i-70: Surviving Colorado’s Mountain Corridor

Between Utah and Maryland runs over 2,000 miles of Interstate 70. Every year, caravans of cars commute via I-70 across the Rocky Mountain Continental Divide, right in the middle of Colorado, where road, weather and traffic conditions make for some of the most dangerous driving in the country. Year after year, fatalities are in the hundreds. Storms in every season are liable to obscure vision and make surfaces slick on steep grades and tight curves reaching well over 9,000′, and at speeds over 70 mph. Summit County, Colorado, surrounded by mountain passes up to 11,000′ and above, is the highway traveler’s gauntlet of possible peril. As another year comes to a close and Winter peak season gets into full swing, preparing to get up to this elevation is just as important as preparing for the altitude while you are here.

Born and raised at Colorado’s highest elevations, Chris Erickson is well into his fourth year working for the Colorado Department of Transportation (CDOT), up at the Eisenhower-Johnson Tunnel, as an Operator Dispatcher: he monitors traffic flow and conditions, deploying staff, services and heavy machinery when necessary. They operate the Colorado traffic management center from his roost right at the Continental Divide, which covers I-70’s mountain corridor. Over 200 miles of winding highway from Dotsero to Golden. He’s seen his share of disasters, so it occurred to me that he may have some valuable observations and advice for the rest of us.

The most intimidating aspect of his role is pretty much the same now as it was when he first started: Winter storms. When the snow gets heavy, they get out the big guns, snow plows deployed from every affected region, operating over stretches of 10 to 20 miles. There is a lot more to this than the drivers think, and I’ve seen cars trying to squeeze around side-by-side plows on icy roads, not aware that they are in formation to control traffic while effectively clearing snow and debris.

What is one thing you wish people would stop doing, knowing what you know now?

Obey the laws, observe speed limits. I wish semi drivers would stop catching on fire all the time. Their brakes catch on fire when they haul ass going down the hill [from the tunnel]. 

How could we forget about the variety of vehicles on the highway? You will often find yourself right next to literal tons of machinery flying down steep grades. Trucks jackknifing is not an uncommon sight, especially in the Winter, and there are enough runaway truck ramps to suggest these monsters losing their brakes is not uncommon, either.

What is one thing you wish drivers would start doing?

I wish people would educate themselves more on driving conditions in the mountains before they came up here. I wish people would educate themselves more on the difficulties of travel on this mountain corridor. There are just so many things: cliffs, rocks that fall all the time … we’re trying, but we only have so many plow drivers and we can’t be plowing every inch of the road every minute. For example, Silverthorne Hill, if that starts to get backed up, the plows can’t get through when they turn around and head back uphill. It’s difficult to manage this corridor with all the obstacles at elevation. People need to be more patient. 

When it comes to road and weather conditions, what do you consider to be the worst or most dangerous?

Black ice.

Stuck in Winter traffic at the Continental Divide

If you didn’t know, now you know. It’s in the local news year after year, but the very thing about black ice is its lack of visibility. Blending right into the black of the asphalt, this ice that has been sitting on the highway without warm conditions to allow it to melt is the cause of many accidents.

Animals on the road: moose, elk, deer … 

The sheer size of these animals rivals the weight of the largest SUVs you’ll see on the highway. Trying to predict the animal’s movement is useless, so it’s best to be prepared to come to a full stop when necessary. Road signs where animal activity are often present are up and down this corridor, and variable message signs (VMS) will always report the immediate presence of reported sightings.

Incidentally, writing the messages you see on these VMS is one of Erickson’s responsibilities. If you’ve paid any attention to each marquis in the mountain corridor (which you should be), you’ve read his work. He often jokes that he is the most widely read author in the state.

“Moose, marmots and motor homes: Spring Migration is on!” is the one he is most proud of, he says. I must admit, it’s pretty clever. When you put it that way, humans are arguably the most migratory animal on the planet.

Fortunately, drivers aren’t left completely without aid on this dangerous trek. CDOT provides a Courtesy Patrol that many are not aware of. This service will dispatch to the location of vehicles that need assistance moving out of the way of oncoming traffic to a safe space to troubleshoot all kinds of common car troubles from flat tires to running out of fuel. They won’t get you to your final destination, but they will give you up to a gallon of gas to move out of danger.

