iluka

My hunch given that he spent all that time in the ICU was that this may not have been bursitis after all and may have been a different infection such as an infected (aka "septic") elbow joint. An alternative explanation would be that he had an infected bursa and the infection spread to the surrounding soft tissues causing a nasty deep soft tissue infection +/- some accompanying sepsis (body wide inflammatory response to a bad infection. All pure speculation on my part. I'm very glad to see from the other thread that he has been doing better.

I take back my earlier enthusiasm for the BD Shadow... even with the good price. Doesn't feel very comfortable when loaded. The various compression straps (particularly for the pack's top pouch) don't stay snug and come loose quite easily. The fact that it's tapered and gets wider as it goes up also leaves me suspicious that the center of gravity won't be great and will make skiing more difficult. Back it goes (if they'll take it) and I ordered myself an MEC Alpinelite 45

I ended up going with a BlackDiamond Shadow 45. I wandered into ProMountain Sports and it was on sale for 60% of the list price of $189. Hard to argue with that deal in what seems to be a pretty good pack.

Thanks for that post and for including the photos... very useful

Hey... I'm in the market for a new daypack. Need it for BC skiing and scrambles. Need to be able to carry skis, axe, helmet, shovel and crampons on trips. I've checked out the BD Revelation, the Osprey Switch and the Millet Peuterey. I'd be curious to hear thoughts on those or others. Thanks!

Here's a new one on the Big E: http://news.yahoo.com/s/afp/20070307/wl_sthasia_afp/nepalnetherlands2;_ylt=Am57Etj4XuaPQtF.cojvrscDW7oF

I was there a few years back in February and March. There are a few spots around town where you can get in some turns on a board or some BC skis (can't remember the peaks off hand but locals who ski will be able to give you the easy beta on these). If you're feeling somewhat adventurous and there is a good weather window, Mt. Edgecomb, across the Sitka Sound has some nice lines. You need to get a lift by boat out there but some locals with adequately sized boats might be willing to take you out. You'll also need to hoof in quite a ways to get the turns Weather can be really cruddy this time of year as the town sits close to the Gulf of Alaska and gets plenty of precip -- usually in the form of rain and lots of wind. When the sun is out, it's quite pretty. Salmon runs may start around that time so fishing gear would be good.

No audio but send me a PM with your email and I can get you some other materials you might find useful

I've been to this one three years running now... it's quite good particularly his talk about his West Ridge climb on Everest. Hard to beat his photos. Whether he continues to do the lecture is a year-to-year decision now as he's moved off to Colorado and isn't teaching as part of the larger course like he used to.

Don't blow that next big trip because the altitude made you or your partner(s) sick... Lecture: How To Travel Safely At Altitude Speaker: Andrew Luks MD University of Washington Where: Seattle REI When: Wednesday Feb 21 7PM Free to the Public

I have both G3 and BD skins and am a much bigger fan of the BD set. I haven't had problems with the glue on the G3 skins but have had a lot of problems with the tail system -- it tends to come off a lot. The BD skin glue has lasted a long time and the tail system is much easier to use and stays on a lot better

I don't think you should be allowed to have your finger on the button unless you can pronounce the darn word correctly

For some it's better for others it's not. There has been thought for a long time that people with severe asthma often do better with moving to higher elevations. That's one of the reasons Davos in Switzerland has been popular over the years with people with bad asthma. One reason for the improvement up there... much fewer allergens. In particular, dust mite burden goes down at altitude. Short term exposure to altitude will have varying effects on people. Things at altitude that will improve control: - Lower allergen burden - Better air quality Things at altitude that will worsen control: - Cold air - Dry air - Travel through villages in the developing world with poor air quality. - Hyperventilation: this leads to lower blood CO2 levels which can cause the airways to spasm in some cases (bronchoconstriction). How this all plays out will vary from person to person depending on what the main trigger of their asthma is. In addition, exercise may trigger asthma in some, whether they are up high or down at sea-level.

