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El Cap's Hardest: Wings of Steel
In fading light I balanced in my stirrups, hanging from a sharpened hook set precariously on a dime-sized edge on the granite slab. I took a deep breath, and announced to Kait that I was committing to the placement and was likely going to fall … again.
"Watch me!"
She grimaced and braced herself as yet another one of my 20-foot whippers rag-dolled her for the fourth time that day. My focus wavered as guilt crept in. Was I being fair to my partner, my girlfriend? She'd become frazzled catching fall after fall, and I could tell it was starting to take a huge toll. She wasn't having fun anymore. I wasn't even sure I was, either, but we'd given too much sweat and blood and heartache to retreat now. Was this route even worth it? Hours upon hours of tedious micro-flake hooking had infected my psyche. I was cracking.
I took several deep breaths, eyed the placement one last time, and slowly climbed to the top-step of my aider, beads of sweat popping out on my forehead. Climbing in the dark has never really bothered me before, but this route Wings of Steel was a different kind of animal. I reached high with my right arm, pushing another talon hook toward what looked to be my next micro placement. Ping. The hook that I was standing on blew. I flew down the slab, dragging the upper hook until it caught an edge, ripping my shoulder from the socket. The pain was tremendous and I knew exactly what had happened—my shoulder had partially dislocated. Once I fought it back into place, Kait pulled me to the portaledge using the lower-out line. After all our hard work, it was now looking like we would have to bail.
"Let's see how I feel in the morning," I told Kait. We settled down, drank a beer and let the night take us into unconsciousness.
Wings of Steel is, without doubt, the most controversial route on El Capitan.
When Mark Smith and Richard Jensen showed up in 1982 inspired to make a first ascent on El Capitan, their arrival did not go unnoticed by Valley locals. Conflict was inevitable: Smith and Jensen had never climbed a grade VI big wall, yet they chose as their first a new route the blankest, slabbiest, least naturally climbable section of El Cap, the 1,000-foot Great Slab on the Southwest Face, left of the Dihedral Wall. From almost the moment they started the route, they were threatened and slandered by a small group of locals who adopted the surfer's "don't surf my wave" turf mentality.
"We were repeatedly told that my car would be destroyed," says Jensen. "Groups of climbers would surround us in parking lots, even in the Village Store, to yell at us. Always there were threats: 'You're gonna be walking through the forest, and then there's just gonna be the sound of bones snapping.' And, 'We're gonna ship you back to San Berdo in a box.' We always felt outnumbered, and there wasn't the sense that it was going to be just a fist-fight; the intensity of the verbiage always made it seem like it was going to be much more."
Was this route even worth it? Hours upon hours of tedious micro-flake hooking had infected my psyche. I was cracking.
The warnings went unheeded, with Jensen and Smith continuing up the route, angering some locals even further.
Things spiraled out of control when three locals decided to erase the burgeoning route. In a covert midnight raid, the crusaders ascended Smith and Jensen's fixed lines and chopped the rivets and bolts. They then took turns defecating on the pile of ropes left at the base. The "shitters," as they became known, bragged to their friends about the deed, but to this day have preferred to remain anonymous and unavailable to question for this article.
The raid and threats caused the park rangers to hold a meeting with Jensen and Smith and some locals and SAR members, with the aim of keeping the peace. The rangers instructed all present that Smith and Jensen were to be left alone, threatening disciplinary action if not. Smith and Jensen picked up the pieces and continued their adventure, replacing the chopped gear and enduring 39 days on the wall. But the attacks continued even as they climbed—they were pelted from above with bags of excrement by a team on a route overhead.
Jensen and Smith knew that their ascent would rile the Yosemite locals, but, says Jensen, "We figured that people with any concerns would talk to us and give us an opportunity to dialog, and that we would catch at most a bit of chiding for not having kissed all the right booty prior to having the audacity to do such a route. We honestly thought that people could be reasoned with."
"I heard the team drilled their way up the thing then chopped the bolts while cleaning."
As a long-time Valley big-wall climber, I've always had a mild interest in Wings of Steel but had heard it was just a bat-hook ladder protected by rivets up a blank slab, put up in the worst possible style by a pair of hacks. In 2005, a simple question was asked on the popular climbing forum Supertopo: "Has Wings of Steel ever seen a repeat?" I chimed in, believing it to be a botch job, like most others. Rumors abounded.
"I heard the team drilled their way up the thing then chopped the bolts while cleaning."
"There was a streak of feces and trash 200 meters long below their hangin' bivy camp."
"It's nothing but a rivet ladder."
Suddenly the FA team joined the discussion to defend themselves, with Jensen facetiously calling himself "madbolter1," opening a can of worms resulting in thousands of posts in dozens of threads.
"For 29 years we've been widely accused of putting up the ultimate botch job on El Cap and then lying about it," says Smith. "And the online forums have contained some amazingly vile speculations. Because we cared about what the climbing community thought, we tried to defend ourselves. But even our defense got spun into 'hyping the route,' or, ironically, 'being defensive.' We wanted there to be a second ascent, because we believed that other teams would see that we told the truth and that the route was not a botch job."
Twenty-nine years after the first ascent the controversy only intensified. The players included: the shitters, the haters, the believers, the supporters, the gawkers, the onlookers and the lurkers … quite the arena of spectators! It didn't help that Jensen had written a book boasting of "A world record 39 days on the face of El Capitan" or that the back cover—written by an overzealous editor—states: "El Capitan soars 3,600 feet." In fact, the wall is a bit less than 3,000 feet tall, and Wings of Steel is not quite 2,000 feet high.
In 1990, the book Big Wall Climbing included a chapter by Steve Grossman, one of Wings of Steel's most vocal detractors, where he singled out Wings as an example of how not to establish a big wall, writing that the first ascent team "ignored local ethics and bolted excessively." Smith and Jensen were also berated when they showed up at crags to climb, with crowds gathering to fling insults and order them to leave. It went so far as climbers calling Ed Leeper, a bolt manufacturer, and saying: "If you sell any more bolts to those guys, none of the Yosemite climbers will ever buy from your company again."
In September 1988, six years after the first ascent, Rob Slater, who made the first asent of El Cap's Wyoming Sheep Ranch (VI A5) in 1984 and who would die on K2 in 1995, attempted a second ascent along with Bruce Hunter. They reached the top of pitch 5, but with intense heat—the slab bakes in the sun—they decided to bail. Back on the ground, they noted that the route was tedious and very hard.
Since then, other parties tried their hand at a second ascent. In the late 1990s the wall master Kevin Thaw, along with Tim Wagner and Calder Stratford, made another strong attempt. Their idea was to climb Wings of Steel in a single push. Kevin led the first two pitches—the two most natural hooking pitches on the route. Calder continued, pushing forward on the next couple of pitches and encountered bathooks (a small hook hole drilled into blank rock) and batheads (a copperhead pounded into a drilled hole). On the fifth pitch Wagner proclaimed the route bullshit—too many batheads to clean. With Thaw and Calder also unwilling to take the sharp end, they all bailed.
To a non-aid climber, the difference between bathooks, batheads and enhanced hook edges, and especially hole counts might seem trivial, but in the world of aid climbing such things determine the righteousness and purity of a line, and its difficulty, which is why Wings of Steel has been so contentious: Jensen and Smith's claims of rock alteration have been reputed to be inaccurate, undercounted and understated.
Smith and Jensen contend that they did not drill a single hook hole into blank rock, and that they only used the drill to peck off micro crystals, "maybe the size of a couple of periods," that prevented a hook from holding at all. Anytime they drilled a hole, they said, they either pounded a bolt, rivet or bathead into it. "We've always been honest about our reporting, and meticulous with the hole count," they wrote in an e-mail. "It wouldn't serve us to lie about the hole count, then be discredited by a second ascent, especially since vindication about our honesty was what we've been seeking for almost 30 years."
Curiosity and the online controversy got the better of me. In 2006, I hiked up to the Great Slab to see for myself. Once there I was confused by two different starts. Since I didn't know the history, I decided on the left start, which looked better. I later learned that Smith and Jensen had established this "Bogus Start" in hopes that it would be an easier way to reach the top of the second pitch to replace the chopped bolts. The first pitch wasn't too bad, but the second took me nearly five hours. It was the most confusing climbing puzzle I'd ever dealt with. There was no real way to see which hook placements were useable—they really are that small—and I constantly found myself at a dead end, only to deliberately choose a placement that would fail so I could fall and start over. I finally made it to the anchors but not before I took three huge falls, including one 50 footer, which filleted the skin on my leg.
After that, my nerves were shattered and I needed to take a few days off. Meanwhile Pete Zabrok, Tom Kasper and Randy Wenzel showed up in the Valley also intent on the second ascent, and had none other than Mark Smith and Richard Jensen in tow. Pete attempted to lead the original start, but failed and used a cheat-stick to bypass hook moves he couldn't—or wouldn't—do.
"Hardest damn hooking I've ever tried," Pete lamented later. "Light years harder than anything else I've done on El Cap, and I've done plenty. Mark and Richard were sick!"