They’ll help you change a tire. They’ll give you a jump. They’d probably even let you use a phone or let you charge your own.

I ask Erickson if there’s anything else he’d like to share with drivers through the mountain corridor:

Buckle up. The worst wrecks often happen on clear, dry days with dry roads.

If you plan to be out there in the middle of the highway through the mountains, be patient, be kind, be courteous. There are long stretches of highway where cell service is unreliable. Being stuck roadside in the mountains requires more than the standard emergency kit. Temperatures are often below freezing in the winter, so bring gloves, hand warmers, blankets, washer fluid (don’t add water) for your car, water (don’t add washer fluid) for yourself, and warm, waterproof boots you can push a car in (worst case scenario). For more insight into how cars operate differently at altitude, check out our previous article on The Physiology of an Automobile.

Thanks for lookin’ out, Chris!

robert-ebert-santos

Roberto Santos is from the remote island of Saipan, in the Commonwealth of the Northern Mariana Islands. He has since lived in Japan and the Hawaiian Islands, and has made Colorado his current home, where he is a web developer, musician, avid outdoorsman and prolific reader. When he is not developing applications and graphics, you can find him performing with the Denver Philharmonic Orchestra, snowboarding Vail or Keystone, soaking in hot springs, or reading non-fiction at a brewery.


Section House in December: Moose Country

Section House sits at 11,481′ (3499 m), on Boreas Pass, just south of Breckenridge, Colorado. It isn’t the highest hut in the Summit Huts system, but its unique location and history is what makes it one of the most challenging.

Many of the huts in the Summit and 10th Mountain Division systems sit on a hillside, below tree line, which provides a significant amount of weather mitigation. Section House is right at the tree line, on the pass, which means any wind and weather will likely be funneled right into you. And because you are in one of the highest counties in the United States, weather is highly variable.

I’ve done this hut in a blizzard before, arriving to find the padlock on the front door was frozen shut. That may have been the most I’d ever despaired in my life up until then.

Even in great weather, however, the temperature alone is a liability. When we set out from the trailhead this time, it was sunny and relatively balmy for December, in the 30’s (Fahrenheit). But the temperature in the shade can be several degrees lower, and as the sun sets below the Ten Mile Range, the temperature starts to drop by the tens of degrees really quickly.

The Stats

Distance: a little over 6 miles; GPS and some maps may differ by tenths of a mile. If you tell your friends 6, they may resent you.

Timing: the same hike has taken me a couple hours with no weight on my back besides water, on well-packed snow. This time, it took over an hour a mile, including frequent breaks, thanks to all the weight I was carrying and pulling. Additionally, we constantly had to redistribute weight among sleds and backpacks to relieve shoulders and keep sleds from tipping over. If you decide to pull a sled, keep the weight low and as evenly distributed as possible. The other very limiting factor was the last half of the trail was covered in at least a couple feet of unpacked, fresh powder. Our lead was breaking trail in snowshoes.

While the grade going back down to the trailhead isn’t steep enough to keep momentum without skating, it is significantly easier and faster, and took us half the time even after waiting for moose to safely cross our path.

Elevation gain: about 1100′.

Capacity: 12 people.

Packing

I’ve pulled a sled both times I’ve done this hut. I don’t regret it, but it is challenging at best in calm weather. Unless you are going for more than a couple nights, I’d recommend packing everything into a backpack.

Because the elevation gain is so gradual, the challenge with weight is the distance. Pack your weight so it will still be comfortable on your shoulders after three miles. The advantage of pulling a sled was having less weight on my shoulders, but after several miles, even minimal weight can dig into your muscles.

The only source of water around this hut is the snow you melt, which is why it isn’t open in the Summer season. Water purifying filters are the quickest way to refill all your containers at the hut, but you will want plenty of water for the hike in alone. Running out of water on the trail is dangerous. An added risk: when the sun went down on us after the first three hours in, the water in our CamelBak nozzles started freezing if we weren’t regularly sipping on them.

Bring a sleeping bag. Most huts I’ve been to have blankets and pillows on the mattresses, but this one does not. This is also one of the oldest and coldest cabins; built in 1882, it takes hours to heat up by wood stove, especially if no one has been in it recently.

