mneagle

Not much chance of that happening (the wt gain). He's been on the road climbing in South America, Europe and the Middle East for most of the last few years. I do plan on trying to get him up to the North Cascades sometime. My only chance of contributing to any joint climbing effort would be to take him up some ultimate bushwhack, suffering slog-fest and carry most of the gear. I e-mailed Chris after I put this up and he wrote back that he was flamed relentlessly for months afterward. He also directed me to one of his recent adventures, here: SPvfjkO58BI He's got a pretty tough lifestyle.

I went to high school with Chris back in Illinois. I came across this video and just had to post it. As far as credibility goes, he did the second ascent of World's End (amongst many other psycho routes). The climax of the story he told me involved holding a sling over a sloping rock with his fingertips and wetting himself for an eternity before finding the courage to high step. He was rewarded by a hidden bolt on what otherwise looked like a blank field of dirt. boQHYBhlOcs

I once saw the Ramones and Iggy Pop as a double bill in Chicago. Epic. Blitzkrieg Bop Lust for Life

Absolutely the USA, assuming that I am the educated white person that I am...see below. A Secondary Analysis of Race/Ethnicity and other Maternal Factors Affecting Adverse Birth Outcomes in San Bernardino County. Nanyonjo RD, Montgomery SB, Modeste N, Fujimoto E. Objectives: Though it is the largest county in the lower United States, minimal attention has been given to the elevated rates of poor perinatal outcomes and infant mortality in San Bernardino County. This study sought to analyze adverse birth outcomes such as low birth weight, and infant mortality as an outcome of specific proxy maternal sociodemographic factors. Methods: Data from the California Department of Health Services Office of Vital Statistics birth cohort of mothers delivering between 1999 and 2001 (N = 1,590,876 participants) were analyzed. Of those, 5.5% (n = 86,736) were births in San Bernardino County. Low birth weight, very low birth weight, death in infants less than one year of age, and other maternal sociodemographic factors were explored. All events of low birth weight and deaths among infants less than one year of age were used as significant variables in statistical models. Results: Black mothers experienced more than twice the rate of very low birth weight (3.89) than their White counterparts (1.39). The most significant contributors to adverse birth outcomes among Black women were length of gestation and maternal education, whereas the most significant predictor of infant mortality was birth weight. My opinion: There are other studies with similar outcomes. We provide absolutely stellar medical care for pregnant women and newborn infants in this country. That's not the problem. It's providing that care to those not educated or wealthy enough to get it that is the issue. Articles like the one above demonstrate where we should putting our resources, which is into public health and education.

"Insurance" is not what we need. Insurance implies that nothing has happened to you yet, but if something does then you are covered. You shouldn't expect to get fire insurance after your house burns down. You need to have it before. Too many people in this country already have health problems and for them the term insurance isn't even applicable. What we need is universal health care through a single payer. Of course what we really need to improve the health of the nation however is eat healthier, exercise, get more sleep and reduce stress.

I thought the ending was a little bit contrived, but how do you end a book like that? I agree that it was brilliantly written. It just absorbs you into their (our future?) world. As a father of a 3 1/2 year old boy it really touched a nerve. I haven't read a book in 20 years that made me have to wipe my eyes. I did NOT sleep well the night I finished it.

So I was browsing the gearEXPRESS.com "Blowouts" page and noticed that they still have these things for sale. They have been listing these "rare" pitons on the page for a year or more. Despite the added features such as spreading peanut butter and using them as a nut tool they can't seem to unload them. Anyone ever use these things? Linky

Yeah, my question: sys versus cis; is the manmade saturated fat "more" solid than the naturaly type? My wife went to a cardiology conference a few months ago where they spent 2 days discussing cholesterol and fats. One of the take home points was that saturated fats are still the worst kind of fats (worse than partially hydrogenated fats), in regards to cardiovascular risk. Hydrogenation of unsaturated fats makes them worse for you than the unhydrogenated version. This is important because many products were being marketed as containing "No Saturated Fat" but were still very unhealthy because of the hydrogenation process. Also, "cis" is the correct spelling.