After securing permission from my brother Gabe, the team used my ropes to gain my high point so they could replace the rivets and bolts on the first two pitches. Zabrok wanted to chicken out, but Smith and Jensen convinced him to give it another try, which he did after rehearsing the hook moves on top rope. Ultimately, Zabrok bailed, unwilling to commit to the long fall potential presented by the hooking sequence.
While I recovered, my partner Cheryl Seger showed up and we were priming to get back on the wall when I learned I had only climbed the Bogus Start. Continuing would mean that we would not have made a legit second ascent. I ended up pulling my ropes and choosing a more natural line, the Jolly Roger (A5).
Five more years flew by and the controversy on Supertopo only got worse. Vitriol and insults were hurled back and forth, and a bounty thread appeared, pledging thousands of dollars to the team that could do the second ascent. A rumor that Wings of Steel might be the hardest big wall on the Captain was circulating and I felt compelled to unlock the mystery, to find out for myself and formulate my own opinion.
Looking from the base up the massive slab, I was perplexed as to why Jensen and Smith had chosen to climb the blankest section of El Capitan when plenty of other natural lines remained. It seemed odd, but maybe they were ahead of their time? Maybe their route wasn't a bathook hole ladder protected by rivets? I usually choose my big-wall routes based on natural aesthetics and the presence of a solid first-ascent team, but the unknown details of Wings of Steel kept the route in my mind.
Now climbing with my girlfriend, Kait Barber, I stood on a block at the base of the wall using my fingertips to push a hook up the warm slab, the first move of the route. The next move was on a Zmac rivet, intended for concrete in the construction world, and rated to only 400 pounds. I knew that a fall could generate enough force to sheer one of these rivets, so we came prepared with a hand drill, 25 rivets and 10 bolts, which we wouldn't place unless absolutely necessary. I also donned skateboard knee pads and elbow pads. From my experience with the "Bogus Start," I expected to take multiple falls and it made sense to protect myself from slab rash.
I methodically hooked my way up the first pitch. I knew from Jensen's Wings of Steel book that he had dislocated his ankle in a big fall getting to the belay. I did a few free moves and entered the delicate zone where he had fallen nearly 30 years before. The edges thinned and it was a crapshoot as to which ones would hold.
Ping! My first fall was a 40-footer. I instinctively went to my knees and slid down the glacier-polished granite. Next, a 50-foot fall had me calling to Kait for the whiskey. "Send up the Jameson!"
This became a common refrain throughout the rest of our climb. I'll give the FA team extra credit for being dead sober on those sketchy hooks. I pulled myself back up to the high point and tried again. Once more, I found myself whipping down the rock, but this time the rope caught my forearm, leaving a painful and nasty rope burn. I was finished for the day.
The next day a layer of dark clouds drifted in from the coast. A ridge blocked our view and we couldn't see just how bad the storm might be. I made my way up the rope determined to finish the pitch. With the knowledge of which flakes and edges wouldn't hold, I reached the anchors without incident and encouraged. In total, the first pitch took me six and a half hours. Wow, I thought, I've climbed an entire El Cap route faster than that!
The rain started falling lightly as I tried to haul our enormous flotilla while Kait cleaned the pitch, but I finally resorted to waiting for her to help me haul. I set up the Portaledge so Kait would be comfortable, knowing that the next pitch was going to take a while. The next pitch started with more natural hooking and some really spaced-out rivets—perhaps 25 feet apart. I stared at the granite, scrutinizing every inch for features to hook. When that didn't work I used my fingertips. I took a couple of 15- to 20-foot falls and finally made it to the anchor at the top of the second pitch, only four and a half hours later. So far, I was impressed with the quality of the route and the natural hooking involved. We fixed and bailed for a few days of rest.
A few days later we were back on the route, the sun beating on the slab, but thermal breezes kept us cool. I began the third pitch and found the first dimples made with a hammer and drill. We figured the holes were from a previous second-ascent attempt, since Jensen and Smith were so adamant about not making many dimples or bathook holes on the slab. Some tedious hooking and a couple of falls led me to the only real rivet ladder on the entire route. Even though we had plenty of light left to start the next pitch, I just wanted to chill, drink a few beers and decompress from the mental strain.
At the belay, Kait endured another white-knuckle session. "The further away Ammon got from a rivet," she says now, "the more my stomach would knot up with anticipation, waiting for him to take these massive falls. I preferred to keep my head down, wait for the sound of a piece popping and his yell—and then brace for the fall. Most of the time I kept my head down."
That night Kait had a meltdown. She told me she was over it. "My mental game isn't where it should be for this route. I need to go down."
The combination of watching me fall all day and some serious family problems at home had all come to a head.
"I thought I could go up on El Cap and get away from it all, have some time to clear my head," Kait says now. "Instead, while Ammon was on lead, I had hours to sit and think about my life and how my family was falling apart around me."
We talked for hours, debating why this particular route was so much more stressful to us than other hard El Cap routes we had climbed together. We determined that it was because of the certainty that I was going to take long falls. Most El Cap routes require no falls, but I'd whipped eight or nine times already and we were only on the third pitch. The hooking on the sloping ripples in the smooth granite was so delicate that my hook placements would unexpectedly blow off with the slightest wrong shift in weight. I also fell off the bathooks, which on this route had been drilled so shallow they barely held body weight.
My heart ached as I watched her shed tears, but I wasn't going to try and talk her into something she didn't want to be a part of. We agreed to go to the ground, where I would find another partner. I was sad, and couldn't imagine being up there with anyone else. I was very disappointed in the way the ascent was turning out.
The next morning Kait felt a little better, but still wanted to go down. We talked for hours. I had my own hissy fit and kind of lost it when our friends on Excalibur called over to us with encouraging cheers of, "Go Team!"
"We're not a fucking team!" I screamed, then went ballistic on the ledge, thrashing around like a toddler having a tantrum. This was my one and only chance to climb this route and I knew it would disrupt my momentum and focus if I had to find another partner, possibly thwarting my efforts. I sulked and hoped that she would change her mind.
Eventually I calmed down, and felt ashamed of how I'd acted. After hours of negotiations and cowering from the sun, Kait decided she was going to suck it up and take one for the team. She didn't want to let me down and hated the idea of bailing. I apologized and gave her a big hug. We continued up, Kait cleaning and me hauling the enormous load, glad we weren't carrying 1,200 pounds like the FA team did. By the time we settled onto the anchor, the day was pretty much a wash, so we lounged on the nylon ledge and relaxed.
The next morning we had to wait a few hours to climb because the reflection of the sun off the slab was blinding. The fourth pitch starts out like just about every other—with a pulse-quickening runout. We were starting to see a pattern in how the FA team operated: scare the hell out of yourself, sink a questionable rivet, scare yourself some more, and repeat.
"Our choice of a bolt or rivet [on the first ascent] was determined by runout," says Jensen. "We only drilled holes where we could find nothing to hook. So, we would choose on the spot whether to fill the hole with a bolt or rivet depending upon how crazy things were getting. Rivet to 'keep the commitment level high,' and bolt if the commitment level was getting 'too high.'"
Each day was the same: sleep in, numb myself by drinking beer and whiskey, get a single pitch done, then unwind for the rest of the day. As I led, I would occasionally ask Kait to dig into Jensen's Wings of Steel book. "What did they say about the fifth pitch?"
The situation was humorous. What other route on El Cap can you climb while simultaneously reading a pitch-by-pitch account of what the FA team was thinking and doing? Reading also gave Kait something to do while I took hours to figure out the sequence and finally clip the belay bolts. Another day, another pitch.
In anticipation of the heat, we had brought a 6- by 6-foot tarp with a reflector side. It fit nicely around the ledge and acted as a parasol. Our shady nook was so cozy I didn't start the fifth pitch until 7 p.m. I figured I would be at the belay in a few hours, or could lower whenever I got to a good piece. I set off, not really too surprised when I saw bathook holes traversing out right. I again attributed them to repeat attempts, but this was the last pitch that had been repeated, by Thaw, Calder and Wagner, who reported numerous batheads, which, oddly, I didn't find.
By now I'd gotten into the groove, and was even having some fun. The traverse led to some thin seams that seemed to continue forever, and I kept wanting to lower to the bivy, but wasn't comfortable fixing from the small heads I had placed. I was forced to press on through the night and didn't make the anchors until 11 p.m. I came back down to the belay delirious, telling Kait that it was a fine pitch and that Jensen and Smith had utilized the seams really well.
After another ridiculously long day of cowering under our sunshade, I started up the sixth pitch with a smirk, this time having no expectations of how long it would take. It was one move at a time, pitch after pitch. I was in Wall Mode, forgetting the days and not knowing or caring how long we'd been up there.
Some natural hooks led to some bathooks, a rivet and more dimpled hooks. At this point we were convinced that the dimples and bathooks had come from the first ascent, since we knew of no other attempts that reached this height. Was it possible that someone else did a second ascent and didn't report it? Ping! One of the dimpled hooks blew and I took a 15-foot fall. I examined the placement and I could clearly see the fresh green-colored rock where the lip had broken. I tried to hook it again … Ping! The fall dislocated my shoulder and activated one of my only Screamers, clipped to an old rusted Z-mac.