Moose

Now forget all the advice I just gave you and center your whole packing strategy around how you plan to evade a charging moose.

This region is moose country: high, high meadows filled with willowy wetlands. They don’t care how cold it is. In the dead of night, one of us opened the front door to use the outhouse and a young bull was standing right in front. On the trail back, two different parties ran into a moose and her calf right on the trail. They are not in the way. You are on their trail.

But seriously, pack to be prepared for your comfort and sustenance on the trail and at the hut. The only thing you can do about the moose is give them a lot of space while avoiding any confrontational, jerky movements that may suggest any predatory intent. If moose perceive a threat, they are liable to charge, male or female. If they charge, drop everything weighing you down and pray-run (praying while running).

When we ran into the moose on the trail, we stayed over 50 meters away and just waited while the moose wandered further off our path. As soon as they were about 50 meters off our path, we proceeded with caution. But we waited for over 30 minutes, and would have waited longer if we needed to.

Skis vs. Skins vs. Snowshoes

This was the most highly contested logistical conversation among our party. In the end, four of us were on cross country skis (without skins), one was on skis with skins, one was on a split-board with skins, and one was on snowshoes.

This really depends on the conditions. Two weeks prior, three of us hiked the trail in boots, on well-packed snow after days of warm, dry weather. Days before we left for the trip, however, a series of storms blew several feet of snow in, which changed everything. Boots alone were definitely not an option.

Most people, who aren’t hiking to the hut, will stop and turn around at the halfway mark where historical Baker’s Tank stands. This means the trail up until that point will reliably be pretty packed down. Because of the recent snow, however, no one could be sure what conditions would be like for the second half of the trail.

Freshly-broken trail through fresh snow past the midway point to Section House.

Sure enough, Baker’s Tank to the hut was unbroken trail through deep, soft snow. Our lead, on snowshoes, was cursing all the way to the hut as he carved the path for the rest of us. But in deep snow, snowshoes are sometimes the most comfortable option for an ascent, especially if you are inexperienced on skis and skins.

The advantage to skinning up on a split-board or downhill skis is the width of the blades. They are wider than cross country skis, which makes balancing the extra weight more comfortable and stable.

On a packed track, cross country skis were relatively comfortable, if narrow. The boots are more similar to normal footwear, so are more flexible and comfortable than ski or snowboard boots. Price was also a determining factor: renting skis or a split-board can cost upwards of $45 per day at most rental shops. We found cross country skis for $10 per day at Wild Ernest Sports, above Silverthorne, and they worked well. One thing about cross country ski boots, however, is that they aren’t as well-insulated as downhill ski or snowboard boots. Trekking through deep snow in them requires much better waterproofing and insulation than we were prepared with.

Jupiter rising in the dusk on the way up to Section House.

As for skins, although the trail grade is very gradual, there is enough of a grade at times that you will be thankful for the traction that skins provide. So unless you’re on cross country blades, you’ll want some skins.

Altitude & Acclimatization

One advantage of carrying all the weight we did was that it forced us to make a slower ascent and take frequent breaks. These are two things you can do to minimize the affects of the altitude on any ascent. In our party, all but one of us have lived at an altitude over 7,000′ for at least one year. Most of us have lived over 9,000′ for several years. But this was the first hut trip over 10,000′ for three of us, one of whom flew in two days before from sea level.

Fortunately, no one in the group experienced any severe symptoms of acute mountain illness, and I credit that to our meticulous supervision of each person’s blood oxygen saturation as well as our slow ascent. The first night we were at the hut, the lowest oxygen saturation we saw was 85%, but most were between 85 and 90%, which, at over 11,000′ is not surprising. If some slow, deep breaths hadn’t brought oxygen levels up, I would have been more concerned.

Hitting kickers behind Section House.

As seems to be tradition on our expeditions, we arrived well after dark. But these days, sunset is at 4:30 pm. Luckily, the weather was calm, and the trail is quite obvious. Our biggest concern after dark was the tremendous drop in temperature. With no cloud cover and a recent cold front, it was well below freezing, and the only thing that kept us from freezing was the constant movement, which kept us progressing forward.

Ken’s Hut, next to Section House.