Your question has in fact been looked into... Sports Med. 2007;37(4-5):392-5.Links Altitude training for the marathon. Chapman R, Levine BD. Based on published mathematical models of marathon performance, a marathoner with a typical or average running economy who performed 'live high, train low' altitude training could experience an improvement of nearly 8.5 minutes (or approximately 5%) over the 26.2-mile race distance. Note that the "Live High Train Low" method is really only applicable to low altitude exercise. There is another body of evidence that shows that exercise at altitude is necessary to obtain peak performance at altitude. When I was at the Telluride Bluegrass festival this year one of my buddies from Seattle dropped by our campsite for breakfast with Scott Jurek. He was helping Scott train for the Hardrock 100. I guess Scott knows what he is doing because he not only won the race he also set a new course record.

Seth Schwartz Dr. Schwartz We finished residency around the same time at UW. He is also a climber.

Haven't you heard? Bacteria and viruses don't cause disease (at least according to the folk for Natural Hygiene.) "Natural Hygiene is teaching us that viruses and bacteria never cause disease (virus H5N1 does not cause Aviar Influenza, just like HIV does not cause AIDS!). Hygienists see clearly that disease is not contagious, like health as well." -From INHS website

I climbed it back in 1994. The "hut" is large and well furnished. It's not quite as nice as the refugio at Huayna Potosi. I climbed the standard route and found it to be a glacier slog but with glacial retreat I could see it being much different. Even back then there was a short section that you had to rush through as it was prone to rockfall. One thing to keep in mind is the altitude. It's still pretty high even though you start high. I went straight from the jungle to the hut and then went for the summit the next day and got the worst case of AMS I've ever had. We made it to the 1st summit before I puked and then turned around. The main summit is only 100m higher, but it involves descending a saddle between the peaks and would have taken about an hour more to reach and I didn't have it in me. If you are going all the way to Ecuador to climb, you might as well just go to Bolivia where the climbing is much better.

I just heard about a potential job in Bend, Oregon. I have a good job in Colorado with good access to RMNP, Eldo, etc but the job in Bend looks like it would actually have better hours (= more time to actually climb, ski, travel, etc). My only experience with the area was one weekend trip to Smith about 8 years ago. Here are my questions... How much multipitch stuff is near Bend? How is the skiing at Mt. Bachelor? How far is the drive to backcountry skiing? Where is the closest ice climbing? Is there any good granite in the area? Is Bend a decent places to live these days? Thanks.

I think the punch line is a bit muted by the fact that the studies in question were both observational. There was likely a large amount of bias on the part of patients and doctors as far as choosing surgery or conservative treatment. One possibility is that the equivalent outcome at 1 year shows that the doctors (or patients) were experts at deciding who would benefit from surgery and who would get better without it. A randomized-controlled trial would be much better but I would doubt you would get patients or doctors interested in enrolling. A case-control study may be helpful but still wouldn't eliminate bias.

