iluka

One other piece of advice I would give... if you develop shortness of breath or chest pain at any point in the near future, I would head into see your physician as that could be a sign that the clot has migrated from your legs to your lungs (unlikely while you're on Coumadin but you should watch out for it).

You should touch base with your physician about the timing of the Lovenox and the Coumadin. It shouldn't be used for just three days, but, instead, should be used until 2 days after you have reached a therapeutic level of the coumadin in your blood stream (when your INR gets to between 2 and 3). Some people get to a therapeutic level in only 3 days but others require longer to get there and stopping the Lovenox early could leave you at increased risk for another blood clot. I cannot second enough scheissami's advice about the increased risk of bleeding. You should absolutely wear a helmet but need to be aware that any cuts will bleed a lot longer without good pressure on them and any good whack somewhere (into your quad for example) could lead to a significant amount of bleeding. If you have a headache or the like, I would stay away from aspirin (another blood thinner that works by a different mechanism than Coumadin) and perhaps Ibuprofen (or it's relatives) and, instead, rely on acetaminophen. Finally, if you go to high altitudes, get closer follow-up of your INR as there is some data to indicate that the Coumadin levels in the blood can be altered in the high altitude environment. Good luck with this.

Prevention (long-sleeve clothing, DEET etc.) is very important but not 100% effective. The CDC website is probably your best source for advice about whether or not prophylaxis is necessary. When you go to a travel clinic or another physician's office, more often than not, they're giving you advice based on info they already looked up on the website. Not all of the prophylaxis meds are terribly expensive so it might be better to purchase your meds here rather than having to find them over there. Doxycycline is cheap as is Chloroquine (it can only be used, however, in areas that don't have chloroquine-resistant P. Falciparum (one of the malaria parasites). Malarone is expensive but easy to take and with not a lot of side effects. Larium is expensive but only has to be taken once a week. It's main downside is that a lot of people get bad psychiatric side effects ranging from vivid dreams in most cases to frank psychosis in rare cases.

Or at least as well as Diamox at 1/100th the price. Diamox is generic and pretty cheap as a result

Acetazolamide (Diamox): Good evidence for its usefulness preventing and treating AMS Methazolamide (Neptazane): Not used as much in practice but works the same as acetazolamide so it should be effective. Nitric Oxide (INOmax): Never studied for the prevention or treatment of AMS. It is used for research purposes and, given the way it works, it would be useful for HAPE prevention and treatment but there is no way to administer it easily in the field. When used in the hospital, it is fantastically expensive. Sildenafil (Viagra) (weak evidence): actually the evidence of its usefulness is improving. It is not useful to prevent or treat AMS or HACE but does interfere with the mechanisms that cause HAPE. Some limited data shows it can improve exercise tolerance at altitude (see a previous thread from two weeks ago on High Altitude Performance) Ginkgo Biloba (conflicting evidence): I would not waste my time with this. The studies that showed it "worked" had small numbers of patients. Some more recent larger studies have shown no benefit. Stick with Diamox for which there is good data. Dexamethasone: Good evidence to support its use to prevent or treat AMS and HACE. A paper is going to be published soon (I think it will be in the Annals of Internal Medicine) that shows that it may also be useful for prevention of HAPE. Others to add to the list: Tadalafil (Cialis): the same study that looked at Dexamethasone and HAPE showed that this medicine can block the development of HAPE in people known to be prone to the disease. It has no role in AMS or HACE. Nifedipine: the current standard for prevention and management of HAPE Salmeterol: an inhaled medication (long acting version albuterol): a study within the past 5 years in the New England Journal of Medicine showed it can be used to prevent HAPE in people known to be susceptible to the disease. Some useful review articles on altitude illness: http://www.ncbi.nlm.nih.gov/entrez/query...l=pubmed_docsum http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?CMD=search&DB=pubmed

I'm not much of a technofile but happen to have an ibook and and ipod and have been really happy with both. My ibook (knock on wood) is still running well after 3 years and one system upgrade. My latest ipod is great and I think they resolved the battery issues with the earlier generation ones. My only beef with Apple is the service. It irks me that you have to fork over for the AppleCare plan after already giving them big $ for the machine. That being said, I got Apple Care and when I had a big malfunction at one point, they fixed it with no hassles, fed exing it down to California and fed exing it back up just two days later.... all for free

