End of the line

Well, I am happy to report that testing at the Xtreme Everest 2 Namche Laboratory has concluded! Quite honestly, it really snuck up on me. Yesterday our last Sherpa bike tester finished up and we took off her mask and asked her, "What caused you to stop exercising, your breathing or your legs?" (as we do) and Andy, my bike testing partner, and I looked at each other and just sighed - and then it was over. I can't believe we opened this lab almost two months ago.

However, the story is yet to be told. It's waiting to be told in two ways, really. The first is that while some testing will still happen at the other labs at base camp and in Kathmandu, essentially my research work is complete which means that in a few short days, I'll be off on my own climbing and trekking adventures (and trust me, I'll be happy to share those stories in a few weeks). The other story that is left to be told is held in countless hard drives and frozen at -40 Celsius in a number of freezers up and down the Khumbu:

Treasure troves of frozen fluids

The aftermath of this trip is that for months or even years, the data will be analyzed and hopefully over time we will come to understand more about how the human body reacts and responds, either well or poorly, to low levels of oxygen. All this in hopes that we can get better at treating people who find themselves not only climbing peaks at high altitude but also who wind up in a hospital bed fighting for their lives.

But for now I can't hardly predict the future so I'll give you all a brief look at the facilites. It's a bit drab, but I figured somebody might like to see some of our set up and all the stuff that I've come to take for granted a little bit.

Yep, that's a tube stuck up her nose. Tom knows how to treat a lady right.

I know have thrown in a lot of pictures of the bike testing but I think it bears repeating that we are running over 60 studies on this expedition on close to 200 trekkers including Sherpas, Westerners, twins, and children. It is an enormous undertaking. Above is recently qualified doctor Tom Davies running a machine that measures the amount of nitric oxide present in this Sherpa's exhaled breath. Nitric oxide is a chemical that vasodilates (if your arteries are a hose, vasodilation is opening up the valve) and may be linked to circulation changes that occur at altitude - Sherpas typically have higher levels.

I'd love to say that Steve wasn't injecting small amounts of urine into tiny bottles... but I'd be lying

The cold hard truth is that not all science is just standing next to an exercise bike and looking like a red-headed Rico Suave. All the samples have to be treated with care. Here is our processing table next to the freezers where you can just crank some tunes and pipette some fluids with your homies.

Sonam and the Skinny Guy (AKA Skinny Dude... essentially we don't remember his name and we've been here for two months so it's awkward to ask)

Potentially one of the biggest tasks for a full day of testing is organizing when people get to eat. The staff at the Hotel Sherwi Kangba have been incredible and following our complicated eating schedules to get 14 people per day tested and fed at appropriate times so as to comply with our scientific protocols. Above is the bar at which I have eaten about 90% of my meals for the past few months. We know the menu rotation quite well - tonight I'm enjoying curried chicken, potatoes, with daal (lentil soup) baat (rice) - it's one of their best.

The Namche lab Cinema - playing "Doctors in the Death Zone"

While I think that a person could easily survive on combination of science, climbing, and daal baat, it is nice to mix it up from time to time. Our lodge owner has graciously provided a projector and a large screen for our viewing pleasure. On four nights a week, we invite our treks and any fellow guests here to watch the documentary on our 2007 expedition, "Doctors In the Death Zone" - Part 1 and Part 2 are free on youtube. When we have the lodge to ourselves, we diversify a tad...

Club Namche - The Height of Entertainment!

Perhaps as a consolation for all the poking and prodding, we have established Club Namche for our trekkers. The highest night club in the world, Namche boasts a pool table with token poorly-placed pillar, disco ball, gold-painted yak skull, and laser light show. My tagline used to be, "I'm a much better dancer than I am a pool player," but my billiards skills have improved drastically if I may say so myself.

Barrels on barrels

Here is a small look at just a few of the barrels that carried our equipment here to Namche. Our current task is to repack 2 months worth of supplies to send down and ship home. I can say from today's experience that there is a lot of gear - probably around 2 tons for our lab alone!

Taken on the boulders between Syangboche and Khumjung

Oh yeah, and I still climb of course. The past week has seen a lot of busy lab days and dismally cold and cloudy weather, but this little gem was taken by Tom Geliot last weekend just off the trail to Khumjung. The area is incredible with lush pines. The rock is good where it's not too mossy.

Never tell me that, "No one cares that you ski at Alta"

Here's a shout-out for all the people who understand why heaven is always illustrated as having white fluffy stuff all over the ground - that ain't no cloud, that's four feet of fresh! I found this Alta sticker in the Danfe Bar - the owner lives in New York in the off season and while she's no Altaholic, her husband apparently gets out West quite a bit and knows where it's at. LCC!

