Ascent to Pangboche

The ascent from Namche to Pangboche was undoubtedly the best day of trekking so far: fresh legs, undulating trail & the most spectacular scenery.

After breakfast at the Namche guest house we were introduced to the new 'super' yak: they are woollier and better adapted to the terrain at higher altitude than their lowland counterparts. They also have a menacing look in their eyes - we were warned to stay well away from their large, curved horns.

The trek to Pangboche via Tengboche was very relaxing. In contrast to the preceding days' trek where rocks & stones were the norm, the trail was predominantly soil and dust. In the photo in the foreground you can see the trail winding its way round the side of the hill; in the center of the photo on top of the hill is Tengboche - the site of the monastery and in the background the range of dominant mountains with the larger plume of cloud coming off the peak of Everest. Add to this the tranquility of no vehicles except the occasional helicopter flying up the valley.

The monastery was burnt to the ground in 1989 as a result of faulty wiring and was rebuilt with assistance of Sir Edmund Hillary's organization. Climbers making their way to Everest usually stop here to receive a blessing from the monks.

Rest Day in Namche Bazaar

Good day to rest tired legs...so what do we do? Yes, hike up to Kunde at 12,000 feet to visit the Kunde Hospital where team members Mike, Joe & Nick are performing cardiac scans on Sherpa teenagers.

The hospital is the main facility in the area, staffed by two Sherpa doctors & serves a population of approximately 4,000 villagers. Given the terrain it is rather isolated but does offer basic care: essentially primary care but also emergency care. I was interested to know how they dealt with orthopedic injuries such as fractures. They have X-ray but treat nearly all fractures with closed reductions. Anything more technical than that needs treatment only available in Kathmandu which is considered too expensive by most villagers. So most of the reductions are performed by (blind) nerve blocks and/or ketamine. By his own admission, the success rate of the blocks was pretty low. As the doctor gave me a tour of his hospital we came across a new Toshiba ultrasound machine used for obstetric scans. Even if the probe was low frequency & not ideally suited to nerve blocks, I suggested that its use for femoral nerve blocks may be better than the blind technique. He thought that it was a good idea, so perhaps he will try it next time!

Out in the grounds of the hospital we found Ike trying to satisfy his curiosity as to how the round dish focused the sun's rays...

Back in Namche I had the opportunity to see how my physiology was doing:

• SpO2 88%
• HR 98
• ET CO2 30
• RR 16

Good enough to go for a stroll through the streets of Namche:

Ascent to Namche Bazaar

Monday was spent getting up to Namche Bazaar, situated approximately at 10,000 feet. It was certainly harder work than the first day. Ike was still suffering from GI abdominal spasms. On Sunday he had looked absolutely awful & had shuffled up the trail. On Sunday he was 'half dead'; Monday he was 'half alive'!

There were several crossings over metal bridges strung across the river gorges. Everyone and everything (donkeys, yaks) have to go across. There is a distinct gentle oscillation to the bridge as you cross...

As we approached Namche Bazaar we came across a clearing in the trees through which we had our first glimpse of Mt Everest offing the distance. The peak has the distinctive wisp of cloud trailing from the peak.

First Day's Trek

An inauspicious start for me! As we left the airstrip I stopped to take a photo & buy water. As I emerged from the shop I could not see any of the group. Within 400 yards of starting the trek I had become detached from the group! I tried to catch up but as I scurried through the streets it became clear that I had lost them. I couldn't believe that a group of 20 could move so much faster than me; nor could I understand which other route they could have possibly taken. I retraced my steps to the airstrip - no joy. I headed back along what was obviously the only route out of town when suddenly Keith emerged from a tea shop. The group had gone in there while the Sherpas organized the loads. I am glad to say that it was Nick who eventually noticed my absence!

We entered the National Park...

And hiked for approx 5 hours. It wasn't until later that we discovered that with all the ascents/descents we had gained only a total of 300 feet when we arrived at the guest house for the night. But along the way we passed some very picturesque sights.

This was the view from our bedroom!

The Flight into Lukla

Simply spectacular! We took off from Kathmandu in a Yeti Airlines de Havilland Twin Otter. It seats 20 passengers, 10 down each side separated by the aisle.

It has a high wing & two powerful turbo props, which is well suited to this type of landing in Lukla. As soon as we took off from KTM, one can see the city sprawling out on the plain.