Diamox doesn't agree with everyone but most people tolerate it pretty well. It is a diuretic (water pill) so you do urinate more while you're on it than you would otherwise so it is possible to get dehydrated. It isn't as powerful a diuretic as Lasix so people don't usually urinate huge amounts but it is still more than if you didn't take it. It's usually a good idea to drink more while you're on it. Whether that has to be another 4 L per day... ? Diamox doesn't prevent AMS in everyone. If you look at the studies, it isn't 100% effective but many fewer people on the medicine get AMS when compared to people who don't take it. An alternative would be to try Dexamethasone. You can take 2 mg every 6 hours or 4 mg twice a day. 4 days to 4750 m (15,400 ft) is also pretty fast for some people. Even while taking Diamox, if you go too high too fast you can get sick. Did you take any rest days along the way and sleep at the same elevation for a second night. By way of comparison, on the standard trek to Everest Base Camp in Nepal people start at 2800m and don't get to the elevation you hit until Day 6 or later with a few rest days along the way. Some can go faster and do fine. Others need longer time to avoid symptoms... the response varies a lot from person to person.

Glad the post was helpful. Diamox seems to work against altitude illness by two means. The first is that it apparently stimulates the areas of the brain -- called the central chemoreceptors -- which control respiration such that you breath more at altitude than you would without the medication. More breathing means more oxygen down into the air sacs of the lung (alveoli). It's other mechanism of action is what you describe -- it creates a metabolic acidosis by causing loss of bicarbonate in the urine. The reason that is useful is this: when you go to high altitude, the low oxgyen conditions in the environment serve as a trigger for you to breathe more. That's the appropriate response but by breathing more, you blow off the carbon dioxide in your blood. This causes the pH of the blood to rise (called a respiratory alkalosis). The high pH has some degree of inhibitory effect on the drive to breathe and tones down how much extra you breathe in response to the low oxygen conditions. By creating a metabolic acidosis, diamox helps bring the pH of the blood back down which helps restore the drive to breathe. If you breathe more... more oxygen gets down to the alveoli and into the blood stream. How this translates into preventing AMS and HACE isn't entirely well known. I think the sense is that by keeping your breathing up where it should be, you get more oxygen into the blood and delivered to the tissues which helps prevent the symptoms of AMS and HACE from developing. AMS and HACE are not due to high pressures issue as with HAPE. The blood vessels in the brain appear to leak and edema fluid accumulates for other reasons. HAPE, on the other hand, is driven by the high pressures in the blood vessels in the lungs. So... if you can bring those pressures down, you can prevent HAPE from occuring. You can do that with medicines that cause these vessels to dilate (nifedipine, viagra, cialis) or by getting more oxygen into the air sacs in the lungs (the constriction of the blood vessels in the lungs is caused by low oxygen levels in the air sacs of the lung and, interestingly, is not due to the low oxygen levels in the blood itself). There is some preliminary research going on now in animals and in humans which appears to show that diamox may also block this constriction of the blood vessels in the lungs and may, as a result, be able to play a role in HAPE prevention. It's all very preliminary work so I wouldn't rely on it for this purpose in someone with a history of HAPE going back to high altitude. AMS and HACE are now thought to be the same disease... just different ends of the spectrum of severity. In regard to your last question... viagra and cialis don't change the level of oxygen in the blood. They just cause the blood vessels in the lungs to dilate and bring the pulmonary artery pressures down. This helps the right heart pump better and send more blood to the left side of the heart, all of which helps the left heart due a better job pumping blood out to the body. The amount of oxygen in the blood hasn't improved, it's just that the heart is doing a better job of pumping around the little oxygen that's in there. All long winded answers to your questions... hope they make sense.

