Summit County pediatrician explores health effects of altitude on children
July 29, 2014
For Summit County visitors, tips on preventing and treating altitude sickness come standard in the informational packet in every condo and hotel room.
But what about those of us who live here full time? Even after we've acclimatized, what does living at high altitude do to our bodies?
One local pediatrician has been trying to chip away at that question.
Dr. Christine Ebert-Santos runs the Ebert Family Clinic in Frisco and has been researching the effects of altitude on her young patients.
Her practice sees 100 kids a week, she said. Every year, she said she treats about half the children in the five-county area of Summit, Lake, Park, Grand and Clear Creek counties.
For years, she has been collecting data on cases of children who may be misdiagnosed, and based on her results, she recommends making two changes in health care standards for children living at high altitude.
GOT A COUGH?
The first change has to do with a severe, potentially life-threatening form of altitude sickness called high altitude pulmonary edema, or HAPE.
In general, as you increase in elevation, barometric pressure decreases, the air is thinner and less oxygen is available to the body. High altitude pulmonary edema is the medical term for fluid building up in the lungs at high elevations.
HAPE symptoms include a tight feeling in the chest, congestion, extreme fatigue, gurgling sounds while breathing, poor judgment, breathlessness, confusion, collapse and coma. Treatment is descending in elevation and receiving extra oxygen.
Scientific literature currently recognizes two kinds of HAPE. The first affects people who live at lower altitudes and travel to high altitude, while the second, called re-entry HAPE, affects high-altitude residents who travel to low altitudes and then return.
Ebert-Santos is researching a third kind: children who live at high altitude and suddenly develop HAPE without a recent trip to low altitude.
Because the symptoms are similar, these children are often diagnosed with pneumonia, she said, which involves antibiotics and sometimes a trip to the ER.
Ebert-Santos, who worked as a pediatrician on a tropical Pacific island for 20 years, said she knows pneumonia well and thinks many of those cases are not pneumonia. The kids have low oxygen levels, but they're not as sick as normal children with pneumonia, she said, and "their x-rays are not very impressive."
In the last six months, her practice has seen 37 cases of HAPE, and she thinks many of those fall into the third, less-known category she described. Ebert-Santos said she has been tracking the issue for about eight years, and recently she has been trying unsuccessfully to collect data from other local clinics.
"They don't recognize it as an issue," she said, because they don't see as many children.
She added that research on high-altitude health in general is limited because too few people in the world live at high enough elevations to warrant much funding for interested scientists and health care providers. "It's a real small niche."
As of 2009, when the world's human population was almost 7 billion, about 140 million people lived at or above 9,000 feet. Those people were concentrated in Ecuador, Peru and Bolivia in South America, Nepal and Tibet in Asia, and Summit County and a few other counties in the western U.S.
The implications of her research, which she is trying to get published, could save time and money and lead to better care for kids who may have this type of HAPE she calls resident HAPE, she said, because it is "totally preventable."
She said she would like every parent in Summit to buy a pulse oximeter, a small device that tests the oxygen level in the blood, in case their child develops a cough or respiratory infection.
"It wouldn't hurt. It's cheap," she said.
The device, which she said can be bought at the store for about $40, is placed on the finger. If a low oxygen level is measured, parents can call Ebert-Santos and she will order them oxygen, which would save a trip to the hospital and prevent the kid from taking unnecessary antibiotics.
To further confirm her ideas about HAPE, Ebert-Santos said she wants to collect data on the number of pneumonia cases in the county and compare it to national and international incidence rates. If kids are getting diagnosed with pneumonia at a rate three times greater than average, she said some of those cases are probably HAPE.
Ebert-Santos will present her findings on HAPE when doctors, physician assistants, nurses and experts on altitude and health gather Saturday, Sept. 27, in Breckenridge for a conference called the High Altitude Summit.
The Thursday before the conference, the general public will be invited to a forum where Ebert-Santos will also talk about her research.
For decades, science has known that women who are pregnant and give birth at high altitude are more likely to have babies born earlier and smaller.
Ebert-Santos has found that high-altitude kids stay smaller than world averages into the first few years of their lives. This has caused problems because when young mountain kids see specialists at lower altitudes, they are often given a diagnosis of "failure to thrive."
The complicated diagnosis leads to expensive tests for chronic illnesses like thyroid conditions and celiac disease and causes parental anxiety.
When Ebert-Santos first began practicing in Summit County about 15 years ago, she worried about these smaller children and did unnecessary tests. She quickly realized that being smaller than normal is normal for High Country children until they are 2 or 3 years old and catch up to the weights and heights expected based on averages produced by the World Health Organization.
Using information from her patients combined with the power of electronic medical records, she hopes to analyze enough data that could help establish a standard growth chart specifically for high-altitude children that will ease fears and save money.