Graduate of Temple University School of Medicine, Director of Wilderness Medicine Fellowship at University of California San Francisco Fresno Department of Emergency Medicine, Sue Spano, MD, FACEP, FAWM presented twice this year at the Wilderness Medicine Society’s annual (virtual) conference. Boasting the experience of about a thousand miles of the Pacific Coast Trail in Oregon and California and other recreational excursions, she shared a wealth of advice and personal recommendations for long distance backpacking.
To put it all into perspective, she referenced the Pacific Coast Trail (PCT), John Muir Trail (JMT) and the Appalachian Trail, each covering 2650 mi, 211 mi, and 2200 mi respectively. These are trips that last, easily, months. The general time frame for many of her recommendations is about five to six months.
Not surprisingly, the issue of weight comes up frequently for travelers. There are a number of studies done on this, from body mass index to base pack weight, and every ounce counts. While fitness level does not directly correlate to the incidence of injury, increase in BMI does correlate directly to increased risk of illness, injury, and trail evacuation. It is notable, however, that in a poll, about 2/3 of those hiking the PCT and well above those on the JMT trained before embarking on the trail, and most of them considered themselves to be “above average” in their level of fitness (7 or 8 on a scale of 1 to 10).
Although Dr. Spano does recommend carrying backups of three things — lighters, water treatment systems, and first aid — when it comes to base weight, there are several items that may be worth a little more investment for fewer ounces. Right off the bat: trail runners over boots. The mere difference in ounces becomes significant after so many miles, and the flexibility of softer shoes helps prevent a lot of discomfort (blisters, for example). She also notes that trail runners are more breathable and dry more quickly, sharing that she doesn’t typically bother to take them off to cross water or in snow as they will dry right on your feet along with your socks. It would be interesting to hear accounts of the footwear of preference on the Colorado Trail, where elevations are frequently higher and there may likely be more snow in general.
In another poll, 21.8 lbs was the base weight carried by packers, most of whom would have carried less in hindsight. This can be achieved by investing in lighter backpacks, tents, hiking poles, sleeping bags and sleeping pads, specifically. ULA Equipment out of Logan Utah makes an ultra-light pack that Dr. Spano prefers, “no conflict of interest”, just her personal favorite.
Skip the toothpaste, Spano urges. It doesn’t actually clean your teeth, so you might as well just brush with water.
Something else we’re seeing more and more of on distance excursions is tents that incorporate hiking poles as tent poles. Hiking poles themselves are recommended more and more as well, as they distribute more weight away from your legs.
Toilet paper must be packed out with you on much of the trail these days! Thus, the rise of the “backcountry bidet”, which you can make yourself by poking holes in the cap of a plastic liter water bottle. “You come out feeling like you had a full shower,” Spano testifies, and the water you use does not have to be filtered or potable.
Water! Know where your next water source will be. “Camel up at water sources … When you get to a water source, spend some real quality time there soaking your feet, cleaning your bandana, drinking as much water as you possibly feel like you want. Because the only time that your water is going to be ice cold is when you’re at that stream. Anything that you carry with is going to get really warm … Your easiest way to carry water is in your belly.”
When it comes to long distance backpacking, one of the finest pieces of advice Dr. Spano offers is that you should always be upgrading and optimizing your strategy:
“A person who hasn’t changed their backpacking practices in the last 10 years is not a person that I would really want to backpack with. A person who practices medicine the same way they did 10 years ago is not someone I want to practice medicine with. You should always be improving your gear, improving your behaviors, improving the way you approach the same challenge so that you’re a better backpacker as a result.”
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.
Over 800 participants from 25 countries joined the virtual conference this year which included Dr. Chris’ poster presentation on growth at altitude. Over the next several months we will extract the most relevant information to publish in our blog, starting with:
The Rule of 3’s
You can survive 3 minutes without oxygen
3 hours without shelter in a harsh environment
3 days without water
3 weeks without food
Dr. Christine Ebert-Santos presents her research on growth in children at high altitude, “Colorado Kids are Smaller.”
