High Altitude Illness

by Dr. Theresa A.V. Donati

It is winter in the mountains and friends and relatives from low altitude will descend upon our area. As they travel to higher altitudes, we need to be familiar with the signs, symptoms and treatment of high-altitude illness.

Every year the western U.S. attracts 30 million visitors to sleep at elevations ranging from 6,500 to 9,800 feet. Millions more visit high-altitude cities around the world, and most of those destinations can be reached within a day. We all know climbers, trekkers and skiers who climb to elevations up to 13,000 feet, often without time to acclimatize. We can all be of help if we know the signs, symptoms and treatments of high-altitude illnesses.

It is possible to prevent serious effects of high-altitude illness by ascending slowly and allowing the body to adjust. If your friends or relatives have never been to a high-altitude location like many places in Colorado, it’s not possible to know in advance if they will become ill. However, certain groups of people are more prone to developing high-altitude illness, including those with a prior history of the illness; those who drink alcohol before the altitude change; those who ascend rapidly; and people with medical problems that affect breathing.

Colorado visitors should also know that certain medical conditions need special attention at higher altitudes. Anyone with a history of heart attack or heart disease who develops chest pain, shortness of breath or dizziness should seek medical attention immediately. A person who uses oxygen may need a higher flow rate at high altitude, or someone with lung disease who doesn’t use oxygen at sea level may need it here. And anyone with sickle-cell disease will probably need oxygen above 7,000 feet. Surprisingly, though, asthma does not become worse at high altitudes.

Acute mountain sickness, or AMS, is the most common of the high-altitude illnesses. About 50 percent of people who live at low altitude will develop this condition when they sleep above 10,000 feet. Symptoms include headache, fatigue, light-headedness, lack of appetite, waking frequently during the night, and nausea and sometimes vomiting. The symptoms can be mild or severe, and they usually improve after the first night if the person stays at altitude, but may return if he continues to climb higher.

To avoid AMS, ascend slowly and do the following:

• If you live below 5,000 feet, don’t sleep above 9,000 feet the first night.
• If your travel plans have you going above 10,000 feet, ascend only 1,500 feet per day. Rest a day at one altitude for every 3,000 feet you climb.
• If you are backpacking, cross high passes during the day but descend to lower altitudes to sleep.
• Don’t drink alcohol or use sleeping pills, and don’t overexert yourself during the first few days at altitude.
• Caffeine is safe at high altitudes, so if you’re a regular consumer, don’t stop — abstaining from caffeine suddenly can cause the same symptoms as AMS.

If you develop AMS, treatments include acetaminophen or ibuprofen for headaches; prescription drugs for nausea or vomiting; oxygen; and, especially, descending to a lower altitude, usually dropping down by 1,500 to 3,000 feet.

Other, more serious, altitude sicknesses include high-altitude cerebral edema which can causes severe headache and lethargy or confusion, and high-altitude pulmonary edema which causes sudden severe shortness of breath. These conditions require immediate attention and treatment by a physician.

So, the next time you have visitors from New York or Chicago — or from much of the rest of the country which is at lower altitudes — advise them to take it easy for a few days before heading to the top of Pikes Peak or Mount Evans. The view is great, but the hazards of rapid ascents shouldn’t be ignored.

Dr. Theresa A.V. Donati is on the staff at New West Physicians’ Evergreen office.

Top Five Health Concerns for Women

Heart works
As a woman, your heart goes out to everyone you care about. But how much care do you give your heart? Did you know that heart disease is the number one killer of women? Take a moment for yourself and use our interactive tools to find out if you are at risk for a heart attack.

The cancer that kills more women
Lung cancer is the leading cause of cancer deaths in women. And it's not just among women who smoke. Nonsmokers are at risk too. Learn what else—in addition to tobacco—causes lung cancer.

The odds of a stroke
The older a woman gets, the higher her risk of having a stroke. Stroke also kills twice as many women as breast cancer. Take charge of your health by learning what puts you at risk and what you can do to prevent a stroke.

