The end of the road

Just thought I'd let you all know that we have left the Pyramid lab last weekend, and most of us are on our way back home. Since our departure from the lab coincided with the Nepali New Year (year 2065!!!), the staff threw us a big party and got everyone to dance Nepali style (which resulted in some very embarrassing photos and videos taken).



A small group of us (Jim, Bruce, Joe, and I) left the lab early and decided to go on a wee trekking expedition over 2 +5200m passes (Ranjo and Cho la). Which resulted in 17 hours of trekking and over 1800m of climbing in just over 2 days. Needless to say, the crew was very tired after that effort.



By now, pretty much everyone would be on a plane (or in a extended transit like me) making their way back home; feeling very tired from all the intense shopping done in Kathmandu over the past 2 days.



I hope you all have enjoyed reading this blog.



THE END



Mickey

Useless Information

Just some interesting (or not!) numbers about our time up here and all it involved:

730kgs of experimental equipment carried by 19 porters (not including personal gear!)
7000L of cylinder gases
53 sleep studies
107 ventilatory response tests (about an hour duration each)
107 arterial blood samples
720 transcranial magnetic stimulation "zaps"
200 cardiac echos
18 hours of hyperventilation
20L of infused saline (plus one that exploded in the microwave)
8 life-saving intramuscular (bum!) Dexamethasone injections
And the data we collected - 1042800000 sampling points across 6 channels!!

All this made possible by the consumption of 1200 hot drinks, 132 mars/snickers bars and only 12 HOT SHOWERS between us!!

Today the packing up begins and the trek down starts tomorrow...

Kate :)

More Photos

The Pyramid Lab

Memorial stones

Phil setup for a sleep study
Karen and Becky running a ventilatory response test on Kate
another memorial stones for those who perished while climbing Mt Everest

Steve during his sleep study, suddenly developed a semi mono brow in the middle of the night.

sorry for the random order these photos appear in, it literally took me over an hour to load all these. Enjoy

Mickey

The Testing

Group photo!!!

Phil doing an endothelial function test on Mike Jim, Kate and Sam running a sympathetic blockade test on Dougie (see the neck chamber on him)
Phil, bracing (fearing for his life) himself for a TMS from Emma

1 April - 6 April

We’re officially half way through our testing, as well as our stay here at the Pyramid Laboratory. I am pleased to say that everything is running smoothly…. despite my absence for the last 3 nights. For those of you concerned, I was sent down to lower altitude since I suffered from a nasty combination of acute mountain sickness and pneumonia, and was not recovering as well as our doctors hoped. (NB This was due to my stupidity in trying to keep up with Jim on a "brisk hike" on our supposed rest day.) Anyway, after 3 nights I’m back to make up for the lost time. (And we certainly plan to put Mickey to work to make up for his many missed shifts over the past week! (Kate))

Unfortunately, my return also coincided with the departure of Sam, Hamish, Dougie, and Robin who left us after just a week at the Pyramid. Their contributions to the experiments and of course the life and spirit of the lodge were invaluable. Their presence will be sorely missed (and the place will certainly be a lot quieter without them around).

When any of our party have been free from the experiments (and the weather allowed) there have been many day trips and exploratory walks of the area. Steve and Bruce made it to Everest Base Camp (although were quite disappointed with what they found – rocks and tents apparently!) and stayed the night in Gorak Shep to allow easier access to a sunrise at Kala Patthar (5545m), which sounded unbelievable. Sam, Hamish and Joe followed suit and had a sunrise walk up Kala Patthar too, and many more of us are hoping to do the same before our time here is up. Today Emma, Kelly and Mike have ventured off to Base Camp despite the constant snow that’s been falling at the Pyramid – let’s hope the weather held out for them! So there’s plenty to see and do when the experimental schedule allows.

THE EXPERIMENTS!

