iluka

I think that as impressive as his first ascent was, an equally impressive set of accomplishments is all the work he did for the people of Nepal in the years that followed. You cannot go anywhere in the Khumbu Valley without seeing something with his name or the Himalayan Trust on it. Schools, clinics, reforestation efforts... he did a lot with his time and money.

Very little information is known about how high altitude affects people with Raynaud’s phenomenon and whether they experience more frequent and/or more severe attacks when traveling at high elevations. We are conducting a research study on the effects of high altitude on people with Raynaud’s phenomenon. If you have Raynaud’s Phenomenon and would be interested in participating in a short, anonymous on-line survey about this issue please contact Andrew Luks at aluks@u.washington.edu or by phone at 206-221-2814. You will then receive further information about the study and a link to the on-line survey. Please be aware that the confidentiality of emails cannot be guaranteed. This is a University of Washington research project and the forum administrators have granted permission to put this post on this website.

Perhaps more warnings via the local media outlets would be useful when avalanche conditions are high. Weather forecasts on the local TV stations always include plenty of information about anticipated snowfall and the stations devote attention to road conditions at the passes but how often do they announce that avalanche conditions are high and skiers, snowmobilers and the like should use extreme caution. I don't recall hearing them say such things that much.

Alcohol will make you feel warmer but in significant enough quantities can increase the risk of hypothermia. It causes blood vessels to dilate. As a result, more warm blood goes from your core to your body's periphery. This makes you feel warmer but over time takes heat away from the core and increases the risk of a fall in your body temperature.

Man... I'm lit up like a Christmas tree riding at night around here. Still a big near miss here or there but it likely has cut that number down a lot. Lately, as much as I don't get the people riding without lights in black clothing on the dark sections of the Burke, it's the people yapping way on their cellphones on their bike that are starting to bother me. They swerve all over the place.

Favorite Movie at this year's festival? I'll go with the ones about the climber-photographer and the deep water climbing

This strikes me as a potentially bad idea idea. Offering incentives of one sort or another to get people to donate kidneys may certainly increase the supply of available organs which would be a good thing for those on the waiting list. It may also create adverse incentives whereby people hide certain information during the donation evaluation process which, in turn, may result in some bad organs getting transplanted into unsuspecting recipients.

Don't want to blow that next high altitude climbing trip because of altitude illness? Wondering why a previous trip to high altitude went badly? "How To Travel Safely in the Mountains" Speaker: Andrew Luks Date and Time: November 27, 2007 7PM Location: Wide World Books and Maps in Wallingford 4411A Wallingford Avenue North Phone: 206-634-3453 Free to the public

There is some element of truth to this but a large part of the extra expenses in our system are related to the huge administrative costs involved in running it. Administrative costs in the U.S. are something like 300 times as much as in other industrialized countries and these costs get passed onto the consumers. Why the administrative costs? This is largely due to the problems tracking down payments from the insurance companies and the government. The UW medical center, for example, has several hundred full-time employees working in the billing department whose main roles are to ensure compliance with medicare billing practices so the government will reimburse (albeit not very well) for the services provided and to track down payments from insurance companies. Insurance companies, for example, reject a certain percentage of claims up front regardless of their merit. They do this because they know many providers and physician's offices will not put in the effort to resubmit the claims or argue on their behalf. Dealing with such problems takes time and people and.... costs lots of money. I heard a talk a few years back from a leading proponent of national health care who related an experience he had when he visited a public hospital in Canada that is part of their national system. Their billing department... 3 people... whose role was largely to track down payments from Americans treated at that hospital. The billing department at his hospital in Boston... 300 people. You do the math.

I'm not sure all the arguments about statistical methodology are worth it. It's not as if there's only a single study with questionable methodology showing the US lags behind other countries in the quality of care it delivers. There are numerous studies looking at a variety of endpoints suitable to between country comparisons (maternal mortality, infant mortality) which show that the US, despite spending WAY more per capita on health care than any other industrialized country, lags far behind the rest of the industrialized world on markers of quality of care. This isn't an aberration due to statistical methods... it's a clear trend. What I find frustrating about the debate on whether we should move to national health care is this: look at the people who are the most vocal opponents of a move to a different system... the insurance industry, who stands to lose a lot of $ if such a change is made, and a large block of wealthy conservative political and economic elites who have solid private health insurance and/or the financial wherewithal to handle significant health care expenditures. You don't see a lot of the un- or underinsured running around out there saying "boy, I wish we had national health care but I'm afraid we'll have 'socialized' medicine and pictures of lenin, che guevera and Chairman Mao on every corner and I wouldn't want that." It's easy to oppose a change when you don't have much at stake or aren't at high risk in the current system. And for what it's worth... the president's idea of health savings accounts isn't much of a bargain. $3000 per year may work fine if all you need is a clinic visit or two a year and a pap smear but have one illness requiring hospitalization or something more serious like cancer treatment etc. and that money is gone in a day or two.

