Arthritis and....

...an assortment of questions.

First, yes, I've been to my doc office recently, and saw the PA, who had knees x-rayed then sent me off to the Physical Therapy joint. Those appointments are underway, and, I will be in for a physical within a month. In the meantime,  I'm crowd sourcing second opinions and learning some more ahead of that appointment. Frankly, some of you will know more than the family practice doc will, especially relating to climbing and....well. Other stuff.

1.Arthritis requires I move, to keep my mobility, as much as I can, without injuring myself. With something that bugs me much of the time, any insight on differentiating between that and overuse or actual injury? We're talking knees, here, by the way. 

2. Would the brace/support bandage things help my knee that is the worst?

3. Here's the really stupid one that annoys me mightily: anyone out there have experience/info on cold pressed hemp seed oil and arthritis (purchased as a supplement, but just bottled oil)? Sooooo annoying, but that's all I've got in the entire category that is legal here. Info on use/dosing?

4. Anyone have info/experience with tart cherry juice? This, I'm mainly battling the knees waking me up at night, and it is supposed to be helpful for interrupted sleep.

5. Once in motion, I'm okay. First thing in the morning, I lurch around until the worse knee gets with the program. Any way to lessen whatever it is that happens overnight?

6. At what point should I pop for a specialist? I have a 70/30 split for my insurance, so I can't afford a whole lot.

7. Hands/feet. I swear I'm getting bonier. Is this possible? Arthritis, something else, or just old?

Thanks, all. I'm heaps better for mobility than in late 2016, but one knee has gotten worse, per the recent x-rays.

Best, Helen

https://www.mountainproject.com/forum/topic/108001081/osteoarthritis#ForumMessage-108015185

Old lady H wrote: 

6. At what point should I pop for a specialist? I have a 70/30 split for my insurance, so I can't afford a whole lot.

You should see a specialist (orthopedist) when you want accurate information on treatments and diagnoses for your joints. That means, paying some money and giving up on the idea that you can get useful medical information on MP.

FrankPS wrote:

You should see a specialist (orthopedist) when you want accurate information on treatments and diagnoses for your joints. That means, paying some money and giving up on the idea that you can get useful medical information on MP.

Gee thanks Frank. Think they'll advise me about CBD? Illegal in all forms for anything whatever in Idaho? They can't. Anymore than I can risk my job with illegal stuff, even if it's effective and less harmful than what can be prescribed.

I know about the older threads, but a lot has changed in recent years, and there is more out there now.

Actually, arthritis specialist probably, but they still aren't going to have some of the answers I'm looking for. I also don't want to be sent off for tests that cost a bundle just to be told the obvious, just to cover their bases.

Best, Helen

EDIT to add, and, Frank, I hope you are doing okay, and your pups as well. Bigger dogs are in the same boat, sadly, and I know you've been here awhile too. Sorry if I was snarky, sir.

Old lady H wrote:

Gee thanks Frank. Think they'll advise me about CBD? Illegal in all forms for anything whatever in Idaho? They can't. Anymore than I can risk my job with illegal stuff, even if it's effective and less harmful than what can be prescribed.

I know about the older threads, but a lot has changed in recent years, and there is more out there now.

Actually, arthritis specialist probably, but they still aren't going to have some of the answers I'm looking for. I also don't want to be sent off for tests that cost a bundle just to be told the obvious, just to cover their bases.

Best, Helen

The experts on arthritis are orthopedists, not climbers. You want alternative treatments that aren't supported by the medical community? Go for it, but there's a reason those treatments aren't recommended - generally because there are no studies proving efficacy or the risks/side effects are too great. Sure, you'll get a few "that worked for me" on MP. If that's how you want to select your treatment, well, godspeed. 

Every one of your initial questions is best answered by an orthopedist. You get what you pay for.

Large doses of tumeric has helped my hands tremendously. I can climb all day with my nomics and life is good.

 I take 1,000 mg blend of tumeric and black pepper compounds daily.

FrankPS wrote:

The experts on arthritis are orthopedists, not climbers. You want alternative treatments that aren't supported by the medical community? Go for it, but there's a reason those treatments aren't recommended - generally because there are no studies proving efficacy or the risks/side effects are too great. Sure, you'll get a few "that worked for me" on MP. If that's how you want to select your treatment, well, godspeed. 

