Surname…………………………. Forename………………………NHS number……………….D.O.B………… Community Respiratory Team MANAGEMENT PLAN – COPD Exacerbation Actual Problem………………………………………………………………………………. Goals agreed with patient, family and nurse Short Term: Long Term: Exacerbation is manag
Bardzo tanie apteki z dostawą w całej Polsce kupic cialis i ogromny wybór pigułek.
Inspired by the comic relief kilimanjaro climb my son booked us to do likewise in june this yearClimbing Kilimanjaro
Inspired by the comic relief Kilimanjaro climb my son booked us to do likewise in June this year. “How hard can it be?” he said, “if Chris Moyles can do it….” I was a little apprehensive joining a group of 26 young university students, at 54 years old I was no spring chicken. My mum had died earlier this year at 92, and had been a great traveller in her younger days. I decided to take some of her ashes and sprinkle them at the summit…if I got there. I was relatively fit, always on the go doing housework and gardening, but decided a month before to make an effort and join the local gym. I concentrated on the treadmill, walking at an incline for an hour at a time. I felt as long as I could walk for fairly long periods at a time uphill I should be fine, but how the altitude would affect me I just didn’t know, and there was no way to train for that. We flew to Nairobi on 14th June 2010, a bunch of nervous and excited individuals wondering what they had let themselves in for. The journey to the town of Moshi Tanzania, which lies at the base of the mountain, was a challenge in itself. We all felt that after being packed like sardines in a rickety old bus for 8 hours over rough roads, things could only get better. After spending a day relaxing at the hotel, we were driven to the Machame gate to begin our climb. Day one. Today we strolled through the rain forest, a constant uphill gradient that
after 6 hours began to take its toll. We only had a brief picnic lunch stop earlier on in
the day and a few 5-minute breaks to allow the slower walkers to catch up. Finally,
after 8 hours, we staggered into our first camp at Machame hut. After dinner, we
were all tucked up in our tents by 9pm, although sleep was difficult. Height 9850 ft.
Day two. Another long trek. We cleared the rain forest and walked through low
vegetation and rocky outcrops. The first part was very steep and we began to notice
the thinning air as we stopped more frequently for rests. Today seemed to go on
forever I remember, just when you thought you were almost at camp, another high
ridge loomed before you. Thankfully, a hot lunch was served on a long table at just
the right time as our energy levels were at an all time low. It gave us the strength to
make the remaining 3 hours to Shira camp. It was here that I had some doubts about
making it, but they had disappeared after a good nights sleep. Started to take Diamox,
the high altitude drug as a preventative. Height 12,600 ft.
Day three. Today we climbed to the same height as summit base camp and we all
noticed the affect. Headaches, nausea and tiredness were reported among several
group members. I had a slight headache, nothing more. It was uphill for the first part
of the day and then downwards over streams, waterfalls and large slippery rocks. We
had snow, fog, hot sun and cold winds to endure on the way. Ending the day with a
high cliff to get up before camp, which was a real effort. Barranco camp was very
pretty, surrounded on three sides by steep valley walls. Height 12,950 ft.
Day four. Today we had to scale the Barranco wall first thing. A sheer cliff of
some 300m that looks scarier than it was. It involved the use of hands to scramble
upwards, and only one spot required the help of a guide to haul you up a high rock
step. It was fun and everyone enjoyed it. The rest of the day was constant hiking over
barren landscape with no vegetation. I now had the hang of this relentless walking,
and when you reach the “I can’t go on stage” your body seems to go into remote
control and you walk on in a painless dream until you get to camp. Karanga valley
Camp was like being on the moon. Had a bad headache relieved by painkillers.
Height 13,900 ft.