We will be sharing some of the science, experience and wisdom from these meetings addressing how to survive. For example, Dr. Peter Hackett of the Hypoxia Institute reviewed studies on how to acclimatize before travel or competition in a low oxygen environment.
Susanne Spano, an emergency room doctor and long distance backpacker discusses gear, how to build an emergency shelter in the wild, and when it is OK to drink from that refreshing mountain stream.
Michael Caudell presenting on plant toxicity.
Michael Caudill, MD shares what NOT to eat when you are stranded in the wilderness in his lecture on toxic plants.
Presentations included studies of blood pressure in people traveling from sea level to high altitude, drones delivering water to stranded hikers, an astronaut describing life and work at 400,000 m, what is the best hydration for ultra athletes, how ticks can cause meat allergy, and, as always, the many uses for duct tape.
Duct tape for survival.
We will also update you on the treatment of frostbite as well as a discussion about “Climate change and human health.”
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Last week we were privileged to have a Zoom discussion with two high altitude experts from the Instituto Pulmonar Y Patologia de la Altura (IPPA) founded in La Paz, Bolivia in 1970. Dr Gustavo Zubieta-Calleja and Dr. Natalia Zubieta-DeUrioste answered our questions about their recently published article, Does the Pathogenesis of SAR-CoV-2 Virus Decrease at High Altitude?. They and the seven coauthors presented data comparing COVID cases in high altitude areas of China, Bolivia and Ecuador showing a marked reduction in numbers compared to low altitude areas in the same countries, with dramatic, colorful topographic maps.
Drs. Zubieta-Calleja and Zubieta-DeUrioste and their colleagues theorized four reasons why altitudes above 2500 m could reduce the severity of the corona virus. (Note: Frisco, CO is at 2800 m, Vail 2500 m). As described in their previous paper published in March, the intense UV radiation at altitude as well as the dry environment likely reduce the viability of the virus in the air and on surfaces.
Dr. Zubieta-Calleja on a Zoom chat with Dr. Chris explaining a chart comparing UV exposure in La Paz, Bolivia (top line) and Copenhagen, Denmark (bottom line).
Dr. Chris with Dr. Gustavo Zubieta-Calleja and other altitude experts from the Hypoxia Conference in La Paz on the Camino Chacaltaya, which reaches an elevation of 17,785’/5421 m.
The low barometric pressure causes air particles to be spaced more widely, which would also decrease the viral particles inspired with each breath, reducing the severity and frequency of infections.
Furthermore, residents accustomed to chronic hypoxia may express reduced levels of angiotensin converting enzyme 2 (ACE2) in their lungs and other tissues. This enzyme has been found to be the entry path for the corona virus into cells where it replicates. Finally, the normal adaptation and acclimatization of populations with prolonged residence above 2500 meters may reduce the severity of the disease in individuals, and reduce mortality. This includes increased ventilation, improved arterial oxygen transport, and higher tissue oxygenation mediated by increased red blood cells produced under the influence of erythropoietin, which could be explored as a possible therapy.
Dr. Zubieta-Calleja with statistics reflecting the number of COVID-19 infections at different elevations in Bolivia. Note the most infections occur at a lower elevation.
As we stated in our interview quoted in the Summit Daily News March 17th, none of these factors can be relied upon to protect every individual. Therefore it is important to continue frequent hand washing, wearing masks, social distancing, and avoid touching your face.
Another Spring season in Colorado. The ski resorts have closed early per the COVID-19 protocol, along with most other establishments. Even on the normal schedule, most ski resorts would have been closed for the season by now, bringing more people to the backcountry. But this year seems to have seen an upswing in backcountry activity, where many people are going to stay active while limiting exposure to others. Just over a week ago, a team of 20 search and rescue volunteers rescued a 26-year-old man who had fallen hiking on steep terrain around St. Mary’s Glacier, Colorado. Last year, a total of 10 snowmobilers were killed in the backcountry in avalanche slides. Only one was wearing a beacon.