Great discussion. People have related a lot of great information about their personal experiences with asthma. All very useful to hear but at the same time, it's anecdotal and what applies to or works for one person will not necessarily apply to or work for someone else. For example, some people see their asthma get worse with cold air while others actually do better in the cleaner air in the mountains. While some do well with cleaner air in the mountains, others may do worse trekking in remote areas where the local air quality in villages with alot of wood or yak dung stoves can be pretty bad. The bottom line is you have to be cautious taking in all this advice. A work colleague and I have actually examined this issue in great depth recently, reviewing all the information in the medical literature pertaining to asthma and high altitude. Not a lot of great research data out there. In fact, only 3 formal studies have taken a small number of asthma patients to high altitude and measured various markers of their lung function. The patients that were studied only had mild asthma. The remainder of the studies are all very indirect attempts to get at the questions. It's hard to draw very firm conclusions from all of this because even the formal studies had some problems with them. We've written this up and are getting set to publish it in a larger article on lung disease at high altitude. The conclusion we reached regarding going to altitude with asthma is as follows: "Patients with mildintermittent or mild persistent asthma can ascend to altitudes as high as 5000 m. They should maintain their preexisting medication regimen and should travel with an ample supply of rescue inhalers and oral prednisone to treat any asthma exacerbations that occur in remote areas away from medical attention. Patients should consider traveling with their fixed orifice peak flow meters, since variable orifice meters underestimate flow at higher altitude and with cold. Even if the absolute peak flows are not accurate, however, the trends may provide useful information to guide management. In cold or windy environments, patients should consider protecting the nose and mouth with bandanas or balaclavas to warm and humidify the inhaled air. Because of the lack of data and the lack of medical facilities in many high altitude regions, patients with more severe disease at baseline should be cautioned against traveling to remote high altitude regions. If such travel cannot be avoided, aggressive attempts to control the patient’s symptoms with high dose inhaled steroids or even oral steroids should be made prior to such travel." As far as asthma and HAPE: it's not an issue as asthma is NOT a risk factor for HAPE. The main risk factors for HAPE are: - Going to high too fast (by far the most important) - Overexertion - Preceding viral or upper respiratory tract infection - Individual susceptibility (most HAPE patients have a characteristic pattern in which the blood pressures in their lungs -- pulmonary artery pressures -- skyrocket when they go to high altitude, much greater increases than in people who don't get HAPE.

There shouldn't be a problem with doing this at the elevations you're talking about. In fact, you'll find that if you are staying at relatively high elevations between all your climbs (i.e. not coming back to sea-level for long periods of time) you will become quite acclimatized to the altitude and, as a result, on your subsequent trips your risk of altitude illness will go down and you should find your exercise tolerance improving. You'll also find that when you finally return to sea-level at the end of your trip, exercise and climbing will be a lot of fun for a few weeks as your high hematocrit (blood count) will give you plenty of oxygen delivery capacity and improved exercise tolerance. It doesn't last for that long but it will provide you with some idea why elite athletes blood dope etc.

Any physician can prescribe these medicines. One problem that people often run into, though, is that their physician might not know much about altitude illness and as a result may not know the proper doses and how to take the medications. Physicians at travel clinics might do better in this regard, although, there is some variable practices there as well. The key is to make sure your provider knows this information or where to get it and, if they can't to find someone who knows about it. To get the proper doses yourself, you can consult various references/guides. There is a great review article on altitude illness which has the drugs and their doses in the New England Journal of Medicine from 2001 by Hackett and Roach. A link to the citation is: http://content.nejm.org/cgi/content/extract/345/2/107 You can use this yourself or refer your physician to this if they need the information. As for pain medications, if you want to evacuate someone with a broken bone, you are going to want to have a supply of narcotic medications in your first aid kit. Tylenol or I-B-Mopin' (Ibuprofen) won't cut it for such severe injuries. Your doctor should be able to write a prescription for that too provided you explain the need for it adequately.

If people have interest in hearing more about all this... http://www.cascadeclimbers.com/threadz/s...;vc=#Post614434

Topic: How To Travel Safely at High Altitude Speaker: Andrew Luks Location: Wide World Books and Maps in Wallingford When: Tuesday November 14 7PM Free to the public Link: http://www.wideworldtravels.com/NASApp/store/IndexJsp?s=storeevents

Yes. Women can take this class of medications to prevent HAPE. Keep in mind that only Tadalafil (Cialis) has been shown to prevent HAPE in HAPE-susceptible people (i.e. with a history of having had the problem before at high altitude). Sildenafil (Viagra) has not been studied for the purpose yet but I suspect that because it works the same way, it will have the same beneficial effect. Neither Tadalafil or Sildenafil have been studied for treatment purposes. Given their mechanism of action, they should be useful for treatment as well but this has not been put to the test in a research study yet. Bosentan is already being used extensively in the U.S to treat pulmonary hypertension. It is fantastically expensive, on the order of 10s of thousands of dollars per year. There was just a trial released in the journal Circulation, looking at its role in altitude illness in humans and the results were not that great. In the end, with it's super high cost, I'm not sure it's worth the bother since there are already many effective and much less expensive options out there (acetazolamide, dexamethasone, nifedipine, tadalafil) for prevention of the various forms of altitude illness.

Unless you have good winter camping skills and can travel well on snowshoes or backcountry skies, I'd vote for avoiding the mountain "backpacking" trip that time of year and look elsewhere. There usually still a lot of snow up in the mountains in March which can make travel somewhat difficult if you don't have the skills and equipment. Avalanche awareness skills would be a plus as well. I agree with an earlier post that a trip along the Olympic coastline would be a nice one. The area around and north of the Ozette River is nice. Another particularly pretty area for coastal hiking is the West Rim trail up on Victoria Island in BC but I'm not sure what the conditions are like that time of year. If you're somewhat mobile, March is a great time to visit the desert southwest and explore parts of the canyon country.