Enough of the bickering. Jens, go to an ortho foot doctor and let us know what happens. Here's a relatively modern (2003) summary concerning calcaneus fractures from an orthopoedic textbook. It should leave you with the right questions to ask the surgeon. When I was working in the ER it seemed like they were doing more surgery, but it sounds like there is still some debate about closed vs. open treatment. It would be important to let the surgeon know that you intend on returning to rock climbing and other athletic activities. This may be important in determining how to proceed. (See below under treatment and decision making for details on this.) Canale: Campbell's Operative Orthopaedics, 10th ed. Copyright © 2003 Mosby, Inc. Chapter 86 – Fractures and Dislocations of Foot G. Andrew Murphy Fractures of Calcaneus The appropriate care of calcaneal fractures continues to be an unresolved dilemma. The history of the treatment of these fractures is characterized by periods of enthusiasm for surgical intervention followed closely by periods of advocacy of closed treatment methods. Since the early 1990s enthusiasm for certain surgical procedures for carefully selected fractures in appropriate surgical candidates has increased. As technology in imaging has improved, we have learned more of the anatomical features of these fractures, and now several objective studies in the literature with sufficient follow-up recommend surgical treatment for some fractures. MECHANISM Calcaneal fractures can be extraarticular (not involving the subtalar joint) or intraarticular (involving the subtalar joint). Extraarticular fractures involving the body, anterior process, or tuberosity should be treated with cast or brace immobilization and non-weight-bearing for the first 6 weeks. An exception to this is the displaced tuberosity avulsion fracture, which serves as the attachment of the tendo calcaneus ( Fig. 86-1). Open reduction and internal fixation of this fragment with a large partially threaded cancellous screw is advised to restore the power of the tendo calcaneus and prevent a wide heel with the ensuing difficulties of shoe-fitting. Another extraarticular fracture that may need early intervention is the avulsion of the anterior process of the calcaneus by the bifurcate ligament. Minimally displaced fractures of the anterior process are easily missed and should be suspected in a patient who does not recover appropriately from a lateral ankle sprain. If the fragment is small or diagnosis is delayed, this fragment can be simply excised. Intraarticular fractures account for approximately 75% of calcaneal fractures and have historically been associated with poor functional outcome. These fractures are uniformly caused by an axial load mechanism such as a fall or a motor vehicle accident and may be associated with other axial load injuries such as lumbar, pelvic, and tibial plateau fractures. Cadaver studies, anatomical dissections, and the use of computed tomography (CT) have allowed a detailed description of the mechanism of injury and the resulting fracture patterns ( Fig. 86-2 ). The contact point of the calcaneus is situated lateral to the weight-bearing axis of the lower extremity. As an axial load force is applied to the posterior facet of the calcaneus through the talus, shear forces are directed through the posterior facet toward the medial wall of the calcaneus ( Fig. 86-3). The ensuing fracture (primary fracture line) is almost always present and extends from the proximal, medial aspect of the calcaneal tuberosity, through the anterolateral wall, usually in the vicinity of the crucial angle of Gissane. The most variable aspect of this fracture line is its position through the posterior facet of the calcaneus; it can be located in the medial third near the sustentaculum tali, the central third, or the lateral third near the lateral wall. As the axial force continues, two things happen: the medial spike attached to the sustentaculum is pushed farther toward the medial heel skin, and various secondary fracture lines occur in the region of the posterior facet. Often an anterior fracture extends toward the anterior process and may exit into the calcaneocuboid joint. The additional fractures of the posterior facet can be divided into two types, as described by Essex-Lopresti ( Fig. 86-4). If the fracture line producing the posterior facet fragment exits behind the posterior facet and anterior to the attachment of the tendo calcaneus, the injury is called a joint depression type ( Fig. 86-4, B ). If it exits distal to the tendo calcaneus insertion, it is called a tongue type ( Fig. 86-4, C ). As the talus pushes the posterior facet and the underlying thalamic fragment into the body of the calcaneus, it also pushes out the lateral wall, closing down the space for the peroneal tendons and occasionally abutting the fibula. As the force is removed, recoil of the talus occurs, leaving a depressed, thalamic fragment, and the medial spike is retracted into the soft tissues. For this reason, medially open fractures of the calcaneus require deep dissection to thoroughly expose and irrigate the medial spike. Simply excising the skin wound in this injury results in inadequate debridement. ROENTGENOGRAPHIC EVALUATION Roentgenographic evaluation of the fracture should include five views. A lateral roentgenogram is used to assess height loss (loss of Böhler angle) ( Fig. 86-5) and rotation of the posterior facet. The axial (or Harris) view is made to assess varus position of the tuberosity and width of the heel. Anteroposterior and oblique views of the foot are made to assess the anterior process and calcaneocuboid involvement. A single Brodén view, obtained by internally rotating the leg 40 degrees with the ankle in neutral, then angling the beam 10 to 15 degrees cephalad, is made to evaluate congruency of the posterior facet ( Fig. 86-6). For surgeons experienced in the care of these fractures, three roentgenograms may be sufficient, but most often CT scans are obtained to evaluate the injury completely. The scans should be ordered in two planes: the semicoronal plane, oriented perpendicular to the normal position of the posterior facet of the calcaneus, and the axial plane, oriented parallel to the sole of the foot ( Fig. 86-7 ). CLASSIFICATION With increasing use of CT scanning for these fractures, more complex classification systems have been developed that have been shown to have prognostic