Backcountry and Avalanche Safety resources, thankfully, are growing more plentiful and accessible, and last winter, we published an article on the basics. Earlier this winter, I spoke with backcountry athlete and web development colleague Dan Beerman, whose experience in the backcountry really broadened as a backpacking guide in New Mexico during the summers 12 years ago, followed by a position as a climbing instructor.
Dan Beerman on the Pacific Crest Trail
When I was a backpacking guide, I was on the search and rescue if I didn’t have a crew … We had a radio, so we were the point of contact for finding and doing extraction. That’s when I learned the most and was exposed to the most. I took my Wilderness First Responder course in 2014, and that was through the Wilderness Medical Institute.
Dan’s also a fellow hut tripper, and we’ve been talking about doing one together (when we’re on the other side of the current pandemic). He’s spent the last two New Year’s in huts, backcountry skiing or snowshoeing tours. This past year, he skied Buffalo Mountain’s Silver Couloir, in the Gore Range, and made an attempt at a couloir on Mt. Torrey’s. And there have got to be some good “couloir” puns out there.
Beerman on Buffalo, Summit County, CO.
I have aspirations to do the Colorado trail quickly, but I don’t know if I wanna do that in a competitive way or just recreationally backpack it. It’s hard to balance summer objectives, or climbing objectives vs. winter backcountry goals vs. alpine mountaineering objectives.
And he makes a great point:
In Colorado, your recreation is so close to becoming high-consequence all of the time! If the weather changes from the trailhead, that could be a really big problem.
I’m familiar. Nothing really teaches you as much or as quickly as getting caught in Colorado’s extreme weather patterns.
Avalanche Safety
Dan took an Avalanche Awareness and Safety class through Colorado Mountain School, held up in Rocky Mountain National Park over two field days after two nights of class in Boulder. His main takeaway:
Check an avalanche conditions snow report daily. Observing the snowpack over the seasonis going to make your confidence on the day of your excursion a lot higher. I’d had no context for why avalanches were happening, where and why it’s dangerous. Having that lens through which to view weather events in terms of avalanche conditions is so valuable. It’s an intuitive thing about paying attention to the weather.
This is my first season getting out at Copper, for example, and they all have that double-black diamond terrain in the back bowls that are labeled ‘EX’ on it. There’s a sign that says, ‘Ski with a partner,’ and I just thought, ‘Oh, shit, that sign should probably be much bigger!’
Beacon, shovel, probe are the mandatory avalanche terrain items — you’re putting other people at risk if you don’t have [them], because even if you observe a slide, you can’t do anything about it. Additionally, if you don’t have a beacon in a slide, others can’t find you. You’re not contributing to a rescue, nor can you be rescued. In Colorado, there’s an increasing awareness for that. I typically will bring that with me all the time, it’s just always in my ski bag. Having some snacks, having some water, those are the kinds of things: you should never not have them.
Beerman in his beacon.
Training
I’ll take the goals of the expedition and plan accordingly. If I’m doing a ski trip, I’ll wanna get out and do hikes with weight or runs where I’m doing elevation several times. I like to do six weeks out, of four weeks of training and two weeks of tapering down.
Nutrition
I tend to be in a constant attempt to gain weight. On the Pacific Crest Trail I tried to gain weight prior, eating a lot of fatty foods, that kind of thing. Jonathan and I came up with this metric: calorie-per-dollar-per-ounce. Lightweight food that’s affordable, easy to ingest, easy to prepare, and you aren’t having to burn a lot to carry that with you to the backcountry.
