Oxygen

It has everything to do with how well the body functions at increasing elevation. In Summit County, Colorado, we live at an average elevation of 9000′ (2743 m). Most bodies start a significant physiological response to 8000′ (2438 m). Even healthy athletes experience shortness of breath during certain activities that wouldn’t be noticeable at lower elevations. The body compensates by circulating more oxygen-carrying red blood cells, because there isn’t as much oxygen packed into each breath you take. Heart rate increases, you take quicker breaths, speeding up your ventilation. You are hyperventilating. If you manage well enough for a couple weeks, your body will eventually start creating more red blood cells to circulate more oxygen throughout your body at all times. This process will peak at about three months.

We often get questions about the canisters of oxygen sold at convenience stores, souvenir shops and gas stations across Colorado and whether or not they make any difference. There is a 100% consensus among every physician, athlete, EMT and ski patroller we have ever interviewed that they do not.

Why not? Dr. Chris has been practicing medicine at 9000′ for 20 years in Frisco, CO, so I asked her a couple of the questions that have come up at our clinic and on our blog recently and frequently.

How much oxygen is needed to actually mitigate symptoms of altitude sickness?

For someone with low blood oxygen saturation, our target would be 90% . They should be put on a concentrator or a large tank [of oxygen]. The adult dose is 2 to 4 liters per minute, the pediatric dose can be between 1/4 L per minute and 1 L per minute, 24 hours a day, for up to a week, or until their oxygen saturation can maintain at 90%. Less than that, and usually, it will drop again after 10 minutes off oxygen; and it’ll often be lower when you sleep, too.

What if I bought ten of these canisters of oxygen available at the gas station and breathed all of them in, one after the other. Would that make a difference?

You might get three hours worth of oxygen if you bought ten of those store-bought cans, which might help an altitude sickness-induced headache. But again, your oxygen would likely drop shortly thereafter, and you would be experiencing the same symptoms.

What happens if someone struggling with acclimatization also contracts COVID-19 or another disease with associated respiratory complications?

We don’t know. Their oxygen requirement might be higher. All of us at altitude might be at greater risk than someone living at sea level.

When do you make the decision to send someone to a lower elevation? How low?

If they are having trouble breathing in spite of being on 4 L of oxygen per minute. If they need more than that, we would send them to a lower elevation. Most people are fine going to Denver. By Georgetown (8530’/2600 m, a town between Summit County and Denver), they’ll experience an improvement. It’s above 2500 m where altitude issues become problematic.

Research in recent years, including our own, is revealing many other different variables that may affect an individual’s ability to acclimatize to high elevations, including different hormones, genetics, and muscle mass. We continue to advise anyone traveling to the Colorado mountain region above 7000′ from lower elevations to stay hydrated and well-rested, and time a slow ascent, planning to spend at least 24 hours in Denver, or another comparable lower elevation, before arriving at your final destination.

robert-ebert-santos

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.

COVID-19 at Altitude Update

This is a Corona virus update from Children’s Hospital of Colorado and Ebert Family Clinic as of March 27, 2020.

Dr. Chris attended the weekly Children’s Hospital providers update webinar last night.  The good news is that the number of admissions and outpatient visits for children with respiratory illness is down by 50% compared to this time in previous years.

Another hopeful report about COVID transmission is that only 10% of family members develop symptoms when someone in the household becomes ill.

Testing priority update:

  1. Hospitalized patients and health care workers with symptoms;
  2. People in long term care and/or over age 65 with underlying health conditions, first responders and those working with seniors AND symptoms;
  3. Others with milder symptoms.

Testing involves inserting a swab deep into the nasopharynx. This requires having the swabs, tubes, protective equipment for the care provider, test kits and coordinated delivery of the specimens. There are shortages in all these areas, along with the risk to the health care worker. Thus, in Colorado at Children’s Hospital and in Summit County there are very limited controlled locations where respiratory specimens are collected. Currently, this is at the Summit County Community Care Clinic at a station behind the medical office building.

Anyone needing a test or face-to-face exam for respiratory symptoms must call ahead to any of these locations providing care: 970-668-4040.

Both the American Academy of Pediatrics and the Center for Disease Control recommend we continue providing well child care to those under age 2 in order to maintain vaccination rates at a level that will reduce the risk of another outbreak, such as measles or pertussis. If the child or any family member has respiratory symptoms, the visit should be rescheduled.