Well the lack of discussion about experiments really reflects that most folk involved in running the experiments have been working 12-16 hr days so no time to write about them. Now, we have about 5 days of testing left and, thankfully, are almost through most of the work. So what have we done, and why? The details of each experiment would take too long to describe, so we will keep the overview brief. But, without question, due to the sophisticated equipment, the invasive interventions, the large amount of volunteers (including high altitude sherpas) we have managed (if all continues to go well over the next week) to conduct some of the most detailed experiments about breathing, vascular health, brain blood flow and sleep at high altitude.


Ventilatory control and abnormal breathing during sleep.

This experiment involves giving participants drugs which either increase or decrease their brain blood flow and we study how this affects their control of breathing by getting them to breathe various gas mixtures (high O2 & high CO2, low O2 & high CO2, low O2) from a closed bag.

Following the ventilatory response tests before and after drug administration, the participants are set up with numerous electrodes and wires to monitor their sleeping patterns throughout the night (making you look like robots from the future). The results of these experiments will tell us the mechanisms (i.e. ventilatory control and brain blood flow changes) by which abnormal breathing occurs during sleep – the same changes occur in people with heart failure and typically occur just before people die. Experimental studies at high altitude provide the perfect ‘model’ to study these changes without the confounding influence of disease.

Sympathetic blockade

One notable thing which occurs at high altitude is a large increase in the sympathetic nervous system activity; this elevates heart rate, amongst other things. It is also possible that such sympathetic changes have a profound effect on breathing, vascular health, brain blood flow. To examine whether this is the case or not, we need to effectively ‘block’ such elevations in sympathetic nerve activity.

To do this, in Dunedin and at 5050 m we administer drugs (specifically alpha and beta blockers) to our volunteers to inhibit the sympathetic nervous system. Kelly had a particularly severe response to the blockade, her symptoms included: feeling very sleepy, loss of (voluntary) movement in her legs, fainting, severely hypotensive (which resulted in her been carried feet first up the stairs!!!), complete loss of colour in her face, looking like she was on her death bed, and a very vague recollection of the whole event.


Following the drug administration, we conduct a series of tests which include:

1) An ultrasound scan of the brachial artery to measure the ability of the artery to dilate following forearm occlusion (by inflating a cuff around your forearm).

2) Putting on a neck chamber which alters the pressure surrounding the neck to measure the body's control of blood pressure.

3) Blowing against a closed tube to measure the blood pressure responsiveness.

4) Breathing a various mixtures of gases (high O2 & high CO2, low O2 & high CO2, low O2) in a closed bag to investigate the control of breathing (it feels particularly uncomfortable as the bag starts to empty and you begin to feel like you're suffocating).

Endothelial function and arterial stiffness experiments

It is known that patients who are exposed to low levels of oxygen (like we are experiencing at high altitude) tend to have a reduced endothelial function, stiffer arteries and tend to die much sooner that otherwise healthy people. People born and bred at high altitude also die much sooner than low-landers, but it is not clear why this occurs. The hypoxia at high altitude may reduce endothelial function and elevate arterial stiffness, making them much more prone to cardiovascular events and early death. For the first time, these experiments assess whether high altitude residents, and newcomers to high altitude (i.e. us) might have alterations in endothelial function and arterial stiffness.

To do this, we examine how stiff the arterial walls are and their ability to dilate in response to a shear stress response, oral administrations of nitric oxide, and the potential ways in which changes can be altered by inspiring 100% O2 at high altitude. We do this by measuring changes in blood vessel diameter and velocity and the arterial stiffness of the carotid (neck), brachial (arm), and femoral (inner thigh) arteries using special Doppler and pulse-wave velocity probes.

Neuromuscular tests

This study looks at the functioning of the brain to muscle pathway of the quadricpes muscles and the respiratory muscles (in partcular the diaphragm). It uses a technique called transcranial magnetic stimulation, which involves placing a magnetic coil over the part of the subject's brain which controls muscle contraction, and discharging a stimulation which causes an involuntary muscle contraction in the muscles under investigation. The response is recorded by electromyography and as the force produced by that muscle during the contraction. By doing stimulation before and after a fatiguing exercise it is possible to understand more about how the brain communicates with the muscles when they are fatigued, and how this communication changes during environmental stress such as hypoxia.