[On the trail], peanut butter is always a winner. Olive oil is one of the highest calorie-per-ounce [food]. I have literally drank it before, but just add it to everything. I do eat a lot of standard trailmix, it’s easy and accessible. I’m a big fan of pumpkin seed mix or stuff with chocolate in it. I like CLIF bars. I do not like Luna bars because I’ve eaten so many of them. I can’t eat pop tarts anymore because they used to be in the meals that were issued when I was a guide. Snickers bars are a great calorie-per-dollar-per-ounce deal. I eat a Snickers bar or two before bed when I’m sleeping at altitude so my body has calories to stay warm.
I’ll make these mass-gainer complex food supplements. It’s like protein powder, but it also has carbs, like a workout and performance powder. And I would add that to water with coffee, and that would be a breakfast while hiking. There’s a lot of different kinds of powders and mixes you can add, but when you’re in calorie-burning mode, I do recommend this. If you’re hiking 20+ miles in a day or 4000+ feet of elevation in a day, you’re burning greater than 4000 calories, so you really have to eat more than you think you can.
Acclimatization
I wouldn’t say that I had HAPE (high altitude pulmonary edema) or HACE(high altitude cerebral edema) … Definitely, especially when I was younger … I would travel from 4000′ to 10,000′ in a 24-hour period. I’ve actually had search and rescues where someone was having night-terrors or hallucinations [due to HAPE or HACE]. I was a backountry professional for the Boy Scouts at a camp at 10,800′ (one of the first backcountry camps, in New Mexico). I’ve experienced dizziness, nausea, insomnia, weakness of the knees, elevated heart rate … and I’m a runner, I’m in decent shape. But you should acclimatize before setting out on a trip.
Skiing down the Silver Couloir.
One last piece of advice,
Learn the Leave No Trace principles. We live in a state where impact is so concentrated that the more that everybody knows, the more likely it will be there for the next generation.
Dan and his backpacking, backcountry cohorts keep a blog full of breathtaking landscapes and telling captions on CaptainsofUs.com.
There will be plenty of time to escape to the backcountry again after the risks of COVID-19 have subsided. The current time is a good time to start preparing mentally. Know before you go.
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.
“I’ve been here 25 years,” Sinclair shares with me over coffee at the Red Buffalo in Silverthorne, Colorado (9035’/2754 m). “Born and raised on the East Coast in Philadelphia.” The software company he had been working for moved him out to Colorado Springs. He hadn’t ever skied in his life until then. Shortly after, “on a whim”, he moved up to Summit County and started working on the mountain as what we used to call “Slope Watch”, the mountain staff often in yellow uniforms monitoring safe skiing and riding on the mountain. After a month, he got really bored, “and I said, ‘How do I get to be a patroller?'”
Sinclair then went to paramedic school to get qualified as an Emergency Medical Technician, then spent 19 years as an EMT and 9 years as a Medic. For the last six years, he’s worked for the ambulance service in Summit County, one of Colorado’s highest counties, with towns at above 9000′. He has also worked as a ski patroller at Copper Mountain, Keystone, and Park City (Utah). This year is the first he hasn’t been patrolling in 18 years. During the summer, he is a wildland fire medic, where he often works with crews that are shipped in from lower elevations, including sea level.
Although he’s decided to take this season off, he still maintains a very active relationship with the outdoors, travelling around the backcountry on expeditions to remote mountain cabins, and has made a recent trip to Taos, New Mexico (6969’/2124 m). He’s witnessed his share of altitude complications.
What are the most common altitude-related complications you see?
You see the families coming up to go skiing … Usually 90% of them are fine. Altitude doesn’t seem to bother them at all – they’re either healthy enough or lucky enough. They get in, they ski, they get out. But there’s that one family or that one couple that just don’t acclimatize. They don’t realize that they don’t acclimatize, and the rest of their group doesn’t realize. A couple of days go by and they think, ‘Geez, I feel awful,’ then they go ski, or do something active, and their condition is exacerbated. Or ‘Geez, I haven’t slept,’. you get that story over and over.
And you’re having this conversation on the hill as a patroller?