That night I felt like a bombshell victim, traumatized by all the falls I had taken, and worse, the falls I knew I had yet to take. I convulsed awake after "feeling" the sensation of falling. I'd never before experienced nightmares on a wall.
I hadn't considered using the drill buried deep in our haulbag, but I had broken the flake and it wasn't going to hold a hook. I eventually drilled, and counted exactly four rotations, the minimum amount of rock removal to hold a hook, and in line with the first ascentionists' dimpled trademark. The sixth pitch ended up being one of the most natural pitches on the Great Slab, winding through the weaknesses, using every feature possible. It was the most aesthetic pitch on the slab and I even placed cams in a crack. It was good to see Jensen and Smith's choice beginning to make sense.
The next day we watched our peregrine buddies score a meal. A male peregrine pounded into a swallow and dived after it while a female peregrine chased. With its kill in its mouth, the male swooped up and landed on a ledge parallel to ours, only 50 feet away. We watched in awe as the male spread his wings and wouldn't let the female near until he was nearly done devouring the swallow. Then he flew off with the remains clutched in his talons, while the female pecked bits of the meat in mid air.
We were three pitches from the Overseer Roof, the obvious feature that marks the end of the slab, nine pitches up, and I couldn't wait to put my paws into the cracks. I'd had more than enough of the slab! The clouds had continued to threaten and Jensen and Smith's descriptions of getting pounded by waterfalls haunted me. A few hours later we were merrily hanging out on the top of pitch seven.
The next afternoon when Kait made her daily call home, she said, "Two more pitches and we are done with the slab." I made my way up to "The Pits," a scooped section disrupting the smooth slab where I was able to place cams in a nice crack—finally! I lowered from the last rivet before I could make the belay, leaving 35 feet of natural hook and head placements for the following morning.
Those 35 feet ended up taking an hour and a half. The ninth pitch also had some good features. It started out with bathook holes between rivets to a nice head seam that turned into a crack that took cams. Some hooking between rivets brought us to the Overseer Roof where Wings of Steel shares the Horse Chute anchor. That night we shared our camp with a crack full of chirpy swallows and I drank the last of the beer and whiskey.
I racked ten pounds of cams onto my chest harness and set off through the grassy crack. I didn't care that it wasn't clean—just being able to place cams for an entire pitch made me giddy. Beaks and a few heads took me about halfway up the next pitch, the 11th. A bulge in the middle was the crux and sharp edges on the rock were definitely a concern. I hooked and headed, precariously making it onto some tipped-out beaks. I arrived at the belay, four quarter-inch bolts, knowing that we had the equipment to beef it up, but not wanting to add anything to the route. The original hardware seemed sufficient. I fixed the lead line and yelled down to Kait to lower the bags, leaving her to clean in the dark. After hauling, stacking the ropes, setting up the portaledge and getting out all the supplies we would need, I settled in comfortably. That's when I heard a small voice from below.
"Babe, I'm stuck … I need help."
"What's going on?" I yelled. The next 20 minutes I tried to talk her through the predicament, but finally gave up and rapped on the tag line. I wasn't happy and lost my composure, once again yelling. I found her hanging exhausted in midair, between two pieces, not able to reach behind her and clean a welded knifeblade. I got Kait on the rope and she jugged the line to the bivy. It wasn't long before we were both back at the ledge, comatose.
I was worried about pitch 12 because in Jensen's book he said that he had placed 73 pieces of gear, most of them #0 heads, and our head rack was thin. The pitch started off with a few beaks and opened to a #3 Camalot. I placed the blue cam and heard chirping in the back of the crack. Twenty feet later I realized that I had plugged the door to a swallow's home, her anger evident as she flew in frantic circles trying to reach her babies. I put in a couple of good pieces and had Kait lower me so I could remove the cam and let the family reunite.
"If only everybody knew what a softy you are," she said, laughing. I continued to the belay and felt that with our modern gear the pitch wasn't all that bad, just tricky.
I started the last pitch, the bathook hole traverse, which took no more than 10 minutes. Kait did a couple of lower-outs and we were on Aquarian, finished with the second ascent of Wings of Steel.
From Aquarian Wall, we only needed a few days to reach the summit, in spite of it being nearly as many pitches as Wings of Steel. We were hauling the final pitch when our friend Dean Potter came free soloing by. We chatted a bit, catching up since we hadn't seen each other for a while. Kait and I gave one another a huge hug on the summit, took the obligatory photo, then headed for the East Ledges descent.
On the way down I started thinking again about the Wings of Steel controversy. Most of us climb for ourselves and don't really care what anyone else thinks. There are no written rules. We can do what we want when establishing routes and only have our peers to judge us, to steer us in the right direction if we're out of line. With everything in society that can go too far, who is to say how many holes are justifiable for a good aid route?
These questions swirled in my head as I stumbled down the trail. I was unsure of the answers, but I did know that we had had a great journey on an obscure part of El Capitan. The route had not been easy and I learned a lot about micro-hooking on a slab. We had learned something about ourselves and each other as well, things like patience and forgiveness.
I also pondered Jensen and Smith's hole count. They reported drilling 157 placements. Counting the 30 or so bathooks I used, the route as I found it had 188 drilled placements, which includes 48 belay bolts, some of which were likely added during repeat attempts. Subtract out the 30 drilled hooks that Jensen and Smith deny placing, and their hole count is almost exact.
But you can't subtract the bathook holes, which begs the question: Where did they come from? It is conceivable that the drilled hooks were added by a later and unknown party. Yet I tried to avoid the drilled holes and hook around them, but couldn't find any natural features, even well off to the side. I had to use the holes. The drilled hooks are one mystery about the route that may never be solved.
Then there is the question of whether Wings of Steel is El Cap's hardest.
I took 20 falls, triple the amount of any other El Cap route that I have done. In total, I logged about 500 feet of air—half the distance of the entire slab! So if falling is an accurate measure of difficulty, then Wings of Steel is the hardest. But it is hard only because of the technical hooking, and it is relatively safe. The aid route with hard and dangerous technical climbing is Warren Hollinger and Grant Gardner's 1998 Nightmare on California Street (A5), unrepeated despite strong attempts.
Is Wings a good route? Depends on what you're after. I think my feelings about the route were best summed up by Jim Bridwell when he described one of his routes on Half Dome by saying: "I wouldn't recommend it to my worst enemy."
And what of Jensen and Smith? They went on to do the second ascent of the most feared aid route in the world, Jim Beyer's Intifada (V A5), in the Fisher Towers, and the fifth ascent of Sea of Dreams (VI A5) on El Cap. Do they feel vindicated now that Wings of Steel has been repeated?
"Maybe 'vindication' is nothing more than a shift from the majority believing we lied, to a majority believing we told the truth" says Jensen. "Perhaps there's some hope for that."
Ammon McNeely, aka The El Cap Pirate, has climbed El Capitan 68 times via 53 different routes. He holds 23 El Cap speed records, including 11 first one-day ascents. McNeely and Barber live in Oakdale, California.


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Read the fine print:
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However, the real-world ambiguities and uncertainties of policy and strategy rarely accommodate this understandable desire. George Tenet's assertive claim to President George W. Bush preceding 2003 American invasion of Iraq that Saddam's possession of weapons of mass destruction was a 'slam-dunk' case did not make it necessarily so. The CIA director's confident assertions were conclusively proven wrong. In hindsight, this false sense of certainty rested on a flimsy case of largely circumstantial evidence underpinned by the unquestioned logic that Saddam had to be guilty of developing WMD because he hadn't proven himself innocent through total unconditional cooperation with international inspectors.
The parallels with present-day Iran are striking. The international community is essentially requiring Iran to prove the negative case that it doesn't have a covert nuclear weapons program. As I've suggested elsewhere (here and here), no international inspection regime can guarantee success although a rigorous regime can be an effective deterrent to developing a nuclear weapons capability.
The most recent IAEA report does not definitively clarify the status of Iran's nuclear program, although it largely confirms the assessment of the US intelligence community that Iran has not yet made a decision to go forward with a nuclear weapons program. For instance, the report notes that "the Agency continues to verify the non-diversion of declared nuclear material at the nuclear facilities…declared by Iran." This is a clear statement that there is no concrete evidence indicating Iran is diverting its nuclear fuels for military purposes. This conclusion is consistent with repeated claims by Iranian political and religious leaders that Iran has no intent of producing nuclear weapons. Indeed the highest religious authority in Iran – a country whose identity is grounded in Shi'a Islamic theology — has declared the pursuit of nuclear weapons a 'big and unforgiveable sin'. Eternal damnation can be a powerful incentive for good behavior.