The contrast between control of the limb muscles and the respiratory muscles is interesting, as the respiratory muscles have to work harder than usual all the time we are at altitude, as we increase our ventilation in response to the hypoxia. This may change the brain muscle relationship in a different way than in the limb muscles. The stimulation technique is painless (it doesn't activate any pain receptors at all) - however some of the group have identified the transcranial stimulation as their least favourite test (see Phil in the photo!!) - but this testing hasn't made anyone feel ill yet - the same can't quite be said for all the other testing....... (this is Emma defending her study!!!)

Only five days to go….

Phil, Kate and Mickey

The Pyramid Laboratory

31 March 2008

We've been at the Pyramid for three nights now and the blog has taken a back seat as several members of our team (including our chief blogger!) are not adjusting to the altitude quite as well as we expected. On the way up here Mickey found great pleasure in shoving the camera in everyone's face to determine how they were feeling - paying us particular attention if we were feeling a little under the weather... Well it seems the tables have turned... Mickey is in bed on oxygen treatment and has been for the past 24 hours! Not to worry, he is being well cared for by not one, but three doctors fussing over him every minute. Apparently being fit and sure of yourself does not save you from Mountain Sickness!!

Fair to say though, we’ve all suffered a little - good sleep is hard to come by up here, with central sleep apnea affecting nearly all of us. Talk around the breakfast table usually involves rating our headaches out of 100 as they are commonplace in the morning.

Enough complaining – it’s beautiful at 5050m above sea level. The Pyramid Laboratory and our lodge are in an isolated valley amongst the mountains. The Lobuche glacier is a stone’s throw from the lab and we have great views of Pumori and Nuptse just to mention a few from a ridge above our hideout. Every day has started out with blue skies and plenty of sun (thank goodness, as the Pyramid runs mostly on solar power!) but by late afternoon each day we’ve had a light snowfall. Most of the crew have had a chance to explore around the area when they are not taking part in the experiments, and there will be a lot more exploring to come in the remaining 10 days or so…

Onto the real reason for being here – the science. I’m delighted to say so far so good. We had a thousand little hassles and trials during the unpacking and setting up phase, including finding several broken pieces of equipment in the cases that got brought up here by yaks… Thank goodness we have so many handy men in the group (engineers, mechanics, electricians) – everything is fully functioning now except one gas analyzer that is older than I am, and so we’ve happily laid it to rest.

The experiments are running as smoothly as one could hope for in these kind of conditions. We are running four sleep studies a night plus countless other tests during the day, all in spite of unreliable battery power, lab temperatures below freezing and tired experimenters!! Let’s hope this continues for the remainder!!

That’s all for now, hopefully Mickey will be up and about soon and updating you further, we’ll try and get some pictures of the lab and experiments on here soon. And please excuse my writing skills, I blame it on the hypoxia!!

Kate

The Himalayas

Looking in to a valley on route to Namche
Yaks!!! These are actually a cross between yaks and cows... We've called them yeows.
Sting and Trudy Styler!!!
black and white does make things look cooler
the crew

Sorry for the 2 massive posts, we haven't had any (cheap) internet connections since arriving to the Himalayas (the price of internet went from $1 USD per hour in Kathmandu, to $1 USD every 4mins in Namche!!!).

23rd March, 2008

It has been 3 days since we left Lukla and began our trek towards the Pyramid Laboratory, and more than two thirds of the crew has been struck down with a stomach bug. This makes the many hours of (steep) trekking even more difficult; particularly since we are at an altitude of +3000m above sea level (we’re currently sitting at 4200m). Just to give you an idea, at this altitude anything more than a slow walk up the hill would leave you breathless, and following 5 minutes of steep stair climbing (which there is plenty of) you’re left gasping for air.