Telehealth visits for everyone with mild or moderate respiratory illness are being offered at Ebert Family Clinic and most other facilities. Because the illness can rapidly worsen, even after five days, IT IS CRITICAL THAT YOU HAVE A PULSE OXIMETER TO MONITOR YOUR OXYGEN. Blood oxygen saturation level is a critical vital sign that greatly aids in medical assessment. You can obtain a pulse oximeter at any pharmacy or at Ebert Family Clinic: (970) 668-1616.

Most patients can be treated at home with oxygen if they have saturation readings in the 80’s or high 70’s, but a rapid increase in oxygen requirement, shortness of breath, and readings below 75% merit an evaluation in the Emergency Room. CALL BEFORE YOU GO! (970) 668-8123. 

Health care providers in the mountains can evaluate your breathing effort by phone and video, and order oxygen to be delivered to your home.

Ibuprofen is safe (barring allergy), and along with acetaminophen, are the only medications recommended to treat the fever and pain (headache, backache, earache) of COVID-19, according to the infectious disease experts at Children’s Hospital. Other medications mentioned in the news are experimental, used on very ill patients in the hospital, and could possibly make an individual’s condition worse.

COVID-19 at Altitude

I am here at the Ebert Family Clinic waiting for the Public Health nurse to arrive for our staff training. Our plan is to set up an outdoor facility to screen individuals for COVID-19, Influenza, Strep, and Respiratory Syncytial Virus, when symptoms indicate to do so. The guidelines are ever-changing, but we are staying updated on the daily, even hourly changes. We are following guidelines published March 15:

  1. If you have mild respiratory symptoms – stay home!
  2. If you have a fever over 100.4° with respiratory symptoms (cough), but no shortness of breath or trouble breathing – stay home! Testing for COVID-19 is reserved for health care workers or senior services at this moment.
  3. If you have a fever, respiratory symptoms and trouble breathing – call the Emergency Room to set up a time to be screened and examined. If symptoms are severe – call 911.

EVERYONE AT ALTITUDE MUST HAVE ACCESS TO A PULSE OXIMETER!

Pulse oximeters are available at pharmacies and most stores. If you are unable to find one, please let us know. Your oxygen saturation is the key to assessing the severity of your illness.

Respiratory infections (such as influenza or COVID-19) puts high altitude residents at higher risk for pulmonary edema. Symptoms of pulmonary edema are cough, shortness of breath, and an oxygen saturation below 89%.  Supplemental oxygen is the treatment, but it must be ordered by a physician.

Resources such as laboratory testing, x-rays, antibiotics and inhalers may be limited during this pandemic.  As a physician, I use clinical judgement when sending patients for additional testing and treatment. I will take extra caution when sending stable patients to the hospital if they can be treated without an x-ray or lab test, or when no treatment is available. I am conservative in prescribing inhalers to people without a clear indication in order to conserve these for patients with definite reactive airways disease that respond to these treatments (i.e. asthma). These individuals should make sure that they have their medications on hand.

Viral pneumonia and pulmonary edema look the same on an x-ray, and clinical standards of care do not require an x-ray for diagnosis. The health care provider will prescribe antibiotics based on clinical suspicion and risk factors since chest x-rays do not always indicate whether someone has pneumonia.

Eagle County has 50 confirmed cases, so far, and several who were severely ill had to be transferred to Denver. As Governor Polis stated, the small mountain hospitals will be quickly overwhelmed as cases increase. There will also be a time when the hospitals in Denver are full and cannot accept transfers.

Ebert Family Clinic will continue seeing patients for preventive care. Wellness visits are scheduled in the morning and sick visits in the afternoon. Patients are not left to mingle in the waiting room as they are taken immediately back into a room. If they wish, they may also stay in their car or outside until we are ready for them to be roomed. Specific rooms are reserved for well visits. Deep cleaning and sanitization is performed after all visits and at the end of the day.  We ask that you also take preventative measures, like covering your cough, staying at home, and washing your hands.

Dr. Christine Ebert-Santos and an MA assess a patient and test a sample for COVID-19 in the parking lot in front of Ebert Family Clinic, Frisco, CO.

Influenza vaccines are important and available. There are cases of combined COVID-19 and Influenza, both of which attack the respiratory system, which is serious. Other vaccines that also prevent respiratory illnesses, such as pneumococcal, pertussis and HIB, can be LIFE-SAVING! These important vaccinations are administered at 2 months, 4 months, 6 months, and 1 year of age. Adults over 50 should receive the pneumococcal and flu vaccines. Children under 18 years have not had severe cases of COVID-19, but they are very contagious, even when they have no symptoms.