By the time we had all made it to the hut and built up a fire warm enough to kick our boots off, our socks were steaming in spite of how cold our extremities were. It took well into the night to heat up the hut, and we all spent the first night sleeping around the wood stove. Yes, it took seven hours for the last of us to make it to the front door of Section House, but the spring trip to the Benedict Huts outside of Aspen was still loads more difficult — and we didn’t even pull any sleds! The next day was windless, sunny, clear, and warmer outside than it was inside, which allowed us to get back out on our skis and snowboards to enjoy the backcountry without weight on our backs.

robert-ebert-santos

Roberto Santos is from the remote island of Saipan, in the Commonwealth of the Northern Mariana Islands. He has since lived in Japan and the Hawaiian Islands, and has made Colorado his current home, where he is a web developer, musician, avid outdoorsman and prolific reader. When he is not developing applications and graphics, you can find him performing with the Denver Philharmonic Orchestra, snowboarding Vail or Keystone, soaking in hot springs, or reading non-fiction at a brewery.

Effects of High Altitude on Appetite and Weight Loss

It’s no secret that people living in high elevation areas such as Summit County seem to be healthier than the general population. But aside from the active lifestyles of many people who choose to live in the mountains, could there be other effects from living at high altitude that result in healthier outcomes?

Several studies have been conducted to examine the association between living at high altitude and weight loss. The overall findings suggest simply ascending to a higher altitude generally results in a reduction of weight. Whether this is due to relative low pressure hypoxia or increased physical activity is another question examined by researchers. Overall, a higher energy expenditure and decreased appetite have both been seen in those living at higher altitudes. One study found that those living below 500 m elevation on average had a 4.6 times higher risk of obesity compared to those living above 3000 m while controlling for differences in exercise, diet, and lifestyle.

Leptin is a hormone produced by the body that results in suppression of hunger. When our bodies secrete more leptin our hunger decreases. Multiple studies have shown that when people not acclimated to altitude are brought to higher elevation, leptin increases and appetite decreases. One such study took ten obese males to altitude and allowed them to eat as much as they would like and also did not allow them to exercise more than their regular amount during the study. After one week the study found the males consumed on average 730 calories less than what they usually ate at lower altitude. This resulted in a 3 pound weight loss over one week, and on average, they kept two pounds off after returning to their base altitude a month after the one week study was completed.

Leptin levels were increased for a time after returning to lower elevation and appetite remained lower than their baseline.

A follow-up study looked to determine exactly what factor of altitude causes this increase in leptin and used a hypobaric chamber to simulate a hypoxic environment similar to Mt. Everest. Subjects in this experiment lived in low oxygen conditions for 40 days and had an average of 16.7 pounds of weight loss and consumed 1,347 fewer calories. This study helped to suggest hypoxia as the driving factor for increases in leptin at altitude, and also showed an increased effect with the higher elevations.

Another possible factor leading to higher rates of weight loss at altitude could be linked to an increase in basal metabolic rate. Basal metabolic rate, or BMR, is the amount of energy or calories humans burn each day without accounting for exercise or general physical activity. In the same study that measured appetite and leptin levels in obese men brought to altitude for one week, BMR was also measured. These measurements showed an increased BMR at the end of one week at altitude and a return to baseline BMR two weeks after returning to lower altitude. This means that people tend to burn more calories just by being at a higher altitude, even without increasing exercise. This increased burning of calories paired with decreased appetite are likely the main driving forces between the weight loss seen in those newly introduced to altitude and lower weights and BMI’s seen in those that have lived at altitude for a long time.

With these findings of weight loss and overall decreased appetite when coming to altitude, it is important for visitors from low altitudes to be aware of these changes and plan appropriately. First of all, in order to avoid unintended weight loss, those new to the mountains should be aware of just how much they are eating. Apps such as MyFitnessPal are great for tracking your calories and can even factor in exercise such as hiking and skiing that may be causing you to burn extra calories. Based on your BMR and exercise, you can see just how many calories you should be eating to maintain your current weight. It is also essential to be aware of the kinds of food you are eating. In the studies showing decreased appetite, it was also shown that study subjects had a decreased likelihood of choosing carbs in their diet. Carbohydrates are an excellent source of energy and should be a main staple of the diet for anyone coming to altitude, especially if they plan to partake in any of the great outdoor activities places like Summit County have to offer. Good examples of healthy carbs include fruits, vegetables, nuts, and whole grains like quinoa, oats, and brown rice.