The more important thing with carbon monoxide is the level it reaches in the blood stream. Each hemoglobin molecule has 4 binding sites for oxygen. When carbon monoxide is in the blood, it will bind to these sites and prevent the hemoglobin from picking up oxygen. This dramatically decreases the amount of oxygen the blood can carry. Carbon monoxide has 240 times the affinity for hemoglobin than oxygen which means that once it's in the blood stream, it will bind quickly and remain there for a while. If someone smokes a few cigarettes, a small percentage (< 10%) of their hemoglobin molecules may have carbon monoxide bound to them. This probably isn't of much consequence. If someone chainsmokes, they can raise that percentage up to 10-15% and if someone is caught in a bad fire or has a car run in their garage overnight flooding the house with carbon monoxide, they can reach levels of of carboxy-hemoglobin (carbon monoxide bound to hemoglobin) well over those levels and can get really sick. It's the levels of carboxy-hemoglobin that will determine the physiologic consequences.

I think there are a few ways to look at this: With acute exposure, if you look at it from a physiologic standpoint, smoking would not be expected to be helpful. Cigarette smoke puts carbon monoxide into the blood. This, in turn, displaces oxygen from hemoglobin (the protein that carries oxygen inside the red blood cells) and, as a result, the oxygen carrying capacity of the blood goes down. Less oxygen delivery to exercising muscles should theoretically impair performance. This has not been studied systematically at high altitude but given the physiology of it all, I think avoiding smoking (or at least heavy smoking) during ascents to high elevations is a not unwise move. It's obvious, however, that many climbers get away with smoking without adverse effects. Perhaps they aren't smoking enough to elevate their blood stream carbon monoxide levels to the point that this physiology would really have an adverse impact on performance. What they are talking about in the study involves more chronic exposures: weeks, months and beyond at high altitude. You do not make red blood cells instantaneously at altitude. Low oxygen levels in the blood stream lead to elevated EPO levels pretty quickly but it will take a while before the red blood cells are actually manufactured and out circulating in the blood stream. The "lift" the sherpa say they sometimes get from smoking on their climbs isn't coming from the red blood cell issue but more likely from the stimulant effect of the nicotine. If you are a healthy person with adequate iron stores in your body (the case with most people except women with very heavy menstrual periods), you will likely produce more than enough extra red blood cells to raise your hematocrit to an adequate level to assist oxygen delivery; the added benefit you would derive from the extra red blood cells that might come from smoking at altitude would likely be small.

Hopefully they will stick with the plans they propose. They just finished repaving Stone Way in Wallingford and the plan called for creating one car lane in each direction, a center turn lane and bike lanes on both sides all the way from 45th St. down to 35th Street. The business owners at the bottom of Stone Way apparently balked and they bailed on the plan. Now there are only lanes from 45th St. down to 40th St. where the road returns to 2 car lanes in each direction.

Absolutely... not an easy thing to study at all. What always amazes me is how big an industry the supplement industry is and how much they manage to sell in the absence of good data for many, if not most, of their products.

This statement probably needs to be qualified a bit as the data is not as clear as this might suggest. The best data is probably the best regarding the effects on coronary artery disease, cholesterol and high blood pressure but even with coronary artery disease the greatest benefits are probably in the area of secondary prevention (preventing repeat problems in people who already have coronary artery disease) than they are in primary prevention (preventing disease in people who have not had the problems yet). With regard to diabetes, there is no clear evidence at this point that fish oil improves glucose control. In fact, some studies even suggested it might worsen control a bit. Either way, there is no clear evidence of benefit in this regard. Where diabetics may benefit is in decreasing the risk of coronary artery disease, a major problem in such patients. As for cancer prevention, most of the data is from studies in animals with tumors and cell culture models. The epidemiologic studies have not shown as clear evidence yet and there is still not a lot of large randomized trials in humans that show benefit. Finally with regard to the anti-inflammatory effect, it probably comes down to what inflammatory disease process you are talking about. There is a trial just out showing a benefit in disease control for people with lupus. Despite several studies, however, there is no evidence of benefit in people with ulcerative colitis, as another example. There does not appear to be a lot harmful side effects to fish oils, however, so it is hard to see much of a downside to them, although I honestly cannot comment on the PCB or mercury issue. The purity and safety of many nutritional supplements should always be a concern given the less stringent regulation of the supplement industry. As to whether a daily multivitamin is really of use in a healthy, well-fed individual is a topic best left for a whole other discussion. The data from randomized trials does not seem to support the earlier from observational studies (a less effective study design)that said there was benefit to their use.