Every one of your initial questions is best answered by an orthopedist. You get what you pay for.

See my edit above, sir. I'm cranky today, my apologies.

Tart cherry juice has an NIH study, as well as other studies, just so you know. They've got a unit dealing with "edible medicinal botanicals", apparently. CBD, I expect the Feds will let it get in on the FDA lists eventually. How long? Who knows.

Again, yes, sir, I'll be off to a specialist down the road. That's why god invented credit cards, after all. And, I apologise for cranky. Our weather keeps changing, I overdid it a couple weeks ago, stuff hurts....

Best, Helen

heya OLH... have you heard of http://journalofprolotherapy.com/prolozone-regenerating-joints-and-eliminating-pain/

I have Ehlers-Danlos which is sort of like an arthritis of the whole body (the chemical specifics of the body breakdown are slightly different from classical arthritis, but I can offer help with physical rehab questions as i've had to do very exacting/precise PT routines for basically every part of my body to rehabilitate and i've been having to keep up that routine for over 2 years now and still have a long way to go. I also have to "move as much as possible".  it is a slow dance of being very regimented and paying a LOT of mental attention to the joints in question.. to determine what is the exact level of "overuse vs enough stress to cause healing"... especially as this exact level is actually a moving target..)

as far as knee braces.. you'll likely want something that provides a relatively heavy level of support like https://www.betterbraces.com/donjoy-reaction-knee-brace or one that has metal reinforcement on either side.  it takes some trial and error to find a brace that truly fits right and helps...

something like CBD can for sure help "mask the pain" but it's not exactly healing you...
my main supplement is https://traceminerals.com/concentrace-trace-mineral-drops/ and it serves a very fundamental purpose for this type of recovery.  when your brain's automatic processes are no longer sufficient, when you have to modify your behaviour consciously and continuously to avoid injury... all this extra brain work burns through salts/minerals far more than normal.. which leads to all kinds of extra effects like crankiness/headaches/fatigue

climbing has saved my life from a PT perspective... as it allows me to support my body using my arms in all sorts of ways while doing gradual weighting and positioning of the legs.. finding a movement that causes the least issues and working through it... but without the brain-rotting monotony of the typical kind of workout / PT routine.. (which I had to do for a year before I even got to the point where something like climbing seemed possible)..   the brain engagement is quite important for being able to deal with the struggle without being consumed by it..

for "5. Once in motion, I'm okay. First thing in the morning, I lurch around until the worse knee gets with the program. Any way to lessen whatever it is that happens overnight? "
when you sleep, do you have any kind of special setup in your bed?  
building a system of, say, rolled up towels of various sizes, and setting them up around your problem areas, so that your body stays in the correct resting position all night, is rather helpful.

a physical therapist who is well versed in something like arthritis can help you establish what the proper resting positions of your body should be, if you are having trouble finding them on your own.

hmm, also.. were you ever actually blood tested for arthritis? or did a doc just tell you that's what he thinks you have??
there are many issues that can happen which just get judged as "arthritis" but may actually be something more complicated or completely different if you get the right blood tests done.
https://www.unmc.edu/mmi/geneticslab/catalog/postnatal-testing/post-p-connectivetissue.html
https://www.arthritis.org/living-with-arthritis/tools-resources/lab-test-guide/

it's JUST as easy to find relatively clueless doctors (even among 'specialists') as it is to find climbers who don't know about these things ;)   it was several doctors before I won the lottery with someone who really knew their shit.

WRT #5, turn it into an exercise routine.

A doctor and/or a PT who understand your goals is worth every penny.  A doctor who doesn't understand your goals ("you ought to quit climbing, then") is worth about as much as some of the advice you'll get on the internet.

As my 86 year old mother reminded me yesterday, "getting old sucks, but it is better than the alternative".

If you have severe OA of your knees, the "cure" is joint replacement. Your insurance might also cover viscosupplementation injections which can be helpful. All that other stuff might help, and it might not. Don't spend too much money chasing alternative treatments. Stay fit, keep your legs strong, and get rid of any excess body weight.

