Category Archives: Technology

High Altitude Research has inspired a lot of fascinating innovation from vital sign tracking to simulation

Athletes vs. Amateurs: Observations of an Altitude Expert

Ski America is a company that has organized accommodations and itinerary for international athletes and vacationers at ski areas around Colorado since 1988. The Omori family, Ski America’s founders, lead their clients on tours of Colorado’s most renowned mountains, including Aspen (8,040 ft.), Vail (8,120 ft.), Beaver Creek (8,100 ft.), Copper (9,712 ft.), Keystone (9,280 ft.), Breckenridge (9,600 ft.) and Arapahoe Basin (10,780 ft.).

Ryoko and Jimi Omori

Jimi Omori started Ski America as a tour operator for Japanese skiers and snowboarders. Ryoko joined in 2005, and now Ski America’s service is more than tour operating, assisting from first-time skiers of age 3 to professional racers. With over 30 years of experience guiding amateur skiers and international athletes alike, the Omori’s have made some fascinating observations of how people adjust to the high altitude environment of the Rocky Mountains.

The other day, Ryoko shared some of their valuable insight and experience with me over a cup of tea:

How long do your clients typically stay at altitude?

So we have two different kinds of customers. In November until early December, we have a lot of Japanese racers from Japan. They are high school kids, college students. They stay two to four weeks here, in Frisco or Copper Mountain. Then, from December to April, we have clients from Japan who stay in Vail or Aspen. Most of them are senior skiers, over 60 years old. They stay about a week in Vail or Aspen. Six nights is very average.

How often do you get repeat customers?

Quite a lot. Not all of them come back every year, but more than once. I would say, 70%.

Do you see new customers every year?

Yes.

How do you advertise in Japan?

Word of mouth.

How do you prepare your customers for the altitude?

When I set up the reservation for them, I send them the lodging confirmation and shuttle confirmation, how to get to the Colorado Mountain Express counter at Denver International Airport. With that information, I also send how to get ready for this altitude by e-mail to every customer: Don’t stay up all night before coming over here, don’t overwork before coming here, most importantly, don’t catch a cold before coming over here. That’s the most important thing. And keep yourself hydrated on the flight and on the shuttle. You can always stop at a restroom on the way from the airport to get here. Do not drink a lot [of alcohol] on the flight, and especially on the first night staying here. I encourage them to drink two liters of water a day.

They are so excited to be here, so they tend to forget about the altitude, because there are all the trees, it’s not above the tree line here. In Japan, [this elevation] is way over the tree line. So I always remind them, “You are going to be almost [at the elevation of] Mt. Fuji. So, move slow the first and second day of staying here.”

What about conditioning, physical exercise to prepare? Are they athletic?

They’re pretty much athletic. They’re avid skiers. They ski in Japan regularly. So I do not give them any athletic advice in Japan.

Do they come straight from Denver up to elevation, or do they stay in Denver a certain amount of time?

No. The flight arrives at 12:30 or 1 pm, so it’s very convenient for them to get on the shuttle in the afternoon, and they will be here before 5 or 6.

Do they ski the next day?

Most of them, yes.

What about oxygen or medication? Do you ever tell them to bring ibuprofen or anti-nausea medication?

No. But if anything happens here, I recommend taking [something] for a headache, like Advil.

What is the earliest sign that something might be wrong or that they need medical attention?

Headache. Or sometimes nausea. We had 150 racers last November, and out of 150, I took 5 kids to the clinic for altitude sickness symptoms.

Is it at the beginning of their stay?

Very beginning. [Typically] the second day of skiing. They are okay on the first day. They do not notice anything on the first morning, so they feel, “It’s okay, let’s go skiing!” and spend the day on the mountain, and they have jet-lag, and they can’t sleep well on the second night. And on the second morning most of them notice the symptoms. Those are the Copper clients. And I have 350 guests from Japan staying in Vail and Aspen. Last year, I didn’t see anyone get sick. So it’s only in Summit County, because it’s much higher.

Do you think there are any other correlating factors, like their age or where they’re from?

Age. The racers are from middle school to college, so they’re young. Their hormone level is not stable. And they are staying with their other teammates, apart from their parents, so it could have some emotional factors affecting them, too. But at the same time, the racers have a lot of muscle that needs a lot of oxygen. The higher metabolism that younger kids have [make them] more prone to high altitude sickness. The clients who stay in Vail or Aspen, they are much older, like, 40s, 50s, 60s. And they’re not as athletic as the racers. They do not do any training. So their basic metabolism is low, so I believe they do not need as much oxygen.