Trip: South Ingalls to Fortune Traverse Date: 10/27/2007 Trip Report: We decided to take advantage of the nice weather today and headed over to the east side to do the Ingalls to Fortune Traverse and perhaps get in one more good dose of the larches. We were on the trail at 8:45AM in some quite cold conditions but warmed up quickly. We encountered snow for the first time around 5500 feet but it was patchy from there to Ingalls Pass and travel and trail finding were no problem. Once in the basin, we encountered more continuous snow coverage but it was not very deep (never more than 1 foot) and the firm surface layer made for easy travel. We had some steps to follow as well as a pair who we ended up later seeing on the summit of N. Ingalls had been through the basin before us. Our original intention was to access S. Ingalls from the saddle between the north and south peak. However, as we headed towards Lake Ingalls from where we would climb to the saddle, we remembered how we had tried this route two years ago around the same time of year and ran into a lot of solid ice on the part from the saddle to the summit of South Ingalls which prevented us from summiting. We figured that given the cold temps, the position of the sun and the recent snow, we were likely to encounter similar conditions and, therefore, decided to get up a different way. A ways before the lake, we left the trail and climbed an obvious broad gully that leads to a saddle on the ridge between S. Ingalls and Fortune (red line in the photo below). The sun had softed up the snow sufficiently to make travel pretty straight forward. Once on the ridge, we then headed up to the summit of S. Ingalls. There is a gully on the right side of the summit block that appears to go all the way to the top, but we opted to work our way around to the left where we found an easy ramp to the summit with little in the way of snow or ice on it. The sun was all over this aspect too so any snow was adequately soft. We were on the summit by 12:30 where we enjoyed some views, including ones of a pair of people over on N. Ingall's, before heading down to grab lunch in a sheltered spot. From there we went back to the spot where we gained the ridge and started to traverse over to Fortune. Rather than following the ridge proper, we dropped to east (left in the photo below which shows the ridge between the two peaks) and stayed in the snow as much as possible. We probably dropped down about 50-100 feet and tried to stay as high as possible in the snow. At one point, we came to some narrow, steep gullies with firm snow so at this point, we climbed up and gained the rocky ridge line (this required one short Class 4 move) and scrambled along it for a short bit until we regained the final snow slopes up to the summit of Fortune. Had we inititally dropped lower down off the ridge in the snow, rather than staying as high as we did, this all might not have been necessary. The snow on these slopes was firmer than we had seen further down as it was pretty wind scoured but it was easy to get purchase without crampons. From the summit of Fortune, we headed down the southwest ridge towards the trail that leads to Lake Ann. There was little snow on this ridge but plenty of soft scree to make the travel pretty straight forward. We found the trail with little difficulty and headed out to the cars, making it back by 4:30. Gear Notes: Ice Axe, Helmets and Crampons Approach Notes: Patch snow beginning at 5500 feet on the way to Long's Pass. More continuous coverage between Long's Pass and Lake Ingalls but easy travel as it's not very deep.

I recently saw the movie and read the book many years ago and very much liked both of them. After reading the book, I didn't have a ton of sympathy for Chris McCandless. He had very romantic notions of what he wanted to do but that isn't an excuse for being woefully underprepared. He went into the Alaska backcountry without a map. Had he had one, he would have known there was a cable crossing for the river, not far from where he was. He also went into the backcountry expecting to hunt for his food having never hunted before and all he brought out with him was rice. There were other similar examples. Romanticism is great... but it is not an excuse for being unprepared. Krakauer saw a lot of himself in McCandless but when you read the stories of his Devil's Thumb experience and other climbs, he struck me as much more prepared for what he would face. The movie didn't change my opinion in this regard. What it did do, however, was give me some more sympathy for the fear he must have experienced at the end as he was dying. Interestingly, a friend of mine ran cross-country with him in high school. His response to the book was that as far back as high school, he was always coming up with crazy ideas of what he would do with his life. When he finally decided to act on it, he added, he was woefully unprepared.