And that's a wrap for now! Although I'll still have access to e-mail and facebook for the next few days and would love to hear from any and all of you, this will be my last blog post before I hit the trail for almost 25 days! I'm sure I'll have plenty of wrap-up once I get back to Kathmandu but for now, take a deep breath, get outside, read up on some science, and don't do anything I wouldn't do. In closing:

Namaste!

Khunde Peak

I will say I'm going to have to get creative for the next couple weeks. At this point I think I can say that I have settled in. Essentially, we have about two more weeks of testing after which the lab will close and a few of our team will go romping in the wilderness for a few days - peak bagging and all that - at the end of which I'll have a whole ton of great pics as I return home. In the meantime, the anticipation makes it hard to find Namche quite as blog-worthy.

Don't get me wrong, the area remains incredible - spring is springing with flowers and butterflies, the bouldering is good and hard, the groups that trek through are tons of fun, and new friends and faces continue to be a highlight. Still, Namche is starting to feel like a home away from home and I wouldn't blog about watching Hulu and eating artichokes on the couch, which is a favorite pastime of mine when I am at home. Now I've made myself hungry for artichokes so I'll distract my senses with some great photos from yesterday:

Helicopter landing at Syangboche airstrip

After seeing a wonderful Trek H group off, Tom, Willem, and myself set our sights on a beautiful ridge that purportedly has a monument to Sir Edmund Hillary as well as his daughter and first wife who were tragically killed in a plane crash outside of Kathmandu in 1975. The ridgeline rises above the village of Khunde, where Hillary was very important and influential - building a hospital and a school. It is well off the beaten path and seemed the perfect objective for semi-permanent residents such as ourselves. The ridge can be seen in the distance with a few sharp shoulders just below the heli in the photo above.

Tom G and Willem, AKA the Belgian Bear - with Namche in the background and the airstrip in the top left

 Unfortunately, the views were a bit obscured by the haze from controlled forest burns which happen down the valley near Lukla this time every year, but it didn't harsh the vibe in the least. Once we passed a few yaks loitering in the grazing pastures below, we didn't see a single soul on the ridge.

I think this is where they killed Aslan

About 3/4 of the way up the ridge, we found a nice little lunching spot with walls, benches and a nice table around 4100 meters. We were here in about 90 minutes which means that if we wanted to sleep higher for some acclimatization and we had a tarp for covering the space between the low walls and the table... Lab duties mean we can't sleep away often so I'm not saying it's going to happen, just food for thought...

Lots of prayers

The ridge must mean quite a bit to the people of Khunde because the ridgeline was covered with small Buddhist rock monuments called "stupas" and countless prayer flags - some of which stretched a couple hundred feet between high points on the ridgeline. In the photo above, the ridgeline continues on to a peak that is famously unclimbable. The story goes that after climbing Everest and gaining both friend and hero status among the Sherpas of the area, Sir Edmund Hillary wanted to climb the peak. The Sherpas asked him not to do so out of the reverence they had for the particular mountain. He paid their request no bother and gave it the ol' college try, returning unsuccessful with a broken leg - how's that for Kharma?

Monument to the Sir Edmund and his wife and daughter with the Unclimbable Peak in background

In only two hours we were on the top of the peak enjoying a nice Snickers with the wind in our hair (my hair definitely catches the most wind) and not a care in the world (except how to get down).

Not exactly a US Geological Survey Marker, but much easier to read

For good measure (and because we already told the lodge we wouldn't be back for lunch) we decided to make it a round trip by following the ridge as far as possible before finding a trail to turn back towards Khunde. Further along the ridge we had some incredible views down the opposite face over exposed cliffs towards a valley that crosses between Thamo and Machermo.

Another rare sighting of the Belgian Bear

From one of the last shoulders we spotted what appeared to be a trail heading straight back down to Khunde. When we arrived we found that it was not a trail but rather a trench that has been dug, probably to bury utility lines or water (although where they were taking the utilities is anyone's guess, it seemed like the middle of nowhere). Still, the trench served as a general direction for a nice steep bushwack down past a few wandering yaks into Khunde.

A good reference view at the end of the ridge: Khunde in the foreground transitioning to Khumjung further down. Just right of center is the trail that leads from Khunde back to airstrip at top right

Once we were down the descent to Namche was quick and the kitchen was kind enough to heat up some potatoes for us to hold us over until dinner. With no treks in the house, we had a special dinner with more fried Momos than you can shake a stick at, a movie on the big projector, and a bedtime snack of some phenomenal cheese brought to us from the UK (yaks are pretty solid porters, but their cheese is the pits). All in all, it was quite a day off. Today the sun is shining and trek G arrives just after lunch which means we've got just a couple hours to squeeze in some bouldering. Thanks for stopping by!

