Monday, 28 February 2011

A Lucky Escape From The White Room

Avalanche Details:

Location: Monarch Pass, Mile Marker 201
State: Colorado
Date: 2011/02/27
Time: 2:10 PM (Estimated)
Summary Description: 1 skier caught, fully buried
Primary Activity: Backcountry Tourer

Slope Aspect: E
Site Elevation: 10900 ft
Slope Angle: --
Slope Characteristic: Planar Slope
Accident Summary: A lone skier triggered, was caught, & buried in a small soft slab.

A car was parked on the side of Monarch Pass. The driver watched a skier cut into "Gun Shot Cut Bank", trigger a soft slab avalanche, get caught and get buried. The driver grabbed a shovel and jumped out of his car and ran over to the debris pile. There was a ski pole sticking out of the debris and the driver went to that and dug the skier out. No injuries were reported. Initial reports have the skier buried about 3 feet deep. So, next time you're rollin' a doob on whatever mountain pass you travel on, make sure to keep your eye on the BC skiers around you. You could be the next everyday hero 
5 x Bealach na Ba

Friday, 25 February 2011

Pass the Brufen? Perhaps Not!

Think Twice About NSAIDs

by Larry Creswell, M.D.
Non-steroidal anti-inflammatory drugs (NSAIDs) have been in the news recently and athletes should take notice. In a report in the British Medical Journal entitled, “Cardiovascular safety of non-steroidal anti-inflammatory drugs: network meta-analysis,” a group of Swiss investigators reviewed the use of NSAIDs in a large group of patients and concluded that there are important cardiovascular risks associated with the use of these medications. 

The Basics of NSAIDs
We’ll return to the new report, but let’s begin by talking about NSAIDs in general. As their name suggests, these are medications (which are not steroids) that were designed and are prescribed for their anti-inflammatory effects. They also have anti-pyretic (fever-reducing) and analgesic (pain-reducing) effects, as well.

As a group, NSAIDs are very common drugs. The Swiss investigators noted that in the United States, as many as 5% of all doctor visits are associated with the prescription of an NSAID. Their collection of effects makes NSAIDs useful for the treatment of a wide range of acute and chronic conditions that produce pain or inflammation. The uses are nearly endless, but the NSAIDs are prescribed for the whole spectrum of arthritic conditions, postoperative pain, menstrual pain, migraine headache, and gout, among other conditions. 

The primary adverse effects of these medications are the formation of stomach (gastric) ulcers or gastric bleeding and impairment of kidney function. Each of these adverse effects is dose-related, increasing in frequency with increased dosages of the NSAIDs. 

The NSAID medications act by inhibiting the function of an enzyme called cyclooxygenase or COX. It turns out that there are two important forms of the COX enzyme -- COX1 and COX2. Most NSAIDs inhibit all of the COX enzymes, but newer, “selective” NSAIDs only inhibit the COX2 enzyme. These newer COX2-inhibitors were widely heralded and welcomed in the medical field because they were thought to be associated with less gastric bleeding. With further study, though, this benefit remains to be substantiated.

There are many medications in the NSAID family and the common agents with their trade names are summarized in the Table.

Generic Name - Brand Name(s)
Non-specific NSAIDs
  • Aspirin
  • Naproxen - Aleve, Anaprox, Midol Extended Relief
  • Ibuprofen - Advil, Motrin, Nuprin
  • Indomethacin - Indocin, Indocid
  • Sulindac - Clinoril
  • Ketorolac - Toradol
  • Diclofenac - Voltaren
  • Piroxicam - Feldene
  • Meloxicam - Mobic
COX2 Inhibitors
  • Celecoxib - Celebrex
  • Rofecoxib - Vioxx
  • Valdecoxib - Bextra
The First Indication Something was Wrong
Rofecoxib, one of the COX2-inhibitors developed by Merck, was approved by the U.S. FDA in May, 1999 for use in the treatment of arthritis, acute pain and menstrual pain. This was a wildly popular drug and eventually, as many as 80,000,000 patients worldwide were treated with Rofecoxib. Before approval of the drug by the FDA, studies of the drug suggested that Rofecoxib had a satisfactory safety profile. 

Two post-market studies cast significant doubt on the safety of Rofecoxib, though. The first study was called VIGOR (Vioxx GI Outcomes Research) and was designed to study the possibility of reduced gastrointestinal adverse effects with the COX2-selective Vioxx compared to previously available nonselective NSAIDs. Specifically, this study compared the efficacy and adverse effects between Vioxx and naproxen and found that, over the 12-month span of the study, the rate of myocardial infarction (MI, or “heart attack”) was four times higher in the Vioxx than in the naproxen group. Importantly, this increased risk for MI was noted to occur within only twomonths of starting the Vioxx drug. 

