Summit County residents more prone to deadly illness
January 25, 2009
High Country residents could be more susceptible than flat-landers to a potentially deadly illness associated with quick travel to high elevation, doctors say.
Known as “re-entry pulmonary edema,” it mysteriously strikes some mountain residents who return from visits to lower elevations.
Summit County emergency physician David Gray, who specializes in altitude-related conditions, had an encounter with re-entrant HAPE when his 10-year-old son, Dylan, started coughing the day after returning from a three-week trip to Texas.
“At 10 that night I put him in bed with me. He was coughing, keeping me awake. I took my stethoscope out, I put it on his lung and it was gurgling wet,” Gray said.
The normal blood-oxygen saturation for high-elevation dwellers is typically 88 to 93 percent. His son’s read 38 percent.
“That’s really not compatible with life,” Gray said.
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High-altitude pulmonary edema is the medical term for fluid entering the lungs in an area with low oxygen and barometric pressure. It’s known as a severe ” potentially life-threatening ” form of altitude sickness.
Though as many as 15 to 45 percent of people visiting the mountains get acute mountain sickness ” symptoms include headache, fatigue, shortness of breath ” as few as 0.1 percent get HAPE, according to emedicine.medscape.com.
But re-entry HAPE seems to be more common, especially among young people.
Dr. Peter Hackett, director of the Institute for Altitude Medicine in Telluride, said about one in 10,000 mountain visitors get HAPE but three or four residents of Telluride’s population of about 2,500 people can be affected by the illness annually.
“We see it more in tourists because there are more of them,” Hackett said.
The illness may be treated with oxygen or by returning to a lower elevation.
Hackett said Cialis ” a fast-working medication for treating erectile dysfunction ” can be used for treatment but “it’s not nearly as good as oxygen.”
Gray treated his son’s emergency case with oxygen and Decadron, a steroid that stabilizes cell membranes ” in this case, lung membranes to stop them from leaking.
“If I had not recognized and treated my son, I think he would have died that night,” he said.
Dylan, now 14, sometimes requests oxygen when he returns to Summit County, Gray said.
The best way to avoid re-entry HAPE is to return to high elevation gradually, for example by staying in Denver for a night on the way back from a trip to areas near sea level, he said.
Dr. Rosanne Shaw, who practices emergency medicine in Summit County, said she’s seen re-entrant HAPE mostly in 14-to-15-year-old males.
The higher the elevation, the more likely a person is to develop symptoms of altitude sickness. Gray said the level to trigger symptoms varies among people, but there’s a maximum level for everyone.
“If I take you in a helicopter and put you on Mount Everest without oxygen, you’ll be unconscious in four minutes and dead in two hours,” Gray said. “But I can walk you up there in a six-week period, and you’ll be OK.”
Diamox, a medication that increases respiratory rates, allowing more oxygen to get to the body, can help prevent HAPE.
“That’s what we give kids here that we know” are susceptible to HAPE, Hackett said. “They stay on it a few days, and they’re fine.”
Air in Summit County has fewer oxygen molecules than at sea level, and lower air pressure plays a role, as well.
He said active people often are surprised when they exhibit symptoms of mountain sickness. An athlete’s heart needs exercise to beat faster, but people who aren’t as active generally “just need less oxygen to get the heart pumping faster,” Gray said.
“Most people up here are fit, so maybe that’s why we get it more often,” he said.
Though the reason for HAPE’s higher frequency among mountain dwellers isn’t confirmed, it is believed to have something to do with a stronger pulmonary artery.
“People who live in the mountains ” especially kids born and raised here ” the muscular layer around the pulmonary artery stays thicker,” Hackett said.
The artery relaxes at lower elevations then constricts when the person returns to the mountains.
“It’s that constriction that causes HAPE,” he said. “It seems to be more in children than adults.”
Gray said the symptoms can range from a cough to coughing up “blood-tinged, pinkish frothy stuff.”
“If you or a family member develops a cough, don’t write it off. Take it seriously,” Gray said. “And it will be a cough that worsens quickly in most cases.”
Summit County Coroner Joanne Richardson said in an e-mail that she’s never had a case of someone who died from re-entrant HAPE in Summit County.
Robert Allen can be contacted at (970) 668-4628 or email@example.com.