Our struggle against the altitude (while only carrying a day pack) is constantly put into perspective each time we come across local porters along the trail carrying loads ranging anywhere from 30 to 80kgs, which are braced against their head and neck!!! I’m constantly in awe by the impressive feats of the tiny locals (most of which are usually no more than 150cm tall), while at the same time I also feel a pang of sadness to witness both children and the elderly (although they usually look older than their age) carrying such heavy loads. Despite our perspective of their day jobs, they perform each task with immense pride and a beaming smile, knowing we couldn’t be here trekking without them.

There is no doubt that these mountain dwellers are the hardest working people I’ve ever met, you don’t have to look far to find evidence of this. The sherpa people have only been in the mountains for less than 100 years, when the first mountaineers arrived from distant lands. However, we passed hundreds of stoned walled houses littered throughout the valleys to accommodate the booming trekking business in Nepal. To build each of these houses takes a large crew of sherpas, many of which are involved in chiseling each individual rock into perfectly square-edged blocks. Meanwhile, large planks of timber are hauled up the mountain on the backs of the sherpas. It is difficult to comprehend the magnitude of the work which went into the trekking paths, the houses, and the miles of stone walls surrounding the fields.

24th March 2008

We had two nights in Namche Bazaar and so we had a rest day on the 24th. We didn’t exactly rest but instead decided to visit the village of Khunde, some 400m above Namche. It was a beautiful trek and there had been a massive snowfall that night so we had great fun throwing snowballs at each other all the way up – barely even noticed the climb! The snow fight stopped very quickly when someone got hurt – there’s a reason they say it’s all fun and games until someone gets hurt!

In Khunde we observed some amazing work by other New Zealanders. We first dropped by the Hillary Hospital, built using funding from the New Zealand Rotary Foundation. Afterwards, we went over to the local school which was founded by Sir Ed in 1961, and there we met a group of Kiwi and Australian volunteer dentists and dental nurses (organised by the charity group Smile High) providing free dental treatment and aiming to increase knowledge of dental care in the region.

25th March

Yesterday, we trekked from Namche Bazar to Pangboche, on the way we stopped at Tengboche where we visited the monastery there (which is the oldest in Nepal, and one of the oldest in the world). During our visit, we were treated to an unexpected encounter with Sting and his wife Trudie Styler, who were also visiting the monastery. We managed to snap a few photos of the pair before they returned to one of their two helicopters (yes, two), and Sting, tongue-in-cheek, offered us a lift. That bizarre encounter left us talking excitedly for quite some time!

26th March

We are now in a tiny settlement called Pheriche for two nights, we have another rest day tomorrow before we complete the climb to the Pyramid Laboratory on the 28th. The last day is rumoured to be a massive one so we’ll keep you posted!

Mickey

... Kate helped again

Rafting and trekking

The Rafting (20-21 March)

After spending 2 days in the polluted city of Kathmandu, we decided to go on a 2 day white water rafting trip on the famous Bhote Kosi River. Needless to say, we were all relieved to get out of the pollution and crowded streets, and looked forward to a breath of fresh air (literally!!!).

The country side of Nepal is a vast contrast to the bustling city. The hillsides are sculpted into fields growing a variety of vegetables and grain; the preparation and maintenance which must have taken generations of hard labour. The overall effect makes the hillsides look like stairways to the sky for giants.

However, despite the fact that we were miles from the city, there were three things we could not escape from: firstly, the pollution which was only marginally better after a 3 hour bus ride; secondly, the scary driving, our bus spent an equal amount of time on both sides of the road; finally, the water bombs, the kids in the villages are no different from the kids in the city (we later found out that Good Friday was also holy day in Nepal, and not surprisingly throwing water bombs filled with coloured water is a part of the celebration). During the ride out to the start of our rafting, three of our guides made the mistake of sitting on the roof of the bus (seeing 10-20 people/animals sitting on top of the bus was a common sight out in the country) where they got absolutely drenched as we drove (slowly) through countless villages.

