All posts by Dr. Chris

Pediatrician trained at University of Michigan Medical School, University of Hawaii and University of Chicago for residencies. Spent 20 years at the Commonwealth Health Center in Saipan, CNMI, before establishing Ebert Children's later Ebert Family Clinic in Frisco, CO in 2000. Published in the Journal of High Altitude Medicine and Biology
High Altitude, Medicine, Technology

“Home Remedy” by Ted Katauskas

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Colorado Summit Magazine Summer-Fall 2016

In the Summer/Fall 2016 issue of Colorado Summit there is an interesting article entitled “Home Remedy” by Ted Katauskas.  A company, called Altitude Control Technologies, in Denver can install an air separator that continuously controls the amount of oxygen in a room based on barometric pressure and people entering and exiting that room.  So far, these devices have been used commercially and are now beginning to be used in high-priced dream homes.  There are medical implications of this technology for possible treatment of high altitude illnesses such as hypoxia or HAPE (High Altitude Pulmonary Edema).  Every one per cent increase in oxygen concentration is like descending 300 feet. An increase of five percent can improve sleep and brain function. This could be important for sensitive populations such as newborns and people in critical jobs where an increase in errors could have catastrophic consequences. British physiologist Joseph Barcroff interviewed residents in 1922 in Cerro de Pasco at 14,210 feet and found decreased cognition he termed “bungling”.

For children, the implications would be adequate perfusion of oxygen to the organs to carry out life’s functions and promote healthy growth.   Currently, this technology is very expensive.  Could an air separator be subsidized by insurance? Added into the construction of a new home would promote the health and comfort of mountain residents and visitors.  

Submitted by Joe Brath, NP Student from Georgetown University rotating Summer 2016

Acclimation, Health, High Altitude

Rocky Mountain High?

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With apologies to John Denver, here in the mountains, it’s not just the sunshine on your shoulders that makes you smile. Scientists have been studying the effects of high altitude and mild hypoxemia on dopamine, one of the chemicals in the brain. Dopamine causes feelings of pleasure and happiness. At higher altitudes where oxygen levels in people are lower, dopamine levels are increased.

Here’s a little bit more on how that works: Oxygen makes up 21% of the atmosphere. At sea level, 100% of that oxygen is available to breathe. With a rise in altitude, barometric pressure decreases causing the air molecules to become more spread out. This means that at 10,000 feet above sea level, only 70% of atmospheric oxygen is available to breathe. This results in a state of mild hypoxemia, or lower levels of oxygen in the blood, which in turn causes increased levels of dopamine.

You can read more about dopamine and altitude here:

Toler, A. (2014). “Your brain on altitude.” Catalyst Magazine. Retrieved from http://www.catalystmagazine.net/your-brain-on-altitude-2/

Here’s more about the effects of altitude on oxygenation:

Peacock, A.J. (1998). Oxygen at high altitude. British Medical Journal, 317 (7165). p1063-1066.

Here a calculator to figure out oxygen and barometric pressure at different altitudes:

http://www.altitude.org/air_pressure.php

Submitted by Rebecca Somershoe PNP Student from Vanderbilt University rotating Summer 2016

Child Growth & Development, Health, High Altitude, Medicine

HAPE vs Pneumonia -basic explanation about why I believe in Resident HAPE as a new entity

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This poster prepared by Atsuhiro Saisho explains the difference between HAPE and pneumonia with illustrations
This poster prepared by Atsuhiro Saisho explains the difference between HAPE and pneumonia with illustrations

Acclimation, Health, High Altitude, High Altitude Training & Fitness, Medicine, Mountaineering

Live High Train Low- What’s an athlete to do?

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I just came across this study in the literature from a couple years ago

Optimizing Altitude for Live High-Train

Low (LHTL) Training

Chapman et al (2013) hypothesized that athletes living at

higher altitudes would experience greater improvements in sea

level performance, secondary to greater hematological acclimatization,

compared to athletes living at lower altitudes. After

4 weeks of group sea level training and testing, 48 collegiate

distance runners (32 men, 16 women) were randomly assigned

to one of four living altitudes (1780m, 2085m, 2454m, or

2800 m). All athletes trained together daily at a common altitude

from 1250m to 3000m following a modified LHTL

model. Subjects completed hematological, metabolic and

performance measures at sea level before and after altitude

training. Upon return from altitude, 3000m time-trial performance

was only significantly improved in groups living at the

middle two altitudes. EPO remained elevated after 72 h except

in the 1780m group. Erythrocyte volume was significantly

higher in all groups but not different between groups. These

data suggest that a 4 week LHTL altitude camp at 2000m to

2500m is optimal for sea level performance.