Ultimately, ascent to higher altitudes has been shown to cause a decrease in appetite, increase in basal metabolic rate, and an overall decrease in body weight. Some of these factors return to closer to baseline after acclimatization, but this can take weeks to months depending on the person. Anyone who is traveling to higher altitudes or who has recently moved to a higher altitude should take good notice of their general nutrition and calorie intake to make sure they are giving their body the fuel it needs to succeed in these unique conditions.

Mitch Tiedke is a physician assistant student at the Red Rocks PA Program in Arvada, Colorado. He grew up in Oak Grove, Minnesota and achieved his undergraduate degree in Genetics, Cell Biology, and Development, with a minor in Public Health from the University of Minnesota-Twin Cities. He has previously worked as a personal care assistant for developmentally delayed adults and as a nursing assistant on a pediatric oncology, GI, and med/surg inpatient unit. In his free time he enjoys hiking, snowboarding, biking, and movies.

References

Buchzik, B. (2014). Hypobaric hypoxia causes body weight reduction in obese males, double-blinded, placebo-controlled study. European Respiratory Journal, 44(58). Retrieved from https://erj.ersjournals.com/content/44/Suppl_58/P3650.short

Lippl, F. J., Neubauer, S., Schipfer, S., Lichter, N., Tufman, A., Otto, B., & Fischer, R. (2010). Hypobaric Hypoxia Causes Body Weight Reduction in Obese Subjects. Obesity, 18(4), 675–681. doi: 10.1038/oby.2009.509

Palmer, B. F., & Clegg, D. J. (2013). Ascent to altitude as a weight loss method: The good and bad of hypoxia inducible factor activation. Obesity, 22(2), 311–317. doi: 10.1002/oby.20499

Rose, M. S., Houston, C. S., Fulco, C. S., Coates, G., Sutton, J. R., & Cymerman, A. (1988). Operation Everest. II: Nutrition and body composition. Journal of Applied Physiology, 65(6), 2545–2551. doi: 10.1152/jappl.1988.65.6.2545

Voss, J. D., Masuoka, P., Webber, B. J., Scher, A. I., & Atkinson, R. L. (2013). Association of elevation, urbanization and ambient temperature with obesity prevalence in the United States. International Journal of Obesity, 37(10), 1407–1412. doi: 10.1038/ijo.2013.5

Physiology of an Automobile: Cars Need Oxygen, Too!

There are seven establishments up here in Summit County, Colorado that offer auto maintenance. That means you will be on a waitlist weeks out to schedule any work you need done during the peak seasons. I finally got an appointment at High Country Auto in Frisco after my SUV started shaking when I drove over 40 mph. My undercarriage was caked in enough frozen mud and dirt that it was causing the car to rock. According to Carrie, who started the business with her husband Steve in 1998, this is a relatively common scenario in the high country. Something else she sees a lot up here is people from sea level putting water in with their washer fluid, which easily freezes on colder days. “The only way to unthaw it is to leave it in the garage overnight,” she says.

This prompted more conversation about how cars respond to the extremity of the altitude, incline and lack of oxygen up here.

“A lot of people up here try to run 91 Octane, the high-octane gas. But we don’t have enough oxygen up here to burn it. So they gum up their fuel injectors, they gum up their fuel system because they’re running too high of octane.

“The other thing people think that they can do is they think that they can chip their car to make it go faster … they try to bypass parameters on the computer to make it go faster. But it doesn’t work up here, because you need to have more oxygen.

“The other problem, too, is that they load their cars down with ten million people and all their [stuff], and then they try to go up the hills. And their car can only go so fast, because it can only take in so much oxygen, it can only process so much, plus they’re already fully weighted down. And then they hit altitude and their cars are [struggling].” (Insert Carrie’s imitation of a car struggling.)

“It’s like a big … 500 lb. guy going up four stories, and he gets up the first floor and he has a heart attack. Well, why? It’s because he’s exerting himself at altitude. It’s the same thing with cars. If a car has a little bit of a problem up here, and then you load it down with people and you try to get it to go up to 12,000, it overworks the car. And a lot of people don’t realize that cars have to work harder up here, just like people do.”

