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Learning about the high life

Adventurous patients? You'll need to warn them of the health risks ­ registrars Dr Sarah Wright and Dr Sally Woods know how

Adventurous patients? You'll need to warn them of the health risks ­ registrars Dr Sarah Wright and Dr Sally Woods know how

Wanting to be expedition medics in the future, we stumbled on a fantastic opportunity to fulfil our dream of trekking in the Himalayas and learn about expedition med- icine. Without hesitating, we reached for our flexible friends.

The Everest Medical Trek aims to educate medical professionals about adventure travel, high-altitude and wilderness medicine to aid them in their practice, while providing a fantastic holiday. Organised by World Expeditions, it is led by GP Dr Jim Duff, a recognised authority on these topics. He has a lifetime's experience to impart as an expedition doctor, with many trips to the Himalayas, including two on Everest.

Preparations

In preparation, we attended the Expedition Medicine Course, run by Wilderness Medical Training, in Chamonix. This was useful, but not essential as there is considerable overlap with topics covered on the trek.

Getting fit was a priority and the recommended three to four hours of cardiovascular exercise per week for three months prior to departure gave us a very good fitness. That said, fitness is not a good predictor of who will suffer acute mountain sickness (AMS) ­ as we found out.Other key preparations included ensuring we had the appropriate kit ­ and, not wanting to be those individuals with 'all the gear and no idea', knowing how to use it. Walking poles are an invaluable item, but need practice before setting off.Finally, we had to think of all the appropriate immunisations, dental care and own prescription medication to last the trip.

Experiences

From the UK the trip takes three weeks, with two weeks trekking (mainly sleeping in tents) and a few days either side for sightseeing in Kathmandu. The Gokyo Ri trek is arguably the best in the Everest region, with the sacred lakes being one of the highlights.

The ultimate climb of the trip, Gokyo Ri (5,483m), affords one of the most impressive panoramas in the Himalayas, offering Nepal's most comprehensive views of the 8,000m peaks, including Everest.Dr Duff's wealth of knowledge was imparted by a series of daily lectures, as well as grabbing teaching opportunities as they arose. This included discussing the importance of pre-departure preparation, traveller's common 'medical mishaps', and actively learning about the Lake Louise AMS scoring system, the role of acetazolamide (Diamox) and the use of the portable altitude chamber. We also had the opportunity to visit the world-famous CIWEC Travel Medicine Clinic, the Birendra Police hospital in Kathmandu, and a rescue post at Machermo (4,410m).With Dr Duff's intimate knowledge of the area and its people, we avoided the beaten track in places and gained a special insight into the culture, including a view of Bhuddist philosophy. Another highlight was the stunning Tengboche Monastery at 3,870m.

Benefits to everyday practice

Historically only 'fit, young travellers' went on adventure holidays, but now we see rising numbers of older people and those with chronic disease wishing to go on challenging trips.

Apparently well patients may be unfit for adventure travel both physically and mentally. It is our role as doctors to advise, prepare and medically optimise each patient for their trip of a lifetime. Do you and your patients know exactly what a trip entails? Can you devise personalised travel plans for patients with chronic ailments? If you are interested in gaining confidence in adventure travel and expedition medicine while enjoying a trip of a lifetime, then what are you waiting for?

· Assess and optimise pre-existing medical conditions:­ Asthma, COPD, hypertension, CV disease (angina is a contraindication), diabetes, epilepsy, hip/knee/ankle problems, psychological problemsAs a general rule for patients with any of these chronic conditions the key words are: mild, stable, well-controlled, thoroughly assessed, with suitable preparations and written treatment regimes· Gain altitude slowly ­ rough guide: >2,500m/8,000ft, should not sleep >300m/1,000ft higher than night before; a rest day for every 1,000m/3,300ft of ascent/every third day· If ascending more rapidly/flying into altitude of 2,500m or higher, consider use of acetazolomide (Diamox), 125-250mg 12-hourly; start at least one day prior to ascent and continue for three days after arrival; Acetazolomide helps acclimatisation but will not mask symptoms of AMS; main side-effect of acetazolomide is peripheral paraesthesia· Provide basic information on AMS and advise that should anyone become symptomatic, the take-home message is 'descend, descend, descend'

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