However, the IAEA report goes on to say in the very same summary concluding paragraph that without unrestricted cooperation with the IAEA (something no sovereign government would tolerate from an outside international body), "the Agency is unable to provide credible assurance about the absence of undeclared nuclear material and activities in Iran." In other words, Iran – like Saddam – has to prove its innocence. Clearly, this latest IAEA assessment on Iran falls far short of George Tenet's 'slam dunk' standard of proof for Iraq. Nonetheless, there remains sufficient ambiguity in the report's language providing alarmists both here and in Israel with sufficient fodder to protest about the continued possibility that Iran could have a covert nuclear weapons program hidden from view of international inspectors. The likelihood is that future IAEA reports will continue to offer similarly ambiguous and qualified assessments. Thus informational clarity will continue to elude policymakers as the IAEA hedges its bets.
Of course, some policymakers will strive to compensate for this inherent ambiguity by creating a sense of policy certainty. Israeli Prime Minister Netanyahu is only the most recent example as he pushes the international community (read the United States) to remove any uncertainty in Iranian calculations by setting a "clear red line" for military action against Iranian nuclear facilities. This demand for clarity is especially ironic given Israel's long-standing policy of strategic ambiguity regarding its own nuclear weapons capabilities. Apparently, it is uncertainty and ambiguity in the case of Israel's nuclear capabilities that has its apparent strategic advantages.
PM Netanyahu's essential argument is that the chances of Iranian miscalculation are reduced if leaders in Tehran are convinced that overwhelming military action will be taken if certain 'red lines' are crossed. The problem, however, is in determining where the appropriate 'red line' is to be drawn. PM Netanyahu, as well as some American politicians, would seek to make the mere possession of a "nuclear-weapons capability" by Iran a red line; others suggest drawing the line before Iran has reached a suspected 'zone of immunity' – a point at which when military action becomes ineffective at eliminating an Iranian nuclear weapons program. However, these are themselves ambiguous thresholds that defy clear definition. Is this line crossed when Iran has produced sufficient nuclear fuel for a bomb? When Iranian underground enrichment facilities are in theory capable of producing highly enriched uranium? When Iran actually produces weapons-grade fuel? When Iran has acquired the scientific knowledge needed to design a nuclear weapon; to actually produce a nuclear weapon? When Iran has successfully tested a nuclear weapon? When Iran has successfully mated a nuclear warhead to a missile capable of hitting targets in Tel Aviv, Madrid, or New York? And the list goes on. The search for clearly identifiable 'red lines' in Iran's case is illusory.
Moreover, there is also the alternative prospect that strategic clarity itself could be counterproductive — especially if the goal is to reach a diplomatic resolution of this problem. Most analysts recognize that the minimum acceptable deal from an Iranian perspective is an agreement that will allow some level of domestic nuclear fuel enrichment by Iran in exchange for intrusive inspections that verify the non-diversion of technologies and fuels to military purposes. Such an agreement would be consistent with the terms of the Nuclear Non-Proliferation Treaty which confers on Iran (as with any signatory to the treaty) the "inalienable right…to develop research, production, and use of nuclear energy for peaceful purposes without discrimination." However, permitting these activities would necessarily enhance Iranian nuclear know-how, expand Tehran's access to advanced nuclear technologies (even if only civilian), and thus likely shorten the timeline to nuclear weaponization if that were the intent of leaders in Tehran. In this case, the strategic 'clarity' demanded by PM Netanyahu could well undermine the achievement of his basic strategic objectives – limiting Iran's access to nuclear technologies in order to prevent Iran from becoming a nuclear weapon state. Of course, this is exactly why the 'red lines' envisaged by Prime Minister Netanyahu are likely to abridge the basic rights entailed within the NPT (to which Israel is not a signatory) and thus serve to simultaneously undermine prospects for a diplomatic resolution – raising an entirely different set of strategic complications and challenges for decision-makers in Washington and Tel Aviv.
Finally, the Christian Science Monitor recently echoed these calls for certainty by making an empty plea for "more information, not less…for decisions of peace and war"; by critiquing President Obama for not having a clear "red line" for military action; and by calling for the President to 'clarify' his position at the upcoming Democratic National Convention. As we've already discussed, the latest IAEA report is evidence enough that no definitive evidence in Iran's case is likely to be forthcoming. Moreover, echoing Prime Minister Netanyahu's desire for specific triggers for military action also has its practical downsides, as we've already explored. Additionally, clear 'red lines' now would obligate the actors – whether the international community, the United States, or Israel — to specific actions down the road. Those 'red lines' made explicit now will necessarily narrow the future flexibility of the decision-makers at a time when nuance and sophistication may be required to avert a crisis. These 'red lines' could also limit the ability of policymakers to adopt a more favorable course of action that is not readily apparent in the present. Unfortunately, President Obama has already unwisely fallen victim to this trap by publicly dismissing the viability of a strategy of containment in his AIPAC speech earlier this year. Finally, these premature pledges to action ultimately risk the credibility of these actors should they fail to make good on these commitments whatever the subsequent justification.
The nature of the strategic environment is one of volatility, uncertainty, ambiguity, and complexity (VUCA). To be successful, policies and strategies must admit to these realities. To pretend there is certainty where there is none, to create a false sense of assurances about the present or future actions of states, or to overly simplify a complex problem is to court disaster.
Christopher J. Bolan, Ph.D., Col. (R), U.S. Army, is a Professor of National Security Studies at the U.S. Army War College. The views expressed are his own and do not necessarily reflect the positions of the U.S. government.


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FOR MUSIC'S SAKE: Upstage scrapbook reveals a chunk of Springsteen history
"For Music's Sake," a book first published in 2011, fell into my lap recently thanks to its author, Carrie Potter Devening, who happens to be the granddaughter of Tom Potter. Springsteen historians will recall him as the owner of the Upstage Club in Asbury Park, one of the seminal venues from Bruce's earliest years. There's a great segment in Peter Ames Carlin's "Bruce" where Tom's wife Margaret runs excitedly to get him after a young Bruce first takes their stage. (A story retold in this volume in Margaret's own words.)
Far from just owning the Upstage, though, Tom was an ardent artist, photographer and writer (and hairstylist, for that matter), and Potter Devening's book — subtitled "Asbury Park's Upstage Club and Green Mermaid Cafe – The Untold Stories" — captures all elements of his life and background in scrapbook format. It's clearly a labor of love, and it's fascinating.
It's not a Springsteen book per se, but he certainly looms large as an important chunk of the Upstage's glorious (and sometimes sketchy) history. One segment tells of the group of young female patrons who would regularly whack Bruce and Stevie Van Zandt in the butt with spoons as they passed on the way to the cafe. "Stevie didn't know what to make of the spoon attacks," says their Upstage cohort Albee Tellone in the book. "I had to reasure him that the girls thought he was hot and that's how they expressed it. I think Bruce enjoyed the attention."
That story turns tragic when the group's ringleader, Anne Furlong — "Bruce's number one fan," according to her friend Nancy Ferriss — was killed by a vagrant in AP. Potter Devening includes a news clipping about her death, just one example of how the author paints a complete and touching picture of that place and time.
And then there are the photos — the book is absolutely plastered with them from start to finish, alongside letters, news clippings and oral histories. The images are priceless, particularly the full-page spreads of Springsteen and Van Zandt rocking out on the tiny stage, long-haired and shirtless (or in one instance for Bruce, in a red Mickey Mouse t-shirt). You can absolutely smell the atmosphere.
I'm still working my way through it — it's the type of book that needs to be savored in chunks rather than read straight through. But it's clearly a must-have for anyone interested in Springsteen's earliest years, a special era in Asbury Park or just about how one special couple's efforts to reach out to the young and artistic in their community made a real difference. You can order a copy here.


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[This post was first published in October of 2007.]
Several weeks ago, as part of its much lauded "Dove Campaign for Real Beauty," Unilever released "Onslaught," a video (above) examining disturbing images of women in beauty-industry advertising. The video ends with this admonition to parents: "Talk to your daughter before the beauty industry does."
It's a powerful video with a disturbing collection of images. The situation of our daughters — and, by the way, our sons — seems both overwhelming and diabolical. Read the comments about the film on the Dove website discussion board, and you can feel the love and gratitude that viewers, particularly mothers, feel toward Dove for this film.
Skimming the first ten comments, one finds these reviews and remarks:
"This is a POWERFUL little film for sure"; " I love the message behind the Dove movies/ads"; "I applaud Dove once again"; " I think this film is wonderful!"; "I applaud Dove for launching their campaign of what beauty really is"; "Kudos to DOVE for taking a stand"; "My reaction to 'Onslaught' is that I want to cry"; and "Thank you for launching this campaign as it is way overdue."
There's a problem that is easily lost when one contemplates the impressive production that "Onslaught" represents and the possibility that at least some corporations just may be our friends — the kind of friend who cares about our kids and who we can trust to help teach our children the valuable messages about what "real beauty" is and about the traps and dangers of our shared environment.
No, there are actually several problems.
To begin with, although Dove claims to "provide[] a refreshingly real alternative for women who recognise that beauty comes in all shapes and sizes," even the Dove models seem to fit quite comfortably within a slightly expanded perimeter of conventional conceptions of beauty. The young girls, for instance, who represent "our children" in the film "Onslaught" are exceptionally attractive children even by commercially influenced cultural standards.