Does anyone come from a high elevation in Japan, or is it mostly sea level?

Mostly sea level. Only some of them are from Nozawa, it’s about 1000 m (3,280 ft.), so it’s much lower than Denver.

Nozawa, Japan

Is there a difference between the guests that come from Nozawa and the guests that come from sea level?

No. Whenever I see the doctor in the ER, or the Copper clinic, they always say it’s dehydration. No matter how much we tell them to keep hydrated, it’s not enough.

So what does the ER or clinic often give them besides fluids?

Oxygen. And they say it’s okay to take over-the-counter headache medication.

How long is their visit to the hospital? Is it just a couple hours, or do they stay overnight?

Just a couple of hours, or less than that.

Do they ski the next day?

Most of the time, the doctors say not to ski the next day. We carry a pulse oximeter in our office. We have 20 of them. We do not do this for the Vail clients, because they don’t get altitude sickness. So we only do this for the guests staying in Summit County. When we [check them in], we distribute pulse oximeters, one per room. We encourage them to measure [their oxygen level] every morning. Then, after the doctor’s visit, the doctors say it’s okay if your oxygen level is over 90%, 20 minutes after getting off oxygen.

What’s the lowest you’ve seen the oxygen level on any of your skiers?

38. [He was] 15. He was at the ER. He was transferred to Denver by ambulance. He was there about three nights, and he went back to Japan.

Was that the only time somebody had to go back to sea level?

Yes. But it sounds like he had a heart issue, which we didn’t know [about].

Have you witnessed any other factors that help them acclimate more effectively?

I encourage them to eat carbohydrates instead of getting a lot of oily foods. If you have a lot of french fries, it’s very oily, it will take more time and blood to get to the stomach. So the blood flow doesn’t go through the brain [well].

What about caffeine or other holistic remedies?

No. We have some repeating guests who had … symptoms in past years, and we encourage them to visit a doctor in Japan [who] can prescribe … Diamox. One of the ski coaches [from Japan] … has to be here with his team. He has no choice. And he’s [had] a lot of altitude sickness in the past. So we told him, “You should see a doctor and get Diamox prescribed, and start taking it before leaving Japan,” and it’s been working great.

A young skier shreds her way down a snowy back bowl on a powder day.

Is there a routine that your clients do to prevent feeling this sickness?

Just check blood oxygen level every morning.

Of the clients that come here regularly, do they acclimate quicker each time?

They learn. We always see lower numbers of altitude sickness patients, because they learn what they need to do, like drinking a lot of water and checking their blood oxygen level. And only the numbers can tell. Even if they feel good, if the numbers are bad, if they go skiing, they will have a problem. Especially for the young kids. They [don’t] trust what you say. As the years go by, the coaches will learn, and the kids will learn what they can and what they cannot do.

Is there anything different about the philosophy of treatment in Japan vs. the US?

You know what, we do not have altitude sickness in Japan. Only if you climb up Mt. Fuji, in one day, it could happen, but not everyone does that. The highest elevation of one ski area in Japan is about 2000 m (6,561 ft.). No one has experienced high altitude sickness in Japan.

When I climbed Mt. Fuji, I saw a lot of people with cans of oxygen that you can spray. Do you ever use or recommend that?

No. I don’t think it works. If you breathe it for five minutes, it will work for five minutes. So I guess it’s very effective if a ski racer uses it right before the start [of a race]. I believe some of our Vail clients [have seen] the bottle and have purchased it, but I’ve never heard anything about it, good or bad.

Smiles and high spirits all around

In closing, I asked Ryoko if she’d noticed a change in her own physiology since living at high altitude, to which she replied that she is always impressed by her increased stamina and speed when she steps on a treadmill back at sea level. I asked her if she ever experiences symptoms upon coming back to a high altitude from sea level. “No,” she says, laughing. She doesn’t typically engage in any strenuous activity the first day or two after travelling, “because I’m lazy,” she says.  

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.

Packing for a Spring Hut Trip

Another winter has come and gone, and now Spring is in Colorado. Which means Winter will be back a couple more times before the snow all melts.

We’ve organized a team of friends from San Francisco, Denver, and Colorado high country for a backcountry excursion to one of Colorado’s 10th Mountain Division huts. The Benedict huts, our dwelling for two nights tucked into the wilderness outside of Aspen, are almost 6 miles from the trailhead, with an elevation gain of over 2000 ft. : a formidable trek, even for the experienced. And experience in wilderness trekking is one thing, but altitude is a game-changer. We will be well over 8000 ft. long before we reach the huts, so preparation for such an undertaking requires as much attention to mental, physical and physiological condition as much as clothing, gear and rations.