If you or your child are otherwise well and do not need vaccines, it is reasonable to postpone contact with the medical system and to reschedule routine checkups.

Dr. Chris is always available on her cell outside clinic hours for advice and treatment to continue her epic and ongoing efforts to keep patients healthy and out of the emergency room.

Please monitor our Facebook site for updates from our viewpoint.  Read our blog for a wealth of information on living in a low-oxygen environment, including interviews with local physicians practicing here for 20-30 years.

Medicine Man: Ski Patroller & EMT Jonathan Sinclair’s Elevated Experience

“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 them when 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.

robert-ebert-santos

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.

Skin at Altitude

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

Confused about sunscreen? Get the facts. (2019, May 21). https://www.mayoclinic.org/healthy-lifestyle/adult-health/in-depth/best-sunscreen

Understanding the effects of nocturnal hypoxemia in healthy individuals at high altitude: A chance to further our understanding of the physiological effects on residents in Colorado’s mountain communities

The population of Summit County, Colorado is projected to grow by 56% between 2010 and 2030. Along with adjacent Park and Lake Counties there are now over 40,000 people living above 2800 meters elevation. This is the largest high altitude population in North America. As opposed to native populations in South America, Africa and Asia who have been residing above 2800 m for centuries, the North American residents are acclimatized but not adapted. Symptoms related to hypobaric hypoxemia are notable above 2500 m.  Recognized conditions associated with altitude include central sleep apnea leading to hypoxemia (abnormally low oxygen level in the blood) which activates the sympathetic nervous system. In susceptible persons this can cause systemic and pulmonary hypertension. The incidence of this potentially devastating side effect of mountain living is unknown.  In order to better understand the potential side effects of nocturnal oxygen desaturation in healthy individuals, it is beneficial to investigate the normal physiological changes that occur during sleep, which leads to low oxygen levels in all individuals.

When the body enters the sleep state, many of the behavioral mechanisms that are active during wakefulness are blunted, and it’s been found that different sleep stages have varying effects as well.  One of the major changes is a diminished response to hypercapnia (high carbon dioxide levels in the blood) and hypoxia.  During sleep, the CO2 set point is elevated from 40 mmHg to 45 mmHg, which results in reduced alveolar ventilation.   It’s also observed that minute ventilation is reduced, which is due to decreased tidal volumes that is normally compensated for with an increase in breathing frequency during wakefulness.  Also, during sleep, there tends to be upper airway narrowing that is normal and there is reduced reflex muscle activation of the pharyngeal dilator muscle.  All of the above factors contribute to decreased ventilation during sleep. 

A lot of what is understood about the effects of nocturnal hypoxemia is due to extensive studies in individuals with underlying diseases, and these studies are not always conducted at higher altitudes.  One such study investigated the effects of nocturnal desaturation (SaO2 < 90% occurring for > 30% of the sleep study) in chronic obstructive pulmonary disease (COPD) patients without a diagnosis of sleep apnea.  The authors found higher rates of dyspnea, increasing rates of worsening COPD symptoms, poorer quality of sleep and health-related quality of life.  Another such study found that some patients with COPD experience increased transient arterial hypoxemia (TAH) during rapid eye movement (REM) sleep.   In this study, the authors observed that the study subjects experienced increased pulmonary vascular resistance (which can lead to pulmonary hypertension) and a few subjects experienced an increase in their cardiac output. The authors found that individuals could experience a decrease in this phenomena by using nighttime oxygen therapy.

Studies, such as above, do not assist in identifying healthy individuals that may need early intervention due to nocturnal hypoxemia at altitude.  What about the healthy individuals without underlying diseases?  In the study conducted by Gries and Brooks in 1996, the authors collected data from 350 patients.  Their recorded average low saturation in the study of 350 subjects was a reported 90.4% lasting an average 2 seconds.  This study was conducted at the Rainbow Babies and Children’s Hospital located in Cleveland Ohio, at an elevation of 653 feet (198 m). This is one of the largest studies done to assess normal oxygen levels observed during sleep, and the results, along with results from other studies are displayed in Table 1.  As of right now, there is no equivolent study for subjects at elevations like that of Summit County, CO, which is at an average of 9110 feet (2777 m). Aside from the normal physiological changes noted above, the rates of developing underlying central sleep apnea leading to systemic and pulmonary hypertension is unknown.  Further, there are no guidelines as to initiating treatment in patients that may be experiencing adverse effects of high altitude nocturnal hypoxemia, because there is a lack of data to establish baseline normal values observed at this elevation.  This leads to unnecessary sleep studies, and further involvement of a myriad of healthcare professionals that have no specific guideline to reference when approached by one of these patients. 