value in the treatment of these injuries. While the Essex-Lopresti system has been used for many years and is useful in describing the location of the secondary fracture line, it does not describe the overall energy absorbed by the posterior facet, demonstrated by comminution or displaced fragments ( see Fig. 86-4). Classification systems by Crosby and Fitzgibbons, and Sanders have become more widely accepted in evaluation of these fractures ( Fig. 86-8 ). Both classifications are based on CT scans and describe comminution and displacement of the posterior facet. The advantage of the Sanders classification is its precision regarding the location and number of fracture lines through the posterior facet. However, both systems lack descriptions of other important aspects of these fractures, namely, heel height and width, varus-valgus alignment, and calcaneocuboid involvement. Although CT scans have become valuable in the evaluation and classification of these fractures, it should be emphasized that correlation with plain roentgenograms is mandatory. Ebraheim et al. demonstrated that a CT scan may underestimate sagittal plane rotation of the depressed fragment. For this reason, plain lateral roentgenograms must be used to scrutinize the displacement seen on a CT scan. TREATMENT Closed treatment of intraarticular calcaneal fractures includes closed manipulation and casting, compression dressing and early mobilization, traction-fixation, manipulation as recommended by Böhler, and pin fixation as recommended by Essex-Lopresti. Closed treatment methods have been successful in some studies. Omoto et al. reported success in 11 of 12 patients treated with his manipulation technique. Aitken reported 75% return to employment using methods similar to those described by Böhler. Kundel, Brutscher, and Bickel compared the results of 30 patients treated operatively with 33 patients treated nonoperatively. Age, associated trauma, calcaneocuboid joint involvement, Böhler angle (postinjury), workers' compensation status, percentage of joint depression, and tongue type were compared. The authors specifically excluded patients with comminuted fractures. They found that the only statistically significant advantage of operative over nonoperative treatment was the ability of patients to return to their previous occupation. They also noted that those who had near anatomical reductions with normal restoration of Böhler angle did better than those who did not have anatomical reductions, and they concluded that open reduction and internal fixation of intraarticular calcaneal fractures can be expected to benefit only those patients with near-anatomical reconstruction. Crosby and Fitzgibbons compared 23 type II intraarticular calcaneal fractures treated with open reduction and internal fixation with 10 type II fractures treated with closed methods. The fractures treated with open reduction and internal fixation had superior results to those treated by closed means. Thordarson and Krieger also had similar results in a small prospective, randomized series with follow-up of only 17 months for operatively treated fractures and 14 months for nonoperatively treated fractures. Results were statistically better after open reduction and internal fixation through the extensile lateral approach than after nonoperative treatment. Essex-Lopresti recommended treatment on the basis of displacement and type of fracture as follows: (1) conservative treatment for nondisplaced or minimally displaced fractures with early range of motion, (2) axial fixation with a metallic pin for tongue-type fractures, and (3) open reduction and internal fixation for joint depression fractures. Although the debate over open or closed treatment of calcaneal fractures may continue for some time, most authors would agree that the inability to surgically obtain and maintain an anatomical reduction of the posterior facet is probably associated with a worse outcome than closed nonoperative treatment. Open reduction can be obtained through a medial approach (McReynolds, Burdeaux), combined medial and lateral approach (Stephenson, Romash), or a lateral approach alone (Benirschke and Sangeorzan, and Sanders et al.). Also, success after open reduction followed by immediate arthrodesis has been reported by several authors. Decision Making in Calcaneal Fractures Goals common to all types of treatment of calcaneal fractures are as follows: (1) restoration of congruency of the posterior facet of the subtalar joint, (2) restoration of the height of the calcaneus (Böhler angle), (3) reduction of the width of the calcaneus, (4) decompression of the subfibular space available for the peroneal tendons, (5) realignment of the tuberosity into a valgus position, and (6) reduction of the calcaneocuboid joint if fractured. Factors to be considered in formulating a treatment plan are as follows: Age of the patient. Most of these injuries occur in patients younger than the physiological age of 50 to 55 years. Older patients should, in general, have closed treatment. Health status. An insensate limb caused by either trauma (sciatic or tibial nerve disruption) or disease (diabetes or other neuropathy) is a strong relative contraindication to open treatment. Patients with limited ambulation as a result of other medical conditions likewise should be treated closed. Fracture pattern. Sanders Type I or nondisplaced fractures should be treated closed. Types II and III fractures can be treated with open reduction. Type IV can be treated either closed or, in experienced hands, with open reduction and immediate arthrodesis. Soft tissue injury. As described earlier, fractures that are open medially require more aggressive debridement than simple opening of the wound to wash out the soft tissue. The medial spike should be exposed and debrided. It is better to wait 2 to 3 weeks until the wound is stable before internal fixation is attempted. Open treatment should not be performed through tight, swollen soft tissues and certainly not in the region of fracture blebs. The report by Levin and Nunley is an excellent guide to evaluation and management of more complex soft tissue problems. Surgeon's experience. Sanders et al. have confirmed that the learning curve for this fracture is somewhat steep, and with substantial literature supporting closed methods of treatment, a thorough knowledge of the anatomy and clearly defined goals are necessary for a successful outcome.