The alcohol-based hand sanitizers are, in fact, being used much more frequently in the hospitals and are now located on the walls outside most rooms. In addition to their effectiveness at disinfecting, they're more convenient than the sinks and therefore people are more likely to wash off before then enter and as they leave a room. However, there are still a few situations in which you still need to wash your hands. The most important one in the hospital is with a bacteria called C.Difficile or C.Diff, for short. The alcohol gels don't work with this and handwashing is necessary. Regarding the cryptosporidium issue, it is more of an issue in people who have suppressed immune systems (HIV, medications etc.). People with normal immune systems can still get symptomatic infection (eg. the big outbreak in Milwaukee in the 90s) but they tend to be less severe and will usually resolve without therapy in 10-14 days. In people with suppressed immune systems, the infections can be quite severe and quite prolonged.

The main medication for treating Giardia is Flagyl, also known as Metronidazole. It is taken as 500 mg three times a day for 5 days. An alternative which is now available in the US is Tinidazole. It is taken as a single 2 gram dose. The medications are actually reasonably well tolerated from the standpoint of the kidneys and liver. The bigger problem is that you cannot drink alcohol while you take them. If you do, there is a good chance you will feel like absolute crud. When combined with alcohol, metronidazole causes what's called a disulfiram effect. Disulfiram, also known as "Antabuse" is a medication occasionally used to help treat alcoholism. Drink alcohol while on the medication and you feel violently ill. Alcohol plus metronidazole causes a similar reation so down those beers at your own risk while on the medication.

There's a nice review article on going to altitude with preexisiting ocular conditions that includes a discussion of Lasik and RPK procedures: http://www.ncbi.nlm.nih.gov.offcampus.lib.washington.edu/sites/entrez?Db=pubmed&Cmd=ShowDetailView&TermToSearch=14672545&ordinalpos=1&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVAbstractPlus

You are better off training at low altitude than you are at high altitude. The big reason is that at high altitude, it is hard to train at the high work rates/speeds you will be hitting at sea-level. For example, suppose you do a VO2,max test on someone at sea-level. If you take them to high altitude, they will not achieve the same VO2,max and will not hit the same maximum work rate. This was recognized a long time ago. There had previously been a lot of interest in training at altitude but the cyclists and other racers found that they couldn't hit and sustain the speeds they would need to be racing at when they came back to sea-level. This then led to the live high (or sleep high)/train low philosophy. The non-exercise exposure to high altitude allows for certain important adaptations such as an increase in the red blood cell content of the blood which, in turn, aids oxygen delivery to exercising muscles. Then you come out and exercise at sea-level and can work at the speeds/work rates that you would want to be competing at and get in the appropriate pre-race training at these speeds. By way of personal experience, I have spent several long periods at high altitude and, upon returning, have found that exercise seems much easier for a few weeks, as I can hit the same work rates/speeds with what seems like less effort. The so-called "oxygen tents" are ways to be able to do the "sleep high" approach while living at lower elevations.

Nice TR... what a trip... certainly left you well prepared for that rugged ascent of Hawkins this past weekend!

Nice TR... what a trip... certainly left you well prepared for that rugged ascent of Hawkins this past weekend!

I've used Husky Stadium over at UW in the past. Although most of the tunnels are usually closed, there is typically one or two that is open that give you access to the lower part of the stadium. You can go up and down the rows and work your way around the stadium. Each row isn't too long but by going around and perhaps back you can get in a lengthy workout. With a full pack on my back, it was a worthwhile workout. Unfortunately, the upper deck which has the steeper stairs that would be great for training is always closed off when games are not going on.

For the trip we had last year on the Ptarmigan, I would gladly walk an extra three miles up the Cascade River Road. There is supposed to be an alternative exit than coming out Downey Creek and the Suiattle River Road. I think it involves going from Dome to Sinister and then out via the east (Stehekin, perhaps?). Haven't done that route myself but I have been told it's a reasonable alternative. Plus, from Dome, Sinister looks like it would be a great climb.