Today was the last day before we begin trekking. As usual I woke up early, though it is getting later and later as my biological time zone catches up to my geographic time zone. I had a decent breakfast with most of the team. After breakfast I needed to replace the toiletries that I left on the bed in Huntington Woods on Thursday.

Ben used the wonders of google maps to find a drug store that turned out to be more of grocery store. I was able to get my deodorant and tooth brush (I had already replace the toothpaste), but Ellen needed a pharmacy so off we went. First north, then south. Past the crazy wedding car. Past the French embassy. And finally, after getting no closer to our goal, and realizing the futility of Google Maps in the twisted streets and back alleys of Kathmandu, we encountered a friendly Sherpa who guided us to a pharmacy. On the way back I bought a local SIM card with 10 gb of data for $22.

In Kathmandu with #MM4MM

Cipro eye drops: $0.25 for a bottle. No Rx needed.

SIM Card: $22.50 for 10 gb of data. Need passport, photo, page long application. pic.twitter.com/HvcPj17acs

— Joel M. Topf, MD FACP (@kidney_boy) March 4, 2018

Then we had a morning meeting where we went over our equipment and weight limits. The guides and sherpas on our trip are surprisingly hostile to prophylactic acetazolamide while simultaneously extolling the ability of a positive attitude, a swallow of water, and mushroom soup to stave off altitude illness. A number of them support the use of symptomatic acetazolamide. At one point, one of the guides said acetazolamide only treats altitude illness and does not prevent it. I could hold my tongue no longer and blurted out the reference I covered on PBFluids months ago. In this study a randomized, blinded trial was done on the very route we were hiking. It showed that acetazolamide (Diamox) prevented the development of acute mountain sickness, both mild and severe.

The discussion on acetazolamide continued. The discussion on equipment continued. And then we broke up and did final packing. We had lunch and I had my first course of dahl bat. This delicacy of rice and lentils is a mountain staple and will be what fuels the team up to Everest Basecamp.

I loved it. I’m going to be just fine with Nepalese mountain food.

After lunch we gathered to board a bus to go visit the Monkey Temple and Boudhanath Stupa. We were all waiting in the lobby when I realized I had forgotten my sunglasses so I ran up to the room, borrowed the key from the cleaning staff, grabbed my sunglasses, ran back down to the lobby. Empty. Everyone was gone. I figured they must have just left so I walked out of the hotel grounds. Still no peeps. So Plan B: get a passport picture (I needed one for entry to the park and had used my last one getting the SIM card). I figured I’d get the picture then hail a cab and hook up with the group at the Monkey Temple. So I walked to the main drag (I had seen a photo place on our wanderings, looking for a pharmacy that morning) where I bumped into English Paul. Paul had to run out to do some last minute errands but he told me where to catch the crew. So I hustled back to the Radisson parking lot and hopped the bus.

Big mistake. I was at the back of the bus, on a bumpy road, with a belly full of dahl bat. It was hot stuffy and I could barely understand the tour guide. Traffic was terrible and it took an hour to reach Boudhanath Stupa.

The Boudhanath Stupa is a Buddhist religious site. It is a world heritage site. Surrounding the base are prayer wheels. You are supposed to circle the building clockwise and need to circle it only clockwise and an odd number of times. Thankfully 1 is an odd number. We then checked out a Thangka art school. A super knowledgeable proprietor gave an amazing lecture on symbology in the art and the various techniques that the artists use. He showed us how to differentiate a master from a novice. I was able to escape without buying one. (You’re welcome Cathy).

When we got back to the hotel I went for the passport photo. After that I went to the porch where a number of trekkers were hanging out. I brought out my scale, pulse oximeter, and blood pressure cuff and started gathering baseline data on almost everyone in the group for my science experiment. I’m totally going to win the science fair this year. People were really supportive and I got 15 out of 18 of our group to go through baseline data. Really excited for this.

Then we had dinner. And we were all given personalized headbands. I am Detroit Runner.

After dinner I went back to Bablo’s T-shirt emporium and bought a hat.

(That’s not the hat, this is)

I capped off the night by having a drink with an exiled Indian national that now makes his living as an arms dealer, though he preferred the title “defense contractor.” (My favorite part of the encounter was when he answered his phone “Yes General, thanks for calling me back”).

You meet all types at the hotel bar in Kathmandu.

Tomorrow Lukla!

All day I have been trying to think of a funny joke among the line of “What’s an interventional cardiologist’s favorite city? Kathmandu.”

Yeah, yeah, yeah, I know. Keep the day job.

I woke up at 1:00 AM

Went back to bed until 3:00 AM

Got up and started my day.

Figured out to use the origami coffee bags. Very cool.

Went down for breakfast. What a feast. The Korean breakfast at Paradise City was awesome. They had this noodle bar. I filled my cup with some noodles, lettuce, chicken meatballs, and some mushrooms. I took the bowl back toward my table when I was intercepted by the noodle chef who ran that station. Turned out it was a soup bar. Make you own soup. Once you have all the ingredients the chef boils it to cook the veggies and noodles. Total tourist move.

During breakfast we all agree that we have successfully made the leap to local Korean Time and congratulate ourselves on strategic withholding of sleep. (Important post script for this conversation: later That day, at around 2 PM, we all fell dead asleep on the plane. Total time zone hubris)

The Korean dad at the table next to us was wearing a Detroit Tigers hat. I asked him if he was a Tiger fan. Nope never heard of them. In fact there were lots of American sports logos everywhere you looked:  Tiger Woods, New York Yankees, Michael Jordan.

I started my acetazolamide.