The same is true for the models in the Real Beauty campaign — yes, there is variety, but the variety is measured in small deviations around an average that is itself only a tiny enlargement of the single standard of beauty given to us by those other beauty products. In other words, Dove's claim that beauty comes in "all shapes and sizes" seems to mean that beauty comes in "a few more shapes and sizes — particularly if the women are laughing and playing together in their underwear."
What is the implicit message to those girls and women who don't measure up to even the "lowered" Dove standard? And what is the message of these particular images — where groups of young women reveal their "inner beauty" by standing in their underwear touching, rubbing, and giggling?
There may be another even more troubling feature of these ads. Telling parents to "talk to [their] daughters before the beauty industry does," is equivalent to telling parents to teach their children how to float in thin air before gravity gets to them. The beauty industry "talks" to our children either directly or indirectly at virtually every waking moment, and, I suspect, during many of our children's dreams. If you don't agree, just watch "Onslaught" again. Those images set the beauty standard not simply for the young girls who strive to slim down and measure up, but also of their friends and families and society at large. Those cultural expectations and pressures enmesh our children even when the ads and posters are briefly out of sight.
Parents fortunate enough to have the time, energy, and resources to "talk to their children" meaningfully and consistently about "real beauty" might be able to hold their children up against the force of gravity for a brief spell. Eventually, though, the "onslaught" of commercial images and messages will take its toll. After all, the barrage is incessant, multidirectional, and credible. Existing beauty standards matter in the lives of those who do, and those who do not, meet them. A parent's words are among the least frequent, least credible, and least relevant words that their adolescent children will hear, particularly when it comes to questions of beauty and social acceptance among their peers. In fact, by even focusing on the problematic standards of beauty that their children face, parents risk underscoring and strengthening the power of that standard.
The "Onslaught" video may itself have that effect by bringing into relief the current unforgiving and unrealizable standard of beauty that now dominates our culture. Thus, while the "Onslaught" video urges parents to "talk to your daughters," it probably should add "but don't show them this video" which all-too-clearly highlights the undernourished and oversexualized prototypes of "beauty."
A parent's task is made that much more difficult by the fact that commercial marketing is not simply teaching our children about the importance and meaning of "beauty," it is also pitting parents and kids against one another — from encouraging children to "nag" for more stuff to undermining the credibility and authority of parental limits or advice. (For fascinating and detailed accounts of the consumerist kidnapping, you can read Susan Linn's Consuming Kids or Juliet Schor's Born to Buy — if time permits, both are worth reading. For an excellent website covering these topics, visit the Campaign for a Commercial-Free Childhood.)
Do not misunderstand: I accept that some parents may be able to make some difference — or, as a parent of three, I hope that is true. My point is that parents are competing against a force that is far larger than any one of us, a force not of our choosing.
As Cornel West and Sylvia Ann Hewlett have written:
[S]imply heaping blame on overburdened moms and dads will not solve our problems. Modern-day mothers and fathers, like those before them, struggle to put children at the center of their lives. But major impediments and obstacles stand in their way, undermining their most valiant efforts. From early in the morning till late at night, America's parents are battered by all kinds of pressures, most of which are not of their making.
It seems peculiar, therefore, that Dove would offer a film demonstrating the ubiquitous attack of the beauty industry that ends with the suggestion to parents that they are the ones to make a difference by simply talking to their kids. If the industry is the problem, it strikes me as odd that the parents are supposed to be the solution.
"Peculiar?" "Odd?" Maybe the word "suspicious" is a better fit. Telling parents to talk to their children is not unusual as a public relations strategy. For instance, Philip Morris, among other companies, has long been pushing that message in its "public service" ads, particularly since the industry began to face a real threat of tort liability in the 1990s. The message seems public-spirited, but most industry analysts believe that Philip Morris is delivering, not a public-service message to parents, but a responsibility-shifting message to the public: kids smoke because of uninvolved or irresponsible parents, not because of anything that Philip Morris has done. (For a discussion of how the fast food industry has engaged in similar attribution-shifting tactics, you can link to an article by Situationist contributors Adam Benforado, David Yosifon, and me by clicking here.)
To add to my suspicions, many of the comments on the Dove website indicate that those who watch the video are concluding that the problem created by the beauty industry should be solved by parents — as if the industry conduct is immutable and the key variable to protecting our children is the presence or absence of good parenting.
Here is a sample of comments — again, from the first ten on the Dove website discussion page:
"I do NOT condone the way a lot of families allow their children to become obese"; "[S]hame on their parents for letting this affect their child"; "The media is not totally to blame"; "I do believe that it is the job of the parent to their daughters. I have read articles describing girls at 16 and younger getting plastic surgery and breast augmentation. What's wrong with those parents??"; "it all starts in the home and with the kind of role model a mother is to her daughter"; and "I do agree that it is up to parents to educate children about what is right and what is wrong."
If Dove were attempting to shift responsibility to parents for the "beauty" preoccupation of adolescent girls, it seems to be working. But, still, why would Dove do that?
One plausible answer is that they wouldn't. Dove is selling soap, not tobacco. Any suspicions that one might have about the Philip Morris campaign do not translate easily to the message of the "Onslaught" video. To be sure, Dove may be criticizing the rest of the beauty industry and its standards to maximize its own profits; expressing concern (genuine or not) about our children might be a saavy route to getting our dollars. Selling "real beauty" instead of "commercialized beauty" seems a brilliant strategy for distinguishing Dove products form those of its competitors and for attracting that group of consumers who fancy themselves beautiful, but who want to reject the standards of "unreal beauty" set by those other beauty product ads. The returns indicate that this plus-sized marketing strategy has been immensely profitable. But that sort of profit-seeking does not seem particularly nefarious. As one commenter on the Dove website puts it:
"Good for Dove to tackle the 'real beauty' of women. As a former, public relations professional it's hard for me not to be cynical of the company's dollar-driven agenda, but I'm moved by the campaign and hopeful that others will follow suit in responsible social marketing."
If it's profitable for Dove to push meekly against the tide of commercial messages, more power to them, right? Philip Morris, in contrast, is attempting to shift blame that otherwise would be placed on them through law suits, legislation, and regulation or through reduced consumption by an angry public. Dove does not face those potential costs or public relations problems, so why would they want to shift responsibility from the beauty industry toward parents?
The second plausible answer is more troubling.
Dove is not, as most people seem to imagine, a company devoted to helping parents and their children in their battles against the polluting and quasi-pornographic images and messages of commercialized beauty products. Dove is not a person, and Dove is not a friend.
Dove is a brand — one member of a "family" of brands owned by the company Unilever. If Dove were a person, then, Unilever would be its parent. And, in light of that relationship, the question is, not whether Dove would have an incentive to shift responsibility to parents for the practices of the beauty industry, but whether Unilever would. Is Unilever acting responsibly by doing its part to stem the "onslaught"? If not, is it possible that that is because Unilever has the same sort of incentive that Big Tobacco has for shifting responsibility to others for the consequence of their own culpable conduct?
When one gives some thought to that question, the "real beauty" campaign begins to look a little ugly.
Unilever, as a company, seems uninterested in expanding our conceptions of beauty, much less in helping parents confront the problem of beauty-industry marketing. Unilever is not part of the solution; in fact, Unilever — one of the largest manufacturers of cosmetics, skin lighteners, diet products, and the like — may be one of the worst offenders.
A previous Situationist post has already detailed some of the ways that Unilever helps to set and reinforce harmful beauty standards with its products and marketing. (See "Shades of Fairness and the Marketing of Prejudice.") But there is more to say . . . or show.
In fact, the cascade of objectifying images in the "Onslaught" video seem surprisingly tame when compared to some of the actual ads for other Uniliver products. Consider, for example the following two ads for Lynx body spray, a male deodorant that seems to promise more than just deodorizing (indeed, the product slogan is "Spray More. Get More"):
According to the Dove website, "The Dove Campaign for Real Beauty is a global effort that is intended to serve as a starting point for societal change and act as a catalyst for widening the definition and discussion of beauty." Apparently Unilever has a different global vision. To learn more about the global "Lynx Effect," check out this ad:
Unilever's other body spray, Axe, is no better, as the following videos illustrate:
What are those ads if not an onslaught? The Dove website explains that "the media and advertising set an unrealistic standard of beauty that most women can't ever achieve." Elsewhere, the website describes the pressure on young women this way:
"The comparisons are non-stop, especially among girls who see rich, beautiful young women in the media and want to be just like them. Dissatisfaction with body image increases as girls move into adolescence, according to a 2000 study by the Girl Scout Research Institute. Although 75 percent of 8- and 9-year-old girls in the study said they like their looks, only 56 percent of those ages 12 and 13 did. And of the 33 percent of girls ages 14-17 who said they're too fat, two-thirds were dieting. Ninety percent of eating disorders are diagnosed in girls."
Ummm. Good point.
