mneagle

Trip: Nooksack Tower - North Face Date: 8/25/2007 Trip Report: I've been meaning to post this up for awhile but wasn't able to get it done until today. The correct date should be August 2007, but the TR format won't let me use last year's dates. Anyways, on to the story. On my first foray to do Nooksack tower, I was still a North Cascades noob. After a full night of listening to rockslides coming down the glacier, we made it to the edge of the snow before my partner declared he wouldn't be climbing that day. He was right, we really didn't have any business being there at that point in our climbing careers. On the way down I lost both big toe nails from poorly fitting boots and walked the last 2 miles in socks. On the second attempt I never actually left the living room of Sam "Spinal injury" Warren's house. I had decided that after being denied the tower once that we should now add the traverse of Nooksack ridge and tag Shuksan as well. After shouldering the pack necessary to accomplish this feat I immediately dropped the pack back to the floor and we headed off to climb Liberty Crack instead. The plan of climbing Nooksack still smoldered in my mind for years. Not willing to let a mountain beat my ego I eventually conviced myself that I needed to up the ante. I would not settle for the standard Beckey route on Nooksack but would instead take on the North Face and, of course, still plan on the ridge traverse and bagging Shuksan to boot. I needed a victim to dupe...er, I mean inspire! into taking on this challenge. My buddy Rich who is a wiz at hard desert cracks was the perfect person (Moab trip) . I still owed him for the time he fooled me (as well as several other people including both of our wives) into doing a mountain bike circumnavigation of the Henry Mountains in Utah. Only after we crawled back to our cars did he inform us that we had just completed one of the top 6 "climbs from hell" in utah mountain biking. We had kind of figured it out by that point anyway. The fact that Rich really had minimal alpine experience and recently moved to the Omak made it perfect. We arrived at the trailhead to find ourselves in matching orange and black. Team-Nooksack had arrived. We headed off carrying pretty large packs, proceeded to miss the trail down to the river on our way in before backtracking and eventually locating the infamous log crossing. For those who care to follow in fools footsteps, this is a pretty accurate representation of the bashwhacking involved in getting up the wooded slope to the lake. Finally we had our goal in sight. The North Face is along the right side of the tower, starting just left of the snow tongue. We intended on bivying somewhere over the summit near the notch with Nooksack Ridge and then complete the traverse the next day. We made camp just before the snow slopes/glacier crossing to the tower. Running water and a bed of heather made things very comfy. The next day we managed to avoid most of the rocks and ascend over mostly snow to get to the glacier. We traversed to the rocks just below the start of the route and then solo'ed up the choss to the start of the route. Rich is standing on the bivy ledge mentioned in Nelson. Personally I thought it would be pretty exposed to rockfall. The opening pitch had decent 5.8 climbing with good pro. We ran the first few pitches together. There was a lot of fun, moderate climbing. Rich on lead. Still smiling. This is several pitches higher. You can see the faint approach trail along the ridge, just below tree-line. It's best not to descend to the lake at all. Up to this point the climbing is still pretty straight forward and mostly solid. There's a traversing section similar to Mt. Stuart's below the headwall. Soon after this section there is a seriously chossy/shitty traverse up and right that really sucked. From that point Rich led out right around a blind corner and found the first section of 5.9. We both managed to send off car door sized chunks of rock and began to take the route a little more seriously. This is a view of the gargoyle studded ridge which was our next day's objective. This is the next 5.9 pitch, which was longer and quite strenuous when carrying a large alpine pack. There is a bomber blue camalot placement that makes up for some of the dicey smaller placements along the way. Finally we came to the last traversing pitch to the summit. To our surprise, as we came over the ridge we realized we had been shielded by the tower from the gale force winds howling in from the south. We could barely stand up and only spent a few cursory moments entering our names in the summit log before descending towards the notch to get out of the wind. The weather didn't look good at all, but fortunately there are 2 very nice bivy spots about 100 ft below the summit that were well shielded from the wind. We got out our bivy sacks and waited to see what the North Cascades would throw at us. My spot: Rich, still smiling: I apparently really offended the mountain gods, because they threw a wind and rain party for hours before finally deciding that snow was in order. We had run out of water the night before but had no trouble rehydrating off of the 2-3 inches of snow that covered us and everything else. That was the end of our aspirations to climb the ridge and bag Shuksan. We were more concerned at the time of how to climb a hundred feet of verglas encrusted rock and find our way down the Beckey route with about 100 feet of visibility. Rich's bivy the next morning (probably not smiling): Me on belay, while Rich prepares to tackle the verglas: Through our disorientation we ended up descending way climber's left. After several raps off of a single 70m rope we had run out of pitons and found ourselves above an overhang looking down on the Nelson route. After swinging leads, traversing across wet ridges, Rich finally spotted a red sling in the distance. In what seemed like hours later, we finally had the comfort of knowing at least we were on the correct chossy descent route. No pictures were taken for a long time as we made our way down the hundreds of feet of wet rock and then descended the slippery couloir. Lots of crevasse hopping later, we finally made it back to our camp where we shivered in our soaking wet bags through another night. The next day was beautiful and we got one last look at the monster before heading down. The long bushwhack through the now wet foliage was tempered somewhat by the copious blueberries that had somehow been overlooked on the way up. Though denied the grand plan, getting up (and down) the North Face of Nooksack was still a pretty awesome experience. Gotta love Washington climbing. Gear Notes: 1 set of nuts and 0.4 to #3 camalot single set was more than adequate bring pins if you are going to set rapel stations Approach Notes: The trail down to the river is just after the wilderness area sign nailed to a tree. After the log crossing trend up and right to find the "trail". Stay high above the lake and follow the top of the morraine to a good bivy spot before the glacier crossing with running water.