The first day of the rafting was an introduction to basic rafting techniques and safety tips, which also included lots and lots of water fights. In hindsight, the water fights probably weren’t the best idea, since it might have been the cause of the gastrointestinal upsets (both ends) most of us experienced in the days to come (since all the villages’ waste water goes straight into the river).

On the second day we were guided down a more technical section of the river, it was much more exciting and fun was had by all. The highlight of the trip (besides the amazing food the guides provided) was when one of the rafts (mine!!!) folded and flipped between two rocks and one member (ME!!!) got swept downstream whilst the rest of the crew (somehow) managed to cling on.


Trekking (22nd March, 2008)



On Saturday we left Kathmandu on a small twin engine plane and flew to Lukla (where the runway was merely 200m long… and uphill). Almost immediately we felt the temperature drop as the crew began piling on 2-3 more layers of their winter coats (this process was reversed within 5 minutes into the trek).



The scenery from Lukla to the rest of the trek was mind blowing, around every corner there’s another impressive peak which reaches up to heights near impossible to comprehend. We found ourselves constantly pausing and reaching for our camera. The landscape of the Himalayas presents a strong resemblance the Southern Alps of the South Island, with one exception, the scale!!!

Mickey

... and Kate helped

The Beginning

The Trip

Loaded Sam’s van with all our gear (over 370kg!) bright and early on Sunday morning and he and Phil took it to the airport to start checking it in while we waited for the group to arrive and load into the taxi. We were finally on the way to the airport, although just as we got onto the highway out of Dunedin Sam called and we realized no one had picked up THE lab book, the book with everything we need to set up our computers for testing written in it! A quick u-turn found us heading back to the lab to get the book, so we finally arrived later than planned but with everything in hand. Getting all of our gear checked in and on its way to Auckland involved jumping through a few hoops and charming some of the check-in ladies but we managed. One check-in down, one to go…

In Auckland we met the remaining three of the group and checked in with no hassles. On the 12 hour flight to Bangkok we were all very excited, watching movie after movie and phoning each other on the seat phones. It was Joe’s first international flight and Phil explained to him that the supplied earphones were in fact nose plugs! Credit to Joe for not believing Phil. Bangkok airport was a monstrosity, and as 15 of us traipsed through looking slightly lost and bewildered we must have looked quite a sight! Had an uneventful night and returned to the airport first thing the next morning for the final leg of travel.

Arrived at the little dilapidated building that was Kathmandu Airport. Felt like we were stepping back in time, there were no computers to help them check us in, all the forms were painstakingly filled in by hand. We also set off the metal detectors one by one as we passed through and the guard just smiled and waved us through! Out of over 40 pieces of luggage only one didn’t turn up on the carousel – MINE! Typical! I didn’t panic too much, just filled out more forms to describe the bag and they said to phone the next day, but I didn’t feel too hopeful.

We caught a shuttle to The Kathmandu Guest House where we are staying and that trip was interesting to say the least, but Mickey is explaining the traffic… The Guest House itself is lovely, a peaceful sanctuary away from the chaos. There are pretty gardens with honeysuckle and jasmine, several bars and cafes to relax in, the rooms are perfectly adequate and the staff are wonderful. So here’s to the next few days exploring this city!!

Kate



The beginning

It has been 2 days since we’ve arrived in Kathmandu. We have experienced a number of power shortages throughout the city during our stay, this is not surprising considering the wiring around the place (see photo). Kathmandu couldn’t be more different to New Zealand. This place is a stark contrast to the world which we take for granted. The streets around the hotel we’re staying are narrow with tall buildings pressed tightly against each other, whist hundreds of power lines looms overhead.

