By Derek Meyer
I’m from a cornfield south of Chicago
– about 600 feet above sea level. Like
many of our patients, I felt the altitude
at Big Sky my first week. Altitude related
illnesses were very rarely discussed
in my Midwestern medical education.
But it’s different
story
at 6,000
feet above
sea level,
where
altitude can
wreak havoc on unsuspecting tourists.
In late June, a patient on a road trip
from a California coastal city came to
the clinic complaining he couldn’t catch
his breath. He said this started a few
days earlier and at lower altitude. He’d
been on a strenuous hike in Yellowstone
when he began to feel nauseated,
dizzy and short of breath. At a local
hospital, the patient’s blood oxygen
level was found to be severely low.
After close observation, with oxygen
provided, the patient recovered and was
discharged.
Unfortunately, his travel plans for the
next day sent him 2,000 feet higher,
to Big Sky. In the clinic here, his blood
oxygen was again low, and he was
huffing and puffing up a storm. We
provided oxygen, ran a few tests, and
recommended he either take an oxygen
machine back to the condo and rest, or
descend to
Bozeman –
wisely, he
chose the
latter.
Altitude
sickness commonly occurs in people
ascending more than 8,200 feet and is
a result of the body’s faulty response
to low blood oxygen. The three main
altitude sickness syndromes include:
• Acute mountain sickness (AMS)
• High-altitude cerebral edema
(HACE)
• High-altitude pulmonary edema
(HAPE)
In most cases, a mild form of AMS
occurs 6-12 hours after reaching high
altitude, and one may experience headache,
nausea or vomiting. Fortunately,
AMS will usually resolve by stopping
further ascent and taking an ibuprofen
for the headache.
HACE and HAPE are much more
severe and can lead to coma and death
if left untreated. In HACE (which
typically follows AMS), the brain
begins to swell, leading to changes in
a person’s level of consciousness. In
HAPE (which may occur after two to
four days at altitude), the lungs become
leaky, causing coughing and shortness
of breath. For both of these conditions,
immediate descent with oxygen and
drug therapy is lifesaving. Luckily, Dr.
Daniels only sees a case of HAPE about
every two years around here.
So what advice can you give your
visiting cousin from Miami who has
ambitions to hike the Spanish Peaks
this summer? Tell him to take it easy!
The best strategy for avoiding altitude
sickness is gradual ascent with plenty
of rest. For someone with a history
of mild AMS, a physician may recommend
taking a medication called
Diamox. Avoiding alcohol isn’t a bad
idea, either.
Derek Meyer is a forth year medical
student at the University of Illinois College
of Medicine. He did a rotation at the
Medical Clinic of Big Sky in 2011.