Or they’ve called 911 on their way [up to the mountains]. They have no idea. Just no idea. I ask them what they’d had to eat. They had a donut or a pastry or just coffee before the plane ride. I ask themwhen was the last time they peed. You’re trying to find the physiology of what’s happened.
I tell them, ‘You need to sit down or go back to your condo. You need liters of water. You need liters of Gatorade. No fried foods, no alcohol, no coffee. No marijuana. Let your body catch up. Wherever you’re staying, tell them you need a humidifier. Put it in every bedroom, crank it up and leave it on. You’re gonna have trouble sleeping.’
And they never wanna hear it. They never wanna take a day off, but by the time you see them, they’ve taken the day off anyway, because there’s no way they’re getting back up there!
Sinclair also expresses some frustration with the lack of resources provided by the ski industry itself:
How do you educate them? The marketing people don’t want to. Because if they have to spend a day in Denver [to acclimate], that’s one less day up here [at the ski resort]. They don’t want to publicize that [altitude sickness] can happen, that it’s common. People ask, ‘How often does this happen?’ Easily, at any resort in a day, Patrol probably sees 20 – 25 people, whether they called, they walked in, you skied by them and started talking to them. ‘You’re dehydrated. You’re at altitude. It means this …’ The resorts don’t want that many to know, otherwise, you’re gonna go to Utah or California, where it’s lower.
You get such misinformation. ‘At 5000 ft., you have 30% less oxygen.’ No, the partial pressure is less, there is still 21% O2 in the air. You just have to work harder to get the same volume. The real physiology of what’s going on is systemic. [People experiencing altitude sickness] don’t know why they feel like crap. They think it’s because they’ve been drinking too hard.
How do you mitigate their symptoms on the mountain?
We do a lot, but it’s reactive, not proactive. I hate to bash the oxygen canisters, but it’s not doing anything for you. It’s not gonna make you feel better, other than what you’re sucking up. At 10,000′, it’s questionable. We’ll be at the top of Copper [Mountain] giving them two to four liters of oxygen, then they’ll ski down and feel great.
Sinclair refers to the Summit County Stress Test, which was the first I’d heard of it:
You’re 55, you’re 40 – 50 lbs. overweight, and you come up for your daughter’s wedding. You walk over to Keystone [Ski Resort], you take the gondola over, then all of a sudden, you find out you have a heart condition. You find out whatever else you have going on. We’ve done it over and over and over. They go ski, they call us at 3 in the morning, we find out they’ve got a cardiac issue, or they’ve irritated the pulmonary embolism they’ve had for years.
I had a guy last year, at the Stube at Keystone for lunch.
Keystone’s Alpenglow Stube is a reputable restaurant that sits in the resort’s backcountry at 11,444′ (3488 m).
He had some food, alcohol, he’s having a great day. Ski patrol gets a call, ‘Hey, my husband doesn’t feel well.’ This guy looks bad, sitting on the couch, sweating profusely, and he can hardly tell what’s going on. It’s the classic presentation of an inferior heart attack.
‘I don’t have any heart conditions. I saw my cardiologist.’ You saw a cardiologist, but you don’t have any heart conditions?!
And there are a lot we don’t see. People who go home because they think they have the flu.
Have you seen any rare or surprising complications?
We see HAPE (High Altitude Pulmonary Edema) now and again. That seems to be a walk into the hospital where [their blood oxygen saturation is] at 50 – 52. We’re not in the zone to see HACE (High Altitude Cerebral Edema). We’re just not at the altitude.
HACE is more typical above more extreme elevations, above 11,000′. Colorado’s highest peaks are just above 14,000′. Most ski resorts in Colorado are below 12,000′.
I’ve only seen one HAPE case on the hill. In their 50s. You listen to their lungs, and they’re getting wonky. A guy who was reasonably fit, but you look at him and go, ‘Hm, this is bad.’ But he was responsive and talking. Then you start seeing the things like the swaying, getting focused on something else [in the distance]. One of those [situations] where you’re like, ‘Let’s get out of here.’ [We need] tons of oxygen. Again, ‘I didn’t feel good yesterday, but I decided to go skiing today.’ He was sitting at the restaurant at the top of Copper [Mountain].
