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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.

Alpinfox raises a lot of other good possible explanations for the eye symptoms you had. It is entirely plausible that this was a mild case of snowblindness that developed as a result of exposure on Saturday. Snowblindness can cause asymmetric symptoms (i.e. one eye worse than the other). It also does not take a lot of sun exposure to cause this. Just a few minutes without glasses in a super bright environment such as on a snow field or glacier at altitude may be all you need. An irritant conjunctivitis due to the wind is another good possibility. It sounds as if your doctor did the prudent thing which was to rule out corneal injury and then treat empirically with antibiotic eye drops and have you follow-up to make sure that things are resolving. The eye drops are warranted in snowblindness as well to help prevent infection of the damaged cornea.

Has anyone been up the Royal Basin route on Mt. Deception recently? We're looking for some information about what shape the route is in. Thanks!

An interesting read on this fiasco: http://www.nytimes.com/2007/06/26/opinion/26kodas.html?

Trip: Robinson Mountain - Southeast Ridge Date: 6/23/2007 Trip Report: When the weather forecasts for the weekend made our original Olympics plans less than appealing we opted to head east in search of better weather and settled on Robinson Mountain in the Pasayten. Given that the forecasts for Sunday weren't so great even that far east, we opted to do it in a day. We were well-rewarded with a great scramble in great weather. The approach starts by heading out the Robinson Creek Trail from the trailhead 9 miles out of Mazama. After 3 miles and about 1,000 feet of gain, we crossed the bridge at Beauty Creek. 50 feet after the bridge, a climbers trail heads up through the woods. It wasn't entirely obvious with the brush growing a bit but once on it, we had no problem following it. It climbs steeply for about 1,100 feet before leveling out a bit as it traverses the Beauty Creek drainage. At 5200, you come to an obvious creek draining down from the left. The crossing here was no problem. Once on the other side, we found a grassy slope ascending steeply to the left. You head right up this slope, keeping relatively close to the creek the entire way. There is a faint trail in spots but it keeps petering out but it's a no brainer to figure out the route. After 1,000 feet, the incline lessens as you hit a forested area. Still not trail, but it's easy travel up an easy grade until you get to the top of the basin where there's a beautiful tarn. This is the camp spot if you're doing it as an overnight... would be great in the fall when the larches are bright orange. From there, we took the snow slope up to the ridge at the head of the basin (red arrow on the photo below). Rather than going over the highest point, we opted to shoot for a lower saddle a bit to the left. It was a bit steep up near the top but easy to get good purchase in the snow. In the summer, this may be a big scree slog. Once at the saddle, we had a great view to the N Cascades and of the rest of the route. From there, we followed the obvious ridge as it climbed towards the summit. The high point that's visible from here is actually the false summit and not the true summit. It's a one mile ridge run with great views on both sides. For most of it, the hiking is no problem. If you meet any obstacles, it's plenty easy to move a bit to the left (west) and get around it. The only obstacle was the false summit. From a distance, it felt like I was back at Tomyhoi where one stands on the false summit, looks at the true summit and wonders why we didn't bring protection, only to get on the route and find that the scrambling is pretty straightforward. Many people opt to take the line marked in yellow in the photo up the steep first part of this portion of the scramble. We opted, instead, to drop down a bit and follow the red line around to the left of this section where we found a short gully (hidden by the rock wall in the photo) that went up to our right and regained the route where it's marked in green and continued scrambling up. This section is Class 3 with some pretty good exposure. We read reports that mentioned no need to have a helmet along but were glad we had ours... definitely needed. You could justify a scramble rope here as well. Once at the top of this section, it was a short easy walk to the summit and lots of great views in great weather. For the descent, we followed the ridge back down to the slopes above the tarn. The snow at the top of our ascent route was pretty steep and, given that it was reasonably firm and the clouds had kept things cool, we didn't want to descend that route. Instead, we followed the yellow line in the photo above down the ridge to the SE until we were able to access the scree slopes that headed down to the snow where it was less steep. The scree was quite easy for descending. An easy trip down from there. Overall, a great scramble. Lots of solitude. Great views. Mixed terrain. It doesn't seem to be as well known as other east side scrambles but well worth the trip out there. Gear: Axe, helmet, crampons (perhaps a scramble rope depending on one's level of comfort) Car-to-Car: 13 hours Car to Summit: 7 hours Elevation Gain: 6100+ feet Distance: 14 miles

This is interesting. One positive study may not be enough to get this adopted as standard practice and hopefully they'll be some follow-up studies to try and confirm the results. It will be useful to help define how severe the frostbite has to be before you use this. It's not a completely benign medication. Because it's a "clot-busting" medication (used for heart attacks and stroke) it has the potential to cause bleeding in not particularly good places to have bleeding (i.e. the brain). This is not a medication I would be keen to use in the field on an expedition. In the hospital, people who receive it for a stroke or heart attack have to be monitored for a period of time afterwards to look for evidence of bleeding. If someone had a severe bleeding episode in the field, it would be a bad situation.

