Dr Chris was invited to present a poster : “Chest X-ray Findings on 139 Hypoxic Children at High Altitude” in the Peaks District three hours north of London. She also gave a presentation with slides to the assembly of over 200 doctors from around the world-Japan to Kyrgyzstan. She introduced our book “Surviving and Thriving at Altitude” in the section on mountain literature and addressed a small group with an overview of conditions she sees in children at altitude. The meeting was held in a tent with the participants in their puffy jackets carrying their backpacks.
Speakers covered topics relevant to mountain living including “Women at Altitude”, “Children at Altitude”, hypoxic training for athletes, REDs: relative energy deficiency syndrome, climate change, hypothermia, frostbite, and more.
A concern here in Colorado with so many world class athletes, especially adolescents, is the balance between calories burned and calories needed for maximum muscle development and performance. REDs affects every system in the body, from sleep to mental and physical well-being. German orthopedic and trauma surgeon Volker Schoffl works with Olympic athletes using a questionnaire for initial screening, blood tests and physical exam to establish the diagnosis. A team of psychologists, nutritionists and physicians determine and implement treatment.
Experts from The Altitude Centre in London, James Barber and Dr. Patrycja Jonetzko, a cardiothoracic anesthesiologist, described programs to prepare athletes competing in low oxygen environments. Using equipment to create a hypoxic environment such as face masks and tents, they expose subjects for various lengths of time from minutes to hours during the weeks leading to the event. They described progress towards individualized targeted programs to increase mitochondrial efficiency.
Dr Deborah Miller spoke during the section on “Children at Altitude” . She had just spent three months working as a pediatrician in Saipan in Micronesia where we first met. Her altitude expertise comes not only from several rotations in remote mountain clinics but personal experience with altitude illness in her children in Nepal and Colorado. She described her experience at the HRA Clinic in Nepal, at 14,300 ft. Her talk included environmental exposures with descriptions of sun toxicity. Ultraviolet radiation exposure is increased by 90% due to reflection of light from snow compared to 15-30% from sand or 5-20% from water. Treatment is similar to that for hives with antihistamines and topical steroids.
Dr Miller shared guidelines for estimated walking distances with children from momgoescamping.com. Start with ½ mile per year of age, reduce by 50% for steep elevation, increase by 10% if the destination is of interest to the child and by 25-50% if they have friends along. Now for the pack: decrease distance by 10% while assuming you will end up carrying it, and another 10% if you have a heavy pack.
The final and most important points from both her and Dr. Chris’ experience about children visiting altitude are:
- Previous excellent altitude performance does not always predict future performance
- Recent illness can play a role (and make them more susceptible to altitude illness)
- Emergency plans are important
- HAPE can take a long time to fully resolve
The day devoted to frostbite and hypothermia highlighted the importance of international registries and cooperation for progress in these devastating conditions. Although Canada, Alaska and Scandinavia have many cases the group leading investigations is based in Minnesota, where extremely cold winters and homelessness create conditions that make frostbite and hypothermia common. Rachel Nygaard, PhD discussed her work in this field.
There were fascinating and complex discussions about how and when to combine the various drugs used for resuscitation from cardiac arrest in hypothermia and the vasodilators for frostbite. Of course, there was emphasis on the universal adage that “no one is dead until they are warm and dead”, citing cases of cardiac arrest for over 2 hours with full recovery.
There were many more interesting sessions and much informal learning and networking. Dr. Chris was reacquainted with physicians who remembered her presentations at conferences in Telluride in 2016, Snowbird in 2024 and Lake Louise in 2025.
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