I have been dealing with traumatic, end state OA for about a decade. I've seen every specialist on the planet, and at one point was seeing my rheumatologist so often he was my primary care physician. I'm also a medical researcher. A few thoughts:

- I had synvisc injections which provided very temporary relief. They are FDA approved, but $$ and don't last that long. I don't recommend them
- I had an autologous stem cell transplant from my own bone marrow into my damaged joint as well as an distraction arthrodiastisis. These are the big guns, and cost upwards of $100k. These two procedures gave me my life back so I could climb and hike again. Prior to these procedures, my arthritis was so bad I could walk maybe 50-100 steps a day and had to use a cane. Last year I climbed the complete North Ridge of Mt Stuart, which involves a significant hike and tons of climbing. And then the next day I hiked up to the summit of South Sister. It doesn't sound like your arthritis has progressed quite as far as mine so those might be overkill. 
- I take Move Free Joint Health and Glucosamine + Chondroitin from Costco every day. These supplements help immensely. I used to have to crawl to the bathroom in the middle of the night because I was so sore and stiff and didn't have time to do all the stretching I usually do in the morning before I take my first step, but basically don't have to do any of that any more after starting on G+C. The key is that they only work for true arthritis -- if you have other random soft tissue damage, they won't do anything. I've had intermittent tennis elbow and a torn MCL for a while and these supplements do an incredible job for my arthritis, but nothing for other soft tissue pain/damage. Without seeing a physician, it's impossible to tell if you truly have arthritis or something else. That said, they are pretty cheap and don't have any negative side effects.
- I use topical CBD (not FDA approved!) as well as topical diclofenac sodium (FDA approved). They are both effective anti-inflammatories that help, but require you to use them every day. When I forget to use them the pain and swelling comes back. The Pennsaid is prescription, but you can get a really super cheap large bottle of the generic that lasts forever. But if you don't use it, it doesn't work. I also found arnica to be pretty helpful, but not nearly as good as the CBD or pennsaid. 
- I've tried tumeric and fish oil supplements and the anti-inflammatory diet and none of them gave me any benefits
- lose weight. I had a frank discussion with my ortho specialist and my rheumatologist about this one. Given that I was young woman in my 20s who was already near underweight (5'4", 115lb) they hesitated to tell me to lose weight, but it's the single most effective thing you can do. I had a very thorough body composition analysis done, and was told that I could safely get down to 108 and still be healthy. I try to stay around 110b so I have a little bit of buffer. If you are carrying ANY extra weight around, losing it will be the best thing you can do for your knees. Every single pound you lose equals 4-6 pounds of force off of your knees, so if you lose 10 pounds, it's the equivalent of taking a 60# pack off in relation to your knees. 
- I don't think braces help that much other than to control the swelling. I find compression stockings to help much more. They are much less bulky and help control the swelling. I also have a lot of problems first thing in the morning and after long airplane rides. I hate sleeping with compression socks, but will after a really long alpine climb with a significant hike. It helps a lot in the mornings.
- Activity. As you note, one of the treatments for arthritis is movement. You need to do weight bearing exercises. Anticular cartilage is avascular and gets its nutrients from the surrounding interarticular fluid; these nutrients are only forced into your cartilage when you put pressure on your joints. So swimming, while a great exercise, will do nothing for your arthritis. Neither will biking (unless it helps you lose weight). You need to either do some light hiking or very easy running. It sucks and is counter-intuitive, but running makes my arthritis better, not worse. That said, I don't do more than a couple miles at a time.
- Getting bonier. Not necessarily arthritis. As we age, we lose some fat deposits, particularly around our hands and feet. For example, we have a nice pad of fat under our heels that helps cushion our steps, but that fat pad diminishes with age so in addition to arthritis, it just hurts more to walk in general. There's not really much you can do about this.

Best of luck. Hope you find something that works for you.

claty wrote: I have been dealing with traumatic, end state OA for about a decade. I've seen every specialist on the planet, and at one point was seeing my rheumatologist so often he was my primary care physician. I'm also a medical researcher. A few thoughts:

- I had synvisc injections which provided very temporary relief. They are FDA approved, but $$ and don't last that long. I don't recommend them
- I had an autologous stem cell transplant from my own bone marrow into my damaged joint as well as an distraction arthrodiastisis. These are the big guns, and cost upwards of $100k. These two procedures gave me my life back so I could climb and hike again. Prior to these procedures, my arthritis was so bad I could walk maybe 50-100 steps a day and had to use a cane. Last year I climbed the complete North Ridge of Mt Stuart, which involves a significant hike and tons of climbing. And then the next day I hiked up to the summit of South Sister. It doesn't sound like your arthritis has progressed quite as far as mine so those might be overkill.
- I take Move Free Joint Health and Glucosamine + Chondroitin from Costco every day. These supplements help immensely. I used to have to crawl to the bathroom in the middle of the night because I was so sore and stiff and didn't have time to do all the stretching I usually do in the morning before I take my first step, but basically don't have to do any of that any more after starting on G+C. The key is that they only work for true arthritis -- if you have other random soft tissue damage, they won't do anything. I've had intermittent tennis elbow and a torn MCL for a while and these supplements do an incredible job for my arthritis, but nothing for other soft tissue pain/damage. Without seeing a physician, it's impossible to tell if you truly have arthritis or something else. That said, they are pretty cheap and don't have any negative side effects.
- I use topical CBD (not FDA approved!) as well as topical diclofenac sodium (FDA approved). They are both effective anti-inflammatories that help, but require you to use them every day. When I forget to use them the pain and swelling comes back. The Pennsaid is prescription, but you can get a really super cheap large bottle of the generic that lasts forever. But if you don't use it, it doesn't work. I also found arnica to be pretty helpful, but not nearly as good as the CBD or pennsaid.
- I've tried tumeric and fish oil supplements and the anti-inflammatory diet and none of them gave me any benefits
- lose weight. I had a frank discussion with my ortho specialist and my rheumatologist about this one. Given that I was young woman in my 20s who was already near underweight (5'4", 115lb) they hesitated to tell me to lose weight, but it's the single most effective thing you can do. I had a very thorough body composition analysis done, and was told that I could safely get down to 108 and still be healthy. I try to stay around 110b so I have a little bit of buffer. If you are carrying ANY extra weight around, losing it will be the best thing you can do for your knees. Every single pound you lose equals 4-6 pounds of force off of your knees, so if you lose 10 pounds, it's the equivalent of taking a 60# pack off in relation to your knees.
- I don't think braces help that much other than to control the swelling. I find compression stockings to help much more. They are much less bulky and help control the swelling. I also have a lot of problems first thing in the morning and after long airplane rides. I hate sleeping with compression socks, but will after a really long alpine climb with a significant hike. It helps a lot in the mornings.
- Activity. As you note, one of the treatments for arthritis is movement. You need to do weight bearing exercises. Anticular cartilage is avascular and gets its nutrients from the surrounding interarticular fluid; these nutrients are only forced into your cartilage when you put pressure on your joints. So swimming, while a great exercise, will do nothing for your arthritis. Neither will biking (unless it helps you lose weight). You need to either do some light hiking or very easy running. It sucks and is counter-intuitive, but running makes my arthritis better, not worse. That said, I don't do more than a couple miles at a time.
- Getting bonier. Not necessarily arthritis. As we age, we lose some fat deposits, particularly around our hands and feet. For example, we have a nice pad of fat under our heels that helps cushion our steps, but that fat pad diminishes with age so in addition to arthritis, it just hurts more to walk in general. There's not really much you can do about this.

Best of luck. Hope you find something that works for you.

This was awesomely informative and interesting.

I would disagree with a couple of personal things (take the correct turmeric and i have worn braces for 30 years and could NOT do what i do, alpine, long approaches, descents, without them, i have tried) but all in all excellent information, thank you!
How old are you, if i may be so bold, and how did you end up with such degeneration?
I have been diagnosed with NO ACL's (really, my ortho surgeon refers me as the walking miracle), torn hip labrum, nothing left in the meniscus in either knee, 2 blown ankles, etc.  and just good ol'wear and tear. And i too have crawled to the head. Yoga and general stretching helps, tons.
And then there are the hands.
What is your feeling about cortisone injections?

Hey OLH,

I'm not sure how much braces help. I think that strengthening the joint is more effective. I have found that using braces weakens my ankle.

Are you able to do very gentle stretching in the morning? My feet are messed up from martial arts and congenital issues that are causing problems. Mornings when it is really bad, I do circles and alphabets. Really simple easy stuff before standing up. Maybe your PT can show you something similar. I don't know if there is a restorative yoga class near you. That may help. However, you need to find a teacher who will respect your limits. A well-trained Iyengar instructor would probably be best.

Old lady H wrote: ...an assortment of questions.