Namaste

Adult Supervision

This past week saw two special arrivals here at the Namche laboratory and they both arrived at the same time. In addition to testing a great amount of Westerners and Sherpas, Xtreme Everest 2 is getting vital data on another population rarely studied at altitude: children! Treks Y and Z, the Young Everest Study, were composed of 12 children, each with a parent or guardian as well as a wonderful pediatric investigator team from London. Although we often joke that kids are merely 'small adults', their physiology is quite unique and though there have been impressive children who have logged high altitude summits, very little is known about how children adapt to altitude and what is safe for their travel at high altitudes.

One thing is certain, however, the children took the science in stride. As an investigator working with the Young Everest study, it was hard not to get enthusiastic along with the children. They were willing to get up early and do the same step test diary that we subject all the grown-ups to as well as a full battery of completely non-invasive tests culminating at everyone's favorite: the exercise bike.

This is one of our amazing Young Everest participants rating her perceived effort (it was a piece of cake)

One particularly stoked little girl was initially ruled to be too short to participate on the cycle ergometer, but here at Xtreme Everest we don't take no for an answer - some foam risers and a load of duct tape and she was peddling her way into altitude physiology textbooks.

As I helped provide adult supervision for the kids of Young Everest, I got a little adult supervision of my own:

The world's highest installment of Duke Anesthesia - from left: Eugene Moretti, Richard Moon, the prettiest hobo in the Khumbu, Chris Young, Peter Moon

I wouldn't be up here without the support of the faculty of Duke's Hyperbaric Center, in particular Dr. Richard Moon. For those of you who don't know, these incredible three months are part of a year of research that I've been conducting in the Duke Center for Hyperbaric Medicine and Environmental Physiology. I've been able to help conduct simulated altitude studies as well as general hypoxia research which dovetails quite nicely with a scientific romp in the beautiful High Himalaya. In fact, one of the studies I helped with was a collaboration between Xtreme Everest and Duke to use our chamber to collect some preliminary data on the epigenetics (more on this later) of altitude and we kept the lines of communication open to sneak me along for the expedition. Not to be left out, Dr. Moon his son and a few of the great docs in the department decided to come along on the Champion's Trek (for those who were too far to get over for sea level testing in London). We have been trading knowledge all year long: they know a lot about how bodies work, especially in extreme environment... and I know a little about what gear to buy and where to buy it (I think I got the better end of the deal).

Race Day!

As investigators, we get tested - originally on a daily basis and after the first week decreasing to a weekly basis. For some unfortunate reason, our battery of tests does not include the bike test... until today! We were included in a couple of studies that the pediatric investigators performed and they asked me and Kay, our lab manager, to hop on the bikes to compare our results to their other studies. For one reason or another, I actually do reasonably well at altitude (so far... knock on wood). I say "one reason or another" because it is probably due to one of two reasons: genetics or epigenetics (or quite likely a mixture of the two). Genetics, as most people know, are the code that is translated into proteins that make up your body - and essentially make you who you are. Epigenetics are a newer and more complex branch of understanding the genome. If genetics are all the words or letters in a book, epigenetics is a combination of punctuation, highlighting pens, and permanent markers that act in concert to change the meaning, emphasis, or black out portions of the genetic code. While genetics are almost entirely fixed and won't change, epigenetics can respond quite rapidly in response to environmental stressors (even in the 15 minutes between the start and end of a cycle test). 

Summing up, I probably have both on my side: 

1. I'm a ginger, which means my genetic code is already well established to be superior

2. I spent about half of my winter semesters in high school and college working hard on two sticks and fresh powder at an average of 9,000 feet (excused absences of course!) and the repeated altitude exposure (although moderate) is enough to create an epigenetic memory in all the right places to help me adapt

Unfortunately, in spite of phenomenal genetics, epigenetics, and beard - I'm still a skinny white kid underneath
All stickered up for the bike test

And now, for the disinterested masses of my friends and family who have soldiered through the boring science and shout-outs, here's the rad-tastic slackline we threw up while bouldering the other day. Eat your heart out:

Set up

Breathe!

In closing, can I briefly plug the most important thing in my life: my faith! This weekend was the April session of the General Conference of the Church of Jesus Christ of Latter-Day Saints. I don't have the bandwidth to stream the talks but I can't wait to download them to my Kindle as soon as they are available in text. To those who share my faith, don't take this wonderful opportunity for granted - listen/watch/read the talks and "be anxiously engaged" as Elder Ballard urged at the last conference. To those who are curious or want to learn more, please investigate here or here or by asking me next time you see me. Thanks and much love!