Just when you thought this mountain couldn't become more of a crazy side show...

It's not sunglasses but similar luck. I was doing a backcountry ski trip in the Sierra a few years back. We were on the Darwin Bench near Evolution Valley. We skied off away from camp to explore the area and while away from camp, I took off my blue and white bandana for a photo and, without knowing it, dropped it on the ground. Getting ready the next day at camp, I couldn't find the bandana and ended up heading out without finding it. 5 months later, I was backpacking through the same area. It looked very different without all the snow. We set up camp one afternoon and went poking around. Without realizing it we found ourselves on the same spot we had been months earlier on skis when we took the photo. I looked down at one point and there was my blue and white bandana. A bit sun-bleached but otherwise fine. Still use it!

An update on road conditions: You can now drive 3.5 miles up the Twin Lakes Road as they have cleared all the blow down to that point. At 3.5 miles there is a washout of the road which does not appear passable, leaving you about 1 mile short of the TH for Tomyhoi or Yellow Aster Butte The basin up at Yellow Aster Lakes is entirely snow covered and the lakes are all still frozen. Except for a few spots, it is almost continuous snow up to the summit ridge, although with the warm temps, I suspect this will be changing fast.

I read similar reports before I did it a few years ago but found that it was actually pretty straightforward to get in there. Smoot's book "Climbing Washington's Mountains" has an easy to follow description if I remember correctly. Among a host of others that are good scrambles, I would recommend Sloan. Great, varied terrain and amazing views.

One issue to be aware of when using the fluoroquinolones on a trip to altitude... According to the drug information for Ciprofloxacin and other members of this class of medicines, dexamethasone may increase the risk of tendon injury. You cannot find any case reports of this happening in the medical literature but it is listed as a potential interaction in the product information for the medicine. Unclear exactly what the risk is but if one were using dexamethasone for altitude illness prevention, it might be wise to avoid Cipro if one developed traveler's diarrhea and use another antibiotic.

Gingko biloba is of no benefit at high altitude and I would not bother with it. There were several small studies a few years back that suggested it might help prevent altitude illness but later, larger studies showed that it was no better than placebo (a sugar pill). If you want to avoid altitude illness on the climb, the best options are to stay hydrated, avoid overexerting yourself, doing it in two days. If you've had problems at altitude in the past, diamox would be a reasonable thing to use but this is not necessary as most can do this climb without it. Just be sure that as you ascend you pay attention to the symptoms of altitude illness so that if it occurs, you can head down.

Nice TR and photos. Nice meeting you guys on top and sharing a nice summit.

No... different party. They neglected to mention that they didn't have to do any postholing because we did it for them.

When we did the Ptarmigan last year, I heard from one of my friends that there is apparently a southern continuation of the route that comes out much further south than Downey Creek. Unfortunately, I don't have many more details than that but suppose they're out there somewhere.

Neurologic deficits would consist of weak muscle groups... specifically the muscles served by the nerve that is being impinged on by a bulging disc for example. Another example would be areas of loss of sensation... patches of skin where you don't feel anything. Other concerning neurologic deficits include loss of control over your bladder or bowels. These are several of the things the surgeon should be evaluating. I would not get too hung up on the details of the MRI report yourself. The radiologist will call a lot of things that they see on the MRI. The key thing is always to correlate the MRI findings with what problems the patient actually has. For example, you could do MRIs on various people and in some you might actually find bulging discs. Many of them would have no symptoms at all. The key is do the findings correlate with your complaints and what the physician finds when they examine you. As to how to find the "best" surgeon, that's a great question. I wish I had good advice in that regard.

Nifedipine and other calcium channel blockers are also used for this with moderate success.

Does anyone out there have Raynaud's Phenomenon? (fingers and toes turn blue, red or white in response to exposure to cold temperatures). I'm looking to see if anyone with the problem has spent time climbing at altitudes above 5,000 feet and to see what their experience has been, including whether they had more attacks of the problem, more or less severe symptoms etc. If you don't feel like sharing the info in the forum, please send a PM. No spray please. Andy