People do not realize that their diabetes, their asthma, their high blood pressure, things that they commonly manage at home, are exacerbated at 9000′. By the time they realize it, they’re calling 911. At that point, your best bet is to get out of here.
What tools or instruments do you use the most as a paramedic and ski patroller?
Cardiac monitor. It’s got a pulse oximeter. [Also] simple things you ask. ‘Hey, do you know what your blood pressure is?’ I use a stethoscope all the time. Sight and sound. Are they talking to me? Are they having a conversation with me? Are they distracted by what’s happening to them? When was the last time they peed? Was it regular color? Did it smell stronger than usual?
People ask, ‘How much water do I need?’ How much water do you drink in a day? If I’m outside and I’m moving, I probably have 10 liters. If I’m on a roof laying shingles, I probably have 4 or 5 liters before lunch. It’s those little tools. You don’t even have to touch somebody.
Do you have any personal recommendations for facilitating acclimatization at altitude?
Workout, be in shape, go harder than you normally do that month before you get here. Get the cardiovascular system more efficient before you get here. If you have any kind of medical concerns, make an appointment with your doctor and say you’ll be at 10,000′ to sleep. Just ask, ‘What do I need to do?’ The day before you get on the plane, stop drinking coffee and start drinking water. Hydrate before you get here. They humidifier thing. Make sure the place you’re going has one. Find out. Go to Walmart and spend $15 to buy one.
Watch your diet. Just so your body’s not fighting to get rid of fat and crap.
When we’re getting ready for a hut trip, we are mostly vegetarian (although we do eat meat), but we ramp protein up a week prior, pushing more chicken, more red meat. We tend to eat fish normally, but there’s always at least one fish meal at the hut. We don’t do crappy food at the hut. I don’t care if I have to carry another 10 lbs. In addition to going to the gym, go for a skin, go to 11,000 – 12,000′ for a couple hours. Ramp up the altitude work.
What do you eat on the trail?
Pre-cooked sausage, usually some kind of chicken sausage. Cheese. Whole grain tortillas, and if we’re feeling spunky, some kind of hot sauce or pico [de gallo]. For me, it’s just a handful of nuts and raisins. If I feel like something else, I’ll throw in some chocolate or white chocolate. I hate the packaging, the processed foods, the bars. Somebody usually makes granola for on-the-way-out food. And I tend to carry dried fruits. Lots of peaches during Palisade peach season. I used to take a lot of jerky.
A recent topic that comes up alot in altitude research at our clinic is Aging.
I have to work harder to stay at the same place. I’m sitting here and I can feel my right knee. I was at a 15″ [of snow] day in Taos, and I caught something [skiing]. It’s been weeks, and it’s not weak or anything, but I just know. It takes longer. I find I need more sleep. I was a 4 or 5 hour a day guy for a long time. Now I’m at 7. The days I get 8 are awesome. Luckily enough, I’m still healthy, fit. If I’m up at night, it doesn’t shatter my day. Haven’t slept on oxygen yet. Don’t want to find out.
He laughs.
As I get older, I’m adding more supplements: fish oil, glucosamine, glutine (for eye health). My eyes are bad anyway, and I’m constantly standing outside against a big, white mirror (the snow). And I’m cautious of the bill of a hat vs. a full-on brim during the summer. Other than my face, everything’s covered during the winter. The color of the bill on your hat can be way more reflective. A black bill will cut the reflection. Little things.
I’ve rounded out my workouts. They’re more whole-body. I concentrate on cardio. I’m conscious that I’m not as flexible as I was. I’d like to say we’re regularly going to yoga, but at least we’re going.
The gauge for me is you go on a hut trip with our friends in the middle-age category, but we’ll take some younger folks [too]. I kinda monitor who’s doing what – chopping firewood, who’s sitting more than who. It’s not out of pride. I need to realize.