In order to further our understanding of the effects of high altitude and nocturnal hypoxemia in healthy individuals, like that of Summit County, there has to be preliminary and ongoing research in these individuals.  Dr. Chris Ebert-Santos is currently conducting an overnight pulse oximetry study, which aims to recognize which symptoms they may or may not be experiencing, that are related to high altitude or sleep disorders, so that they may receive treatment, feel better, and remain active. 

At this moment, initial study results reveal a decreased average low night oxygen saturation from that of the study conducted by Gries and Brooks.  In a sample of just 14 individuals, the average low SpOs recorded overnight is at 81.3%, which is 9% lower than that recorded by Gries and Brooks (Graph 1).  The study is also revealing a trend in lower night oxygen saturations in individuals that have lived at elevation for a longer period of time (Graph 2). These findings suggest the need to expand and build on the current study being conducted by Dr. Chris and her team at Ebert Family Clinic. If interested, you may apply in-person at Ebert Family Clinic, where you will be required to fill out a health questionnaire on your length of residence at altitude, medical history, and possible symptoms related to high altitude.  Your basic vitals will be logged at the appointment.  After the first study, you will then be rescheduled in 12 months for a follow-up overnight study to monitor for any changes.  Overall, this study is designed to help with an understanding on the potential impact of high altitude on healthy individuals that are acclimated, but not necessarily adapted, to this environment.

Robert Clower is a second year physician assistant student at Red Rocks Community College in Arvada, CO.  His undergraduate degree was in Biology, which incorporated both medical health science courses as well as independent research courses in general biology and ecology.  While attending school at the University of North Georgia, Robert served in the Army National Guard for a cumulative time in service of 8 years.  After completing his undergraduate degree, Robert gained medical experience as an operating room assistant, which included assisting support staff with surgical preparation and patient transport throughout the hospital for surgical appointments.  Outside of his studies, Robert enjoys snowboarding, hiking, snowshoeing, exercising and spending time with family and friends. 

Sources

Summit County Population Projections: Summit County, CO – Official Website. Summit County Population Projections | Summit County, CO – Official Website. http://www.co.summit.co.us/519/Population-Projections. Accessed March 3, 2020.

Tintinalli JE, Ma OJ, Yealy DM, et al. Tintinallis Emergency Medicine: a Comprehensive Study Guide. New York: McGraw Hill Education; 2020.

Gupta P, Chhabra S. Prevalence, predictors and impact of nocturnal hypoxemia in non-apnoeic patients with COPD. 52 Monitoring Airway Disease. 2015.

Lemos VA, Antunes HKM, Santos RVT, Lira FS, Tufik S, Mello MT. High altitude exposure impairs sleep patterns, mood, and cognitive functions. Psychophysiology. 2012; 49 (9): 1298-1306.

Cingi C, Erkan AN, Rettinger G. Ear, nose, and throat effects of high altitude. European Archives of Oto-Rhino-Laryngology. 2009; 267 (3): 467-471.

Altitude Training 101

High elevation prompts physiologic changes in the body. As elevation increases, oxygen concentration in the air decreases; this is why some people suffer from altitude sickness when travelling to high altitude environments like Summit County, Colorado from a lower elevation. Training and/or living at elevation increases our red blood cell mass in order to compensate for the lower oxygen concentration, thus increasing our oxygen-carrying capacity. Red blood cells are like microscopic rafts that flow down the rivers of our blood vessels, picking up oxygen from our lungs when we breathe and then transporting it to all the muscles and organs that need it to function properly. For athletes, this physiologic concept can be used to their advantage in order to improve their performance. If they can train their blood cells to carry more oxygen by forcing them to grow in a more hypoxic (low-oxygen) environment, then they can have more oxygen available to their muscles to perform in any activity.