But if the problem is sexualized stereotypes and unhealthy body types, then why is Dove telling parents to "talk to their kids before the beauty industry does"? Shouldn't Dove be talking to its parent about not talking to our kids? Why would we applaud the arsonist when he passes out pamphlets on how to fight fires? Why buy mousetraps from the same person who dumped rodents into our basement? Should we not judge Dr. Jekyll in part by the sins Mr. Hyde?
If Dove cares about "real beauty," it should start at home. If Unilever doesn't care about "real beauty" it should stop getting rich off the illusion that it does. And if the beauty industry is the source of the onslaught, then Unilever, through Dove advertising, should not be permitted to blame the victims for its own contribution to that attack.
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Situationist friend and legal scholar Tamara R. Piety has recently written an outstanding law review article that, among other things, discusses and further develops some of the themes highlighted in this post. Her article , titled "Onslaught: Commercial Speech and Gender Inequality," is forthcoming in Case Western Law Review (2009). The abstract is as follows.
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Utilizing Dove's infamous "Onslaught" viral ad, this Article explores the ways in which commercial speech constructs images of and attitudes toward women that interfere with full equality for women. Advertising and marketing contribute to creating a social reality in which it is taken for granted that women must spend a great deal of time on appearance and that appearance is of critical importance to life success. As is typical for much advertising, it does this by stimulating anxiety. Such anxiety contributes to low self- esteem, lowered ambitions and stereotype threat reactions, as well as to biased reactions on the part of others. Harms such as these are often justified on the basis of the right of the speaker to participate in public debate or in the public's right to receive advertising "information." The Dove ad itself, however, illustrates the problem in locating a "speaker" for commercial speech and raises questions about the nature of the "information" provided by advertising. Because commercial speech lacks an author with moral interests and because it only has informational value when it is true, this Article presents an argument that women's interest in equality and freedom from harm should outweigh the commercial interests of the speakers, at least to the extent that commercial speech be denied any First Amendment protection beyond that already extended to truthful speech.
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To download Piety's article for free, click here.
For a previous Situationist post highlighting some of the uglier beauty messages of Unilever, see "Shades of Fairness and the Marketing of Prejudice." For a post discussing the situational causes and consequences of beauty, see "Survival of the Cutest." For a sample of other related Situationist posts, check out "The Marketing Situation of Children," "The Magnetism of Beautiful People," "Prejudice Against the Obese and Some of its Situational Sources," "Spas and Girls," and "Fitting in and Sizing up."
To read a New York Times article discussing the seeming contradiction in Unilever's marketing strategies, click here. To read a Los Angeles Times article on the Campaign for a Commercial-Free Childhood's criticism of the Unilever contradiction, click here.


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Industrial Manufacturing TickIT Certification - Software Quality Assurance Certification
The TickIT scheme is an ISO 9000 management system certification for software producers and service suppliers. It is geared toward organizations where the primary business activity is the development and distribution of software products, the operation of data centers or the provision of information services. The scheme provides best practices for design, development and support throughout the software development lifecycle. SGS is a trusted leader in software quality assurance certification, including TickIT.
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Deep Vein Thrombosis
Topic Overview
What is deep vein thrombosis?
Deep vein thrombosis (DVT) is a blood clot (thrombus) in a deep vein, usually in the legs.
Clots can form in superficial veins and in deep veins. Blood clots with inflammation in superficial veins (called superficial thrombophlebitis or phlebitis) rarely cause serious problems. But clots in deep veins (deep vein thrombosis) require immediate medical care.
These clots are dangerous because they can break loose, travel through the bloodstream to the lungs, and block blood flow in the lungs (pulmonary embolism). Pulmonary embolism is often life-threatening. DVT can also lead to long-lasting problems. DVT may damage the vein and cause the leg to ache, swell, and change color.
Blood clots most often form in the calf and thigh veins, and less often in the arm veins or pelvic veins. This topic focuses on blood clots in the deep veins of the legs, but diagnosis and treatment of DVT in other parts of the body are similar.
What causes deep vein clots to form?
Blood clots can form in veins when you are inactive. For example, clots can form if you are paralyzed or bedridden or must sit while on a long flight or car trip. Surgery or an injury can damage your blood vessels and cause a clot to form. Cancer can also cause DVT. Some people have blood that clots too easily, a problem that may run in families.
What are the symptoms?
Symptoms of DVT include swelling of the affected leg. Also, the leg may feel warm and look redder than the other leg. The calf or thigh may ache or feel tender when you touch or squeeze it or when you stand or move. Pain may get worse and last longer or become constant.
If a blood clot is small, it may not cause symptoms. In some cases, pulmonary embolism is the first sign that you have DVT.
How is deep vein thrombosis diagnosed?
If your doctor suspects that you have DVT, you probably will have an ultrasound test to measure the blood flow through your veins and help find any clots that might be blocking the flow.
How is it treated?
Treatment lowers the chance that the blood clot will grow or that a piece of the clot might break loose and flow to your lungs.
Treatment for DVT usually involves taking blood thinners (anticoagulants) for at least 3 months to prevent existing clots from growing.
Your doctor also may recommend that you prop up or elevate your leg when possible, take walks, and wear compression stockings. These measures may help reduce the pain and swelling that can happen with DVT.
How can deep vein thrombosis be prevented?
There are things you can do to prevent DVT. You might take an anticoagulant medicine to prevent blood clots. You might also wear compression stockings. You can try to get up and out of bed as soon as possible after an illness or surgery. If you are sitting for a long time, like during a long flight, you can exercise your legs to help blood flow.
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Deep vein thrombosis (DVT) is a blood clot in a deep vein, usually in the legs. Things that lead to a blood clot in a vein include:
- Slowed blood flow, which can happen when you're not active for long periods of time.
- Abnormal clotting problems, which make the blood clot too easily or too quickly.
- Injury to the blood vessels, because blood is more likely to clot in veins shortly after they are injured.
Deep vein thrombosis often does not cause symptoms or causes only minor symptoms. When symptoms occur, they include:
- Swelling.
- Warmth.
- Pain or tenderness. The pain may be in the calf or thigh and may be present only when the affected area is touched or when standing or walking.
- Redness.
Other problems may cause symptoms like those of DVT. So diagnosing DVT can be difficult. These problems include less serious problems like cellulitis or a pulled muscle.
Symptoms of pulmonary embolism
Sometimes life-threatening pulmonary embolism is the first sign that you have DVT. Pulmonary embolism is the sudden blockage of an artery in the lung. Symptoms of pulmonary embolism include:
- Sudden shortness of breath.
- Chest pain that may get worse with a deep breath.
- A cough that may bring up blood.
- A fast heart rate.
- Fainting.
What Happens
Pulmonary embolism
When you have deep vein thrombosis (DVT), the main goal of treatment is to prevent the blood clot from growing or moving to the lungs. If a blood clot breaks loose, it can travel to the lungs and block blood flow (pulmonary embolism). A pulmonary embolism is an emergency. Treatment for DVT lowers your risk for this problem.
The risk of a pulmonary embolism can depend on the location of the blood clot. A pulmonary embolism is more likely if a blood clot is at or above the knee than if it is in the calf. But a blood clot in a calf also has a chance of causing a pulmonary embolism.
For more information, see the topic Pulmonary Embolism.
Risk of more blood clots
After the first time you have deep vein thrombosis, there is a risk of having blood clots again. Your risk can depend on what caused your blood clot and how it was treated. Your doctor will treat you to try to prevent blood clots from happening again.
Post-thrombotic syndrome
If you have had DVT, you have a risk of a painful complication called post-thrombotic syndrome. Anticoagulant medicine may help lower the risk of this complication.
What Increases Your Risk
Many things increase your risk for deep vein thrombosis (DVT). These include:
- Being older than 40.
- Being overweight.
- Not taking anticoagulant medicine as prescribed.
Other risks include things that cause slowed blood flow, abnormal clotting, and a blood vessel injury.
Slowed blood flow
Blood does not flow normally if you are not active for long periods of time. Examples include:
- Long-term bed rest, such as after a surgery, injury, or serious illness.
- Sitting for a long time, especially when traveling long distances.
- Leg paralysis.
Abnormal clotting
Some people have blood that clots too easily or too quickly. Problems that may cause increased clotting include:
- Inherited blood-clotting problems.
- Family history of close relatives, such as a sibling, who has had deep vein thrombosis or a pulmonary embolism.
- Cancer and its treatment.
- Blood vessel diseases, such as varicose veins, heart attack, heart failure, or a stroke.
- Pregnancy. A woman's risk for developing blood clots increases both during pregnancy and shortly after delivery or after a cesarean section.
- Using hormone therapy or birth control pills or patches.
- Smoking.
Injury to the blood vessel wall
Blood is more likely to clot in veins shortly after they are injured. Examples include:
- Recent surgery that involved the legs, hips, belly, or brain.
- Having a central venous catheter during a hospital stay.
- Injury, such as a broken hip.
When should you call your doctor?
