Health in the High Country: doctors discuss altitude effects on heart, lungs
October 1, 2014
When it comes to altitude and health, the people living in Colorado's High Country have no one else in the world with which to compare themselves.
Genetically, Ethiopians are the most adapted to high altitude after about 70,000 years living in the highlands there, said cardiologist Warren Johnson at a recent community talk in Breckenridge.
The Tibetans are next, after about 5,000 years, he said, and then the Andeans, after 1,000 to 2,000 years.
"Then us," he said.
“If we can help this population to be proactive with their health, that would be great.”
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Warren was one of three doctors who gave presentations Thursday, Sept. 25, at the DoubleTree by Hilton on how high altitude affects overall health for people of different age and conditions.
The free community seminar, "Growing Up and Growing Old in the High Country," was provided by St. Anthony Summit Medical Center and the Summit Medical Center Health Foundation.
ALONE IN THE WORLD
Johnson focused on the uniqueness of the residents of Summit County and other communities above 9,000 feet.
Except for during the mining heyday, fewer than a couple thousand people lived in Summit County until the ski industry boomed about 40 years ago. Now, more than 50,000 Coloradans live at high altitude, he said, and people here will need at least hundreds of years to genetically adapt.
"I don't want to necessarily scare people that this is the problem," Johnson said. "If we can help this population to be proactive with their health, that would be great."
In his presentation, Johnson explained that heart irregularities and pulmonary hypertension, or increased pressure in the blood vessels of the lungs, grow more common among people in Summit and other high-altitude communities.
Like any kind of high blood pressure, altitude-related pulmonary hypertension can damage blood vessels and increase the risk of localized clotting. He said the medical community doesn't yet know the prevalence of high-altitude pulmonary hypertension.
"There are so many genes that get turned on for hypoxia," he said, or oxygen deficiency.
Johnson said he has heard anywhere from more than 27 genes activate to and more than 800, so researchers don't quite know how many genes turn on and what they do.
Researchers also don't know all the effects of high altitude on healthy people or how long a healthy person can live in a low oxygen environment without seeing negative health effects.
BABIES AND KIDS
Pediatrician Christine Ebert-Santos, with the Ebert Family Clinic in Frisco, spoke about her research on the prevalence of high-altitude pulmonary edema, or HAPE, in children living at altitude. HAPE can be life-threatening, she said, and she worries it sometimes goes undiagnosed or misdiagnosed as pneumonia.
When parents say they're worried because their kids are coughing or have congestion, Ebert-Santos said, she asks what is the child's blood-oxygen level, because if it's too low, the diagnosis could be HAPE.
If parents don't know, she sees the child right away, even on nights and weekends, and gives them oxygen if needed, she said. "We're so lucky up here that we have two companies that will bring oxygen to us at any time."
Another anxiety provoking issue for families, she said, is the fact that babies are born smaller and kids stay smaller than average for a few years.
Ebert-Santos has analyzed data from patients over the last 10 years, and she said most kids catch up by age 2 and almost all catch up by age 4.
In the meantime, she said, not understanding that can mean lots of doctors visits, blood and stool tests and dollars spent on nutritionists. Parents and health care providers can save money, time and stress by realizing the children are normal and healthy.
One thing Ebert-Santos would like to research more, she said, has to do with the 50 percent or more of the babies born in the High Country who are put on oxygen for the first few weeks of their lives.
Doctors worry about how low oxygen affects newborn heart and lung development, she said, but they don't know if babies living in Alma should be treated slightly different than babies living 1,500 feet lower in Frisco.
She encouraged everyone to buy a pulse oximeter, a small device people can place on their finger to measure their blood-oxygen level. She also said people should take advantage of supplemental oxygen when needed.
Wearing oxygen is like wearing pajamas, she said. "You feel it when it first goes into your nose and then you forget about it."
CHOKING IN YOUR SLEEP
Pulmonologist Erik Swenson gave the final presentation on breathing issues during sleep. People spend a third of their lives sleeping, he said, and what happens during sleep has a huge effect on everything else.
For people who don't experience sleep apnea, or periods of not breathing during sleep, at low elevations, traveling or moving to high altitude can be the first thing that makes the condition obvious to a bed partner.
At altitude, he said, "that restful state of our lives may not be so restful."
Those seemingly healthy people can experience altitude-related periodic breathing, where they cycle through deep breathing and no breathing up to once or twice a minute throughout the night.
Swenson said he thinks it happens because of a "vicious cycle of confusing signals to the brain." Basically, the brain overreacts to lower oxygen in the air and lower carbon dioxide in the body.
When not treated, this periodic breathing pattern causes an array of health problems because of the disrupted sleep, plus it can be scary for people if they wake up with a choking or suffocating sensation.
The apnea contributes to pulmonary hypertension, or high blood pressure in the lungs, and exacerbates most other health conditions, especially heart problems.
Luckily, the problem goes away when people sleep with extra oxygen or carbon dioxide.
"It's like descending to low altitude when you sleep," he said.
Acetazolamide, better known by the brand name Diamox, also works as treatment as do sedatives, but only in low doses as too much can worsen breathing issues.
For people with sleep apnea at low elevations, treatment isn't as easy.
That kind of apnea is generally a combination of two diagnoses: obstructive sleep apnea, when the airway collapses during sleep, and central sleep apnea, when the body periodically makes no effort to breathe during sleep.
These conditions grow more common as people age. About one in 20 people under age 35 experiences sleep apnea, but once people reach 55 and older, the prevalence grows to about one in five.
At high elevations, the primary cause of the apnea switches to the less common central sleep apnea, and the apnea worsens overall. General treatments include losing weight, quitting smoking, avoiding sleeping on the back, avoiding sedatives and using a device that helps open the airway or regulate breathing.
SOME UNANSWERED QUESTIONS
Most of the questions during the Q&A session came from visitors.
One grandparent asked if children can also take Diamox. Ebert-Santos said yes, though she doesn't give it to infants.
Parents should watch their babies, she said, and sleeping too much, not eating and irritability could be signs of altitude sickness.
Swenson added that Diamox isn't recommended for pregnant woman.
According to the Institute for Altitude Medicine in Telluride, most pregnant women are naturally protected against altitude sickness due to hormone changes and the increased respiratory drive of pregnancy.
Someone asked why he seems to have constant sinus drainage every time he visits the mountains.
Sinusitis is more common at high altitude, Johnson said, and he's not sure why. The runny nose and stuffiness could be caused by less humidity.
Another person asked if the doctors had any advice for healthy aging in Summit.
Johnson replied that people should exercise, eat healthy, educate themselves about altitude and pay attention to their bodies.
After the talk, one audience member approached Ebert-Santos and asked if everyone who's lived in the High County more than 20 or 30 years should be using supplemental oxygen.
"That's a question that's still out there," Ebert-Santos said.
Johnson said he often tells patients experiencing altitude-related health issues that they need to relocate to a lower elevation. A lot of people refuse.
He understands where they're coming from, he said, especially when they've lived in the High Country a long time and have friends and supportive social networks here. He wouldn't want to leave either.
"I don't want to reinvent my life somewhere else," he said.
But he tells his patients who are facing serious health issues and are tired of wearing oxygen to consider moving. Simply moving to lower altitude often improves their conditions, he said, but not all conditions are reversible.