The second important study was called APPROVe (Adenomatous Polyp PRevention on Vioxx). This study was designed to evaluate the possibility that Vioxx could reduce the chance of developing colonic polyps (based on the observation that another COX2-inhibitor had already made this claim). The study was designed to last three years, but was terminated early when the investigators found that, compared to placebo, patients receiving Vioxx experienced a nearly 2-fold greater incidence of MI and stroke. 

Based in large part on the findings of these two studies, Merck voluntarily withdrew Rofecoxib from the market in September, 2004. 

The experience of Vioxx raised questions about the entire group of COX2-inhibitors, and for that matter, all NSAIDs, and any possible link to cardiovascular risk. Many studies designed to re-evaluate the safety of these medications have now been conducted, but there has remained some uncertainty about the degree of cardiac risk associated with the use of these drugs. 

The New Study
In the current issue of the British Medical Journal, Sven Trelle and his colleagues at the Institute of Social and Preventive Medicine at the University of Bern report on a meta-analysis of previous studies of NSAIDs. This statistical undertaking combines the patient populations in 31 previous studies that included a total of 116,429 patients who received naproxen, ibuprofen, diclofenac, celecoxib, etoricoxib, rofecoxib, lumiracoxib, or placebo. The combined observations from the underlying studies amounted to more than 100,000 patient-years. The authors focused primarily on the development of MI, but also examined the effects of these drugs on the rates of stroke, death from cardiovascular disease, and death from any cause. 

For three of the drugs (naproxen, diclofenac, and etoricoxib), there was no evidence of increased MI. For all of the other medications, though, there was an increase in the rate of MI during the study period: 1.3-fold for ibuprofen, 1.35-fold for celecoxib, and 2.12-fold for rofecoxib. 

All drugs were associated with an increased rate of stroke: 1.3-fold for naproxen, 2.96-fold for diclofenac, 2.67-fold for etoricoxib, and 2.81-fold for lumiracoxib.

All drugs were associated with an increased rate of death from any cause, with risks ranging from 1.23-fold (for naproxen) to 2.31-fold (for diclofenac).

One important observation from this study is that both COX2-selective as well as non-selective NSAIDs were associated with increased cardiovascular risk. This refutes the previous claim from some authorities that the risk was inherent only in the COX2-inhibitors. Even ibuprofen and naproxen were associated with these risks. 

The authors’ conclusion statement is quite stark: “Although uncertainty remains, little evidence exists to suggest that any of the investigated drugs are safe in cardiovascular terms.” 

Implications for Athletes
Athletes use the NSAIDs when they’re injured. I’ve done it myself. We all have. Personally, I would rely on NSAIDs for their analgesic effects primarily, thinking that any anti-inflammatory effect would be a bonus. I’ve used NSAIDs for weeks in a row when I’ve been injured, primarily to allow me to continue to work (at my job). I’ll bet that many athletes rely on the use of NSAIDs to allow them to continue to train in spite of being injured as well. I’ve also seen athletes use NSAIDs prophylactically during competition to prevent any pain during an event. 

As time goes by, and particularly with the information from the new Swiss report, evidence continues to accumulate that the NSAIDs -- all of them -- are probably associated with an increased risk of cardiovascular problems including MI, stroke and even death. And although the relative risk may seem small, even a 1.1- to 1.3-fold increased risk of these complications is meaningful. Athletes should keep these risks in mind when they choose to use NSAIDs.

Here are my suggestions for athletes regarding NSAIDs:
  1. Never use NSAIDs prophylactically to prevent pain during training or racing.
  2. As a first choice, use an alternative to NSAIDs when choosing an analgesic. Consider acetaminophen or a narcotic pain reliever.
  3. If you choose to use an NSAID, use it for only a short period of time.
  4. When injured, emphasize alternatives to medications such as rest, icing, compression, elevation, appropriate medical evaluation and appropriately supervised post-injury rehabilitation.

And Another Thing…
by Bob Albright, D.O.
I wished to add a few more warnings on the potential downsides of NSAIDs as they pertain to training. NSAIDs work by interrupting the production and action of prostaglandins. Prostaglandins cause inflammation, pain and increased blood flow via dilation of blood vessels. These effects are “bad” in many circumstances but “good” in others. Nobody wants pain and swelling, and NSAIDs are very effective from this perspective. Many athletes have used these agents with impunity for years. But…
Our bodies need prostaglandins to overcome the vasoconstriction which accompanies stress to specific organ beds. Your kidneys will suffer decreased flow and may even fail when you add dehydration and low blood pressure to NSAID use.
NSAIDs will also lead to decreased blood flow to the stomach and bowel -- impairing digestion, and long-term, predispose you to gastric ulcers. This effect is due to reduced perfusion lowering the production of the protective mucous layer in the stomach. The often-described bloating experienced by most of us is exacerbated by these agents as well due to less blood flow available for digestion.
Dangerously high potassium levels (hyperkalemia), and dangerously low sodium levels (hyponatremia) are also often direct results of NSAID. This is due to the interruption of complex feedback loops, often with disastrous results.
Finally, NSAIDs have been shown to increase healing time, impair tendon healing, delay muscle rebuilding and may lead to bleeding tendencies. So, think about whether acetaminophen (Tylenol brand name) might be a better strategy when you are in pain.
Your non-beating organs thank you.