There is a modern training model that some athletes have adopted called “Live High, Train Low”. This means that the athlete performs high intensity training sessions at a lower elevation, but maintains general training and living at higher altitude. Your body begins making metabolic changes immediately when exposed to high altitude and hypoxia, but it can take a couple weeks for the maximum effect. Expert Dr. Gustavo Zubieta-Castillo, who spoke in La Paz, Bolivia at the 7th Annual Chronic Hypoxia Conference that Dr. Chris attended in 2019, claims that it takes him about 40 days to build up his hematocrit to be back to functional in La Paz which is situated at nearly 12,000 ft. All in all, the goal of living and/or training high, while including high intensity sessions at lower altitude, is to give your body enough time to build up some acclimatization to the hypoxic environment. Several studies in the last 25 years have taken various groups of athletes and placed them on different training regimens over 4 weeks. Some would live at low altitude and also train low, some trained low and lived high, and others trained high and low while living at high altitude. One study completed in 2008 concluded that athletes who either live high and train low, or live high while training low and high, showed about a 1.4% improvement in sea level endurance performance.

How high is too high, and how low is too low?

Snowshoeing above 9000 ft., Summit County, Colorado.

It was found in this same study, that there is in fact a “sweet spot” for implementing the “Live High, Train Low” paradigm. If subjects were living lower than 1800 m, there was not a significant improvement in athletic performance. On the other hand, if subjects were living too high, they could not adequately recover from training and therefore did not show improvement because their bodies struggled to keep up with the hypoxic environment. The best elevation to live and/or train at in order to increase RBC (red blood cell) production, RBC mass, and oxygen-carrying capacity is between 2100 m-2800 m, or about 7000 ft-9000 ft.

What does this mean for athletes in Summit County who live high and train high?

Great news! There are still major benefits to those who live and train in Summit Country, as well as for people who visit the mountains and train while they are in town. This is because of a physiologic process called autophagy. Autophagy is described as our cells’ process of degrading old proteins and damaged cell parts. This is a normal process that modulates cell survival, is important for cell renewal, and is also a promoting factor of exercise performance from altitude training.

When exposed to a hypoxic environment, our cells produce adaptive responses that ramp up autophagy and cell renewal elements. These responses include factors that promote skeletal muscle growth, boost skeletal muscle capillary concentration, and enhance coronary arteries (the arteries that feed your heart). Living and training at altitude is good for your heart and it can help build muscle while decreasing body fat mass. It also shows significant increase in cardiac output and strength of your heart stroke.

However, excessive exercise and especially excessive exercise at altitude can prove harmful to our skeletal muscle. It has been observed in male subjects running 20 km that the excessive exercise induces autophagy too much which leads to degradation of muscle protein, damage, and eventual loss of skeletal muscle all together. Therefore, just as there is a sweet spot for altitude training, it is also a good idea to monitor training in order to maximize the benefits of training in a place like beautiful Summit County.

So, how should I be training if I live in Summit County or if I am visiting for some time?

I had the pleasure of speaking with Mary Scheifley about this particular strategy. Mary is the owner of Peak One Fitness, a 24-hour gym in Frisco, Colorado (9000 ft.). She has over 20 years of experience in fitness and athletic training. She competed semi-professionally in mountain bike racing, and continues to bike today as well as cross-country ski, snowboard, weightlift, hike, and anything else that keeps her active. She loves Frisco and has found that being outside and active is almost spiritual. She is passionate about fitness and nutrition, and she works extremely hard to tailor her training regimens to each of her clients based on their individual needs or goals.

Cardio machines at Peak One Fitness, Frisco, Summit County, Colorado

When she trained people in Denver, she typically was running high-intensity aerobic classes. However, here in Frisco, she prefers to focus on strength and only include high-intensity interval training (HIIT) in short spurts. She believes that you don’t need to be over-exerting your body to see a positive response. She has a client who lives near sea level for most of the year where her main training regimen includes Cross Fit. When she comes to Frisco though, she can see a significant decrease in BMI and body fat index in just two months of lower-intensity training. Though frustrated that she cannot run on the treadmill as fast or as long as she can at home, by the end of her stay in Frisco, this client understands that difference of the elevation and appreciates the process that Mary provides for her.

