The lateral collateral ligament (LCL), also known as the fibular collateral ligament, can be found on the outside of the knee connecting the femur to the fibula. Although not entirely sure that this was the ligament at fault, based on the location of my pain, I have chosen to hand it the blame for my discomfort. Uphill was cardiovascularly challenging, but downhill was challenging in most other ways, and especially on my joints. My “extra bone” ankle was sore but okay; however, the lateral side of my left knee was not as okay.

After the first day of descending, my knees were sore, but I hoped by stretching upon arrival and before starting the next morning, I would be okay. I started down the trail on day 7 of my trek and instead of trekking or even just walking, my gait is best described as hobbling. I am soon passed by Tim, Mark and the rest of Team Australia, who take pity on me and offer help. They start pulling out their wrapping tape, scissors, and strong anti-inflammatory medication. I take out my razor in an attempt to shave where the tape will be placed to avoid the unnecessary “waxing” that would occur upon its removal. My shaving was helpful although I know it wasn’t perfect based on the burn I felt when tearing the tape off.

The LCL works with the MCL, ACL and PCL (also located in and around the knee) to provide stability. With my lateral collateral ligament unhappy, the tape would have to help maintain said stability. Two wide strips were placed where the LCL and MCL are located on either side of my patella bone, and two narrow strips were wrapped around the top and bottom holding the thicker tape in place and hopefully locking the knee.

In the end, my knee was stabilized, my pain was lessened, and the final stretch of my Himalayan adventure made much more enjoyable. I owe those days to Team Australia. Thank you! Fortune and luck were again on my side and it’s hard for such a pattern to go unnoticed.

Risks of Mountaineering

In preparation of my small, civilized hike in the Himalayas, I chose to get in the mood by watching a couple documentaries on Everest and reading Nick Heil’s “Dark Summit: The True Story of Everest’s Most Controversial Season”.

The first realization was that death is too much of a reality while climbing Everest. Over the last 15 years, Everest’s trek to the summit has claimed on average about 5 lives. And whether that death comes from falling and sliding down some of the highest snow and ice formations on Earth, or whether it is a slow death from hypoxic hypothermia, the risks of making this journey are very real. According to Heil, hypoxic hypothermia is a slow death where initially hands and feet begin to tingle and throb. Eventually, your limbs begin to ache as if being relentlessly squeezed. The brain will start to starve and swell causing slurred speech, poor balance, and finally persistent dementia. Humans are not meant to exist at 29,000 feet, where the summit of Everest resides.

In Nick Heil’s book, to describe the affects of hypoxic hypothermia, he writes:

“As the deep cold intrudes, nerve endings go numb and the pain recedes as circulation retreats toward the core. Often, ironically, it is around this point where freezing feels like being tossed into a furnace. Victims tear at their clothes, throw away gloves and hats, and frantically unzip their parkas, accelerating the slide. Flesh farthest from the heart—toes, fingers, nose, cheeks—freezes first, death advancing from the perimeter. Skin turns pales with frostnip, white during the full throes of frostbite, red and purple with blisters, and ultimately black with gangrene—cellular necrosis, doctors call it, the point at which living tissue is permanently destroyed.

“In the final stages, limbs become insensate and immobile, freezing into place as your body shunts blood toward the lungs and heart, trying to preserve the vital organs. Vision blurs and darkens. Involuntary shivering ensues, a last-ditch attempt to generate heat through movement. You mind swirls deeper into the subconscious, a deep dream state. A few who have returned from the brink of hypothermic oblivion have recounted their last conscious moments as almost pleasurable. ‘You really do start feeling warming,’ Weather wrote in his memoir Left for Dead. ‘I had a sense of floating. I wondered if someone was dragging me across the ice.’

“The ends arrives a few hours later, quietly, in the dark waters of unconsciousness. You blood runs chilled; most brain activity has ceased. The heartbeat slows, fluttering erratically, a wounded bird. This action might continue for a while, the vessel destroyed by the encroaching cold while the heart presses courageously on. At last the pump shuts down, and with that the limited circulation ceases. Internally, there is perfect stillness, equilibrium returning between a delicately calibrated but dissonant energy field in the form of a man and the larger energy field around him—the mountain, the air. The only movement now is wind, ice crystals skittering over rocks and snow, a jacket flap rustling, a clump of hair, stiff with rime, flicking across the forehead.”

Not to worry though, because in contrast, the Annapurna Base Camp Trek, which I am attempting will only take me to a maximum of 13,500 feet. Still a formidable height that will probably cause me to experience some altitude sickness, shortage of breath, and fatigue, but nothing that will threaten my life or necessitate me to bring my own oxygen.

For a little more of the science of altitude sickness, I did a little research. Higher altitudes come with a limited supply of oxygen, and oxygen levels in our blood are determined by the saturation of hemoglobin. After a certain elevation, this oxyhemoglobin begins to decline. Luckily, as amazing as the human body is, we can adapt in many ways, both short term and long term, to the effects of the decrease in oxyhemoglobin. That said, there are theories which show that above 26,000 feet, most humans can no longer acclimatize. This area has come to be known as the “death zone”.

The oxygen saturation of air at sea level is about 21%, and this concentration remains relatively constant until about 21 kilometers up. 21 kilometers is equal to about 70,000 feet, so I’m not planning on having to worry about anything except 21% concentration of oxygen. However, although the percentage stays constant, the atmospheric pressure decreases exponentially with altitude. This lack of oxygen pressure is believed to be the main cause of symptoms of altitude sickness.