First, yes, I've been to my doc office recently, and saw the PA, who had never x-rayed then sent me off to the Physical Therapy joint. Those appointments are underway, and, I will be in for a physical within a month. In the meantime,  I'm crowd sourcing second opinions and learning some more ahead of that appointment. Frankly, some of you will know more than the family practice doc will, especially relating to climbing and....well. Other stuff.

1.Arthritis requires I move, to keep my mobility, as much as I can, without injuring myself. With something that bugs me much of the time, any insight on differentiating between that and overuse or actual injury? We're talking knees, here, by the way.

2. Would the brace/support bandage things help my knee that is the worst?

3. Here's the really stupid one that annoys me mightily: anyone out there have experience/info on cold pressed hemp seed oil and arthritis (purchased as a supplement, but just bottled oil)? Sooooo annoying, but that's all I've got in the entire category that is legal here. Info on use/dosing?

4. Anyone have info/experience with tart cherry juice? This, I'm mainly battling the knees waking me up at night, and it is supposed to be helpful for interrupted sleep.

5. Once in motion, I'm okay. First thing in the morning, I lurch around until the worse knee gets with the program. Any way to lessen whatever it is that happens overnight?

6. At what point should I pop for a specialist? I have a 70/30 split for my insurance, so I can't afford a whole lot.

7. Hands/feet. I swear I'm getting bonier. Is this possible? Arthritis, something else, or just old?

Thanks, all. I'm heaps better for mobility than in late 2016, but one knee has gotten worse, per the recent x-rays.

Best, Helen

I've been dealing with rheumatoid and osteoarthritis for about 13 years.  I've tried every over the counter med there is.  The most highly recommended is glucosamine chondroitin which didn't seem to have an effect on me.  The best anti-inflammation solution I found was a grain-free diet, it's super hard to stick to but worth the effort. 

I have/had very light arthritis (on the arthritis spectrum, at least) in both of my feet, mostly stemmed from compounded overuse and injury. A couple years ago it started to become unmanageably painful where I could no longer walk properly.

I went to a specialist who was supposed to be the “best”, and he recommended a whole lot of surgery with nearly a year of recovery and rehab. He told me that there was a 1-2% chance that I would never fully recover from the surgery. I wasn’t a fan of his response.  

...This is not where I tell you I took a bunch of supplements and smoked pot and it all worked out!

After that, I started searching out for a specialist who specifically dealt with endurance althelete foot and knee injuries. It took about a year and a half of constant work, but at this point I live pretty much pain free.

I do believe that getting a highly specific specialist is indeed worth it. It wasn’t cheap though. My feet are now my most expensive pieces of climbing gear I own haha

claty wrote: 
- I had synvisc injections which provided very temporary relief. They are FDA approved, but $$ and don't last that long. I don't recommend them
- I had an autologous stem cell transplant from my own bone marrow into my damaged joint as well as an distraction arthrodiastisis. These are the big guns, and cost upwards of $100k. These two procedures gave me my life back so I could climb and hike again. Prior to these procedures, my arthritis was so bad I could walk maybe 50-100 steps a day and had to use a cane. Last year I climbed the complete North Ridge of Mt Stuart, which involves a significant hike and tons of climbing. And then the next day I hiked up to the summit of South Sister. It doesn't sound like your arthritis has progressed quite as far as mine so those might be overkill.

I dunno how much knee arthrodiastisis runs, but its surgery so I'm sure its pricey. BMAC stem cell injections can be under $2k, though out of pocket as they aren't covered by any insurance. Stem cells seem to work better when you still have some existing cartilage to work with, so I'm not sure the advice on waiting until its bad is very sound. Don't do cortisone injections unless you're resigned to knee replacements. They are pretty helpful for short term pain relief, but they are destructive to your joint.

Muscrat wrote:

This was awesomely informative and interesting.

I would disagree with a couple of personal things (take the correct turmeric and i have worn braces for 30 years and could NOT do what i do, alpine, long approaches, descents, without them, i have tried) but all in all excellent information, thank you!
How old are you, if i may be so bold, and how did you end up with such degeneration?
I have been diagnosed with NO ACL's (really, my ortho surgeon refers me as the walking miracle), torn hip labrum, nothing left in the meniscus in either knee, 2 blown ankles, etc.  and just good ol'wear and tear. And i too have crawled to the head. Yoga and general stretching helps, tons.
And then there are the hands.
What is your feeling about cortisone injections?