Call 911 or other emergency services if you have pulmonary embolism symptoms, including:
- Sudden shortness of breath.
- Sharp chest pain that sometimes becomes worse with deep breathing or coughing.
- Coughing up blood.
- Fainting.
- Rapid pulse or irregular heartbeat.
- Anxiety or sweating.
Call your doctor immediately if you have DVT symptoms, including:
- Swelling, warmth, or tenderness in the soft tissues of your leg. Swelling may also appear as a swollen ridge along a blood vessel that you can feel.
- Pain in your leg that gets worse when you stand or walk. This is especially important if there is also swelling or redness in your leg.
Who to see
Health professionals who can diagnose a blood clot in the leg include:
Exams and Tests
First checks
When you first see the doctor, he or she will do a physical exam and ask questions about your medical history. These help your doctor decide what tests you need based on your risk for deep vein thrombosis (DVT).
Physical exam
Your doctor will check:
- Your heart and lungs.
- Your legs for warmth, swelling, bulging veins, or changes in skin color.
Medical history
Your doctor may ask:
- Do you have any swelling or pain in your legs?
- Have you had a blood clot before?
- What medicines do you take?
- Have you had surgery recently or have you been on any long trips lately?
Ultrasound test
Ultrasound is the main test used to help diagnose DVT. It creates a picture of the flow of blood through the veins.
If your doctor thinks you should have more tests, you might have two or three more ultrasounds over the next 2 weeks.
Additional tests
More tests may be used when ultrasound results are unclear. These tests often aren't needed, but they may help diagnose or exclude a blood clot in the leg. These tests may include:
If your doctor thinks you might have a pulmonary embolism, he or she may test your lungs. For more information, see the topic Pulmonary Embolism.
Blood thinner testing
If you are treated with anticoagulant medicines, you may need periodic blood tests to monitor the effects of the anticoagulant on the blood. Blood tests include:
- Activated partial thromboplastin time (APTT) to monitor treatment with heparin.
- Prothrombin time (PT), also referred to as INR, to monitor treatment with warfarin (Coumadin).
Tests for clotting problems
Special blood tests may help identify inherited blood-clotting problems that can increase your risk of forming blood clots or help explain why you got a blood clot. These tests check for genetic conditions or specific proteins in your blood.
Testing might be done if you have or had one or more of the following:
- A blood clot in a vein that has no clear cause
- A blood clot at age 45 or younger
- A blood clot in a vein at an unusual location, such as the gastrointestinal region, the brain, or the arms
- A first-degree family member (mother, father, brother, or sister) who has had a blood clot in a vein before age 45 or has had problems with blood clotting
Screening for these problems in the general population is not routinely done.
Treatment Overview
The main goals of treatment for deep vein thrombosis (DVT) are:
- To prevent the blood clot from becoming larger.
- To prevent the blood clot from traveling to the lungs (pulmonary embolism).
- To prevent post-thrombotic syndrome, a condition that can cause pain, sores, and swelling of the affected leg.
- To prevent blood clots from returning.
DVT is usually treated with anticoagulant medicines. These medicines are often called blood thinners, but they do not actually thin the blood. They prevent blood clots by increasing the time it takes a blood clot to form. Also, anticoagulants help prevent existing blood clots from becoming larger.
You might take anticoagulants for at least 3 months. The length of time will vary based on your own health, where the blood clot is in your leg, and your risk for a pulmonary embolism.footnote 1
Other treatments may be used in the hospital for some people. These treatments include thrombolytic medicine or vena cava filters. These treatments are not common. They might be used for people who are at risk for serious problems from DVT.
For more information on these treatments, see Medications and Other Treatment.
Your doctor may also recommend self-care to relieve symptoms. This care includes:
- Walking.
- Elevating your leg.
- Wearing compression stockings.
For more information, see Home Treatment.
Preventive measures might be used before and after any procedure or event that increases your risk of deep vein thrombosis (DVT). These measures include:
- Taking anticoagulants to prevent a blood clot.
- Quitting smoking to lower your risk of blood clots.
- Exercising your lower leg muscles to improve circulation in your legs. Point your toes up toward your head so that the calves of your legs are stretched, then relax. Repeat. This exercise is especially important to do when you are sitting for long periods of time.
- Getting up out of bed as soon as possible after an illness or surgery. It is very important to get moving as soon as you are able. If you cannot get out of bed, do the leg exercise described above every hour to keep the blood moving through your legs.
- Usingcompression stockings to help prevent DVT if you are at an increased risk.
During travel
Sitting still for a long flight or road trip raises your risk of getting blood clots. It's important to take steps to prevent blood clots when you travel, such as getting up and moving around every hour or so on a long flight.
In the hospital
Intermittent pneumatic compression (IPC) devices are also used to prevent DVT. These devices inflate and deflate knee-high boots, which reduces pooling of blood in the legs. IPC pumps are often used when people stay in a hospital.
Home Treatment
Home treatment for deep vein thrombosis (DVT) focuses on:
- Taking anticoagulants (blood thinners) safely.
- Relieving symptoms.
- Wearing compression stockings.
Taking anticoagulants safely
If you take an anticoagulant medicine, also called a blood thinner, you need to take extra steps to avoid bleeding problems. These steps include:
- Preventing falls and injuries.
- Telling your doctors about all other medicines, supplements, and vitamins that you take.
- Getting regular blood tests, if your doctor tells you to.
For more information, see:
Relieving symptoms
To relieve symptoms like pain and swelling, your doctor might recommend:
- Walking 5 or 6 times a day, if possible.
- Elevating your leg.
- Wearing compression stockings.
If you are not taking an anticoagulant, your doctor might suggest that you take a nonsteroidal anti-inflammatory drug (NSAID), such as ibuprofen, to relieve pain. Do not take an NSAID unless your doctor tells you that it's safe for you.
Wearing compression stockings
Compression stockings are specially fitted stockings. They are tightest at the foot. They get less and less tight farther up on your leg.
Anticoagulant medicines, also called blood thinners, are used to prevent and treat deep vein thrombosis (DVT).
These medicines prevent new clots from forming and prevent existing clots from getting larger. They don't break up or dissolve existing blood clots.
Different types of anticoagulants are used. Talk with your doctor to decide which medicine is right for you.
For prevention, anticoagulants might be used:
- After some types of surgery.
- If you have a high risk for pulmonary embolism.
For treatment, you might take anticoagulants for at least 3 months. The length of time will be based on your own health, the location of the blood clot in your leg, and your risk for a pulmonary embolism.footnote 2
In the hospital, you might be given an anticoagulant as a shot or through an IV. After you go home, you might give yourself shots for a few days. For long-term treatment, you'll likely take a pill.
Medicine choices
Anticoagulants include:
- Apixaban (Eliquis).
- Dabigatran (Pradaxa).
- Edoxaban (Savaysa).
- Heparin. The two types of heparin are:
- Low-molecular-weight heparin.
- Unfractionated heparin.
- Rivaroxaban (Xarelto).
- Warfarin (such as Coumadin).
Thrombolytic medicines are not commonly used to treat DVT. Although they can quickly dissolve a blood clot, thrombolytics also greatly increase the risk of serious bleeding. They might be used for people who are at risk for serious problems from DVT.
How long will you need medicine?
If you're taking anticoagulants after surgery to prevent DVT, you only need the medicine for a short time. This might be 2 weeks or more, depending on the medicine and the type of surgery you had.
For treatment of deep vein thrombosis, you will likely take an anticoagulant for at least three months. You might take it longer, depending on your health.
You might take anticoagulants for a long time, maybe the rest of your life, if you:
- Have had blood clots before or have cancer or other risk factors that make it likely you'll get another blood clot.
- Have inherited blood-clotting problems.
Safety tips for anticoagulants
If you take an anticoagulant, you can take steps to prevent bleeding. This includes preventing injuries and getting regular blood tests if needed.
Surgery to remove a blood clot is rare. It's only considered if the blood clot is very large and is blocking a major blood vessel. Surgery increases the risk of forming new blood clots.
Other Treatment
Vena cava filters are used for some people who have deep vein thrombosis. For example, vena cava filters may be used if a person cannot take anticoagulant medicine. This is not a common treatment.
A vena cava filter is inserted into the vena cava, the large vein that returns blood to the heart from the abdomen and legs.
This filter can prevent blood clots from traveling to the lungs (pulmonary embolism). But the filter doesn't stop a clot from forming.
- Guyatt GH, et al. (2012). Executive summary: Antithrombotic therapy and prevention of thrombosis, 9th ed.—American College of Chest Physicians evidence-based clinical practice guidelines. Chest, 141(2, Suppl): 7S–47S.
- Guyatt GH, et al. (2012). Executive summary: Antithrombotic therapy and prevention of thrombosis, 9th ed.—American College of Chest Physicians evidence-based clinical practice guidelines. Chest, 141(2, Suppl): 7S–47S.
