Understanding High Altitude Sickness

July 25th, 2018

High Altitude Sickness affects plenty of visitors to Colorado. It’s a subject Dr. John Hall, an emergency department physician at UCHealth Pikes Peak Regional Hospital, can talk about from a personal and professional point of view.

Several years back, while completing a residency at a hospital in Chicago, Hall made a quick trip back to Colorado to go ice climbing with his father-in-law, a physician’s assistant.

Hall got off the plane at Denver International Airport, drove to Littleton, slept overnight, woke up at 4 a.m., and drove to Mount Lincoln, near South Park, Colorado, to go ice climbing.

Dr. John Hall rock climbing.
Dr. John Hall, an emergency room physician at UCHealth Pikes Peak Regional Hospital, sees plenty of patients who have High Altitude Sickness.

“We were climbing at about 11,000 feet and half way into the climb, I literally hit a wall,’’ Hall said. “I was hanging on the rope and asking myself, ‘Why can’t I swing my ax? Why can’t I kick my feet into the ice? Why can’t I move?

“I had a little bit of a headache, I was nauseous and a little short of breath and I thought, ‘My God, what is going on?’ ’’

Hall explained his symptoms to his father-in-law, who diagnosed him with high altitude sickness. The solution – move to a lower elevation.

Hall wasn’t convinced, and he told his father-in-law: “I run 5 miles a day. I can do this.’’

As soon as Hall reached a lower elevation, he felt fine. Now an emergency room physician at Pikes Peak Regional Hospital in Woodland Park, Colorado (elevation 8,400 feet), he sees plenty of patients – most of them from out of state – who come to the Emergency Department complaining of headache, nausea, fatigue and shortness of breath even while resting – classic symptoms of high altitude sickness.

Hall said he has seen patients who range in age from 17 to 84 and some of them are extremely physically fit. He cares for them by administering oxygen, an IV of fluid and a diuretic to help reduce the amount of fluid on the lungs. He encourages patients to go to a lower elevation. Those patients who have underlying health issues such as COPD, asthma or heart failure are at significantly higher risk for developing high altitude sickness.

“High altitude sickness is more common than you realize,’’ Hall said. “This hospital sits at just below 9,000 feet and the typical patients we see come from states at sea level. People come up here and they have trouble breathing, they’re nauseous, they’re weak, they are short of breath with minimal exertion.’’

High altitude sickness is a serious condition and can develop into life-threatening illnesses, including High Altitude Pulmonary Edema (HAPE), fluid in the lungs; and High Altitude Cerebral Edema (HACE), fluid on the brain that causes brain swelling. If left untreated, both can be fatal.

Hall has seen people with HAPE in the Emergency Department though, fortunately, he has not seen patients with HACE.

People who are suffering from HAPE often have a cough, chest pain and produce white, frothy sputum. In some cases, patients cough up blood. These patients should seek a doctor’s care immediately and descend to a lower elevation.

“What happens is their lungs are swelling. If you can imagine a sponge, soaking up water, that’s what goes on in the lungs and it doesn’t allow the oxygen to flow very well,’’ Hall said. “So then they start coughing up frothy sputum and we give them diuretics to try to get some of that fluid off.’’ He’ll often send the patient to a lower elevation, where they seem to do much better.

Hall recommends that people who have underlying conditions talk frankly with their doctor about traveling to high altitudes in Colorado. A physician can prescribe Diamox, which reduces and prevents the symptoms of high altitude sickness before a patient travels to Colorado.

“It’s a simple medication, it’s generic and it’s cheap,’’ Hall said. “I recommend taking it three days before you come to altitude. It’s a pill taken twice a day.’’

Hall also recommends that people who live at sea level who have underlying health issues become acclimated to Colorado’s high altitude for a few days before going to an even higher altitude in the mountains. Staying hydrated by drinking plenty of water also helps.

“Don’t get off of a plane and head to 11,000 feet like I did. Make sure that you acclimate yourself before going to the mountains,’’ Hall said.

The onset of high altitude sickness varies, he added.

“Sometimes the onset can be pretty rapid and sometimes it can be a few days to even a week. A lot of times that can depend upon their activity. If they come up, as I did, and say: ‘Hey let’s go ice climbing, let’s go climb Pikes Peak’, you may feel it right away,’’ he said.

 

 

About the author

Erin Emery is editor of UCHealth Today, a hub for medical news, inspiring patient stories and tips for healthy living. Erin spent years as a reporter for The Denver Post, Colorado Springs Gazette and Colorado Springs Sun. She was part of a team of Denver Post reporters who won the 2000 Pulitzer Prize for breaking news reporting.

Erin joined UCHealth in 2008, and she is awed by the strength of patients and their stories.