I'm 40. I had a bad accident when I was in my early 20s, resulting in complete and total destruction of my cartilage. I was 100% bone on bone and had 22 surgical procedures to attempt to fix my leg, including several failed cadaver grafts, OATS, and other salvage procedures. Before my distraction and stem cell transplant, I had some fibrous scar tissue in my joint but no actual cartilage left. I actually consider it a minor medical miracle that I can walk, let alone do any kind of climbing at all.

I've heard good things about tumeric, but didn't see any benefits. I only stuck with it for a few weeks, though. Another one where the research shows mild benefit with no adverse effects (plus it's relatively cheap) so I generally suggest people give it a try. 

I think cortisone can be OK as a very short term solution, like right before a trip as long as people are aware of the trade offs, and the potential adverse events associated with cortisone. It's unsustainable, bad for your soft tissue, and can result in serious long-term damage. Is it worth it for a few pain free weeks? Maybe? Personally, I think if you're looking for temporary relief, synvisc is a better choice. Much lower adverse event profile, just more expensive. Probably the same level of relief, though. 

I'm glad you had such a significant improvement claty! 

Ryan Pfleger wrote: I'm glad you had such a significant improvement claty! 

Yeah, geez! Thanks for sharing your story. I have to remind myself all the time, that there are a lot of you going through a lot worse than I've got at the moment.

All, I'm a work in progress, that's for sure. I see the PT tomorrow, and will have to admit I have done zip as far as the exercises she gave me. Even with such high stakes, I still have a hard time talking myself into slogging through exercises.

I also have to admit I'm really, really missing my climbing gym. Going somewhere I enjoy, with people I like, vs stretchy bands and yoga ball at home? I'm just finding it bleak. I'll get there, I have to. End of whine.

Thanks for all the input from everyone, much appreciated! 

Best, OLH

I’ve added information and my own experiences before on other arthritis and joint pain threads, but an update!  I became very tired of the chronic pain and a couple of total joint replacements that did not help much.  After investigating Stem Cell and ‘Platelet Rich Plasma’ injections, I met with an M.D. in Salt Lake that specializes only in Stem Cell therapy.  

They took 90 units of my blood, spun it down to get the PRP, combined it with Stem Cells collected at a local lab and delivered to the office an hour before.  I got a little carried away with ‘doing the whole deal’.  I did both knees, my right shoulder (left shoulder it a total replacement), my entire cervical spine area and my entire lumbar spine area.  All in all, it was about 190 injections.  Took hours and hurt really, really bad.  

I am four weeks out and just barely turning the corner on how I feel.  I am supposed to feel a significant difference at week five.  I have laser treatments about every week on the effected and injected joints.  I plan to start moderate climbing this weekend and see how it feels.  I am optimistic (because I have no other options) and feel that it has to work (because it cost so much money).  I’lll update my progress over the summer.

RKM wrote: I’ve added information and my own experiences before on other arthritis and joint pain threads, but an update!  I became very tired of the chronic pain and a couple of total joint replacements that did not help much.  After investigating Stem Cell and ‘Platelet Rich Plasma’ injections, I met with an M.D. in Salt Lake that specializes only in Stem Cell therapy.  

They took 90 units of my blood, spun it down to get the PRP, combined it with Stem Cells collected at a local lab and delivered to the office an hour before.  I got a little carried away with ‘doing the whole deal’.  I did both knees, my right shoulder (left shoulder it a total replacement), my entire cervical spine area and my entire lumbar spine area.  All in all, it was about 190 injections.  Took hours and hurt really, really bad.  

I am four weeks out and just barely turning the corner on how I feel.  I am supposed to feel a significant difference at week five.  I have laser treatments about every week on the effected and injected joints.  I plan to start moderate climbing this weekend and see how it feels.  I am optimistic (because I have no other options) and feel that it has to work (because it cost so much money).  I’lll update my progress over the summer.

Wow, sir! I hope it goes well! I'll let you know if I'm headed over your way, and we can perhaps hobble up some rock together, eh? I will say, the old parts love that hot springs in Almo!

And yeah, optimistic is pretty much the only option. Or give up. HAH! Not gonna happen. Not with climbers!

Best to you, Helen