Chinese doctors presenting at the 7th World congress of Mountain and Wilderness Medicine in Telluride last month showed us a familiar photo. They called it Plateau Facial Persistence Erythema and we commonly see it here in Summit County. This rash occurs in women and children under conditions present at the plateau region at high altitude with cold and windy winter temperatures. It’s characteristics are erythema
or redness, of the cheek prominences that is darkest in the center and can even look purple in color. The redness can spread in a spider-like pattern from the center with a gradual transition to normal-appearing skin. It is painless and often symmetrical. The cause of this rash is unclear but is thought to be related to changes at high altitudes affecting vasomotor nerve function, decreased capillary elasticity with persistent expansion, and increased blood viscosity secondary to increased hemoglobin. Children have delicate skin that may not adapt as easily to this extreme environment, causing the rash. Treatment primarily involves prevention by avoiding cold temperatures, windy areas, and UV radiation. In other countries these rosy red cheeks are not considered a disease, but rather a beautiful variant of normal!
Category Archives: Health
High-Altitude Lung Edema Can Mimic Pneumonia in Kids, Even Without Travel by Rob Goodier
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
Those precious epi-pens at altitude
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.
Reflection to MRHAPE in the Mountains: Resident High Altitude Pulmonary Edema
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
Rocky Mountain High?
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
HAPE vs Pneumonia -basic explanation about why I believe in Resident HAPE as a new entity
Live High Train Low- What’s an athlete to do?
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
RHAPE in the Mountains
Caffeine and altitude
Dr. 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.
Going Public at the American Thoracic Society meeting in SF
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.
