Category Archives: Medicine
Follow Dr. Chris around the world for insight from a physician’s perspective
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.
Oxygen Conditioning: As Easy As Air Conditioning
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
How Long With Low Oxygen?
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.
Aging and altitude illustrated
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.
Pulmonary hypertension may be common in high altitude residents
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
SIDS incidence double above 8000 ft
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 state-wide was 4.2 per 10,000 but over 8000 ft the rate was 7.9/10000.
it is possible that hypoxia is a contributing factor, 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.
Does sleeping on oxygen at high altitude improve athletic performance?
I have read many scientific studies on athletic performance at altitude. Active high altitude residents are always looking for ways to improve. As we age we experience a loss of speed and endurance, even with regular training. Some of this is inevitable, but how can we know if there is something else affecting our fitness?
I started sleeping on oxygen 9 months ago because of high blood pressure, which was instantly cured. Now I find that my strength and endurance have improved during the last few months. For example, I was rowing 13400 meters per hour with several brief pauses last fall, and now I am at an all-time high of 14100 m per hour with one pause. My running feels better, I’m back up to 6 miles from 4.
There are other factors that could influence this. In 2012-2013 I was on 17 pills including prednisone and had four surgeries for tongue cancer and myasthenia gravis. I was able to continue working out daily although part of that was less intense, such as yoga. I also had rotator cuff surgery. So my current fitness improvement could just be a rebound from overcoming those health conditions.
The only way to know for sure is to do a randomized controlled double blind study of athletes performance on and off nightly oxygen, or study the same athlete with and without oxygen. This is not an immediate effect, so months or years of observation and measurements would be needed.
In the meantime, if you live above 2500 meters/9000 feet and are losing stamina or strength consider having a night time pulse oximetry test to check for hypoxia during sleep.
School problems and orthodontics
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.