I disagree as well. In my previous life as an ER doc I knew a little about these things. There are a few different kinds of fractures that are all "heel fractures" but are all very different. Some are avulsion fractures where a ligament pulls a piece of bone off. Others involve fractures to various parts of the calcaneus (heel bone), with or without joint involvement. There are a multitude of different scenarios and some of them have some important (often ancient) surgeon's name attached to them. If it involves the joint, that is a very bad thing and almost always requires surgery. Even an extra-articular fracture (not involving the joint) if it heals displaced can cause a lot of problems and require additional surgery. See an foot specialist soon and stay non-weight bearing until you do. On the up-side, there are quite a few possibilities that could still be treated with a cast and no surgery with good recovery potential. It's been a few years since i lived in Seattle, but Harborview used to have a couple of ortho foot specialists that I thought did a good job. Edited to add link to the Harborview Foot and Ankle Clinic: Harborview Foot and Ankle Clinic

I came across a recent study that reminded me of this thread. It's a large study that looks at the risk of tendon rupture associated with fluoroquinolones. It's a retrospective analysis of a database but still has some good information. The bottom line is that the overall risk of Achilles tendon rupture looks to be about 3 times higher with a fluoroquinolone but that the overall incidence is still very small. The risk of tendon rupture with a fluoroquinolone was 0.018% (1 / 5,555) and the risk without was 0.006% (1 / 16,666). Although not looked at in this study, other recent research has shown that around 1/3 to 1/2 of the patients with a tendon rupture were also on corticosteroids, like prednisone. Eur J Clin Pharmacol. 2007 May;63(5):499-503. Epub 2007 Mar 3. Links Use of fluroquinolone and risk of Achilles tendon rupture: a population-based cohort study.Sode J, Obel N, Hallas J, Lassen A. Department of Infectious Medicine, Odense University Hospital, 5000, Odense C, Denmark, Annmarie.lassen@ouh.fyns-amt.dk. OBJECTIVE: Several case-control studies have reported that the use of fluoroquinolone increases the risk of rupture of the Achilles tendon. Our aim was to estimate this risk by means of a population-based cohort approach. SETTING: Data on Achilles tendon ruptures and fluoroquinolone use were retrieved from three population-based databases that include information on residents of Funen County (population: 470,000) in primary and secondary care during the period 1991-1999. A study cohort of all 28,262 first-time users of fluoroquinolone and all incident cases of Achilles tendon ruptures were identified. MAIN OUTCOME MEASURES: The incidence rate of Achilles tendon ruptures among users and non-users of fluoroquinolones and the standardised incidence rate ratio associating fluoroquinolon use with Achilles tendon rupture were the main outcome measures. RESULTS: Between 1991 and 2002 the incidence of Achilles tendon rupture increased from 22.1 to 32.6/100,000 person-years. Between 1991 and 1999 the incidence of fluoroquinolone users was 722/100,000 person-years, with no apparent trend over time. Within 90 days of their first use of fluoroquinolone, five individuals had a rupture of the Achilles tendon; the expected number was 1.6, yielding an age- and sex-standardised incidence ratio of 3.1 [(95% confidence interval (95%CI): 1.0-7.3). The 90-day cumulative incidence of Achilles tendon ruptures among fluoroquinolone users was 17.7/100,000 (95%CI: 5.7-41.3), which is an increase of 12.0/100,000 (95%CI: 0.0-35.6) compared to the background population. CONCLUSION: Fluoroquinolone use triples the risk of Achilles tendon rupture, but the incidence among users is low.