I am aware of the symptoms that can arise at high altitudes and I will be careful as I ascend. If I am feeling really bad, I am prepared to stop and see if I start to feel better. A photograph of the final destination is less valuable if I am not around to enjoy it.

Beijing Pharmacy Experience

When wondering through the old parts of Beijing, I came across a beautiful Chinese “pharmacy”. I placed the word pharmacy in quotes because I would have been hard pressed to find Advil, Tylenol and multi-vitamins. Instead, in this multi-storied building, I found things like flying squirrel feces, rhinoceros horns, snake oils, and turtle shells. I witnessed medicines made from insects, made from fungi, and made from plants. All these medicines, including those only made from plants, came with a high price tag either because of the age of the plant or the care the plant received. There was even a thousand dollar ginseng root. In addition, each medicine served a different purpose from aiding with kidney problems to liver problems to indigestion to sexual dysfunction.

The outside of the pharmacy:


I am not about to discuss the merits of eastern versus western medical beliefs; however, being that I am in Beijing, I wanted to learn and begin to understand some of the basic tenants of eastern medicine. Eastern medicine is based a lot on traditional religious ideas of balance and opposites—yin and yang. Stemming from this, illness then derives from an imbalance, either between competing body systems or between the body and its environment. Furthermore, these eastern medicines can help bring the various body systems into better balance.

Having studied biology at school, I am one who always wants to see evidence for any claim, but in this case, although the westernized explanation for why a specific remedy works may not be available, there is at least some empirical evidence that these medicines work. Chinese medicine has changed little since antiquity and has been improving the lives of people which it has treated throughout its tenure. Also, there are many examples of westerners finding a more scientific explanation to why certain eastern medicines function as they do. All in all, it was an eye-opening experience to walk through this eastern pharmacy in the heart of Beijing.

The Dance of Travel Immunizations

In medicine, I’ve always heard that it never hurts to get a second opinion.  But in the case of travel immunizations, more opinions may mean a little more pain because they usually mean more pokes in the arm by long, sharp, shiny needles.  That said, when I didn’t cry, I sometimes received some celebratory lollypops.  (I’m calling that the silver lining.)  I do appreciate everyone who helped me figure out what I needed, but almost every time a new person, such as my friend’s girlfriend’s mother’s cousins’ next door neighbor suggested I have some XYZ vaccination against a deadly disease that wasn’t worth taking the risk on, I usually followed through.  When I finally leave on this trip, I will have so many fabulous antibodies floating around in my blood, that only kryptonite from my far-away home planet will be able to get me.  And lucky for me, there aren’t many mosquitoes that carry said kryptonite.

All kidding aside, the world and especially its jungles can be a scary place when you learn about all the diseases you can get.  Let’s take one disease, which I will talk more about when it comes to shots and dosages, as an example of nature’s lethality to be Japanese Encephalitis (JE).  Of those infected with JE, the CDC reports that 1 in 4 dies and of those who live, up to half may suffer permanent brain damage.  So with a little math, I learned that 63% of those infected with JE die or have permanent brain damage.  Like that good neighbor of my friend’s girlfriend’s mother’s cousin said, it’s not worth the risk.

Most vaccinations are easy.  One poke and I’m done, and a week or two afterwards, I’m ready to make out—vampire style—with a mosquito carrying that disease.  But not all immunizations are so easy.  One example is JE, which I just finished detailing the dangers of.  Don’t worry because I’m only going to go into detail on this one vaccination.  Currently, there are two vaccinations available against JE in the US, and those are JE-VAX and Ixiaro.  To serve as a quick bio, JE-VAX is the older, been-around-the-block vaccine that has been well tested and well documented, while Ixiaro made itself known in 2009 with a similar profile and slightly higher geometric mean titer. I didn’t know what those three words meant until I looked them up either.  Essentially, geometric mean titer just correlates to how much of the antibody is actually flowing through the blood.  JE-VAX is a 3-dose series at days 0, 7, and 30, and Ixiaro is a 2-dose series spaced 28 days apart.  Big pro for Ixiaro is its one less poke!

For the juicier part of this whole discussion, I was left with 25 days to receive either of these two vaccinations, and neither fit in the right time span.  It was time to put my nerd herd hat on and hit the journals.  First thing was looking at what the difference really was between the two.  I found Tauber et. al.’s article titled “Safety and immunogenicity of a Vero-cell-derived, inactivated Japanese encephalitis vaccine: a non-inferiority, phase III, randomized clinical trial” from 2007 in Lancet.  Basically, the article described the new Ixiaro vaccine and compared it to the old JE-VAX vaccine using a blinded study.  And not to worry, even the Ixiaro patients still had to receive the 3 shots, so they remained blind to what they were receiving, and the middle shot was just saline.  Conclusion of the study was that they both work, and the new one works slightly better.

Back to not having enough time to complete either course of injections, I found a study that compared JE-VAX when it was administered in two ways, one taking the usual 30 days, and one taking only 14 days.  The article, found in the American Journal of Tropical Medicine and Hygiene from 1999 by Defraites et. al. had results that gave me a sigh of relief.  The difference between the two dosing regimens was the geometric mean titers that I mentioned earlier.  Those who received the 30 day regimen had higher titers at follow up time points.  What does that mean for me?  It could mean that I have slightly less immunity; although, this is only very slight.  More than anything, it will mean that my immunity will probably wear off faster than average.  That same Journal of Tropical Medicine article said this; I’m not just making it up.  I’m not planning on being in Southeast Asia more than a couple months, and I’ll remember to boost my immunity next time Asian jungles call my name.  Importantly, I now have a good chance of avoiding that intimidating 63% statistic for the small number who acquire the infection.  Science, for the win.