Day five. Today was a shorter day, but no less tiring. We slowed our pace
considerably and the group were now in three sections. You had to stop to take a
drink, as it was too exhausting to do while walking. Even eating a sweet was
impossible, that might seem crazy but it just got stuffed up the corner of your mouth
until you stopped somewhere to rest and chew it a bit more! Breaths were deep and
heavily through the mouth now. One final push up a steep cliff and we reached base
camp at Barufu 15,200 ft. After a late lunch, we had to do a two-hour walk up the
path we would be taking later that night on our summit attempt. I would have
preferred to rest and conserve energy. On our return, we had dinner and went to bed at
7 p,m. after preparing our clothes for later. We had 4 hours sleep before being woken
up at 11pm.
The summit attempt. It was very cold and dark as we crawled out our tent at
11pm. Dressed in several layers and head torches we huddled in the mess tent
drinking tea. This was it. Everyone was nervous and quiet as we contemplated the 6-
hour walk in the dark ahead of us. The temperature was below freezing as we set off
up the path we had taken earlier. Our water had frozen in the tubes to our camel
packs, but was alright in the thermos bottles in our rucksacks, if only we could be
bothered to get them out. We walked in single file, a line of little lights moving
slowly, snaking its way up the mountain. Stopping every 20 minutes or so to rest for 5
minutes or less. It was too cold to say any longer. On and on we plodded, one foot in
front of the other, in a dream like state. We saw people being sick, people collapsed
with exhaustion and people being carried back down with altitude sickness. I felt ok,
and carried on oblivious to my surroundings. Time passed and after 5 hours of
walking, which seemed like only an hour, I saw the sun start to rise. The golden rays
of sunlight gave us an extra boost and the willpower to get to the crater rim at Stella
point. My son was ahead of me somewhere, as our little group of four collapsed in a
heap. From Stella point, where many people give up, it is another 45 minute to an
hour hike to the summit along the rim. The temperature was now -17c with wind. We
had lost one member to altitude sickness on the way up, and she was taken back down
to camp on oxygen. I was not going to give up now, and after a 10-minute break, we
pressed on. It was hard work and painfully slow going as I stumbled like a drunk over
the snow. I passed my son coming back down, he had made it. At approximately 9
a.m. I staggered towards the famous board at Uhuru peak 19,340 ft. I had made it. I
do not recall much of that last walk or the time at the summit, it is all a blank. I do
remember seeing magnificent glaciers, and most importantly, sprinkling my mum’s
ashes. The attitude affects your brain and you are in a semi-conscious state. That is
why they do not allow you to stay at the summit more than 15 minutes, just time to
take a few photos if you can remember how to work the camera!!
Coming back down was so much faster and easier, although the loose scree was
slippery and you fell often. All our water was frozen still, and we only had a small
bottle from the guide between four of us. The sun was hot, and we became dehydrated
quickly. My lips cracked through licking them continuously. Arriving back at Barufu
camp, we were allowed to eat and rest a couple of hours before packing up and
moving on down to our last camp at Mweka. This was very hard, as we had been
walking for 22 hours since 11pm the previous night. We got to camp having walked
the last 3 hours in the moonlight and fell into our tents without the strength to have
any dinner. I was sick through exhaustion and stress.
After a good nights sleep we left next morning to walk the final 4 hours to Mweka
This may all sound a torturous and traumatic experience, but one I would not have
missed for the world, it was a truly amazing experience. My son and I still talk about
it, and I am sure we will for many many years. So if you have ever considered doing
something adventurous and are up for a challenge, then climb Kilimanjaro. Whether it
is for a charity or not, you deserve to be very proud of yourself. It is certainly no walk
in the park!
Good luck to all the KLFM climbers, you can do it!!!
Journal of Ethnopharmacology 98 (2005) 367–370Alkaloids from Boophane disticha with affinity to theMikkel Sandager , Nicolaj D. Nielsen , Gary I. Stafford ,a Research Centre for Plant Growth and Development, School of Botany and Zoology, University of KwaNatal Pietermaritzburg, P/Bag X01, Scottsville 3209, South Africa b Department of Medicinal Chemistry, The Danish University of