Colorado doctor: Health effects of living in mountains unknown to medical establishment
October 11, 2017
Dr. Christine Ebert-Santos, M.D., is on a mission.
The longtime Summit County pediatrician has, for several years, been trying to spread the word on an acute altitude illness that even locals can develop no matter how long they've been residents. If not diagnosed or treated properly, the results can be fatal.
"All the doctors who work up here know that this occurs, but it's not widely recognized outside of the mountain community," said Ebert-Santos, who's operated her family medical practice in Frisco for approaching two decades. "They think that kids and people who live up here are acclimatized and they won't be as likely to get it. We just have to keep an open mind so that we can help people with simple treatments that could really keep them out of trouble."
High-altitude pulmonary edema, or HAPE, can be difficult to identify because there's no particular test for the disorder. Complicating matters is the fact that the symptoms — characterized by a bad cough, congestion, fatigue and/or sudden respiratory issues — often mirror those of pneumonia or asthma.
The ailment, which stems from the accumulation of fluid in the lungs and can be treated with oxygen, occurs in individuals who spend roughly 48 hours at elevations of 8,200 feet or above. The towns of Summit County range from approximately 9,000 to above 10,000 in some locations; so it stands to reason Ebert-Santos tends to see more of the cases than physicians on the Front Range.
In 2015, for example, she documented a total of 44 cases across three unique forms of HAPE that she defines as those primarily occurring in lowland visitors, one in people re-entering the community from lower altitudes and another that can arise in long-term residents. The latter, which accounted for 35 of those cases, is one form not specifically recognized by the larger medical community, but that she believes at least contributed to the deaths of two children, a 6-year-old and a 16-year-old, last few years in Summit County.
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It's why Ebert-Santos recommends to patients that each keep a pulse oximeter, at a cost of between $40-$50, in their homes when symptoms arise. It's also the main reason she spends a good chunk of her freetime researching the disorder and presenting about it at various pulmonary conferences.
"A lot of the time an X-ray isn't going to show anything," said Ebert-Santos, explaining why pulmonologists aren't willing to agree to the diagnosis without more hard proof. "When you see this number of cases, it's a clinical diagnosis. I don't need to X-ray them; I know all they need is oxygen."
What she argues is, when presented with these symptoms and an oxygen level at or below 89 percent saturation — the lowest accepted level for maintaining healthy cells and heart and brain function — she has good reason to believe it's HAPE. A person with pneumonia doesn't typically have a low oxygen issue, and if they do, they're routinely much sicker and would have needed to go to the emergency room by the time that occurs.
"The key with (HAPE) is they've got a low oxygen, but they're not really sick," she explained. "If you have asthma or pneumonia with a low oxygen, you would be very sick and you would not stay at home. You would probably not even go to a clinic, you would go to an ER."
Due to the frequent misdiagnosis of the disorder as asthma, many children who live at altitude, but visit doctors outside of the mountain communities, are often unnecessarily prescribed inhaled steroids. But only about 8 percent of the population actually has asthma, according to the Centers for Disease Control and Prevention. And while the prescription can help a person recover, it isn't a permanent solution.
Compounding matters is the fact that Ebert-Santos' experience with HAPE suggests that those who are stricken with the illness are more likely to redevelop it again down the road. And once the inhaler no longer works as a remedy, parents can become worried, when in fact all the child — or adult, for that matter — needs is oxygen to begin recovery.
"You just have that underlying reactivity in your lungs," she said of the disorder's chance at recurrence. "But once I saw this pattern, I thought, 'All they need is oxygen.'"
Still, those clinicians less familiar with HAPE are not as accepting. That's why Ebert-Santos, who also possesses a master's degree in public studies with a focus on health care leadership from the University of Denver, continues to produce posters for professional conferences each summer and publish her research on the disorder, most recently in a medical journal this past September.
"There's so much that we don't know, in every walk of life — every facet, not just medicine," said Ebert-Santos. "So we cling to the things we know, like asthma and pneumonia, and it's like if you have a hammer, everything's a nail.
"It would be helpful to be aware of this as one of the differentials," she added. "So if you get told you have pneumonia or asthma, or you have low oxygen, sometimes all you need is oxygen to get on top of it. It's a preventable disease, and we can keep people out of trouble."