15 replies to this topic

[HighPlainsMedic]

As winter begins to loosen her grip and spring is just around the corner, many are making plans on heading into the high country. Some things to consider along with mosquito spray and SPF 50,000 lol.

I used to work for the Ambulance service in EP and am stil active in EMS in Northeast Colorado. More of a meeting hack now though. With that said, There is nothing more disconcerting to a visitor to be told "Go Down" when they have a high altitude emergency. I mean how would you feel if after 6 months of planning and preparation your vacation is suddenly cut short by something as silly as elevation.

So, why all the acronyms? well.. good question, AMS.. "Acute Mountain Sickness, HAPE; High Alittude Pulmonary Edema, HACE; High Altitude Cerebral Edema are all the severe reactions to what in it's milder forms is simply called Altitude Sickness. something almost all of us get when we go from low altitude to high altitude. So what is "high altitude" again that is dependent on which article you read.. to some it's as low at 6,500 feet. However common literature uses the level of 8,000 as a defining point between the milder effects and the more acute serious forms of the malady.

In its milder forms, its hard to diagnose as it mimics other diseases.. I can describe it simply as "flu like" Headache, tiredness, general malaise, Some times easily masked with Tylenol or Ibuprofen.

So what is the mechanism of AMS.. at sea level and at altitude there is around 21% oxygen right? Yep.. the issue is not the percentage, its the pressure of the atmosphere its just there are less oxygen molecules available. I could get all scientific and lose you here, but i do better with analogies.. Let's paint a common theme first... You live at or below 1,000 in altitude, you hop a plane and fly to Denver (Mile High City remember?) then you rent a car, head up past Ed's place in Lyons and motor up Hwy 36 to Estes Park. WOW... what a view ! You have reservations somewhere so you have time right? Park pass in hand you head up to RMNP, Oh BTW.. Estes is around 7500 feet. You show the pass and your ID to the ranger at the kiosk, grab your map and head up to AVC.. (Alpine Visitors Center).. Somewhere along the way you complain of a headache, take an ibuprofen or Tylenol, but its no big deal "YOUR ON VACATION" YAY.. your here. Darn headache anyway.. and wow, your now nauseous, SOB, (Which doesn't mean you have magically turned into a jerk) SOB means Short of Breath, Lips look a little SMURFY.. (Blue) , your sick as a dog.. now what? well to some it's not that clear, Sometimes people read the signs and symptoms and head down, some well wait.. the symptoms get so bad that they end up using Emergency Medical Services. Which means a HUGE BILL! horrible inconvenience and possibly and end to the vacation.. Wow no wonder people wait to call 911 ?

We used to call it the 7500 feet cardiac stress test, Shortness of breath, chest pain, in anyone over the age of 40 means coronary artery disease until proven otherwise. So is it Altitude Sickness or Heart Disease, for the sake of this discussion, we'll focus on altitude sickness.

So... what just happened? well simply you went from 1,000 feet to around 12,200 feet in less than a day. OMG... Other contributing factors can include, alcohol consumption even in small quantities, lack of sleep, dehydration, (Remember there are less water molecules in the air too, even though it's cool outside, the air at altitude is very dry..) physical fitness etc.. and maybe your just susceptible.

So lets do it differently, Land in Denver, get a room.. (might be nice anyway ?) NO ALCOHOL>>> get a good nights rest, drink lots of fluid, eat a healthy breakfast and then.. head on up.. take some time in town, buy a T shirt (lots of selection there ?). Head on up to Bear Lake, get a short walk in around the lake.. Get another good nights sleep,

THEN>>> go on up to AVC.. If at any time you feel short of breath, nauseous, head achy, go down and spend more time in EP..

A good rule of thumb is always.. Climb High, Sleep Low... that's even for the experts, there are many stories of young healthy climbers being overcome with the acute forms..

I Look forward to not hearing from you in the Emergency Department.. see you on the trails

Jeff

Links
http://www.princeton...y/altitude.html

http://www.ncbi.nlm....lth/PMH0001190/

http://en.wikipedia....titude_sickness

This post has been promoted to an article

Edited by HighPlainsMedic, 19 March 2011 - 10:09 AM.

[foxfire]

Thanks for providing the above info. Many may not know too much about the problems of AMS. Sure many here do! I by no means know anything near a medic but have read and seen much on AMS.
Hape and Hace are quite dangerous but luckily we don,t hear to much about these accute cases in the RMNP area. It is fun to think that base camp on Everest is higher than Longs Peak summit, for example. Think about that and it kinda puts the ideas of mountains like Everest, K2 etc. into perspective!