This actually is from the old Merck Manual, I shit you not. The Merck Manual of Diagnosis And Therapy, 16th edition GAS Symptoms, Signs, and Diagnosis Excessive gas is commonly thought to cause abdominal pain, bloating, distention, belching, or passage of excessively voluminous or noxious flatus. However, excessive intestinal gas has not been clearly linked to the above complaints; it is likely that many symptoms are incorrectly attributed to "too much gas." In most normal persons, 1 L of gas/h can be infused antegrade into the gut with a minimum of symptoms, while persons with gas problems often cannot tolerate much smaller quantities. Similarly, retrograde colonic distention by balloon inflation or during colonoscopy often elicits severe discomfort in patients with the irritable bowel syndrome, while causing minimal symptoms in other people. Thus, the basic abnormality in persons with gas-related problems may be a hypersensitive intestine. Altered motility may contribute further to symptoms; gas could be the inciting agent or have no role in their pathogenesis. Repeated belching indicates aerophagia. Some persons with this problem can readily produce a series of belches on command. This form of belching is due to unconscious, repeated aspiration of air into the esophagus, often in response to stress, followed by rapid expulsion. When such habitual aspiration is suspected, patient education and behavior modification should be undertaken rather than extensive medical evaluation and drug therapy. In the splenic flexure syndrome, swallowed air becomes trapped in the splenic flexure and may cause diffuse abdominal distention. Left upper quadrant fullness and pressure radiating to the left side of the chest may result. There is increased tympany in the extreme left lateral aspect of the upper abdomen. Relief occurs with defecation or passage of flatus. Infantile colic is a syndrome of presumed "crampy" abdominal pain. Such infants appear to pass an excessive amount of gas. However, recent data showed no increase in H2 production or increase in mouth-to-cecum transit times in colicky infants. Hence, the cause of this syndrome remains unclear. Flatulence: Among those who are flatulent, the quantity and frequency of gas passage shows great variability. As with bowel frequency, persons who complain of flatulence often have a misconception of what is normal. In a study of 8 normal men aged 25 to 35 yr, the average number of gas passages was 13 ± 4 in one day with an upper limit of 21/day, which overlapped with many persons who complained of excess flatus. On the other hand, one study noted a person who expelled gas as often as 141 times daily, including 70 passages in one 4-h period. Hence, objectively recording flatus frequency should be the first step in evaluating a complaint of excessive flatulence. This symptom, which can cause great psychosocial distress, is unofficially described according to its salient characteristics: 1. The "slider" (crowded elevator type), which is released slowly and noiselessly, sometimes with devastating effect; 2. The open sphincter, or "pooh" type, which is said to be of higher temperature and more aromatic; 3. The staccato or drumbeat type, pleasantly passed in privacy; and 4. (4) the "bark" type (described in a personal communication) is characterized by a sharp exclamatory eruption that effectively interrupts (and often concludes) conversation. Aromaticity is not a prominent feature. Rarely, this usually distressing symptom has been turned to advantage, as with a Frenchman referred to as "Le Petomane," who became affluent as an effluent performer who played tunes with the gas from his rectum on the Moulin Rouge stage. Despite the flammable nature of flatal H2 and CH4, no hazard is likely to those working near open flames, and youngsters have even been known to make a game of expelling gas over a match flame. However, gas explosion, rarely with fatal outcome, has been reported during jejunal and colonic surgery, and even during proctosigmoidoscopic procedures, where diathermy was used. Because "excessive gas" symptoms are so nonspecific and commonly overlap with the irritable bowel syndrome (see above) as well as with organic disease, a careful history is essential to guide the extent of medical evaluation. Long-standing symptoms in a young person who is otherwise well and has not lost weight are unlikely to be caused by serious organic disease. The older person, especially with the onset of new symptoms, merits more thorough examination before "excessive gas," real or imagined, is treated.