Viagra (Sildenafil) and Cialis (Tadalafil) have been getting more attention in the research literature on high altitude illness lately. The study that was done at Everest Base Camp with Viagra showed that it could improve exercise performance at high altitude while a recent study that will be published in the next few months showed that Cialis can be used to prevent high altitude pulmonary edema in people known to be susceptible to the disorder (i.e. they've had it before). The drugs have no role with regard to acute mountain sickness or high altitude cerebral edema. Those diseases have a different cause and diamox (acetazolamide) and dexamethasone are the mainstays of prevention and treatment for those disorders. Viagra and Tadalafil have a role at altitude by virtue of their effect on the blood vessels in the lungs. Specifically, they cause the blood vessels to dilate and bring down pulmonary vascular resistance and, therefore, the pulmonary artery pressures. With regard to exercise performance, it's known that if you do a VO2max test at sea-level and then go up to high altitude, you will not reach the same VO2max. Can't be done. In that study at EBC, they gave people Viagra and then had them exercise. Exercise capacity went up but still not to the VO2max seen at sea-level. The hypothesis about why it worked was that by lowering the pulmonary artery pressures, the right side of the heart was under less strain and pumped better. If the right heart pumps better, the left side of the heart is happier and can deliver more cardiac output to exercising muscles. The improvement in VO2max in this study was pretty modest at best and it is unlikely someone would notice the difference between being on or off the drug while climbing at altitude... at least based on what they saw in this study. With regard to high altitude pulmonary edema, it occurs because the blood pressures in the lungs (pulmonary artery pressures) rise too high. They rise in all people at altitude. It's just that in HAPE-susceptible folks, they go really high. Under the high pressure, the blood vessels begin to leak and protein and red blood cells move from the vessels into the lung tissue and air sacs. Tadalafil works vs. HAPE by bringing down the blood pressures and preventing this leakage. No one has studied if Viagra can be used to prevent HAPE but it has a similar mechanim of action as Tadalafil and would likely do the same. No one has studied the effect of either medicine on promiscuity or sexual performance at EBC... perhaps that could be Alpinefox's research grant...

Time to give it up for my friend Gretchen. 4 months after finishing chemotherapy and 2 months after finishing radiation treatments, she's back at it in the mountains. In the last 1.5 months: Curtis Gilbert NE Buttress of Goode Ptarmigan Traverse with summits of Formidable and Dome Mt. Constance This week... off for some aid climbing in Yosemite! Here's to getting out there and getting it done! http://www.cascadeclimbers.com/plab/showphoto.php?photo=21407&size=big&sort=1&cat=500 http://www.cascadeclimbers.com/plab/showphoto.php?photo=21406&size=big&sort=1&cat=500 http://www.cascadeclimbers.com/plab/showphoto.php?photo=21405&size=big&sort=1&cat=500

Doubt it... as good as his commentary was, this degree of sopohistication flies WAY over the head of the "average" American voter who elected Bush and his cronies in the first place. What we need is someone on the left to start coming up with some pithy phrases along the lines of "flip-flopper" and "cut and run" and to repeat them ad nauseum so that they will actually stick in the minds of the mesmerized masses.

Can you purchase COBRA coverage through your current plan. Not sure how expensive it is, but do know its a way to extend coverage after a job ends.

Not sure exactly for what info you are looking. We were there in July. It's a great summit with awesome views of the entire Olympic range. The approach hike is on the long side... 13 miles from the Dosiwallops road washout into a campsite in the forest at Honeymoon meadows and then another 2 miles before you get to the Anderson Glacier and the start of the climb. The bridge across the river at Honeymoon Meadows is washed out. At the time, a fjord at that point was infeasible and we went about 200-300 m up past the camp on the same side of the river and found a good, big log to cross. I suspect now that the river may be low enough to fjord at the meadows but if not, you'll find the log okay if you move beyond the camp and bushwhack close to the river's edge. Can't speak to what the glaciers look like at this point as it's been 6 weeks since we were there (at the time, there were no crevasse issues on either glacier but I suspect that is not the case now as the Eel was starting to show some crevasses back in July). At that time, there was snow all the way up to Flypaper Pass on the Anderson Glacier side but that may also have changed.

