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ISEH Sports and Exercise Medicine consultant Dr Kal Parmar recently went on a Mountain Medicine course for 3 weeks as part of an organisation called World Extreme Medicine. This is for doctors and medics wishing to experience extreme environments. There are lectures, tutorials and practical sessions as well as some of the most spectacular trekking in the world to Everest Base camp and takes about 12 days to trek there from a remote airport called Lukla. A lot of the medics go on to become expedition doctors.

Dr Parmar gave this report of his trip:  

“My motivation was firstly a challenge that I had always wanted to do. Secondly, I will likely do some expedition work in the next few years and so I wanted to see how I faired with altitude. The route goes to over 5000 metres, so we all experienced the effects of altitude. Trekking was slow with long, steep climbs where fatigue was a factor. The trail was mainly rocks, with some mud tracks and loose scree. A number of acclimatisation days were built in to become accustomed to the low oxygen levels at high altitude. The panoramas at this altitude are awesome and constantly changing; we left the treelike behind, trekked to above the clouds with stunning views of the Himalayan Mountains.  

When trekking to Everest Base Camp, there was a very early morning rise and a long day trekking - typically 8-10 hours. At this altitude every step was tiring with efforts rewarded when reaching Base Camp, with Everest looming above and the spectacular Khumbu Icefall in the background. This was a tough challenge but met with memorable rewards; the smiling and welcoming faces of the Nepalese people, the breath-taking views, experience of the Buddhist culture and monasteries and some strong friendships. We had opportunities along the way to visit various medical clinics - the Himalayan Rescue Association Clinic was one of these. The HRA Aid Post is located at 4300m and located at an important trekking junction where a high proportion of trekkers really start to feel the effects of acute mountain sickness. The clinic provides medical support for thousands of trekkers and Sherpas annually and is staffed by volunteer medics from all over the world.  

There were around 20 of us from all over the World and a variety of backgrounds. We had lectures along the way in the evenings after the trekking during the day was done. This concentrated on practical aspects of multi-day treks, preparation of the medical kit, effects of altitude including the more serious High Altitude pulmonary and cerebral oedema. These are very real risks with one of our group suffering from high altitude pulmonary oedema and had to be evacuated by helicopter. Near base camp, in another group from us, there were reports of a trekker dying from the effects of cerebral oedema.  

We stayed in “tea houses” which is basic hostel type accommodation with a communal eating area which is heated by a yak dung burner! Bedrooms are not heated and temperatures got down to around -5 Celsius. Due to the remote location and short water supply there were very few showers or washing facilities. Food was traditional Nepalese style of a for example rice, pasta, vegetable curry, dahl, Tibetan bread - this kept us going as we were burning a lot of calories during the day.  

My preparation beforehand was not as thorough as it should have been, but basically involved making sure my gear was up to date and well-worn in - especially my trekking boots and backpack. We had to be prepared for extreme weather conditions and so various bits of kit needed to be bought such as a -10 Celsius sleeping bag, wind and waterproof clothing and specialised hiking sock etc. to avoid blisters. I have osteoarthritis in my left big toe and therefore I was worried about the multiple days trekking and how my toe would cope. I find that regular visco-supplement injections with ostenil plus really help and have had this over the years. A month before the trip, I had the toe injected again with ostenil plus, the effects took around a week to work but I remained pain free throughout the trip and really glad I did it. Other than that, I was taking regular anti-inflammatories and some pain killers after a hard day’s trekking which allowed my body to rest and recover before the next day. There were many highlights, but a stand out was the 1am 2 hour trek to see the milky way - it was tough with a hard uphill trek using head torches but well worth it.  

All in all, it was a great trip which will be cherished forever and is a region I’m planning to go back to at some stage. The remote location, clean mountain air and being out of my city comfort zone will always be remembered as well as being in a place with no cars! With thanks to TRB Chemedica for sponsoring part of the trip.”