Within minutes we were crossing high ridge lines, seemingly just a few hundred feet below our wheels. Off in the distance we could see peaks getting higher & then suddenly Nick excitedly called me over. The horizon had distinctly changed: we could now 'FBMs' - big mountains!

We had a very smooth landing at Lukla. It is incredible to see this tiny airstrip right in the middle of the village.

The upper photo is the view from the top of the runway, with the control tower just out of view on the right hand side. The lower photo shows the area where the aircraft dance in between each other as the head to the tiny terminal. In the space of 30 mins we saw 4 aircraft land, unload the passengers & cargo, then fill up & head off. In about 4 weeks we will be back here to experience the take off!

The Perils of Nitrogen!

Jim & Sam, two guys from NZ, are interested in measuring the levels of certain proteins once we arrive at the Pyramid Lab. Once the blood samples are taken the proteins are fairly fragile if the sample is not immediately frozen, typically placed in a -80 degrees Centigrade freezer. That obviously poses quite a challenge for any samples taken at the Pyramid Lab, not only for storage on site but also during transport back to NZ for analysis. The answer had been to take a 2 Liter canister of liquid nitrogen up to the lab in which to store & transport the samples - simple! Last week Jim & Sam were told that it would be possible to put the liquid nitrogen canister on one of the planes heading up to Lukla. When they arrived earlier this week that had changed - not possible to put on the plane but OK to go on one of the helicopters heading up there as additional baggage. Last night at dinner they were informed that option wasn't available and that they would have to charter the helicopter themselves at a mere $2500 per hour - a total of $7500!! So they are now faced with having to make a decision on what to do. Phil, the expedition leader, is hopeful that our trekking organizer, Bonid, can work something out. But it is obviously a major concern to Jim & Sam. We leave for the airport in an hour's time - will discover the fate of the liquid nitrogen and the proteins!!

Plan of Ascent

Plan A: we will leave early on Sunday morning & catch a flight up to Lukla, noted for its challenging airstrip. There are plenty of YouTube videos describing the pleasures of landing at this airstrip.

The ascent will be done in stages, stopping off at wayside guest houses. We will also have a couple of rest days to help acclimate. We plan to arrive at the Pyramid Lab after 8 days of trekking.

Studies

Today & yesterday have been busy for everyone. If you weren't testing someone you were being tested!
It's all being done in various hotel rooms, but needs to be shifted from one room to the next as the power failures hit.

So far we have had:

• Dopplers of carotid & veretbral arteries in the neck
• Middle cerebral artery diameter measurement
• EEG & Cognitive testing
• Pupillometry - measurement of pupil response to light

The sleep studies will start once we are on our way to the Pyramid Lab - might be better to describe them as 'sleep disturbance studies'.

Meeting the rest of the team

The team will eventually expand to 23. The majority are from University of British Columbia at Okenagen (UBCO) & they arrived on Monday with the bulk of the equipment. The rest are from around the world (UK, Netherlands, New Zealand & Australia), arriving at different times of the week.

The plan for the week was to set up the baseline testing equipment & run nearly everyone through the series of studies on Thu & Fri. The other task was to get all of the equipment destined for the Pyramid Lab shipped out on Thu evening so it could head up the mountain ahead of us. The photo shows just some of the 50 - 60 lbs cases that we have - and all of them will have to be carried by porters!

The Kathmandu Garden Hotel is situated in a district of the city center called Thamel. Although the district is thronging with stores where you can almost anything, the hotel is secluded & comfortable.

Arrival in Kathmandu

Heading Off: Our departure date finally arrived: Mon 23rd April. In our party was Keita Ikeda ('Ike'), David MacLeod & Nick MacLeod (17 year old student attending Carolina Friends School). We arrived at RDU airport with 6 heavily-laden Pelican cases, knowing already that we exceeded our luggage allowance. The cases contained all of our equipment to run our section of the studies at the Pyramid Lab: including two blood gas analyzers, central & arterial lines. Other than the clothes we wore, any additional clothing was carried in our hand luggage. The plan was to reach Kathmandu & buy any additional clothes in the markets.

Route: RDU to JFK, then overnight flight to Doha, Qatar. Further stopover (with time to watch the Chelsea - Barcelona game) before finally reaching Kathmandu on Wed morning.