Mary recognizes that fitness is not “one size fits all”. She typically likes to start people out at 80% of their maximum heart rate when exercising, but there are factors that may change this. Her clients that live in Summit County have already been acclimatized to the elevation so she can add a little to their 80% max heart rate because for them, 80% may feel like 70%. On the flip side, if you are visiting from sea level, she may have to decrease your 80% of maximum because of the hypoxia at elevation. Other factors that play a role in how Mary develops her training regimens include age, the client’s goals, their previous fitness level, and their overall reaction to altitude.

I also asked Mary about her experience with competition and professional athletes. Personally, she could tell that her endurance was superior to her competition when she raced at altitude against bikers from Denver. She also noticed that when she was in Denver, the racers there were stronger and bulkier than her. She also has experience training athletes who are preparing for competitions such as the Leadville 100 or who are professional skiers who tell her that it is more beneficial for them to come to altitude about 3 weeks prior to competition in order to prepare rather than just training at lower altitude. This is because their body will better adapt if they give it a little more time before competition while training.

At the end of the day, whether you are training for a competition, or just trying to stay healthy, being at altitude can pose challenges as well as benefits to our bodies. The following are some tips from Mary on maximizing your workouts at altitude without compromising your health and wellness.

Mary’s tips for athletic training and exercising at high altitude:

  • Increase water intake, even before you come to elevation. You should be drinking at least 3-4 liters of water per day.
  • Increase caloric intake. At altitude you are burning more calories than at sea level, and if you are wanting to train you need to fuel your body appropriately. Especially increase protein intake.
  • No alcohol. If you enjoy one drink here and there you should be fine, but if you are wanting to train at a high level alcohol should not be on the menu.
  • Add electrolytes. In addition to increasing water, you need to make sure you are replenishing your body with the salts it requires.
  • Take it slow. Maybe start with some yoga or moderate stretching before moving into running or HIIT classes. You may need to decrease your level of training by 20%.
  • Consider spending a night in Denver before heading up the mountain to Summit County. Dr. Chris has expressed this frequently to travelers and visitors of Frisco; it gives your body a chance to acclimatize prior to ascending to 9,000+ feet.
  • Don’t expect to be at your “home” level of endurance or fitness. Do not get discouraged if you cannot run your typical 7-minute mile, or you can’t easily warm up with a set of 10-15 squats. Your body needs to adjust, and you may need to just take it easy in the altitude. Ultimately, have fun and enjoy the beautiful outdoors!

Sarah Brzecezk is a 2nd year Physician Assistant student attending Midwestern University in Glendale, Arizona. She graduated from Northern Arizona University in Flagstaff, AZ with a Bachelor’s in Biomedical Sciences and then worked as a medical assistant in Internal Medicine prior to starting PA School. She is passionate about healthy eating and maintaining a physically active lifestyle, and she hopes to specialize in Orthopedics when she graduates this Fall. During her 6 weeks at elevation in Frisco, Colorado, she has enjoyed numerous hikes, two hut trips, yoga classes, and running in the gorgeous outdoors. Her goal as a provider is to help others overcome injury and illness in order to return to physical activity and athletics, enabling them to combat chronic illness and stay healthy for their future years.

References

Zhang, Y., & Chen, N. (2018). Autophagy Is a Promoter for Aerobic Exercise Performance during High Altitude Training. Oxidative medicine and cellular longevity, 2018, 3617508. doi:10.1155/2018/3617508

Brocherie, F., Millet, G. P., Hauser, A., Steiner, T., Rysman, J., Wehrlin, J. P. & Girard, O. (2015). “Live High–Train Low and High” Hypoxic Training Improves Team-Sport Performance. Medicine & Science in Sports & Exercise, 47(10), 2140–2149. doi: 10.1249/MSS.0000000000000630.

Stray‐Gundersen, J. and Levine, B.D. (2008), Live high, train low at natural altitude. Scandinavian Journal of Medicine & Science in Sports, 18: 21-28. doi:10.1111/j.1600-0838.2008.00829.x

High Altitude Hawai’i

Rising 13,803′ (4207 m) from the surface of the Pacific Ocean, Hawai’i’s tallest dormant volcano, Mauna Kea, reaches well into its own unique high altitude environment. Measured from its base on the ocean floor, it is the tallest mountain in the world, about 33,000′ (10,000 m) in height.

A frozen Haleakalā silversword. PC: Lyle Krannichfeld & Pueo Gallery

You may never have thought to find a high altitude environment on the tropical island chain, but Mauna Kea is just one of four peaks that summit over 8,000′. The next three are Mauna Loa (13,679′), Haleakalā (10,023′), and Hualālai (8,271′), with Haleakalā (“House of the Sun”) on the island of Maui and the other three on the Big Island. Each of these dormant volcanoes is home to species of plants and animals found only in Hawai’i, many of them only found around their respective peaks.