Thanks for the info... that's what I figured but wanted to make sure before schlepping out the gear. Sweet tele pics!

Check your personal email that's listed with your profile info... We just finished the route yesterday and I sent over a bunch of photos you might find useful. PM if you need some route info.

The only other time I've been on Ruth was on skis early spring when the glacier was a non-issue. Anyone been up there lately and know if you need to rope for this one or if unroped travel is fine. Thanks

I'll just take seeing his implanted automatic defibrillator starting firing inadvertently while he's giving one of his morose speeches. Now... wouldn't that be a sight!

Update on Sloan Corkscrew Conditions from 8/6 Sauk river crossing remains no problem. Just below knee deep -- and not moving very fast -- in the spot we crossed but you could wander upstream a bit and find a lower crossing. The water level did not change at between when we crossed it on the way up and hit it again on the way out. Glacier is still in good shape. The bridges are still in in the route that goes up the glacier via the diagonal route. Good firm steps but the width of the bridges is shrinking. The route up the glacier on the climbers right is largely without any crevasse issues until you are traversing across the top of the glacier and get close to the exit point

Drove over a nail and punctured my tire just outside of Darrington on the way to a climb at 6AM. Try #2 tomorrow AM after a free repair at Les Schwab!

Considering doing Sloan Peak as a single day trip (6K elevation, 11 miles round trip) this Saturday or Sunday but have struck out with my usual list of suspects/climbing partners and am looking for someone with whom to do the climb. Send me a PM if interested

An interesting story in the Washington Post: http://www.washingtonpost.com/wp-dyn/content/article/2006/07/31/AR2006073100890.html I've been told these make nice camp shoes... much lighter than Tevas and other sandals. Apparently one problem is they have a bad habit of slipping off on stream/river crossings but this can be easily rectified by rigging up bungy cord or the like that goes through the vents and around the ankles and keeps the croc from heading out on its own river adventure.

The Tahoma Glacier route notoriously melts out very early and I suspect that by August it will not be in good shape for an ascent due to the open crevasses.

If you were getting sick at altitudes of 1,500 to 2,000 feet it would extremely unlikely for this to be acute mountain sickness. It just isn't seen that low. I would look into other possible causes. As for prior experience being a predictor for future performance at altitude, mattp is right on the mark. There are very few things you can use to predict whether or not someone will develop altitude illness. One of the few reliable things is how someone has done before. If someone got sick at 10K on a prior trip, the odds are good (but it is still not a guarantee) that they will get sick on another trip to 10K if they go up at the same ascent rate etc. There's now some interesting data about how it's possible to identify HAPE-susceptible people (with exercise in normal air or with breathing a hypoxic gas mixture their pulmonary artery pressures measured non-invasively with an echocardiogram rise much higher than in non-HAPE susceptible people. No such test is out there for AMS

Check out this website: http://bobskiing.com/ It's a site about backcountry skiing in the Sierra but the guy who runs it knows a great deal about summer and winter travel in the range and has climbed all the 14ers (as well as skied the Sierra High Route in, get this, one day!). I think his email address is on the site if you want to contact him.

In case anyone is interested... some conditions for the route to Mt. Anderson. No surprise with the fact that the Dosewalpis road is still VERY washed out 5 miles from the trailhead and will remain so for a while from the looks of things. Trail from the TH to Honeymoon Meadows camp is snow free. The bridge across the river at Honeymoon Meadows camp is out and the West Fork of the Dosewallips is running very high making a crossing there challenging... even in the morning. We hiked about 200-300 meters out from camp on the south side of the river, hugging the bank and eventually found a large downed tree which you could easily straddle and move across to the other side. That was the only challenging crossing. Trail from the crossing up to Anderson Pass had snow in patches but made for easy travel. Little snow from Anderson Pass to the Anderson Glacier morraine. The lake is still frozen. The Anderson Glacier is not showing crevasses right now and there is snow almost all the way to the top of Flypaper Pass (bare for the last 20 feet). Snow all the way down the north side of the pass to the Eel Glacier. Once on the Eel, you can follow a snow ramp all the way to the summit.