|
|
 |
Day 4 clinical rounds began with a 20-year-old Sherpa that had
fever, malaise, significant fatigue, sore throat and non-productive
cough. Physical findings were unremarkable except for decreased
sounds in left lung base. He was treated with antibiotics. If
a sputum specimen can be obtained, it will be examined under the
Olympus digital microscope (tuberculosis is endemic in the local
population). Strict infection control procedures including aseptic
solutions, hand washing, etc is in place to prevent spread of
any potential infectious disease. A second presentation was of
a 41-year-old male who complained of decrease in color vision,
which on visual acuity testing showed decrease acuity and color
discrimination, principally in the right eye. Video fundoscopic
exam revealed two small retina hemorrhages in the right eye, the
images were viewed by the Yale staff and concurred with the diagnosis.
These changes will be observed with repeat exams; if further disturbances
or fundoscopic changes occur, it will be necessary to send the
person to lower altitude. The third presentation was a follow-up
on yesterday's thyroid consultation (thyroid surgeon, Dr. Ronald
Merrell and an earlier review from a thyroid specialist Dr. Gene
Burrows), which concurred with the continuation of the slight
increase in thyroid medication. Discussion centered on increased
metabolic demand at altitude possibly requiring increased thyroid
supplement. Caution was expressed as to looking for other possible
causes for the symptoms. The patient was symptomatically much
improved (back to baseline) and intended to again begin the summit
climb. Blood samples will be obtained for thyroid function tests
(in addition to the current battery of available tests) for post
expedition analysis. The clinic remains busy, with some natives
walking days to see Dr. Ken Kamler (a legend in this region) as
well as climbers from other expeditions at Base Camp. While it
is clearly only the mission of our expedition to provide medical
support to our expedition, it is impossible to turn away the needy.
Earlier in the morning the 5-man team began the ascent into the
Khumbu Ice Fall to Camp 1. As pre-planned, they will remain overnight
to acclimatize, then return to base camp tomorrow; then once again
ascend through Camp 1 to Camp 2 where they will conduct more studies.
Today, by the time the morning rounds had begun, the climbers
had been climbing for 10 hours through the icefall and had successful
reached Camp 1. Throughout the ice fall ascent, Nathaniel Merriam
and Jim Bruton at the telemedicine clinic received continuous
data from the Vital Signs Monitor system, updated every 10 minutes.
Three of the members were wearing the PED vital signs monitors.
(This is the same system as developed for the US Army, and supported
by Natick Labs and the medical research command). It was quite
easy to tell when they were climbing and when they were resting.
At times, when line of sight was not maintained, there were occasional
dropped data, however excellent coverage was obtained. Repeaters
for transmission were used as needed. The information consisted
of location on the mountain (by GPS locator), heart rate, skin
temperature (from the chest wall), core body (internal) temperature
from a swallowed temperature pill, and activity (amount motion)
from a micro-accelerometer. This data was not only sent to base
camp, but the Yale physicians were able to view the data in real
time from the base camp monitor. For ease of use, the information
was displayed as a map of Mt. Everest with the current location
of the individual climbers as a dot on the map as well a graphing
of their vital signs over time. In addition to the real-time monitoring,
this large amount of data has been archived and will be subjected
to off-line analysis.
The scientific inquiry was proceeding well. Using the digital
stethoscope, numerous physicians can listen to the lung and heart
sounds simultaneously, the team is now working a method to transmit
these sounds real time to the Yale physicians, so they can actually
hear breathing and heart sounds real-time. Using the CardioDynamics
non-invasive cardiac output device, an interesting finding (as
expected) is that the individuals have higher responses to exertion,
and that their cardiac function does not return to normal within
5 minutes, as was the case at sea level before departure. Correlation
with the other simultaneously measured values, laboratory tests
ultrasound and Cytometrics microcirculation camera will be performed.
The Buddhist monks appeared to have chased out a number of the
technical gremlins, though there still remains the usual trivial
nuisances such as intermittent generator problems, tape from electrode
leads not sticking, etc that continue to challenge the ingenuity
(and patience) of the team.
Today's participants include Drs. Peter Angood (moderating),
Ronald Merrell, Jim Brink, Vladmir Naleska, and Gary Stilwell,
Brett Harnett, Charles Doarn, Dmitry Albert, and Norman Stewart.
Questions or Comments? Please Contact
us.