Sacred lands, whose access was once restricted to only the divine rulers of Hawaiian society, Mauna Kea now hosts 13 observatories and research staff in addition to its foreign and local visitors, many of whom make the historic pilgrimage to the summit from sea level in a matter of hours via an access road established in 1964.

Visitors to Mauna Kea are advised to acclimate at the Visitor Information Center which sits at 9,200′, although a particular length of time is not specified. In addition to the more intuitive precautions regarding pregnancy or heart and respiratory conditions, visitors in Hawaii are also warned against making an ascent within 24 hours of having been SCUBA diving, which may not be so obvious. You can find this and more helpful tips consistent with current high altitude research on their Public Safety brochure, which includes information about symptoms of HAPE (High Altitude Pulmonary Edema, featured in a previous article, and very common in the Colorado high country).

Poliahu visits Haleakalā. PC: Lyle Krannichfeld & Pueo Gallery

In addition to the hypoxic conditions, Mauna Kea and its aforementioned counterparts are also prone to the dryness and weather systems we see in Colorado, with snowfall above 10,000′ as recent as the past few days, a visit from Poliahu, Hawai’i’s own goddess of snow, and the subject of songs and hula dances in her honor.

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 on a computer, 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.

Dr. Chris’s HAPE Cheat Sheet

Inflammation and altitude can cause low oxygen. Inflammation is commonly caused by viral infections such as colds or influenza, but can occasionally occur with bacterial infections such as strep throat or pneumonia. Low oxygen, or hypoxia, is the result of fluid collecting in the air sacs of the lungs, called pulmonary edema.

There are three types of high altitude pulmonary edema (HAPE).

  1. Classic HAPE, recognized for over a century. occurs in visitors to altitudes above 8000 ft (2500m) beginning during the first 48 hours after arrival. Symptoms include cough, congestion, trouble breathing, and fatigue, all worse with activity.
  2. Re-entry HAPE occurs in people who are living at altitude, travel to lower altitude, and develop symptoms during the first 48 hours after returning home
  3. High Altitude Resident Pulmonary Edema (HARPE) is a recently recognized illness that occurs mostly in children who have an underlying respiratory illness and live at altitude, with no recent history of travel. They have oxygen levels below 89 and lower but do not appear toxic. They are fatigued but rarely have increased work of breathing.
Parents are often worried their children won’t wear a canula for oxygen, but they don’t typically mind.

Treatment of HAPE is oxygen. There may also be signs of asthma or pneumonia which are treated with bronchodilators and antibiotics. Most people with pneumonia at altitude do NOT have hypoxia. All three types of HAPE can reoccur, but typically not with every arrival at altitude or viral illness. Many of these patients are told they have pneumonia again and again, or severe asthma, and are treated with inhalers and steroids. Usually, this adds nothing to their recovery.

A chest x-ray may show typical infiltrates seen with pulmonary edema, but in mild or early cases, can look normal. There is no blood test for HAPE. Oxygen should be used continuously at a rate that raises the oxygen saturation into the 90’s. Length of treatment may be as short as 2 days or as long as ten days

Most importantly, owning a pulse oximeter and measuring oxygen levels in anyone at altitude with symptoms of cough, congestion, fatigue and trouble breathing with exertion can keep people out of the ER and ICU. HAPE can rapidly progress to respiratory failure and death if not recognized and treated expediently.

i-70: Surviving Colorado’s Mountain Corridor

Between Utah and Maryland runs over 2,000 miles of Interstate 70. Every year, caravans of cars commute via I-70 across the Rocky Mountain Continental Divide, right in the middle of Colorado, where road, weather and traffic conditions make for some of the most dangerous driving in the country. Year after year, fatalities are in the hundreds. Storms in every season are liable to obscure vision and make surfaces slick on steep grades and tight curves reaching well over 9,000′, and at speeds over 70 mph. Summit County, Colorado, surrounded by mountain passes up to 11,000′ and above, is the highway traveler’s gauntlet of possible peril. As another year comes to a close and Winter peak season gets into full swing, preparing to get up to this elevation is just as important as preparing for the altitude while you are here.