Larry Creswell, M.D., is a cardiac surgeon and Associate Professor of Surgery at the University of Mississippi Medical Center in Jackson, Mississippi. In addition to his regular column on Endurance Corner, he maintains the Athlete's Heart blog to offer information about athletes and heart disease in an informal way and to encourage exchange and discussion that will help athletes build a heart-healthier lifestyle. You can contact him at

Bob Albright, D.O., is a Nephrologist and Assistant Professor of Medicine at the Mayo Clinic in Rochester, Minn. You can contact him at

Tuesday, 15 February 2011

Glencoe Avalanche Risk Update

15th Feb update for a ScRL profile.  Easy shears and high risk!

15th Feb Graphic Showing high Risk. Basically most of the Bidean and BEM!

A dodgy place to be a few years ago. The 2 circles indicate where two victims were found and the black one where the last one was located (probe find by me).The shallow crown was 500ft above (blue) and had taken 7 winter walkers.  High winds and the big resevoir of snow in the Glen Etive side make this prone to further release in SE to SW winds. SE today so watch out!
Yesterdays pit profile and forecast for today from Paul Moores SAIS. Strong East wind today (15th Feb) and lots of snow movement ontoWest to NE facing aspects. This wind driven slab on top of some hail and also a very soft snowpack giving easy shears, will make things very dodgy. While the ski areas have shut the risky slopes, there remains a substantial risk for climbers walking into trouble on desecent, or mad enough to venture into a gully. Lagangarbh Corrie looked a bit dodgy looking up. Any eejit who says it's safe after an intitial release is talking shite. Hangfire from other aspects, or a second release over time from wind build up is always a hazard and in particular on popular decent routes folk going up can get taken out by folk triggering a release from above. Plenty of places this applies to.

Monday, 7 February 2011

Ooops a daisy! Nearly buried!

Went for a ski at Glencoe today. Strong winds and drifting snow had significanly raised the avalanche risk and visibilty was at times very poor.  I met the SAIS observer Paul Moores with Pete Weir doing a profile at the top of the spring run and they commented that there had been some small  slides triggered by Keith, one of the ski patrol. I had a few runs down as this was the best skiing although some sastrugi and wind ridges.  On my 4th run I trigged a fairly big slab but the runout is shallow at that point so these dont often pick up enough speed to take you out. However, I didnt like the traverse out to the top ski tows as it was hanging and as I was on my own so I went lower ending up above the lower Rannoch glades.  I stopped and just fell over in the whiteout and it whumped cracking accross above me for 50 or so feet and at 2 to 3 feet deep.  It didn't pop thankfully, but on skiing down below I could see that over the apex there was a 12 inch crown and debris. I was pretty wary after that but  I had a run down the Spring run a couple of hours later with Keith and Christine to look at a large slide out the bottom of the Spring run they had triggered.  I skied ahead and in a whiteout accidently cut too high out to the skiers left on a steep NE aspect and triggered a slide that took me out completely and took me down like a rocket covering me totally at one point before spitting me out 150 feet lower down on a patch of ice. Keith couldnt see me, but heard it whump and me shout so they skied accross and down to me. I got a bit of a fright to be honest!

I consider myself fairly cautious but nearly getting it twice in one afternoon is maybe my being over familiar with my local patch which to be honest has loads of little slope aspects that pop but you just get used to it.  A Heuristic trap?
Pete and Paul at their profile site

Weather cleared and Keith at my start point to the white tumble dryer

Not a huge crown wall but big enough!

Christine and Keith

Saturday, 5 February 2011

Friday, 4 February 2011

Stay Safe - It's Avalanche Danger Time

Well folks this combo of storm winds and heavy snow is sure cross loading the slopes so cool your jets for a considerable time to come as it's really dodgy out there.  When it improves be sure to have the transceiver, shovel and probe with you.  On that very subject I have a BCA Tour shovel and probe combo for £65 as a sale item and its not too late to get a deal on a Tracker 1 or 2 with up to 20% of RRP.

These slope aspects just about include all the frontside skiing on Glencoe Mountain and the popular climbing venues

Shear layers not to mention the 50cm + on the harder crust at 50 to 60cm and the temp gradient at near zero at that point

Tuesday, 1 February 2011

ACL Injury - How to Avoid It

 Good hip flexibility and fitness help.  Common findings in skiers who have suffered this injury include:
• Uphill arm is back

• Skier is off-balance to the rear

• Hips are below the knees

• Uphill ski unweighted

• Weight on the inside edge of downhill ski tail

• Upper body generally facing downhill ski