How High is High?

Altitude is described by the following scale:

• High: 8,000-12,000 feet
• Very High: 12,000-18,000 feet
• Extremely High: Above 18,000feet

As of yet, no study has been conclusive as to what factors influence a person’s susceptibility to altitude sickness. Men and women of all ages and levels of fitness may or may not be susceptible. To further complicate matters you may take one trip and have no symptoms, than return at a different time and get considerably ill. While most people can travel to 8,000 feet without problem, if you rarely travel above sea level, it’s best to be prudent in your preparations.

All I Need is the Air That I Breath

At sea level, oxygen concentration is at approximately 21% and barometric pressure is at 760mmHG. With the increase in altitude, oxygen concentration is unchanged, but the number of oxygen molecules per breath is significantly reduced. This is due to the fact that at 12,000 feet, barometric pressure is only 483mmHG, thereby giving even the most enthusiastic skier or hiker 40% fewer oxygen molecules per breath. To properly oxygenate the body, your breathing rate must increase. The added ventilation increase oxygen content in the blood, but not to the same concentration it was at sea level.

Unfortunately, whatever activity you are participating in will still require the same amount of oxygen, but your body must adjust to having less of it. High altitude can also cause fluid to leak from the capillaries, which in turn can cause fluid build up in the brain and lungs.

So What’s the Problem?

Persistent increased breathing results in the reduction of carbon dioxide in the blood. Since carbon dioxide build up is the key signal to the brain that it is time to breathe. If levels are low, the drive to breathe is inhibited. If you are awake it isn't much trouble to consciously breathe. At night an odd breathing pattern develops due to an alternating balancing act between two respiratory triggers. This periodic breathing consists of cycles of normal breathing which gradually slows, followed by 10-15 seconds of breath holding breath-holding, and a brief recovery period of accelerated breathing. This is not considered altitude sickness. However, while it usually improves with acclimatization, it rarely resolves till descent from altitude. Periodic breathing can be the cause of anxiety in a person who wakes up during the breath holding phase, or in someone who awakens during the accelerated breathing phase, believing that they are suffering from an extreme form of high altitude sickness.

Gotta’ Go Again!

Many changes occur in the body’s fluid balancing systems during acclimatization. As blood concentration is reset, a factor known as altitude diuresis causes the kidneys to excrete more fluid. As a result, frequent urination is normal. If this is not happening, you are either dehydrated, or else, you are not acclimating well. I’ve seen many sea level students at Colorado’s Copper Mountain refuse to drink water, for fear of “having to go” in the middle of class. Rest assured, your instructor would rather have you stop at one of the mountain’s many rest rooms, than have you carried down the hill in the ski patroller’s sled due to high altitude sickness.

Defining Altitude Illness

In 1991, an International Hypoxia Symposium was held at Lake Louise in Alberta Canada. The following diagnostic definitions were determined.

Acute Mountain Sickness (AMS) is characterized by:

• Appetite loss, nausea or vomiting
• Fatigue and/or weakness
• Light headedness
• Dizziness
• Insomnia
• Confusion
• Altered Gait

There are a number of ways to avoid acute mountain illness:

• Spend a day at a lower altitude before proceeding to your higher destination.
• Sleep at a lower altitude
• Avoid alcohol and caffeine
• Stay hydrated
• Avoid sleeping pills
• Avoid narcotic pain medications
• Use caution when gaining altitude

If you are experiencing any of the symptoms of AMS, descent is crucial! Failure to do so can result in a more serious case of acute mountain sickness.

High Altitude Cerebral Edema (HACE) occurs when AMS is not treated. The fluid build up causes the brain to swell. This causes extreme disorientation and lack of coordination. At this point, delaying descent can be fatal!

High Altitude Pulmonary Edema (HAPE) is the most severe form of AMS. Its symptoms include:

• Difficulty breathing at rest
• Extreme fatigue
• Cough, possibly with pinkish emissions
• Gurgling
• Chest tightness
• Blue lips and/or fingernails

Medical Treatments & Preventative Methods

Diamox

Diamox is the most commonly prescribed drug for the prevention of altitude sickness. While it is usually effective, it should be avoided by anyone who is allergic to sulfa drugs. Its side effects include tingling of the fingers. Some people complain that Diamox makes carbonated drinks and beer taste weird.

Lest You Forget: Ginko Biloba

In 2000, researched performed at Pike’s Peak concluded that 120 mg. of ginko biloba taken five days prior to ascent reduced both the incidence and severity of AMS. Since ginko is also known to improve memory, at the very least, taking ginko may make your trip a memorable experience.

Viagra: Getting Up and High

Perhaps the most unusual preventative method that is currently being researched is Viagra. The low oxygen levels found at high altitude can cause a narrowing of the pulmonary arteries. Viagra, which improves erectile dysfunction by widening the arteries in the penis, also widens the pulmonary arteries.

Jean-Paul Richalet, MD, PhD, and colleagues wanted to see if Viagra helped prevent high-altitude health conditions. Twelve men, averaging age 29, volunteered for the experiment. None of them were used to high altitudes.

The study began at sea level, where baseline measurements were taken. Then, they spent a day at a higher altitude in Chamonix. The next day, they were taken 10,000 feet higher by helicopter to Observatoire Vallot, located just below the summit of Mont Blanc. This is the highest point in Western Europe. They remained in the mountain observatory for five days. While riding stationary bikes, they filled out surveys that checked for AMS. Half the group received Viagra, the other, a placebo.

After two days, the Viagra group’s blood pressure began to normalize, while the placebo groups stayed high. Keep in mind; these studies are in their preliminary stages. More research is needed before people start popping Viagra prior to their Spring-Break Colorado ski trips. Considering that the ratio of males to females in Colorado is about 5 to 1, this is an especially bad idea!

Head to the Bars

While oxygen bars are the current trend in high altitude ski areas, they are not without controversy. The Food and Drug Administration has determined that any type of oxygen administered by another person is considered a drug, and should only be administered and prescribed by a medical professional. Keep in mind that high altitude ski areas have emergency clinics that will deliver legitimate forms of oxygen right to your doorstep, should you find yourself plagued by High Altitude Cerebral Edema.

High Low, High Low, Elevation's Good to Know

While it’s nice to know that these services exist, prevention is always preferable. Even in High Country, some ski areas are at a lower altitude than others. In Colorado, Vail is at the lowest. You can also opt to stay in Denver, and take the ski train to Winter Park. That way, you’ll be sleeping at a lower altitude. In Utah, the Park City area resorts are at the lowest elevation. Doing your research and taking the proper precautions will ensure a great trip!