Namaste

I'm on the Road to Renjo La

This past weekend at the Namche lab we had the rare occasion to have a planned three full days off and did our best to take full advantage of it by passing the Renjo La. It is one of the "Three Passes" commonly traversed by trekkers who either don't want to deal with the crowds to or from Everest Base Camp or just have an extra week or so to do it in addition. The word "La" means pass (so saying the "Renjo La Pass" is a bit redundant).

Our first stop - return customers for dal baat in Thame!

To get to pass we first headed up thhe valley that leads over into Tibet that I mentioned a couple weeks ago. The stop in Thame for more open-fire dal baat was a no-brainer. Our Thame Mommy wasn't there this time but her giggly husband was (she was in the fields farming 'taters) and he took good care of us. This time around we also discovered that we were eating at the hometown of Ang Phurba Sherpa, the man who currently holds the record for the most Everest summits. Look him up - he's a real champ.

Further up the valley, approcaching Marulung

After lunch we pressed on up the valley through a couple more small villages towards our destination for the night - Marulung at 4210 meters. The walk up the valley was cloudy but still incredible with dark black cliffs lining a wide glacial valley with vast moraine across the floor. When we got to Marulung we were accepted by an excited teahouse owner - typical travel in the Himalayas means staying in teahouses - a lodge with a restaurant. If you eat in house you usually pay a measly 100 rupees (about $1.25) for a room per person. They make the real money on the food but it was soooo worth it.

Sunrise with Kongde in the background
The best part of waking up!

The next morning we got an 5 am start to get over the pass. We could have started one town closer to the hill but for acclimatization purposes we decided to sleep a little lower in order to keep everyone feeling as good as possible for the climb. Trekking in the Himalaya is often limited much more by elevation than by distance. Symptoms of even mild AMS (acute mountain sickness) include headache, loss of appetite or nausea, trouble sleeping, dizziness, and/or fatigue - all of which make a long day of trekking quite miserable and if they don't abate, such symptoms may mandate rapid descent.

Prayer flags at the top of the Renjo La

The climb was tough to say the least. From Marulung we climbed for just over six hours and shot up over 1100 meters to a height of 5360 meters (17,580 feet - almost exactly the height of base camp) and the altitude was definitely a limiting factor. In addition to fatigue and big increases in breathing and heart rate with the slightest exercise, I often felt sudden attacks of hyperventilation. It wasn't necessarily scary or threatening but it would take a few seconds for my lungs to catch up and relax again. This phenomenon is called hypoxic ventilatory response and it can be measured: experienced mountaineers and Sherpas often have a blunted response which allows them to remain composed and maintain a steady breathing rate at altitude.

View of Everest just over Steve's left shoulder from Renjo La - you might guess it's the highest mountain in the world because you can see it from everywhere

As it was Easter, I brought along my LDS hymnbook and we sang a song from the top. I like to think that our heavenly voices made up for the gasping breaths between verses. After topping out on the pass we had a good long descent to lunch in Gokyo. The descent was actually quite snowy and I got a chance to test out my fancy new boots (Taylor - I understand now). The snow was soft which meant that deviating much from the trail meant sinking up to the knees. It was definitely manageable though and the views more than made up for any inconvenience.

The cirque on the backside of Renjo La - check out the humongous hanging glacier on the leftmost peak!

 The lodges at Gokyo were a welcome reprieve. Hot tea and fried rice was just what the doctor ordered at about 4700 meters after just over 8 hours of trekking over the pass. Gokyo is a lakeside village and is a common stay for trekkers crossing the pass in either direction. The lake was mostly frozen over but at the inlet one could just see a sliver of the emerald green water. Even when thawed, the lake is oligotrophic which means very little grows due to the cold and the altitude.

A view of the (mostly) frozen Gokyo lake

Gokyo is normally a stopping point for trekkers crossing the pass, but as we were feeling particularly glutton for punishment, we descended a bit further to Machermo to sleep around 4410 meters (my highest night to date!). The clouds rolled in but it luckily the trail was easy to find and we beat our lunch host's estimated time by a few minutes.

Bluebird morning after a night in Machermo - 4410 m

Machermo was a great stop - the Yeti Lodge was full, bustling, and made great potato and vegetable Momo's and we made a quick visit to the doctors running the Himalayan Rescue Association post there. The clouds that socked in the night before made for a couple of inches of snow in the morning. The views were stunning.

Descending toward Dhole with Phortse village further down the valley and Thamserku peak in the background

From Machermo, we headed down the valley to join the EBC trail back towards Namche, arriving back in town just under 5 hours and just in time for lunch. I'd hate to go back to the office after such a phenomenal weekend... so I won't! It's back to life in the Namche lab. We've got a children's trek as well as a few Duke doctors along for the ride. More on all that later, I hope you all had a great Easter weekend with friends and family. Until next time,

Namaste