Fox

[HighPlainsMedic]

Excerpt from another article.. the incidence is higher than one may think..
Acute Mountain Sickness

AMS can afflict any visitor sleeping higher than 6000 feet. In Colorado, between 15 and 40% of visitors sleeping at 8000 ft or higher get AMS, with the incidence the highest at the highest resorts. Most folks visiting these areas travel in one day from low to high altitude; if an intermediate day is spent in Denver or a similar altitude, the incidence of AMS is much lower. One survey done at a Colorado ski resort at 9800 ft found that 60% of visitors developed a headache, the first sign of AMS, and also called high altitude headache. To meet the definition of AMS, other symptoms need to dev elop, such as loss of appetite, sometimes vomiting, weakness, dizziness, fatigue, and difficulty sleeping. AMS feels exactly like a bad hangover. Symptoms can occur as early as 2 hours after arrival to altitude, or be delayed for 24 hours or so. Symptoms of AMS do NOT develop after 2 days of feeling well, unless one has moved to a higher altitude. . Therefore, a person who has been doing well at altitude and then gets sick after two or three days needs to be evaluated for other conditions

http://www.altitudem...titude-sickness

[DrCloud]

Excellent write up (and even the tone works).

As much as I like to take early flights to Denver, so I can get to Estes Park before noon, I think the best advice for everyone is to take a late flight and overnight at one of the airport hotels on Tower Road (the La Quinta is clean and fairly cheap, for example). And, despite its asceticism, the "no alcohol" (that night) thing is second on the list of good advice.

Because I fly Frontier to Denver, I arrive at the A Concourse, so I always walk that sky bridge to the terminal, making sure to breathe hard all the way. At least that gets the process started. HPH

[DeeCeeM]

Excellent, excellent write up! Thank you so much for posting this.

[rcw]

Thanks for the information. We try to plan our trips so we elevate in steps. From 679 feet at home to 3200 in Lubbock, TX. Then on to New Mexico where we spend time between 7000 and 10500 but with only light hiking and relaxing. Then on to Estes and the park. We feel pretty good by the time we get there but we still wait until later in the week for the highest and most strenuous hikes.

It is good to know what symptoms to watch for.

[Lynette]

Our time is usually limited, so we try to get hiking right away.

First year... easy hikes.. not much elevation gain. Hikes almost all less than 10 miles. No problem.

Second year. Started out first day with a hike with Ed going up above Lake Haiyaha. Headache, nausea developed on hike. Went back down to Bear Lake. Problems gone. No problems rest of trip.

Third year. Started out first day trying to hike Flattop. Never made it to the top. Dizzy, headache, nausea. Did not go away, but did ease up. Next day, hiking above Lake Isabelle in IPW toward Pawnee Pass. Again, symptoms got bad. Headache, nausea, vomiting on the way back to Estes Park from IPW. On recommendation from waitress at Other Side Restaurant, bought some supplements called "Altitude Adjustment." Main ingredient was gingko biloba. Claimed to help body use oxygen "more efficiently." Started taking. Did Deer Mt. next day, continued hiking. No further problems, felt fine the rest of the trip.

I have a couple of questions...

1. Why the symptoms worsening each year? Getting older? Attempting to do more at elevation?

2. Did the Altitude Adjustment really help, or would my body have adjusted to the altitude on its own?

3. Would taking the Altitude Adjustment before getting to the park help prevent me from getting sick?

[HighPlainsMedic]

Lynette, on 18 March 2011 - 03:30 PM, said:

I have a couple of questions...

1. Why the symptoms worsening each year? Getting older? Attempting to do more at elevation?

2. Did the Altitude Adjustment really help, or would my body have adjusted to the altitude on its own?

3. Would taking the Altitude Adjustment before getting to the park help prevent me from getting sick?

First a disclaimer.. i am not a physician nor do i play one on TV.. however, i have 24 years in Emergency Medical Services and my Medical Director i work under thinks I have some marbles left in my noggin..


The flexibility of the alveoli in your lung tissue diminishes with age, Which can mean that the permiability of your lung tissue is higher.. (hows that for medical jargon?) .. in laymans terms, the little air sacs in your lungs become less flexible and have less ability to keep fluid on one side and air on the other.. Air on the air side is good.. fluid on the air side is bad..

You can have some effect on this by staying in shape, deep breathing, and breathing through pursed lips.. we do that almost automatically when we sigh... but if you make it a consious effort to pressurize your lungs it keeps the air on the air side and fluid on the fluid side.

It also meas that there is a reaction from the body to increase the amount of pressure on the fluid side to carry more red blood cells around the system.. Your blood pressure will be higher at altitude too, just because it's a compensatory reaction to the altitude... This can be reduced and in one of the articles posted above one of the treatments including the prescription drug Acetazolamide. I have also read about Ginkgo Biloba, and if you can believe it.. Cialis and Viagra, Acetazolamide works on how the Kidneys excrete BIcarb (makes you pee alot) and the other two work as a nitrate, lowering the blood pressure by increasing the size of the blood vessels.