Born and raised at Colorado’s highest elevations, Chris Erickson is well into his fourth year working for the Colorado Department of Transportation (CDOT), up at the Eisenhower-Johnson Tunnel, as an Operator Dispatcher: he monitors traffic flow and conditions, deploying staff, services and heavy machinery when necessary. They operate the Colorado traffic management center from his roost right at the Continental Divide, which covers I-70’s mountain corridor. Over 200 miles of winding highway from Dotsero to Golden. He’s seen his share of disasters, so it occurred to me that he may have some valuable observations and advice for the rest of us.

The most intimidating aspect of his role is pretty much the same now as it was when he first started: Winter storms. When the snow gets heavy, they get out the big guns, snow plows deployed from every affected region, operating over stretches of 10 to 20 miles. There is a lot more to this than the drivers think, and I’ve seen cars trying to squeeze around side-by-side plows on icy roads, not aware that they are in formation to control traffic while effectively clearing snow and debris.

What is one thing you wish people would stop doing, knowing what you know now?

Obey the laws, observe speed limits. I wish semi drivers would stop catching on fire all the time. Their brakes catch on fire when they haul ass going down the hill [from the tunnel]. 

How could we forget about the variety of vehicles on the highway? You will often find yourself right next to literal tons of machinery flying down steep grades. Trucks jackknifing is not an uncommon sight, especially in the Winter, and there are enough runaway truck ramps to suggest these monsters losing their brakes is not uncommon, either.

What is one thing you wish drivers would start doing?

I wish people would educate themselves more on driving conditions in the mountains before they came up here. I wish people would educate themselves more on the difficulties of travel on this mountain corridor. There are just so many things: cliffs, rocks that fall all the time … we’re trying, but we only have so many plow drivers and we can’t be plowing every inch of the road every minute. For example, Silverthorne Hill, if that starts to get backed up, the plows can’t get through when they turn around and head back uphill. It’s difficult to manage this corridor with all the obstacles at elevation. People need to be more patient. 

When it comes to road and weather conditions, what do you consider to be the worst or most dangerous?

Black ice.

Stuck in Winter traffic at the Continental Divide

If you didn’t know, now you know. It’s in the local news year after year, but the very thing about black ice is its lack of visibility. Blending right into the black of the asphalt, this ice that has been sitting on the highway without warm conditions to allow it to melt is the cause of many accidents.

Animals on the road: moose, elk, deer … 

The sheer size of these animals rivals the weight of the largest SUVs you’ll see on the highway. Trying to predict the animal’s movement is useless, so it’s best to be prepared to come to a full stop when necessary. Road signs where animal activity are often present are up and down this corridor, and variable message signs (VMS) will always report the immediate presence of reported sightings.

Incidentally, writing the messages you see on these VMS is one of Erickson’s responsibilities. If you’ve paid any attention to each marquis in the mountain corridor (which you should be), you’ve read his work. He often jokes that he is the most widely read author in the state.

“Moose, marmots and motor homes: Spring Migration is on!” is the one he is most proud of, he says. I must admit, it’s pretty clever. When you put it that way, humans are arguably the most migratory animal on the planet.

Fortunately, drivers aren’t left completely without aid on this dangerous trek. CDOT provides a Courtesy Patrol that many are not aware of. This service will dispatch to the location of vehicles that need assistance moving out of the way of oncoming traffic to a safe space to troubleshoot all kinds of common car troubles from flat tires to running out of fuel. They won’t get you to your final destination, but they will give you up to a gallon of gas to move out of danger.

They’ll help you change a tire. They’ll give you a jump. They’d probably even let you use a phone or let you charge your own.

I ask Erickson if there’s anything else he’d like to share with drivers through the mountain corridor:

Buckle up. The worst wrecks often happen on clear, dry days with dry roads.

If you plan to be out there in the middle of the highway through the mountains, be patient, be kind, be courteous. There are long stretches of highway where cell service is unreliable. Being stuck roadside in the mountains requires more than the standard emergency kit. Temperatures are often below freezing in the winter, so bring gloves, hand warmers, blankets, washer fluid (don’t add water) for your car, water (don’t add washer fluid) for yourself, and warm, waterproof boots you can push a car in (worst case scenario). For more insight into how cars operate differently at altitude, check out our previous article on The Physiology of an Automobile.

Thanks for lookin’ out, Chris!

robert-ebert-santos

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.


Information and discussion for visitors and residents in the mountains