Jens, you could have a real problem. I'm an actual lung doctor, so I know what I'm talking about. If there's anyway you could send me a copy of your x-ray I could give you more specific advice but I would doubt they have the ability to digitalize their x-rays down there. When they say you have fluid on your lungs that could mean 1 of 2 things. Either they are referring to consolidation within the lung from an infection or they may mean that fluid has accumulated outside the lung (between the lung and the chest wall) which is called a pleural effusion. More specifically, if the fluid accumulates due to an infection in the lungs it is called a parapneumonic effusion. This fluid can be very inflammatory which can cause big problems. The worst case scenario is that the fluid itself is infected in which case we call it empyema. This would be extremely bad. The antibiotic that they gave you is very broad spectrum and should cover most bacteria but it was a good idea to use the azithromycin to cover atypical bacteria. Unless you are immune suppressed it's unlikely that you have a fungal infection. If you have an effusion and the fluid is still present then it should be drained. If you let inflammatory fluid sit in the chest for too long walls can form in the fluid and form multiple pockets that can be difficult to drain. A fibrous "peel" can form around the outside of the lung as well. We call this a trapped lung and it can often require surgery to fix. Here's what you should do: get your ass home. If you can't get home right away then get the x-ray and if a pleural effusion is present find a local lung doctor or surgeon and get them to drain it. They should do a fluid analysis and if the fluid looks infected or very inflammatory they may put a tube in to drain the fluid for a few days. If the fluid is already walled off they may consider putting lytics (streptokinase, urokinase or TPA) to try to chew up the walls but they may not have it. If lytics don't work then surgery is usually needed. If there is no effusion but just consolidated lung from pneumonia then the antibiotic and rest may be all that are required, so a lot depends on the x-ray. This is what an effusion looks like in a kid (R=right side): In an adult:

Few have beheld it's mythical splendor...

Depending on how much I can boost my fitness level, I may be willing to make a trip back to the PNW for a shot at this test piece... IZMctuJ_p-M

Next to Laphroaig and Ardbeg the Scotch you recieved are some of the "peatiest" of all scotches. You might see if you can trade them in for some highland scotches that are a lot less peaty than the island/coastal varieties. Glenfinich, Glenlivet and Macallan would be good bets based on your staed preference.

If it's good enough for Men at Work... "I said do you speak'a my language? He just smiled and gave me a Vegemite sandwich." n577vbu_Gds

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.