Starting the Acetazolamide certainly early couldn't hurt, follow your physicians directions on dosage and directions..

From what i read, its a time thing, the more time you spend acclimatizing will reduce the effects of AMS.. It might shorten the time with the altitude adjustment, but given enough time you will have become accustomed to the altitude. When we did hematocrit testing we found that people that live at altitude had 4-5 percentage points higher in values than people that lived at lower altitudes... plus their pulse oxygen levels.. were around 94 percent at room air where at low altitude it might be as high as 98 percent.. in laymans terms again.. they get used to the altitude..

I hope that isn't too much medical jargon..

[Rhonda]

This is all very interesting to me. Thanks for the info.

[Monica]

Thanks for all the helpful info.!

[DrCloud]

HighPlainsMedic, on 18 March 2011 - 03:58 PM, said:

First a disclaimer.. i am not a physician nor do i play one on TV..

Nor am I, nor do I (although I really am a Doctor, but not at all of the physician persuasion, although I do know a lot about atmospheric stuff). But I get the impression from Lynette's post though that this may help her understanding:

Adapting, or acclimatizing, to the relative lack of air (and therefore oxygen) at higher elevations is something that doesn't last very long, once you return to sea level or thereabouts.

This means you have to re-acclimatize each time you change elevation. So all these adaptation steps are meant for each visit to the Rockies, or other high places. And, yeah, I'm finding it does tend to get tougher to adapt as you age, even if your aging, like mine, is like that of fine wine, in which you get better. HPH

[HighPlainsMedic]

DrCloud, on 18 March 2011 - 05:09 PM, said:

Adapting, or acclimatizing, to the relative lack of air (and therefore oxygen) at higher elevations is something that doesn't last very long, once you return to sea level or thereabouts.

Exactly, If i lose a week of trekking at altitude.. the next time out is a bit harder even though i put in miles on the county road during the week.. I live at 4500, sometimes we leave the house at 4:30 and summit within hours.. easier when we spend the night at Moraine Park CG..

[jflo]

HighPlainsMedic, on 18 March 2011 - 03:58 PM, said:

First a disclaimer.. i am not a physician nor do i play one on TV.. however, i have 24 years in Emergency Medical Services and my Medical Director i work under thinks I have some marbles left in my noggin..


The flexibility of the alveoli in your lung tissue diminishes with age, Which can mean that the permiability of your lung tissue is higher.. (hows that for medical jargon?) .. in laymans terms, the little air sacs in your lungs become less flexible and have less ability to keep fluid on one side and air on the other.. Air on the air side is good.. fluid on the air side is bad..

You can have some effect on this by staying in shape, deep breathing, and breathing through pursed lips.. we do that almost automatically when we sigh... but if you make it a consious effort to pressurize your lungs it keeps the air on the air side and fluid on the fluid side.

It also meas that there is a reaction from the body to increase the amount of pressure on the fluid side to carry more red blood cells around the system.. Your blood pressure will be higher at altitude too, just because it's a compensatory reaction to the altitude... This can be reduced and in one of the articles posted above one of the treatments including the prescription drug Acetazolamide. I have also read about Ginkgo Biloba, and if you can believe it.. Cialis and Viagra, Acetazolamide works on how the Kidneys excrete BIcarb (makes you pee alot) and the other two work as a nitrate, lowering the blood pressure by increasing the size of the blood vessels.

Starting the Acetazolamide certainly early couldn't hurt, follow your physicians directions on dosage and directions..

From what i read, its a time thing, the more time you spend acclimatizing will reduce the effects of AMS.. It might shorten the time with the altitude adjustment, but given enough time you will have become accustomed to the altitude. When we did hematocrit testing we found that people that live at altitude had 4-5 percentage points higher in values than people that lived at lower altitudes... plus their pulse oxygen levels.. were around 94 percent at room air where at low altitude it might be as high as 98 percent.. in laymans terms again.. they get used to the altitude..

I hope that isn't too much medical jargon..

Great advice HPM!

If anyone is planning on going the medicinal route, just be sure your physician is knowledgeable about the dosage for Acetazolamide. this particular drug is used for other illnesses, and the dosages vary greatly. And be sure you're willing to handle the side effects..

Really, the best thing is time and hydration. The more time you can give your body at a "safe" altitude before ascent the better (personal experience). It can take up to six weeks to become fully acclimated, so just be careful, and listen to your body. Water water water... it can't be over-stated.

[Aaron]

Great topic! Would you mind if I made this a static article on rmnpforums.com (outside the forums)?

--Aaron

[HighPlainsMedic]

Aaron, on 19 March 2011 - 09:54 AM, said:

Great topic! Would you mind if I made this a static article on rmnpforums.com (outside the forums)?

--Aaron

I have no problems with that.... I think the peer review done by members validate the information

Jeff
HPM