Children grow and develop differently at high altitudes than they do at sea level
Dr. Chris has the medical community talking about HAPE!!!
“Health providers should advise patients who live at or travel to high altitude to have a pulse oximeter and check their oxygen levels if they are unwell,” the study’s author, Dr. Christine Ebert-Santos at the Ebert Family Clinic in Frisco, Colorado, told Reuters Health…
Click the link to read more:
High-Altitude Lung Edema Can Mimic Pneumonia in Kids, Even Without Travel by Rob Goodier
http://www.medscape.com/viewarticle/867210
With all the news about the 400% price increase in epi-pens, we don’t want to waste them. So what if we are backpacking at high altitude and eat some peanut butter by mistake in our energy bar? Then our face swells up like a chipmunk and we start to wheeze? We whip out the epi-pen from the external pocket of our pack only to find out it is frozen!! Oh, oh. What do we do now? Good news! at the 7th World Congress of Mountain and Wilderness Medicine in Telluride we heard the exact scenario described. It happened to a scientist, who then did a study to measure the effectiveness of the epi-pen after freezing and thawing. It still worked! So don’t throw out your frozen epinephrine. thaw and use.
Another tip: if you can’t afford the new price of the epi-pen, maybe your physician could prescribe injectable epi with a syringe to have on hand.
In beginning my Physician Assistant rotation at Ebert Family Clinic I was introduced to the exciting research of Christine Ebert-Santos, MD. The research surrounded a condition known as High Altitude Pulmonary Edema (HAPE). In growing up at altitude myself, at 6,926 feet in Jamestown Colorado, I have had some exposure to the effects of high altitude. Acute Mountain Sickness (AMS) is a condition that I am more familiar with and in reading Dr. Ebert-Santos’ research it became clear to me that HAPE is a more severe complication to those ascending to or living at altitude, especially if they develop an initial respiratory illness. In her paper Dr. Ebert-Santos describes several pediatric case studies that demonstrate the characteristics of this treatable condition. These patients presented with tachycardia (fast heart rate), tachypnea (fast breathing), decreased oxygen saturation, and rales (abnormal breath sound). Many of the children described were seen directly after an initiating illness such as the Flu. While seen in the clinic, or during admission to the hospital, these patients were treated with oxygen. The fact that HAPE can be treated with something as simple as oxygen is noteworthy.
Through her research Dr. Ebert-Santos has demonstrated that HAPE should be considered in all pediatric patients presenting to clinics or emergency rooms at altitude with hypoxia (decreased oxygen saturation) and a recent viral illness. Through placing HAPE in their differential diagnosis, clinicians can avoid giving excessive inhaled steroid treatments and unneeded antibiotics. Awareness of the prevalence of this disease in both travelers and residents alike ensures a decrease in the incidence of unfavorable outcomes from this potentially fatal condition.
Submitted by Kelly Kyte, Physicians Assistant Student from Red Rocks Community College Fall Rotation 2016
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.
Summit County cardiologist Warren Johnson is impressed by the numbers of people with elevated pressures in their lungs. “It could be as high as 30 per cent of adults,” he told local physicians gathered at a presentation this week. Symptoms are subtle: decreased exercise tolerance, mild shortness of breath, trouble sleeping, high red blood cell counts. Most people just think they are out of condition or aging.
A study in SpitiValley India of residents living at 9000-13000 ft found an incidence of three per cent with PH. Dr Johnson suspects this is a highly adapted population with centuries of mountain living.
Diagnosing this condition early with Echocardiogram can prevent serious disability. Treatment is as simple as sleeping on oxygen
Dr. David Katz at the University of Colorado reviewed 393000 births between 2007-2012. Of these 80% live between 3000-6000 ft. Only 1.9% live over 8000 ft. Death rates from Sudden Infant Death Syndrome (SIDS) state-wide was 4.2 per 10,000 but over 8000 ft the rate was 7.9/10000.
Another study Bu Dr Richard Johnson et.al. was published in 2021 in the Science Reports. This included all births as recorded in the CDC database between 2005 and 2010. Altitude was determined by county of birth. The analysis included many factors including race, ethnicity, marital status, parity, prenatal visits, sex, birthweight, gestation, maternal age, education and smoking status, paternal age and race, and live birth order. Of these over 25 million births, there were 23,673 SIDS deaths. For the 9,245 mothers giving birth at over 8000 feet there were 10 SIDS deaths in 6 years.
Although this is twice the rate o f SIDS at lower altitude, it is still a very small number. It is possible that hypoxia is a contributing factor, since low oxygen can cause apnea, but there is no research on this. Meanwhile parents are urged to place their babies on their backs to sleep and remove all soft material from the sleep area.
My nurse practitioner Laura Amedro and I met with local orthodontist Al Bishop yesterday. Sleep problems are more common at high altitude, and providers caring for children know that poor sleep can cause difficulties with learning and behavior, including ADHD. Dr. Bishop listed ten diseases made worse by poor sleep, including obesity, diabetes, high blood pressure, depression and others.
How does this tie in with the person who provides braces? Dr. Bishop showed us photos of mouths and teeth that can cause airway constriction. Expanders inserted inside the mouth (no more “head gear”) correct these problems but are more effective when started earlier. Some children can be identified and treated as early as 7 years.
Dr. Bishop has offices in Edwards and Summit County, so he is familiar with altitude issues. Night time oximetry is the recommended screening test for airway problems. This has to be ordered by a health care provider such as Laura or myself.
Most people will agree they do not sleep as well at high altitude, especially over 9000 ft/2500 m. In sleep, the drive to breathe is blunted, which may lower the oxygen and raise carbon dioxide in the blood. This causes high blood pressure in some adults and children but what else does it cause? Pediatric pulmonologist and sleep specialist Ann Halbower wonders if it effects growth and development in children. Family practice physician Lisa Zwerdlinger has many years of experience treating patients in Leadville and sometimes has babies that need oxygen for a year to gain weight.
A study published in the Archives of Diseases of Children in February this year analyzed previously published studies of oxygen levels in awake children at altitudes between sea level and 4000 meters, including Summit County. We are in the early phase of formulating a study on night time oxygen levels at various ages. since it takes years for research to be completed we recommend anyone with health issues that may be related to altitude to have a sleep study. this is very simple: a finger clip connected to a wrist band where data is collected.