We took the bus to the airport and it was amazing that nothing in Inchion looked older than a year. The airport was filled with American and Luxury brands. The Dunkin Donuts, Krispy Kreme and Jamba Juice surprised me.

We flew out on Korean Air Boing 777. John and I were in the middle section, each of us on the aisle without a middle passenger. Score! We flew all the way across China, seven-hours to Kathmandu. Seems like Jets are not allowed to fly over the Himalayas so you need to take a southern approach.

We landed. Snapped some photos. Bought a visa. Collected our luggage. Met Jim from Embark Tours. Took a 15 minute bus ride to the hotel. Met with a lot of the group. I am rooming with Stan. I had sesame chicken and some dumplings. Really good.

After dinner, Stan John and I walked into town and I got a t-shirt and some post cards.

Pretty tame day. Tomorrow we get to really see the city.

So the trip to Everest Basecamp began yesterday. Cathy took Jeff, Silva and I to the airport Thursday morning.

I dropped my altimeter (gift from Rose and John) going through security. 😢 First casualty of the trip.

We then met John Raithel at the gate and boarded our A350. About this time it started snowing.

Turns out Jeff, Silva, and I were all assigned to row 32.

The the plane went to the pad for de-icing and then got in the cue to take off. We were the next one to depart when the captain decided we needed another round of de-icing and we would need to refuel since we were burning so much on the ground. The captain we needed to add 2 additional tons of jet fuel, which he then explained was not that much😳.

Current status: de-icing. For the second time. #MM4MM pic.twitter.com/R6wscivMxF

— Joel M. Topf, MD FACP (@kidney_boy) March 1, 2018

So the whole back to the gate to re-fuel, back to the pad to de-ice and get back in the cue to take off put us 3 hours behind schedule.

Jeff found it odd that we would need to refuel before taking off, but it turns out that Detroit to Seoul (DTW-ICN) is one of the longest non-stops that Delta flies.

Note the route we are taking because this the source of the post’s title. A few hours into the flight, I looked outside of the window and caught the last glimpse of the sun setting.

Then a few hours later I opened up the shade expecting to see darkness, but I got…

We had gone far enough north that we were able to keep up with the rotation of the earth so we were trapped in a perpetual moment after sunset. Eventually the sun must have set and night passed but I never saw it. A few hours later I looked out and it was getting lighter with Friday’s dawn.

We landed at 7 PM at Inchion International Airtport. We went through a shockingly relaxed customs and immigration and took a bus to Paradise City, a new, and very nice hotel.

Today’s adventure: Kathmandu!

Cathy (who didn’t want to be in the picture) drive us to the airport. Next stop Seoul and then Kathmandu.

Last fall I crossed the $10,000 finish line that was established for every participant on the MM4MM trip to Everest Basecamp. To everyone who donated thank you! 🙏🏽

Now I want to squeeze the last bit of generosity 💵 from everyone in my network.

I’m raising the roof. The new goal is $14,000.

So once again I come to you with hat in hand.

I’m asking you.

I’m begging you.

If you have ever:

• downloaded a lecture or
• laughed at a tweet or
• Looked smart from a nephrology factoid you learned here or
• Played NephMadness or
• Learned about a new article at NephJC

Then consider throwing a few bucks toward multiple myeloma research. I’d love $100 donations. But what I’m really asking for is a mountain of small donations. Can you spare 25 tax-deductible dollars? What about 10?

Part of me feels that if I can’t engage my network to raise money for something as good as the MMRF then what good is this whole social media thing?

If you are the suspicious type, take a look at what I wrote about the MMRF here. This charity is doing medical research right. They take steps to keep doctors in the drivers seat of study design and that strategy is paying off with new drugs and breakthroughs.

Lets make a great fund push in the last week before I ship out to Nepal!

Help me get to the bottom of Everest!

The trek to Everest base camp is a once in a lifetime experience. I should be bouncing with excitement but that is not what I feel. I feel unease. I feel unsettled. I read about the side effects of high altitude trekking: weakness, confusion, headaches, insomnia, nausea. This makes me nervous.

I look at the weather and see temperatures in the low teens. And that is at Lukla, elevation 9,300 feet, only half as high as Kalapatthar, our ultimate goal. I think of the previous times that I have been to high altitude. The top of Breckenridge at a hair under 13,000 feet, the top of Mount Democrat at 14,154. When you are on these peaks it is cold and windy and the plan is always to quick snap some pictures and get down. In a couple of weeks, we’ll be at those altitudes and the plan will be to go further up the mountain. We will go nearly a mile higher than anything in the continental United States. This is unsettling.

But this nervousness is in the name of something much greater. Something bigger than my personal discomfort. This trek is not an adrenaline fix. It is not about putting a dent in the bucket list. This is more important than my uneasiness and general anxiety. This trek is about rewriting the medical textbooks. It is about changing the narrative of a disease that just a few years ago had a dismal and short disease course. Multiple myeloma has a new narrative, one that is filled with words like remission, and hope, and dare we say…cure.

The Multiple Myeloma Research Foundation is a new type of disease charity. One that is focused on real advances. The MMRF is bringing treatments to patients and lighting lanterns of hope for patients everywhere, because if the story of multiple myeloma can be rewritten, so can any disease.

And so we climb. We trek. We hike to altitudes found few places in the world. We do it to call attention to this disease and the patients that are beating it. We are a symbol of a better future and for that I will suppress my anxiety and ignore some discomfort. This is big.

Help me get to the bottom of Everest. Please use this link to donate to the MMRF through Moving Mountains for Multiple Myeloma

Other posts on my trip to Everest Base Camp

#NoRestTilEverest