So what do you have to do to “prepare” your car for a trip up to altitude?

“Don’t overload it. And don’t push your car. Don’t try to go faster. When you’re going up a hill, be nice to your car. It’s like when you’re going down a hill, try to go into 3rd gear to let your transmission slow you down, take your foot off the brakes.

“The problem up here is people try to haul their trailers with Subarus. I’ve seen fifth-wheels being hauled with little, tiny cars. It doesn’t work up here … it can’t get enough oxygen for the car to process it. The biggest mistake people make up here is they overload everything.

Another little thing you can do to take extra care of your car up here, she mentions, is let it warm up for two to five minutes when you first start it up in the morning. As the water freezes, all the fluids tend to gel, and it’s in your best interest to get these fluids warm again.

“When it’s 20-below, it takes a lot for the car to warm up. Just like us getting out of bed,” she laughs.

“This is not the place to push your car. If your car is gonna break down, it’s gonna break down up here.”

And if you’re an ASE-certified Master Technician, Carrie’s been looking to hire more mechanics for much more than they’re paid in the city. There used to be over 20 repair facilities in Summit County, but since it’s dwindled down to under 10, there is plenty of work for qualified mechanics up here.

And if you need your own blood oxygen, blood pressure, or undercarriage checked out, Ebert Family Clinic offers the former two for free!

robert-ebert-santos

Roberto Santos is from the remote island of Saipan, in the Commonwealth of the Northern Mariana Islands. He has since lived in Japan and the Hawaiian Islands, and has made Colorado his current home, where he is a web developer, musician, avid outdoorsman and prolific reader. When he is not developing applications and graphics, you can find him performing with the Denver Philharmonic Orchestra, snowboarding Vail or Keystone, soaking in hot springs, or reading non-fiction at a brewery.

Increased Risks of Orthopedic Surgery at Altitude

With orthopedic surgeries becoming more common at higher altitudes, it is important that we understand the increased risks of surgery at higher elevations. Patients locally (Eagle, Summit, Pitkin, Grand, Lake and other high-altitude counties in Colorado) and those that travel from all over the world to undergo surgery by our orthopedic surgeons are at an increased risk for complications post-surgery. Patients that have surgery at a lower altitude and return to higher elevations post-surgery are also at higher risk for post-operative complications. These risks are higher for everyone having surgery at altitude regardless if you live at higher elevations or are from sea level.

High altitude is defined as 8-12,000 feet. However, increased surgical risks are seen starting at 4000 feet. There are no differences for increased risk if you are acclimated to the altitude (live here) or are visiting. The increased risk of surgery at high altitude is the same for all.

High altitude increases the coagulation state of blood (clotting ability) and hyperventilation (breathe out more than you breathe in), and oxygen saturation of blood and tissues is 10% lower at high altitude compared to low altitudes, leading to a hypoxic state. The hyperventilation state promotes the hypercoagulable state which causes the immune system to respond with a pro-inflammatory state. Acclimation does occur, we adapt, are able to breathe easier and function normally as our bodies make more red blood cells to compensate for the lower available oxygen in the air. However, the hypercoagulability of blood remains, because the hyperventilation state is sustained at high elevations (even if you live here). At high elevations there are physiological differences in pulmonary circulation (blood through the lungs), heart function, and fluid imbalances which induce dehydration that accompanies blood changes contributing to the increased risk of surgery at high elevations.

Risk factors for blood clots from orthopedic surgery for the general population include: decreased mobility or sitting around more, length of surgery (greater than 4 hours increases blood clot risk), joint replacements, smoking, diabetes, and other illnesses.

In general, there is a 40-60% chance of a blood clot following knee or hip replacement surgery. At altitude that risk doubles. There is a 3.8 times greater risk of thromboembolism (blood clots) for knee surgeries at high elevations. Total shoulder replacement surgery also demonstrates a 2-times greater risk of pulmonary embolism at altitude or 39.5%, compared to a 15% chance at sea-level. For rotator cuff repair of the shoulder, there is also an increased risk for blood clots. There is a 1.4-times greater risk for pulmonary embolism (blood clot in the lungs) for lumbar fusions at high altitude. Higher elevation is an independent risk factor for blood clots which lasts up to 90 days post orthopedic surgery.