I’m colder. You start to notice. It’s not that your feet are cold, it’s that your calves are cold. I succumbed to boot heaters a few years ago.
Year after year, in every season, visitors from all over the state and all over the world come to Colorado’s high country. For many of them, it’s the highest elevation they’ve ever visited, and often ever will. The dryness, the elevation, the air pressure, the intense sun exposure and the lack of oxygen demand a lot of compensation from the body. Sinclair’s experiences at altitude are consistent across every conversation I’ve had with physicians, athletes and other professionals when it comes to preparing your body to be active at altitude, from getting plenty of water to controlling the speed of your ascent to any elevation above 7000′ to consulting with a specialist regarding any pre-existing cardiac or respiratory conditions to how much oxygen one needs to mitigate symptoms of altitude sickness to decreasing elevation in case of an emergency. Any one of these experts will also tell you that the best ways to prepare your body for altitude is to get plenty of sleep, exercise regularly, and limit foods containing a lot of oil, grease and fat that will demand more from your body.
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.
Both residents and visitors of the high altitude of Colorado are faced with the frustration of applying lotion and Chapstick frequently throughout the day and yet continuing to experience dry, irritated skin and chapped lips. Although this can be contributed to by uncontrollable factors such as dry climate and cold temperatures, there are daily modifications that can be made to help treat and prevent persistent dry skin. It is important to recognize that varying factors including environment, chemical exposure, diet, and genetics have a role in the progression and persistence of dry skin and other related skin conditions. To discuss some of these different common skin problems and the multitude of “therapies” and “myths” that surround them I had the opportunity to meet with Kelly Ballou PA-C from Renew Dermatology
A recent study performed in Vail, CO revealed that at higher altitudes, SPF 100+ sunscreen was more effective at protecting against sunburn compared to SPF 50+. The information found in this study differs from the American Academy of Dermatology recommendations of using water resistant SPF 30 or higher. Kelly expressed her wishes for more dermatologic studies to be performed at higher altitude communities like Summit County, Colorado in the future as there is known increased UV exposure risk with higher elevations. Whether it is snowy, sunny, rainy, or cloudy, it is important to be compliant with frequent sunscreen application as recommended on the bottle and barrier repair lotions to achieve the greatest benefit with sun damage prevention (which can develop as brown spots, fine lines, loose skin or precancers) and hydrated skin. Kelly stated how “Even when it is a blizzard in Summit County, the UV exposure is still 80-90% compared to the UV exposure at sea level.” She recommended “setting an alarm while hiking, fishing, or skiing as a reminder to re-apply sunscreen frequently during outdoor activities.” Recognizing and modifying factors such as frequent hand washing and bathing, forced air heating, chemical exposure, and overuse of soaps can help to reduce dry skin.
There are a multitude of moisturizers
available over-the-counter which can be overwhelming to choose from. It is
recommended to choose moisturizers that are plain “no scents or oils added”
such as Eucerin, Aquaphor, Cetaphil, or CeraVe. It is encouraged to apply
moisturizers 2-3 times daily as needed to avoid dry, cracked or painful
skin. For irritable dry skin, scratching and itching are highly discouraged as
this can result in increased risk of infection or scarring. Trimming of nails
and applying bandaging over dry areas can help to reduce these tendencies and
associated risks. If there is a severe urge to itch, over-the-counter
antihistamines such as Zyrtec and Claritin can provide some relief. To avoid
daytime “tiredness”, Claritin (less-sedating) is recommended during the morning
and afternoon hours, while Zyrtec (possibly more-sedating) can provide
relief at night.
Kelly Ballou, PA-C, with Renew Dermatology in Frisco, CO, has over 10 years of Dermatology experience. She’s holding one of her top recommendations for altitude skin care, Epionce Renewal Calming Cream.