Current as of: September 26, 2018
Author: Healthwise Staff
Medical Review:E. Gregory Thompson MD – Internal Medicine & Adam Husney MD – Family Medicine & Kathleen Romito MD – Family Medicine & Jeffrey S. Ginsberg MD – Hematology
This information does not replace the advice of a doctor. Healthwise, Incorporated, disclaims any warranty or liability for your use of this information. Your use of this information means that you agree to the Terms of Use. Learn how we develop our content.


text:
Giants Sweep Tigers For World Series Title
Smart pitching. Clutch hitting. Sharp fielding. Plus an MVP Panda.
All the right elements for a sweet World Series sweep for the San Francisco Giants.
Nearly knocked out in the playoffs time and time again, and finally pressed by the Detroit Tigers in Game 4, Pablo Sandoval and the Giants clinched their second title in three seasons Sunday night.
Marco Scutaro — who else? — delivered one more key hit this October, a go-ahead single with two outs in the 10th inning that lifted the Giants to a 4-3 win.
"Detroit probably didn't know what it was in for," Giants general manager Brian Sabean said. "Our guys had a date with destiny."
On a night of biting cold, stiff breezes and some rain, the Giants combined the most important elements of championship baseball. After three straight wins that looked relatively easy, they sealed this victory when Sergio Romo got Triple Crown winner Miguel Cabrera to look at strike three for the final out.
"Tonight was a battle," Giants star Buster Posey said. "And I think tonight was a fitting way for us to end it because those guys played hard. They didn't stop, and it's an unbelievable feeling."
Posey, the only player who was in the starting lineup when San Francisco beat Texas in the 2010 clincher, and the underdog Giants celebrated in the center of the diamond at Comerica Park.
They built toward this party all month, winning six elimination games this postseason. In the clubhouse, they hoisted the trophy, passed it around and shouted the name of each player who held it.
"World Series champions!" Giants outfielder Hunter Pence hollered.
A total team triumph.
"When pitching is your strength, you want a good defense," manager Bruce Bochy said. "That shows up every day. ... Hitting sometimes, it comes and goes. But as long as you can stay in more games, the better chance you have of winning them, and that's how we play."
Benched during the 2010 Series, Sandoval, nicknamed Kung Fu Panda, went 8 for 16, including a three-homer performance in Game 1.
"You learn," Sandoval said. "You learn from everything that happened in your career. ... We're working hard to enjoy this moment right now."
Cabrera delivered the first big hit for Detroit, interrupting San Francisco's run of dominant pitching with a two-run homer that blew over the right-field wall in the third.
Posey put the Giants ahead 3-2 with a two-run homer in the sixth and Delmon Young hit a tying home run in the bottom half.
It then became a matchup of bullpens, and the Giants prevailed.
Ryan Theriot led off the 10th with a single against Phil Coke, moved up on Brandon Crawford's sacrifice and scored on a shallow single by Scutaro, the MVP of the NL championship series. Center fielder Austin Jackson made a throw home, to no avail.
"That's what makes it so much special, the way we did it," Scutaro said. "We're always against the wall and my team, it just came through first series, second series and now we sweep the Tigers."
Santiago Casilla got one out in the ninth for the win. Romo struck out the side in the bottom of the 10th for his third save of the Series.
The Giants finished the month with seven straight wins and their seventh Series championship. They handed the Tigers their seventh straight World Series loss dating to 2006.
"Obviously, there was no doubt about it. They swept us," Tigers manager Jim Leyland said. "So there was certainly no bad breaks, no fluke.
"Simple, they did better than we did," he said. "It was freaky. I would have never guessed we would have swept the Yankees and I would have never guessed the Giants would have swept us."
The Giants combined for a 1.42 ERA, outscored the Tigers 16-6 and held them to a .159 batting average.
"I think we never found our confidence at home plate," Cabrera said. "It was not the same game we played. We could not find our game in the World Series."
Bristled slumping Tigers slugger Prince Fielder: "This is not about me. This is about the team."
An NL team won the title for the third straight season, a run that hadn't occurred in 30 years. Some find the streak surprising, considering the AL's recent dominance in interleague play. Yet as every fan knows, the club that pitches best in the postseason usually prevails.
Until the end, the Tigers thought one big hit could shift the momentum. It was an all-too-familiar October lament - Texas felt the same way when the Giants throttled it in 2010, and the Tigers knew the feeling when St. Louis wiped them out in 2006.
"For one, we didn't allow doubt to ever creep in," Pence said. "You know, the thing that made this team so special is just playing as a team, caring for each other. We had our backs against the wall and we knew it wasn't going to be easy. It's not supposed to be."
Howling winds made it feel much colder than the 44 degrees at gametime. Two wrappers blew across home plate after leadoff man Angel Pagan struck out, and fly balls played tricks in the breeze.
The Giants started with their pregame ritual. They clustered around Pence in the dugout, quickly turning into a bobbing, whooping, pulsing pack, showering themselves with sunflower seeds. A big league good-luck charm, Little League style.
"That was one of our mottos, and we went out there to enjoy every minute of it and it was hard earned. Just an incredible, incredible group of guys that fought for each other," Pence said.
Once again, San Francisco took an early lead. Pence hit a one-hop drive over the center-field fence for a double and Brandon Belt tripled on the next pitch for a 1-0 lead in the second.
The next inning, Cabrera gave the Tigers a reason to think this might be their night.
With two outs and a runner on first, Cabrera lofted an opposite-field fly to right - off the bat, it looked like a routine out shy of the warning track. But with winds gusting over 25 mph, the ball kept carrying, Pence kept drifting toward the wall and the crowd kept getting louder.
Just like that, it was gone.
Cabrera's homer gave Detroit its first lead of the Series, ended its 20-inning scoreless streak and reaffirmed a pregame observation by Tigers Hall of Famer Al Kaline.
"The wind usually blows to right at this time of year," Kaline said.
In the fourth, Max Scherzer and catcher Gerald Laird teamed on a strike `em out-throw `em out double play.
Trailing for the first time since Game 4 of the NL championship series, Posey and the Giants put a dent in Detroit's optimism. Scutaro led off the sixth with a single and clapped all the way around the bases when Posey sent a shot that sailed just inside the left-field foul pole for a 3-2 lead.
Detroit wasn't about to go quietly, however. Young, the ALCS MVP against the Yankees, made it 3-all with another opposite-field homer to right, this one a no-doubt drive.
Fielder finished 1 for 14 (.071) against the Giants without an RBI. Minus key hits, the Tigers remained without a title since 1984.
All 24 teams to take a 3-0 lead in the World Series have won it all. In fact, none of those matchups even reached a Game 6. This was the first sweep for an NL team since Cincinnati in 1990.
Working on nine days' rest and trying to extend the Tigers' season, Scherzer kept them close into the seventh. Often recognized for his eyes - one is light blue, the other is brown - he's also known as a solid postseason pitcher.
Ditto-plus for Matt Cain, who was working on a nearly perfect year.
The Giants' ace threw a perfect game in June, was the winning pitcher in the All-Star game in July, beat Cincinnati to clinch the division series and topped St. Louis in Game 7 of the NL championship series.
After they left, the relievers decided it.
Octavio Dotel shouted, "Yeah! Let's go!" toward his dugout after striking out Posey to end the eighth. In the bottom half, Jeremy Affeldt got around a leadoff walk when he struck out Cabrera, a flinching Fielder and Young.
Coke returned the favor in the top of the ninth, fanning the side. With Jose Valverde having lost his closer role during a shaky month, Coke stayed in for the 10th and faltered.
The Giants became the first champion that hit the fewest home runs in the majors since St. Louis in 1982. Sandoval's three drives in Game 1 started San Francisco's romp, and its dominant pitching took over from there.
The parade to a sweep masked the problems San Francisco overcame to get this far.
Closer Brian Wilson pitched only two innings before an elbow injury ended his year. All-Star game MVP Melky Cabrera was suspended 50 games for a positive testosterone test, and not welcomed back when the ban ended. Two-time Cy Young winner Tim Lincecum struggled and wound up in the bullpen.
Swept in a three-game set at Arizona to start the season, the Giants were floundering under .500 in mid-May. They soon hit their stride and, boosted by trade deadline deals for Scutaro and Pence, passed the Dodgers in the NL West for good in late August and posted 94 wins.
Getting past Cincinnati and St. Louis in the playoffs presented challenges. Down 2-0 in the best-of-five division series, they rallied for three straight victories in Cincinnati. Trailing the defending champion Cardinals 3-1 in the NLCS, they again took three in a row to advance, clinching in a driving rainstorm.
Six elimination games, six wins. Facing the Tigers, San Francisco proved it could play with a lead, too.
The Giants became the first NL team since the Big Red Machine in the mid-1970s to win two titles in a three-year span. Shut out for 56 years - Juan Marichal, Willie McCovey and Barry Bonds never won it all - their self-described "misfits" captured that elusive crown in 2010.
The Tigers' flop finished off a season in which Cabrera became baseball's first Triple Crown winner since 1967. Detroit overtook the White Sox in the final week to win the AL Central and wound up 88-74, the AL's seventh-best record.
This program aired on October 29, 2012. The audio for this program is not available.