030 arrival of Helicopter (Achnacon os 118567) and talk from crew and chance to familiarise with machine and equipment and experience noise and downdraft. No winching or trip.
Afternoon Avalanche scenario in Coire of Buchaille Etive Beag (OS 186544)
Eve: Steve Hearns “Scottish Mountain Rescue Survey”. Pattern of injuries and skills needed. Brian on the Piano.
Mike Grocott is organising an MSc in Human Health and Performance Under Extreme Conditions. www.archway.ac.uk/Activities/Departments/SHHP/prospect
The way the body performs at the extremes, for example extreme pressure, temperature, acceleration, provides insights into human physiology generally. Knowledge about such areas of physiology has wide application to individuals working in critical care, anaesthesia, and respiratory and cardiac medicine. This new, unique, course provides an opportunity for advanced study in human physiology with particular reference to extreme conditions. It is aimed at the pool of health professionals working in related disciplines and also at individuals with recreational interests in relevant areas (diving, climbing etc) who are keen to marry this interest with study in an academic environment.
Below is a selection of Photos taken of Medex Members at Hypoxia 2005 at the Chateau Lake Louise in the Canadian Rockies
Medical Expeditions News
Annabel Nickol - 30th April 2005
2005 International Hypoxia Symposia - Hypoxia and Exercise
The Hypoxia International Conference was held in the stunning setting of Chateau Lake Louise in Canada. Being the site of some of the earliest Hypoxia meetings, it was an opportunity to return to a much loved venue for the ‘old hands’ and gave others the chance to visit a historical location famous for designing the Lake Louise Sickness Scoring system. Once again the meeting was brilliantly organised by Rob Roach and Peter Hackett, and many felt it was ‘the best yet’. Sadly Peter was unable to attend due to pneumonia, experiencing his personal ‘high altitude at sea level’, with shortness of breath on talking and desaturation on exercise. Hearing the latest in hypoxia and high altitude research, together with the camaraderie generated by bringing together many people from around the world with a passion for their field, makes this one of my favourite meetings. This year there were more students than in previous years reflecting the growing number of young people interested in this area. A new session was a competition of the ‘top ten’ student oral presentations. Our own group, being geographically widely dispersed, also found it a valuable opportunity to meet and a catalyst for progressing ongoing projects.
The altitude community has been saddened by the tragic death of Jack Reeves, and many tributes were paid to him during the course of the meeting. In particular, his role as a much loved and inspirational teacher was remembered. John West was this year's 'Honoree', and gave a wonderful overview of his life in high altitude medicine. On the last night Jim Milledge and Brownie Schoene paid a fitting tribute to him. We feel extremely proud that Jim has been chosen as next year's Honoree.
This year Medex was well represented, with 26 members attending (including our youngest member, baby Alex Dubowitz), constituting over 10% of the delegates. Thirteen abstracts of data from the Chamlang 2003 expedition were presented, and are listed below. As the world of research becomes more high tech and molecular, the challenge of carrying out high quality research in the field increases, and the carefully controlled chamber setting appears attractive. The discussions generated through this meeting are an encouraging endorsement that field work remains a key contributor to the understanding of physiological responses to hypoxia in the ‘real life setting’. In addition to the posters, Mary Morrell gave a presentation regarding the neural consequences of sleep disordered breathing. This provided some interesting contrasts between the responses of patients at sea-level and those of high altitude trekkers. Dan Morris gave an over-view of ‘the eye at altitude’, comparing and contrasting his data gathered during the acute ascent of the Apex expedition, and graduated ascent of the Medex expedition in 2003.
Besides the scientific activities at Hypoxia, we enjoyed the social activities, and the Medex gang were, true to form, noted for the enthusiasm of their skiing and dancing. For those planning ahead for the next Hypoxia meeting, look out for the details on www.hypoxia.net, and keep February 27th – March 4th 2007 free!
For photos from the meeting, and full text abstracts, see the web site.
Spoken Sessions by Medex members ~ papers to be published in full in a book of the Hypoxia conference soon
Session Title: ‘Causes and effects of sleep disordered breathing’
Neural Consequences of sleep apnea – Mary Morrell
Session Title: ‘Hypoxia: State of the art’
The altitude eye – Dan Morris
Hypoxia 2005: Medical Expeditions Abstracts ~ Published in High Altitude Medicine and Biology: Vol 5; No. 4. Winter 2004.