Kelly and I discussed how Epionce has a
medical grade product called Renewal Calming Cream which has shown
incredible results with treating not only eczema, but many other
conditions associated with dry and irritated skin. It is a product which
utilizes multiple natural ingredients that is able to be sold at
medical practices but does not require a prescription. Kelly described
how, in her experience, it “works on most anything red, can
reduce itching and dryness quickly over damaged skin exposed to the outdoors,
and is one of the best moisturizers – much more effective than any over-the-counter
moisturizers or other products.”
As parents may well know, kids can present
with odd skin conditions that are persistent despite efforts of frequent
moisturizing. For conditions such as Keratosis Pilaris, Cradle Cap, and Atopic
Dermatitis (Eczema), there are additional recommendations other than just
applying frequent lotion and sunscreen throughout the day.
Keratosis Pilaris:
Keratosis Pilaris is a chronic
condition that can present as dry skin that appears on upper arms,
thighs, and buttocks. It is commonly described as “rough sandpaper with tiny
bumps”. It is often made worse by soaps that remove the skin’s natural oils,
thus disabling the skin from holding onto necessary moisture. Avoiding
bubble baths, strong soaps, and creams with fragrances can help to improve
Keratosis Pilaris. Dr. Ebert-Santos recommends room humidifiers and applying
moisturizing cream within 3 minutes after bathing at least 2 times
throughout the day for optimal results.
Cradle Cap:
Cradle Cap is best described as red patches on
the scalp covered with oily, yellow scales or “crusts”. It is the result of
hormones causing over production of oil and can be linked with an
overgrowth of yeast. Eventually, cradle cap will go away on its own within 6 to
12 months of age, however, best treatment can include antidandruff shampoo
twice per week or nonprescription Hydrocortisone 1% cream for resistant cases.
Kelly often informs her patients that “oil treatments are not effective for
resolving cradle cap” in her experience, but rather she recommends
prescription antifungal shampoo which can be applied for at least 20 minutes
and then rinsing shampoo off for optimal results. If not resolved with just the
shampoo, a combination of Ketoconazole cream and Epionce Calming Cream has
additionally shown positive results.”
Atopic Dermatitis (Eczema):
Eczema is a red, itchy rash that can appear as early as birth or can start at any time throughout life. The rash can be found anywhere on the body. The overall treatment for eczema may involve steroid creams, moisturization, as well as avoiding frequent use of bathing soaps and anything with fragrance. To prevent further aggravation of eczema, keep shampoo off the rash and try to use non-drying soaps such as Dove, CeraVe or Cetaphil. It may take trialing different therapy regimens to find what works best for each individual. However, if the rash weren’t to improve after a few days of treatment, or the rash were to become raw and appear infected it is recommended to follow up with your doctor.
Breeann Backer is a second-year physician assistant student at Red Rocks Community College. She graduated from Colorado State University in Fort Collins, CO with a Bachelor’s in Health and Exercise Science. Before PA school she completed an internship at Cardiovascular and Pulmonary Rehabilitation and thereafter worked as a medical assistant in outpatient cardiology for 2 years in Denver, CO. She enjoys any excuse to stay active outside and loves calling Colorado home. Her hobbies include photography, exploring, and trying new foods.
References:
Keratosis Pilaris: Schmitt BD. My Child Is Sick!: Expert Advice for Managing Common Illnesses and Injuries. Elk Grove Village, IL: American Academy of Pediatrics; 2017.
Cradle Cap: Schmitt BD. My Child Is Sick!: Expert Advice for Managing Common Illnesses and Injuries. (2018). Cradle Cap Patient Education. Change Healthcare.
Atopic Dermatitis: Schmitt BD. My Child Is Sick!: Expert Advice for Managing Common Illnesses and Injuries. Elk Grove Village, IL: American Academy of Pediatrics; 2017.
Eske, J. (2019, April 10). Top 6 Remedies for Dry Skin on the Face . Medical News Today. Retrieved from Medicalnewstoday.com