Women and Alzheimer's disease
Helping a woman with Alzheimer's disease to stay active and involved as long as possible can ease her fears and depression. Explore four ideas that can help the woman you love live better with Alzheimer's by making the most of what she can do, not what she can't.

Exercise for better breathing
Chronic obstructive pulmonary disease (COPD) is another leading health issue for women. If you have COPD, then you know how it can make it difficult to breathe. So how could aerobic exercise help? Read the article to find out, and then check with your doctor.

These articles can be found in the Health Encyclopedia
on our website at www.nwphysicians.com

2012 Affirmation from Medical Management

The New West Medical Management Committee once again reaffirms that:

• All utilization management decisions are based solely on the medical necessity and appropriateness of care/service as defined by the respective health plan’s Evidence of Coverage and the individual needs and circumstances of each individual patient are taken into consideration.
• New West Physicians does NOT reward in any way the practitioners or other individuals for withholding, delaying, or denying care or services to patients.
• Financial incentives for all UM decision makers do not encourage decisions that result in underutilization.

If you have any questions or concerns, please contact Mary Murphy, RN, Vice President of Clinical Services, New West Physicians at 303-763-4900, ext. 10500.

Top Docs

Drs. Raechel O’Kelley, R. Vic Doyle, and Jonathan Walter have been recognized as “Top Docs” in 5280 Magazine’s annual survey of local physicians, which was featured in the August, 2011 issue of the magazine.  Dr. O’Kelley is an internist and part of our Hospitalist Team, Dr. Doyle is a family practitioner at the Bear Valley clinic, and Dr. Walter is an internist at the Arvada Internal Medicine clinic.

Congratulations to each of them on this well-deserved recognition by their fellow doctors.  They serve their patients and communities well by providing high quality and personalized care and treatment based on the best medical evidence.

Home Sweet (Medical) Home

As children, most of us remember “going home”, whether it was after school for dinner, after playtime for a bath, or for the more rebellious of us, after we had done something wrong to be scolded.  But the concept was still essentially the same – we were headed to one specific place where we knew we were going to get something we needed or wanted.

The concept of “Medical Home” isn’t really much different.  When you go to see your primary care provider, you likely have some sort of need...an examination, some medicine, or to review test results.  But your PCP can’t always have everything you could possibly need; what if you need services that some physicians don’t offer, like getting your eyes dilated?  Sure, you can go to someone else’s “house” for that, but then what?  Your regular doctor might need to know the results so that s/he can take that into consideration for your overall health.  That’s where the concept of “medical home” comes in.

“Patient Centered Medical Home” (PCMH) is the blueprint for what health care should be.  It gives you one place to go where you can consistently get what you need, relative to your health.  You may have to take an occasional trip to a specialist for services that your PCP doesn’t regularly provide, but you don’t just pick a random name out of the phone book; your doctor will give you a qualified referral and then follow up with you and/or the specialist afterward, to make sure important facts come back “home” with you.  Not only that, but s/he will go over those facts to make sure you understand them, and will also go so far as to incorporate them into your treatment plan.  PCMH creates an active, ongoing relationship between you and your doctor to help you BOTH make the best choices for your health goals, to help you prevent getting sick in the first place. 

The philosophy of New West Physicians, “We Put Your Health First”, resonates very well with the official standards for PCMH, set forth by the National Committee for Quality Assurance (NCQA), in Washington D.C.  NCQA is currently the only organization that can grant Patient Centered Medical Home recognition.  Having this recognition sets a medical practice apart for having met or exceeded national standards in treatment at the practice level.  New West has aggressively pursued PCMH recognition for all of its practices over the last year.  It is the intent that all sixteen practices will have gained Level Three Recognition (the highest attainable level) by, or shortly after the end of first quarter 2012.

For more information about PCMH or any of the other recognitions, distinctions or accreditations offered by NCQA, visit www.ncqa.org,  To keep up to date with all the current awards granted to our physicians and practices, visit www.nwphysicians.com and check out the “Meet Our Providers” section.