(S25; p 482) Patent foramen ovale at high altitude
Gerald Dubowitz, Philip Bickler and Nelson Schiller
(S37; p486) Computerised cognitive assessment is more sensitive than written tests at 5100m altitude above sea level
Gregory Harris, Jennifer Cleland, Alex Collie, Kim Bennell, Paul McCrory
(S53; p492) Effect of Temazepam on subjective measures (sleep quality and acute mountain sickness score, AMS) at high altitude
Juliette Leverment, Annabel Nickol, Paul Richards, Philippa Seal, Gerald Dubowitz, Jim Milledge, John Stradling, David Collier and Mary Morrell
(S54; p492) Weight and body composition changes in men and women during a high altitude trek
Mathew Litchfield, Stephan Sanders, Sarah Trippick, Douglas Thake, Sandra Green, David Collier, Annabel Nickol and Don Pattinson
(S62; p495) New insights into sublingual glyceryltrinitrate induced headache as a predictor for incipient acute mountain sickness.
Roger McMorrow, Nigel Hart, Oliver Kemp and Neil Richardson
(S66; p496) Effect of Temazepam on objective measures (sleep disordered breathing and next day performance) at high altitude
Annabel Nickol, Paul Richards, Philippa Seal, Juliette Leverment, Gerald Dubowitz, Jim Milledge, John Stradling and Mary Morrell
(S69; p498) Advances in Mountain Medicine Education in the United Kingdom
Kyle Pattinson, Peter Barry, Peter Davis, Chris Imray, Nicholas Imray, Paul Richards, Piotr Szawarski and David Hillebrandt
(S74; p499) Effect of Angiotensin Converting Enzyme (ACE) genotype on weight during a high altitude trek
Stephan Sanders, Mathew Litchfield, Sarah Trippick, Douglas Thake, David Collier, Hugh Montgomery and Annabel Nickol
(S95; p506) The effect of ACE genotype and Hypoxic Ventilatory Response on arterial oxygen saturation during a staged ascent to 5000m
Giorgos Tsianos, Jim Milledge, E Hawe, M Giannitrapani, David Collier, S Grant and Hugh Montgomery
Appearing in the 2005 International Hypoxia Symposia program guide
(105) Climbing the education mountain: educational appraisal on the first two years experience of the UK Diploma in Mountain Medicine
Peter Barry, Kyle Pattinson and David Hillebrandt
(122) Gastric tonometry at rest and during exercise at 5100m
Stuart McCorkell, Michael Grocott, Daniel Martin, Mark Cox, John Dick, Paul Gunning, Andre Vercueil, and Michael Mythen
(127) High Altitude Pulmonary Edema following Marijuana smoke inhalation
Piotr Szawarski, Thomas O’Neill, Paul Richards and Annabel Nickol
(150) A role for actigraphy as an adjunct to sleep monitoring at high altitude.
Michael Schupp, Chris Hanning and Annabel Nickol
And finally… congratulations to …
Damian Bailey: taken up post of Professor of Physiology at South Glamorgan AND married all in one year
Michael Schupp: gained CCST in Anaesthesia… now off to Toronto to work for one year
Giorgos Tsianos: submitted PhD thesis, including chapter of data from the Chamlang 2003 expedition ~ ‘The hypoxic ventilatory response’
Apex members Andrew Sutherland and Kenneth Bailey presented student abstracts in the Hypoxia ‘top ten’.
Mountain Medicine Diploma holders: Jim Milledge, David Hillebrandt, Piotr Szawarski, Brian Tregaskis, Kyle Pattinson, Chris Imray, Andrew Knight, Jon Dallimore, Matthew Litchfield, Catherine Farrow, Robert McGregor, RIP Dornan, Juergen Rayner-Klein, Laurie Tomlinson, Andy Clark, Nicholas Mason, Catharine Wilson, Gerald Dubowitz.
Current Medex Members as of May 2005 (Please note many former members have not yet re-joined)