Weather & Conditions

This has everything to do with the weather, so it’s important to be on top of tracking all the resources available to you. At the top of my list in this region is the Colorado Avalanche Information Center. They provide up-to-date reports for high-risk areas around the state according to a comprehensive and easy-to-understand rating system. When considering this information, I always remember that our trek will take us through several types of terrain, and thus, several types of conditions: in and out of trees, varying steepness and exposure (to sun, wind, precipitation, etc.), all kinds of microclimates and environments (wetlands, scree fields).

The Colorado Avalanche Information Center provides no shortage of visuals to aid your risk assessment.

As far as incoming weather patterns are concerned, one of the most popular and reliable forecasts endorsed by people who play outside in Colorado is Open Snow. Founding meteorologist Joel Gratz updates local forecasts regularly, and provides information on what to expect with the outdoor adventurers in mind.

For our upcoming hut trip, it looks like the storm we’re expecting will be warmer and milder than recent systems, with most of it heading toward the northern mountain region. That being said, however, I’m keeping in mind that any projected weather system can be just a few degrees colder, a few inches wetter, and a few miles closer and change conditions dramatically. So let’s talk about how we can anticipate this with …

Gear & Clothing

The Commute

In any season in Colorado, there are essential comforts I always pack to get me to and from any hut that requires a hike, and to keep me happy while I’m enjoying the site. Dead of Winter, Height of Summer alike, the sun and glare is liable to be more intense than anything you’ve ever experienced at sea-level, while at the same time, the temperature and lack of humidity can cool your body significantly, night or day. Depending on how strenuous the commute is or how active you intend to be even after arriving at your destination, you may be constantly shedding, then adding, then shedding, then adding layers, so keep it all very accessible.

For this particular trek, I’ll be in snow gear. Basically anything I’d wear snowboarding: snow pants, outer shell on top, hat, gloves. I want it to be warm and waterproof on the outside. Underneath this shell, I want layers that I can strip down to as soon as I start moving and sweating with a 40 -60 lb. pack on. Unless the storm turns out to be much more intense (in which case, I’ll keep the outer layers on), I expect my skin to be steaming, so I won’t want to be in much more than warm compression tights, a t-shirt, and a light pullover. Your outer shell is for blizzards and water-proofing, so whatever you are stripping down to should be significantly lighter. Also, sunglasses or goggles. The glare from snow is significant. I bring both, because goggles get way too hot while I’m trekking uphill.

Here’s the tricky part: What are you going to wear on your feet? This is where the weather forecast comes in. This time of year, after such a snowy winter, I’m expecting most of the trail to be covered in snow, and the storm moving in is likely to bring more. I will be scoping out the trail pre-storm, which will give me a much better idea of what to expect, but I’m preparing to have snowshoes or a split-board and skins strapped to my snowboard boots. Of course, skis with skins are another alternative. There is a very slim chance most of the snow on the trail will be melted down, in which case I would probably opt for waterproof boots instead, which I would expect to get pretty muddy.

Avalanche Gear

Whether it’s on the commute or while you explore terrain around the hut during your stay, there are some essentials you can pack for the worst-case scenario. I’ve gone into more detail in a previous blog, but standards that I will be keeping on me are a shovel, probe and beacon. But these tools are only a small part of avalanche preparedness. More important than the endless supply of technology you can invest in is knowing what conditions and natural phenomena to be aware of during your trek, and the Colorado Avalanche Information Center is a great place to start familiarizing yourself with these.

Cabin Comforts

There is only one limiting factor to this list, but it is considerable: how much you can carry. For six miles. Uphill. In snow.

Most of the huts in the 10th Mountain Division hut system are equipped with soft mattresses, small pillows, and blankets. The kitchens are stocked with utensils and dishes, there is toilet paper, paper towels, hand sanitizer and dish soap, as well as ample supplies of wood for burning in the wood stoves. So most of your weight will be food and drinks.

I always pack a sleeping bag and extra pillow, because the guaranteed warmth and comfort are worth it when you’ve spent your day being intensely active outdoors. And keep in mind you’ll want warm, dry layers to change into that you haven’t been hiking and sweating in all day. What do you want to be wearing when you’re lounging around the cabin reading, cooking, eating, playing cards, etc.? For me, this looks like socks, long underwear, a pullover and slippers that I can crush into my pack. And then what are you going to throw on when you have to go back outside into the dark cold of night to use the outhouse? Your Colorado uniform: a hoodie.