I didn't offer much suppporting evidence because there isn't a much evidence regarding "pressure breathing" and management of asthma. Asthma, in general, is thought to result from three processes that occur in the airways of the lungs: inflammation of the airway walls, over-production of mucous in the airway glands which plugs up the airways and overly reactive smooth muscle in the airway walls that causes them to constrict. All of the processes cause the airways to narrow down and make it hard to move air in and out. There are lots of triggers that can make those processes worse and start an attack. Exercise-induced asthma is though to occur because the heavy breathing with exercise causes one to move large volumes of cool, dry air (a known trigger for asthma) by those airways. Breathing humidified air that is warmed closer to body temperature helps attenuate the process. This is one reason it is often recommended that people with exercise-induced asthma who climb at altitude use a balaclava or bandana over their mouth (it's not foolproof, but can provide some additional help in addition to appropriate medications). There are a lot of other factors that play a role -- too much to write about here. Swimming might have helped -- not because of the "pressure breathing" -- but because the air in the pool area is warmer and more humidified which can calm the asthma process a bit. There are many medications that can also play a beneficial role in treatment of this problem.

If BillA is not satisfied with the work-up his primary doctor does or he doesn't think they're looking into this possibility enough he can just ask for a referral to see a pulmonary specialist. This stuff is right up their alley. As to why this exercise-induced asthma got better, I doubt it's because of the pressure breathing. Probably something else related to the swimming or something else that changed over time. You definitely do hear of cases of asthma (exercise-related or not) that simply goes away over time. In cases where allergy plays a big role as a trigger, it's because the exposure to the allergen was eliminated. In other cases it's not clear why it finally goes away but it does.

Do you remember exactly what your paramedic heard? Did he use the term "wheezing" by any chance. This is sometimes what people sound like when they are having an asthma attack. Has this ever happened to you before? One would need more information to label someone as having exercise-induced asthma but from what you describe it is certainly a possibility. Many asthmatics or people with exercise-induced asthma will have difficulty breating or chest tightness when they have an attack. In other cases, people may only develop a cough. Exercise-induced asthma can certainly be aggravated by breathing cold air, but cold air is not a necessary condition for it to occur. Even if you have never have had problems with asthma before, it is possible for it to start later in life. There are many people who develop adult-onset asthma. The best thing to do at this point would be to see your physician. They can take a proper history from you and get full information about what happened. From there, the logical first step in working up the problem is to do pulmonary function tests (breathing tests) including what's called bronchodilator testing. Further testing can be done from there if that doesn't provide an answer. I wouldn't freak out just yet. While asthma can be a severe problem in some people, in many many others, it is a disease in which achieving good control and maintaining a active life is fully possible. If you're concerned, check in with your doctor and he/she can help you sort this out.

Climb: Del Campo-South Gully Date of Climb: 10/21/2006 Trip Report: We took advantage of the great weather yesterday and headed up to do Del Campo. We were greeted with clear skies from the get-go. Easy trail approach (via Weden Trail off the Monte Cristo Road) with about 3,000 feet of elevation gain to Foggy Lake. The streams that intersect the trail were running a bit brisker after the recent rains but presented no problems whatsoever to cross. From the south end of the lake, we picked up the climbers trail that wound along the lake a short distance and then climbed along the ridgeline above the right (east) side of the lake. Plenty of cairns around to mark what is already a fairly obvious climbers path. From there, we crossed the talus field that leads up to the gully one takes up to the northeast side of the mountain. At the top of the talus field, rather than heading up the gully proper on the right side to the very distinct notch, it is best to break off and go up the Class 3 rock to the left. Plenty of good hand and footholds along the way up to ridge from where we found more solid Class 2 and 3 climbing up the NE face to the summit. A little bit of rock fall hazard on the route so helmets were a nice thing to have along (although a teacher of some outdoor class from SPU obviously didn't feel it was necessary for his 6 novice climbing students who got nice and spread out along the way and kicked off a few rocks). Only traces of snow on the rock at the top but otherwise no new snow or ice on the route. Great views from the top and not a cloud in the sky (Unfortunately, not much snow to be seen either from the latest round of storms so the ski season will have to wait a bit longer!) Here are some photos of the route: The way up from the lake: The way up the talus field: This is where we left the gully and climbed up to the ridge. Go up the Class 3 rock on the left rather than the chute on the right. Climb to the skyline above and to the left of the notch at the top of the chute. This basically means heading towards the trees. A short ways above the trees, you head left and start climbing the NE face to the summit Car to Summit: 4.5 hours Descent Time to Car: 4 hours Gear Notes: Helmet (Earlier in season with snow/ice would have axe and crampons) Approach Notes: Trail -- good condition all the way to Foggy Lake

I would go with one of the MSR Denali models. I've used them on many winter scrambles and have really liked them. They side hill better than traditional snowshoes and also have heel lifts on some models which are really nice to have on steep sections.