The noise and smell of the city can become overpowering at times, and we’re constantly hounded by hawkers and shopkeepers wanting to sell us anything and everything as we walk through the chaos in the streets. The madness of the streets is nearly impossible to comprehend unless you experience it firsthand. The cars and trucks boldly rolls down the streets, whilst scooters, motorbikes, bicycles, rickshaws, and pedestrians weave in and out amongst constant honking. However, if you walk far enough away from the tourist hotspots, you’ll start to find yourself in the local districts, where the shopkeepers sell fruit and vegetables, and whole meat carcasses lying exposed to the air (and flies!!!).

Perhaps one of the most interesting discoveries during our stay here in Kathmandu is what the local children and teenagers like to do in their spare time… throwing water balloons (well water bags are probably a better description) on unsuspecting tourists from the overhead windows. We found ourselves constantly glancing up above our heads, paranoid from these frequent guerilla attacks from the local pranksters.

One of the funniest stories thus far would have to be Jim’s patient approach to dealing with a hounding hawker who tried to sell him wooden flutes. Instead of using the convectional method (to simply say no thank you, then ignore them), Jim patiently decided to dissuade the hawker, by listing a number reasons why it would be impractical for him to buy the flutes. Eventually, after 30mins, Jim resorted to literally running away down the road!!! Of cause the hawker simply caught him again, 10seconds later where they begun round 2.



Mickey

Urban warfare
a very brave electrican
the country side
the smog

doing the touristy stuff
A pimped out rickshaw

dodgy wiring
The garden in our hotel (it used to be a palace)
View from the roof tops of our hotel

Streets just outside our hotel at 7am

Mission Impossible

Less than 24 hours to go and things are a little crazy. Yesterday Sam realised the pelican cases for our gear were going not going to work - a case full of gear clocks in at about 15kg OVER the maximum limit allowed on a plane so we had to come up with a Plan B very quickly. This involved Mickey and Sam running around all over campus begging, stealing and borrowing cases from anyone. The office ladies were kind enough to stop in to say goodbye and had a good chuckle at the circus that is our lab.

Several hours and lots of coffee later it's slowly taking shape. We have 30 pieces of luggage weighing 320kgs in total!! Becky has spent the morning on the phone to the airlines warning them and trying to and organise sending some stuff as cargo etc. I'm in a slight panic that our stuff won't get there at all but I think positive thinking is key right now :) We're going to Nepal people, science equipment in tow or not, it's so exciting!!

Kate :)

Preparing for the trip

Well, 2 days till we leave sunny Dunedin and begin our expedition to Nepal. It has been pretty hectic the past few months with testing, testing and more testing. This week however, Sam, Kate, Karen, and Phil, have been running around arranging the final preparations for the trip, such as checking equipment, baggage transport, consumables, accommodation, testing schedules and so on.

Phil has been placed in charge of establishing what our power requirements are for the running of all our gear once we reach the pyramid laboratory (http://www.evk2cnr.org/en/Piramide). The Pyramid is solar powered during the day but at night we'll be running everything off batteries.

As for me, well I have been busy helping out with Emma and Luke's experiments which involves passively heating up participants (victims!) using a water-perfused suit (which makes you look like spiderman). The goal is to increase the participant's core body temperature till intolerance or till they reach a critical temp of 39.5 oC, measured using oesophageal, tympanic (from the ear canal), and rectal (need I explain?) thermometers. In addition, Emma then "zaps" our subjects with both transcranial magnetic stimulation (on the head)and electric muscle stimulation on the thigh (it literally feels like been zapped by an electric fence).

On the side, I have also been trying to pack our equipments into large pelican cases, making a mess with the padding, and annoying the cleaners by spreading bits of foam everywhere in the Lindo Ferg building.

Amongst all of this, we have also been causing havoc in the administration office with the endless piles of paper work and unpaid invoices we have sent their direction. I'm sure they will all be breathing a sigh of relief once we leave for Nepal.

2 more sleeps!!!





Mickey