There won’t be running water, so you can’t expect to shower. When you’re in the wilderness for a long time and need to be discerning about how much weight you carry that isn’t food and water, bathing is of low priority. But for a short trip like this, I don’t mind bringing some form of wet wipes; they’re light-weight and take up very little space. Toothbrush and toothpaste should be obvious, though.

Medication & Acclimation

From climbing Mt. Fuji to Colorado’s 14er’s, I’ve noticed a lot of people bringing pressurized cans of oxygen. High altitude research has taught me just how temporary and unnecessary this trend is. Often, the most effective remedy for altitude sickness is 5 – 10 minutes on oxygen. I’m pretty sure you’ll blow through a whole can of gas-station aerosol oxygen before it does you any lasting good.

Avoid this by giving yourself time to acclimate before you get to extreme elevation. Ebert Family Clinic in Frisco, Colorado, specialists in high altitude research, always recommend keeping track of blood oxygen saturation with a pulse oximeter, and this is something small, inexpensive and very portable. Our team will be spending at least 24 hours at altitude before we embark on the trek to the hut. This way, members from lower elevations will have access to an oxygen concentrator to facilitate acclimation.

Physician and high altitude expert Dr. Christine Ebert-Santos recommends packing the following mediations for hut trips: Acetazolamide, Benadryl, Ibuprofen, an EpiPen, Acetaminophen, and topical antibiotic oinment. Of course, be aware of any allergies to medication in your party. It is also helpful to be aware of what symptoms you may expect to experience, should you start having trouble acclimating, including dizziness, nausea, hyperventilation, and fatigue.

Food & Water

This is where most of the weight you pack in will be. Again, no running water at the hut, so expect to boil all the water you need for drinking if you run out of what you bring. There are lots of compact water purification systems you can easily pack as well. For our six mile trek to the cabin, I will have a Camel Bak and a couple Nalgene-sized thermoses full of water tucked into my pack.

You don’t want to have to cook everything you bring, so snacks you can easily access and eat are essential, especially for the trail. For this particular hike, I expect to burn more calories more quickly than any other average day, so I want lots of nutrients per gram: pistachios, energy bars, jerky … And don’t underestimate the power of sugar and caffeine, this is precisely the kind of work your body acts quickly to convert these nutrients to energy for. And yes, I mean chocolate. (Fruit also contain a lot of valuable sugar, I’m told.)

While we’re at the cabin, we’ll have access to a propane stove, so we’ll be able to cook some hearty meals. Bacon, fruit, yogurt, bagels and cream cheese are all easy breakfast foods to pack. If you are fortunate enough to be on a hut trip with Dr. Chris herself, you will have pancakes at least once. It’s also easy enough to bring fixings for the most epic sandwich you’ve ever had: guacamole, sprouts, turkey, ham, greens, tomatoes, bread; and remember, it’s a good chance to justify all the calories you get from mayonnaise and mustard.

And speaking of calories and sugar, I feel like whiskey and beer were invented to accompany the warmth of a fire in a remote, mountain cabin. The good news is that you are sure to be carrying less out than you did in. The bad news is that hangovers are exacerbated by high altitude, so pay more attention to your consumption than you would at any lower elevation, and be sure to have plenty of drinkable water at hand.

Am I Ready?

Hut trips in Colorado are mentally and physically challenging, even in the best conditions. The more time you give yourself, the better. Know before you go and don’t go alone. And don’t be intimidated. I’ve successfully guided friends from sea-level who don’t consider themselves athletic to destinations well above the tree line without incident.

Always be checking in with your body, your team, and your environment.

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.

“Home Remedy” by Ted Katauskas

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

Oxygen Conditioning: As Easy As Air Conditioning

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

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.

when to stop using oxygen after an illness

Several parents returned to the clinic this week with their children on oxygen after respiratory illness. Our protocol has been to discontinue the oxygen when their saturation is above 89 in clinic. Now that many parents have a home pulse oximeter, children are using oxygen for longer periods. Measurements at home may be fine during the day, and the child attends school, then decreases at night so parents continue oxygen. since most oxygen equipment is rented by the month, this is not more expensive. I think it helps the lungs to heal, possibly reducing future problems such as pulmonary hypertension.

New information comes from one of the students rotating here at Ebert Family Clinic: Justin Lockwood, a pediatric resident. He reports that even in Denver some children require oxygen during respiratory illnesses that do not get a diagnoses of asthma or pneumonia.