Anesthesia at high altitude has its own risk. The sustained hyperventilation state at high altitude also leaves the patient more vulnerable to hypoxia and pulmonary edema with anesthesia. These risks can be minimized, however remain elevated for surgeries requiring general anesthesia above 4000 feet.

For patients returning to high altitude following surgery at lower elevations, there exists multiple risks due to hypercoagulable state, increased inflammatory response, and hyperventilation that higher elevations induce. Acclimatization to high altitude is lost within 2 days of being at a lower elevation and can take 3-4 months to achieve again. In as little as 2 hours after arriving at high altitude, the body initiates the above changes and this puts the post-operative patient returning to altitude at risk for a multitude of complications: dehydration, thromboembolisms, hypoxia, atelectasis, and pulmonary edema.

I recently spoke with a patient that grew up in Leadville (10,151 feet) and lives in Summit County (average of 7947 feet). She underwent hip surgery (twice) in Denver. Upon returning to Summit County, she developed high altitude pulmonary edema (HAPE) both times. When she underwent an ankle surgery in Edwards, the surgeon prophylactically treated her for high altitude sickness given her previous history. She did not develop HAPE, but was hypoxic and required oxygen therapy following surgery for a few days. She is a prime example that even those living their entire lives at altitude are susceptible to these increased risks from surgery.

These risks can be minimized by drinking plenty of fluids, using compression socks (TED hose) or sequential compression devices (SCDs), blood thinners (aspirin, Eliquis, or the like), doing ankle pumps and glute squeezes, and getting up and walking around every 1.5-2 hours for 10-15 minutes, all of which help decrease the likelihood that patients will experience blood clots following orthopedic surgeries.

To reduce respiratory or lung related complications it is important to do deep breathing exercises or incorporate the use of an inspirometer post-surgery, use supplemental oxygen if necessary, as well as continue to do these exercises after returning from a lower elevation for at least 2-3 weeks.

High altitude is an independent risk factor for orthopedic surgery complications. However, these increased risks have been seen in trauma patients and other surgical patients as well. The hyperventilation state, hypercoagulability, and elevated inflammatory response are not isolated to orthopedic patients, but exists in everyone living at and visiting higher elevations.

— Jessica Guthrie, BSN, RN

References

Cancienne, J., Diduch, D., & Werner, B. (2017). High altitude is an independent risk factor for postoperative symptomatic venous thromboembolism after knee arthroscopy: A matched case-control study of Medicare patients. Arthroscopy: The Journal of Arthroscopic and Related Surgery 33(2). https://dx.doi.org/10.1016/j.artho.2016.07.031

Damodar, D., Donnally, C., Sheu, J., Law, T., Roche, M., & Hernandez, V. (2018). High altitude an independent risk factor for venous thromboembolisms after total hip arthroplasty. Journal of Arthroplasty 33(8), 2627-2630. https://doi.org/10.1016/j.arth.2018.03.045

Damodar, D., Vakharia, R., Vakharia, A., Sheu, J., Donnally, C., Levy, J., Kaplan, L., & Munoz, J. (2018). A Higher altitude is an independent risk factor for venous thromboembolisms following total shoulder arthroplasty. Journal of Orthopedics 15(4). https://doi.org/10.1016/j.jor.2018.09.003

Donnally, C., Vakharia, A., Sheu, J., Vakharia, R., Damodar, D., Shenoy, K., & Gjolaj, J. (2019). High altitude is an independent risk factor for developing pulmonary embolism, but not a deep vein thrombosis following a 1 to 2 level lumbar fusion. Global Spine Journal 9(7) 729-734. https://doi.org/10.1177/2192568219828349

Tyson, J., Bjerke, B., Genuario, J., & Noonan, T. (2016). Thromboembolic events after arthroscopic knee surgery: Increased risk at high elevation. Arthroscopy: The Journal of Arthroscopic and Related Surgery 32(11), 2350-2354. https://dx.doi.org/10.1016/j.arthro.2016.04.008

Wani, Z. & Sharma, M. (2017). High altitude and anesthesia. Journal of Cardiac Critical Care 1(1), 30-33. https://doi.org/10.1055;s-0037-1604203