 

HIGH ALTITUDE MEDICINE & BIOLOGY

Volume 15, Number 1, 2014

ª Mary Ann Liebert, Inc.

DOI: 10.1089/ham.2014.1513

4

 

Child Growth & Development, Health, High Altitude, Medicine

RHAPE in the Mountains

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HAPE POSTER ATS final

Health, High Altitude, Medicine

Caffeine and altitude

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IMG_1462Dr. Oz recently wrote that caffeine can help us stick to our exercise routines.

Caffeine can also help us adjust to high altitude because is increases our ventilation rate.

By making us breath more caffeine increases our oxygen level “naturally.” This is better than any vitamin by pill or IV.

Child Growth & Development, Health, High Altitude, Medicine

Going Public at the American Thoracic Society meeting in SF

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For seven years I have been writing and speaking about what I call Resident High Altitude Pulmonary Edema- a clinical diagnosis I apply to children with hypoxia during a respiratory illness with no recent travel. Now I have an opportunity to present my theory to a wider professional audience. I have been invited to present a poster at the American Thoracic Society annual meeting in San Francisco on May 15. This will be a forum to bring attention to a problem I see frequently in children living in the mountains that is not widely recognized or described in the scientific literature. I expect to be challenged and hopefully form working relationships with other researchers who can help us further define this condition. See post on 1/9/15 for further details. I will share the poster here when it is finished.

Health, High Altitude, Medicine, Technology

Oxygen Conditioning: As Easy As Air Conditioning

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IMG_0747 (2)

Imagine increasing the amount of oxygen in a room with equipment no more complex than an air conditioner. This is the future of high altitude living. This is already happening in some academic and industrial sites at high altitude, such as mines and research telescopes.   Every one per cent increase in oxygen concentration is like descending 300 feet. An increase of five percent can improve sleep and brain function. This could be important for sensitive populations such as newborns and people in critical jobs where an increase in errors could have catastrophic consequences. British physiologist Joseph Barcroff interviewed residents in 1922 in Cerro de Pasco at 14,210 feet and found decreased cognition he termed “bungling”.  Maybe I should install oxygen conditioners in my office at 9,100 feet!

Information from the Journal of High Altitude Medicine and Biology, Sept 2015. John West

Acclimation, Health, High Altitude, High Altitude Training & Fitness, Medicine, Mountaineering

How Long With Low Oxygen?

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We frequently measure oxygen levels on people of all ages here in our mountain clinics. We order nighttime oximetry and sleep studies and analyze hundreds of data points reflecting heart rate and oxygen levels over time. When we see someone with a low oxygen in clinic, there may be no way of knowing if they have been hypoxic for hours, days, weeks unless they have an illness with an abrupt onset, like influenza or pneumonia or they just returned from sea level. Babies during the first weeks may have low oxygen with no symptoms, since they are accustomed to this in the womb where oxygen saturations run 40-60 %.

A recent article in the Journal of the American Medical Association studied extremely premature babies at 18 months for adverse outcomes including vision, hearing, cognition, motor, and language. They correlated the degree of disability with the length of time the child was hypoxic during the first few months. One minute of hypoxia seemed to be the cut-off. Now this doesn’t tell us how low or how many but it may be a helpful guide when watching someone’s oxygen or analyzing a sleep study. Shorter episodes may be insignificant long term.

This is a complex article and the children with the poorer outcomes had more episodes of hypoxia at older ages- 9-10 weeks after birth. This could mean that the insult to the brain was contributing to the hypoxic episodes as well as the deficits.

 

Health, High Altitude, Medicine

Aging and altitude illustrated

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Ever since I moved to the mountains I have been impressed by the number of older adults that pass me up on the trails hiking or mountain biking.

“Altitude is a fitness challenge in itself”, wrote Eric Swenson in the Journal of High Altitude Medicine and Biology May 2015. “Low fitness contributes to events” [altitude illness]

People who live in the mountains usually stay very active, like this hiking group from St. John the Baptist Episcopal church that goes out every week.

 

 

Two of these senior citizens hiking at 12,500 feet sleep on oxygen. They are residents living above 9,000 feet.
Two of these senior citizens hiking at 12,500 feet sleep on oxygen. They are residents living above 9,000 feet.