Trip: Baring Mountain - West Ridge - South Slope Date: 4/7/2007 Trip Report: Went with several friends today up Baring Mountain. FR 6024 is open all the way to Barclay Lake TH (which it apparently wasn't up until a week or two ago due to blow downs). The turnoff from the old road grade up the rock gully is still well marked with a cairn. We got out of the creek drainage after only about 10 meters and picked up the climbers trail to the ridge without much problem. There is some scattered flagging still there. Snow free until about 3600 feet where you can pick up a continous snow slope to the ridge or cut off to the right and stay on steep dirt trail until just below the ridge at 4,000 feet. There are some real nice steps laid in the snow right now. The snow was very firm despite the warm temps. Heading east on the ridge is easy with only patches of snow and no trail finding difficulties. After dropping off the ridge and traversing to the gully that leads to the basin, we ran into some pretty firm snow and put on crampons. From there, it was easy travel up to the basin on steep, continuous snow in the trees. Once at the basin, we took off the crampons as things were very soft. Had the basin been much longer snow shoes would have been nice as there was a fair amount of post-holing but we went without them. By now there is a good, firm track to walk on. The gully to the notch was completely snow-covered and made for easy step-kicking. From the notch, we booted up the snow towards the summit ridge. This first section was steep but because the snow was so soft, we were able to get great steps in and didn't need to protect it. In firmer conditions, it would be tricker as it is quite steep right now and all snow. Once above this, it was easy tracking through the snow as we traveresed left to the ridge line and then followed the open snow fields to the summit. Continuous snow until about 5 m below the summit and from there easy scrambling to the top. Overall, the snow seemed very stable. In spots, there is about 6-8 inches of heavy, less consolidated snow over a firmer base but we did not dig a pit to confirm. Car to summit: 4.25 hours Summit to Car: 3 hours Approach: can drive to trailhead; no route finding issues. Gear: Axe, helmet, crampons. (We carried but did not use two pickets, harnesses and scramble rope because we were not sure about the steep part just above the notch). I'd leave the snowshoes back right now.

I'd be wary of back surgery for the purpose of relieving pain. If there are neurological deficits that result from a back problem (eg. compressed nerve leading to dysfunction in the muscle served by that nerve) it can be useful. For the purposes of pain relief, it is not nearly as successful and some people continue with pain. Perhaps a second opinion from another surgeon is in order?

This is true to some extent but the fact that you may do well on one trip does not guarantee that you won't get sick on another trip, particularly if you push a faster ascent rate the second time around. You are certainly right that it will help getting used to the different way one feels at altitude. This can really be helpful with the sense of breathlessness with exertion. A lot of people are surprised with how out of breath they feel going uphill with a pack but quickly realize this is normal and goes away rapidly when they take a break to rest.

I misspoke in my earlier post a bit. I meant to say that 911 calls involving injuries/illness issues generate a fire department response because the medic system is based out of the FD. Other 911 calls do not generate an FD response. As a rule, the medics do not go into an area until the scene is secure. If there is concern about the possibility a shooter on scene, they will remain in their rig until the police have arrived and secure the area. The medics and firemen are not armed. They may call for that assistance but usually the dispatcher will have already sent a police response based on the information provided in the initial 911 call.

Since when do firefighters respond to gun fire? WTF? The medic system in Seattle is based out of the fire department; all 911 calls generate a response from the FD.

Many cases of cellulitis are seen in people with some underlying disease process but not all. It can happen in healthy people as well. The basic problem in cellulitis is a bacterial infection of the skin. Normally, the skin forms an impermeable barrier such that the normal bacteria that live on its surface don't get in and cause disease. If that barrier is broken, pathogenic bacteria can enter and cause infection. IV drug users often get cellulitis (as well as abscesses) because they put (often dirty) needles in their skin and provide a direct portal of entry. Heart failure patients often get it in their legs because they have swelling/edema of their legs that stretches the normal junctions between skin cells that form part of the protective barrier. In Oly's case, the abrasion or cut he had may have been the portal of entry, particularly if it wasn't cleaned out well -- a good warning to all to clean such wounds really well with warm water. The signs that suggest cellulitis as opposed to another type of rash include (1) redness (blanches if you press on it); (2) pain; (3) warmth. Signs of more concerning deeper soft-tissue infections (necrotizing fasciittis... i.e. "flesh eating bacteria") include severe pain, rapidly spreading redness, bluish, grayish or black discoloration that develops in the red areas, blisters that form in the red areas. I've seen cases of this develop in otherwise healthy people with plain bad luck. Sepsis (the body wide reaction to an infection) can develop from either of these processes but is not as common with cellulitis as it is with necrotizing fasciitis. In his post, Layton hit on most of the warning signs that a simple cellulitis or other infection may be turning into sepsis -- high fevers (or in some cases low body temperature), altered mental status, lightheadedness/about to faint, severe fatigue, nausea -- basically the person starts looking very punky (not a very medical term)

No one has ever really studied this question in a very systematic manner. In general, it all depends on how long you spend up at altitude. If you just spend a few days in Colorado and then take 5-10 days transitting to Elbrus, it will have no lasting effect. If, however, someone spent 2 months up high in Colorado -- eg. above 10,000 feet -- then they would retain some of their acclimatization by the time they made it over to Elbrus.