Child Growth & Development, Health, High Altitude, Medicine

Concussions and Altitude

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With the number of concussions on the rise it is important to have an understanding of the occurrence of concussions as well as the management of concussions at higher elevations. Although the incidence of concussions is on the rise everywhere, high school athletes playing at higher elevations may actually be less likely to sustain a concussion when compared to athletes playing the same sports at sea level.

The Cincinnati Children’s Hospital conducted a research study examining the relationship between concussions and altitude among NFL athletes. The results of the study demonstrated a 30% decrease in the incidence of concussions in athletes playing at higher elevations (greater than or equal to 644 ft above sea level) (Myer et al., 2014). While there is no definitive explanation for this it is believed to be linked to the physiological changes of the brain at altitude. Concussions are typically caused from the rapid acceleration/ deceleration of the brain inside the skull. The hypothesis is that at higher elevations the brain tends to swell due to a mild increase in intracranial volume creating a tighter fit of the brain in the skull, leading to less damage caused by sheer forces (Myer et al., 4014).

While concussions may not be as common at elevation they are still occurring more than ever with detrimental long term effects if not recognized and treated properly. One thing we can do to recognize and treat concussions is to complete an ImPACT test. ImPACT (Immediate Post-Concussion Assessment and Cognitive Testing) is a computerized neurocognitive test which helps to assess neurologic changes after a concussion and helps guide recovery (Glendenning, 2017). The idea behind ImPACT is for individuals to have a baseline test, prior to any head injury/ concussion, and if a traumatic brain injury occurs, that individual would then undergo a post-concussion test, comparing the results to their baseline.  This helps better determine when it is safe for that individual to return to play without sustaining further injuries to their brain.

With the active lifestyle of children and adults in living at high altitudes, ImPACT testing may be just another step to consider when getting your bike tuned up for bike season, or your skis ready for a weekend on the slopes. Even if you aren’t a competitive athlete on a designated team, anyone at risk of hitting their head is at risk of suffering a concussion and would benefit from completing a baseline ImPACT test. ImPACT testing is available for only $15 at Avalanche Physical Therapy and takes only 30 minutes to complete (Glendenning, 2017). By being pro-active now you can help ensure a safer and healthier recovery in the future.

Schedule your baseline ImPACT testing at Avalanche Physical Therapy today!

www.avalanchetherapy.com

Betsy Metz, PA-S

Physician Assistant Student

Red Rocks Community College

References

Glendenning, L. (2017, March 7). Cognitive testing tool used to assess traumatic brain injuries in Summit County. Summit Daily News, p. 5.

Myer, G. D., Smith, D., Barber Foss, K. D., Dicesare, C. A., Kiefer, A. W., Kushner, A. M., … & Khoury, J. C. (2014). Rates of concussion are lower in National Football League games played at higher altitudes. journal of orthopaedic & sports physical therapy, 44(3), 164-172.

Health, High Altitude, Medicine

Does Hypoxia Prevent Cancer?

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Summit Daily News recently published an article based on research in the Journal of the American Medical Association showing Summit County                                                                                                       with the lowest cancer rate in the nation FOR 30 YEARS. Are people moving away when they get cancer? No, they are treated in Vail, Denver                                                                                                      and now the St. Anthony Summit Medical Center.  Do we have fewer older people? No, there is a large percentage of retired residents.

The report shows stark differences in regional cancer death rates : detailed estimates for deaths from nearly 30 types of cancer in all 3,100 U.S. counties for over 35 years.From 1980 to 2014, the U.S. death rate per 100,000 people for all cancers combined dropped from about 240 to 192 — a 20 percent decline. More than 19 million Americans died from cancer during that time, the study found. Healthy lifestyle with low rates of obesity and smoking and increased physical activity contribute to low cancer rates in the mountains.

The picture was rosiest the Colorado ski country, where cancer deaths per 100,000 residents dropped by almost half, from 130 in 1980 to just 70 in 2014;

Acclimation, Health, High Altitude, Medicine

drugs and altitude:

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Consensus by International Federation on Drug Use at High Altitude

New Rochelle, NY, October 25, 2016—Drug taking at high altitude is variably intended to enhance performance, prevent or alleviate the debilitating effects of altitude, or for pleasurable use. In some cases, certain drugs can be advantageous and even life-saving, but many drugs lack evidence of benefit and carry risks of side effects or interactions. The International Climbing and Mountaineering Federation (UIAA) has published evidence-based guidelines advising on the safe use of alcohol, steroids, oxygen, erythropoietin, and many other types of drugs in mountain environments in an article in High Altitude Medicine & Biology, a peer-reviewed journal from Mary Ann Liebert, Inc., publishers. The article is available free online on the High Altitude Medicine & Biology website.

An international team of researchers from Kuwait, Austria, United Kingdom, Germany, Switzerland, Nepal, Spain, France, and the Netherlands, led by David Hillebrandt, MB, BS, President, UIAA Medical Commission, coauthored the article entitled “Drug Use and Misuse in the Mountains: An UIAA MedCom-Consensus Guide for Medical Professionals.” They conducted an extensive review of the medical literature, trials, observational studies, and case series to assess the evidence available for drugs commonly used by mountain climbers. Their conclusions and recommendations cover a broad range of drug types including alcohol, anabolic agents such as androgenic steroids, adrenergic agonists, beta-blocking agents, erythropoietin, oxygen, glucocorticosteroids, benzodiazepines, and stimulants such as amphetamines.

“The use of drugs beyond those proven effective in preventing and treating high altitude illnesses remains very controversial among both physicians and climbers,” says Erik R. Swenson, MD, Editor-in-Chief of High Altitude Medicine & Biology and Professor, Division of Pulmonary and Critical Care Medicine, Veterans Administration Puget Sound Healthcare System. “This broad and comprehensive review of the myriad drugs used for various purposes in climbing will be useful to all concerned in decision-making about their use, determining the level of supportive evidence, and importantly their potential costs and adverse effects.”

Child Growth & Development, Health, High Altitude

Red Cheeks in Mountain Kids

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img_2010Chinese 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 erythemacheeksor 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!

Acclimation, Child Growth & Development, Health, High Altitude, Medicine

High-Altitude Lung Edema Can Mimic Pneumonia in Kids, Even Without Travel by Rob Goodier

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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

Acclimation, Child Growth & Development, Health, High Altitude, Medicine

Those precious epi-pens at altitude

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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.

Acclimation, Child Growth & Development, Health, High Altitude, Medicine

Reflection to MRHAPE in the Mountains: Resident High Altitude Pulmonary Edema

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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

High Altitude, Medicine, Technology

“Home Remedy” by Ted Katauskas

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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).  For children, the implications would be adequate perfusion of oxygen to the organs to carry out life’s functions and promote healthy growth.  Imagine being able to treat hypoxia in the home by simply the push of a button.  Currently, this technology is very expensive.  It does beg the question, could an air separator be subsidized by insurance, or added into the construction of a new home?  Certainly, this technology holds promise for possible future treatment. 

Submitted by Joe Brath, NP Student from Georgetown University rotating Summer 2016

Acclimation, Health, High Altitude

Rocky Mountain High?

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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

Information and discussion for visitors and residents at high elevations.