This is a new route I submitted to the new Olympics guide (not sure if it made it in). It's to the left of the regular route. Pretty steep in places. I did it alone and mostly at night by headlamp. I slept on the ridge crest and finished the traverse the next day. I tried to traverse all the way to the north peak but the snow was too unstable.

The "Exit 38 Bandits" use a slim-jim to open the car, then steal or copy a credit card number and close everything up nicely. The only way you'll know you have been taken is when your credit card bill comes or if the card company calls you because of unusual spending changes. Also, I never locked my soft-top Jeep but that didn't stop some genius from cutting through the plastic window and then bending the drame down.

Here's an interesting site that I came across. It reminded me of the old Nike Missle Base that was behind the farm I used to work on back in Illinois. Missle_Silo

C3 set of 5 (000-2) for $250.00 on Backcountry.com. Using the 20% off coupon (that expires tomorrow 1/3/07) I got the whole set + free shipping and no taxes for $201. http://www.backcountry.com/store/BLD1061/Black-Diamond-Camalot-C3-Package-000-2.html?id=thcHumfD

According to this report, lawyers make $150,000/year on average: Money_Mag_Lawyers Given that this number includes the scum as well as the saints of the profession, it seems reasonable to me that there should be a certain financial incentive to serve the public. You may want to evaluate your own career choices on this page: Money_Mag_Careers

The mountains are no place for people with severe persistent asthma. Stick to cragging until you get it under better control. Even with good control you should consider bringing an Epi-pen if your asthma is really that bad. I'm glad others have had luck with their asthma and climbing but you have to understand that there is a selection bias on a climbing website. Those with a bad response probably either died or took up another hobby and wouldn't be prowling cc.com. Also, upper respiratory tract infections probably increase the likelihood of developing HAPE (at least in children) that travel to high altitude, so I would be extra careful. (Ref: Durmowicz AG, Noordeweir E, Nicholas R, Reeves JT: Inflammatory processes may predispose children to high-altitude pulmonary edema. J Pediatr 1997; 130:838-840.)

Clinics in Chest Medicine Volume 26 • Number 3 • September 2005 Copyright © 2005 W. B. Saunders Company Pulmonary Function Testing and Extreme Environments ASTHMA Convincing evidence is lacking that lower air density at altitude conveys much advantage in patients who have COPD and asthma. Stable asthmatics who do not have hypoxemia at sea level have little added risk at altitude other than remote location in the event of bronchospasm. Reduced exposure to allergens and pollutants in mountain areas may reduce the likelihood of exacerbation, although complete absence of these triggers cannot be assumed. Exercise in cold, dry air theoretically could provoke some asthmatics, although Matsuda and coworkers [125] report no changes from sea level in FEV1, exercise time, oxygen consumption, or heart rate in children who have exercise-induced asthma exposed in a hypobaric chamber. Nonspecific airway challenge testing on current asthma therapy before travel may provide some reassurance. Asthmatics may opt to monitor spirometry in field settings. Jensen and colleagues tested several devices by mechanical means in an altitude chamber and found that portable flow meters underestimate PEF as a function of increasing altitude and increasing target peak flow [126]. Pedersen and colleagues address similar issues and advocate carefully developed correction factors for meaningful use of selected instruments in settings of variable barometric pressure [127].