Archive for July, 2015

Screening for Prostate Cancer: A Urologist’s View

Monday, July 27, 2015 // Uncategorized

From the New York Times Op Ed page:

 

MELVILLE, N.Y. — FOR years, research on prostate cancer has sought an approach to screening that is more individualized than a one-size-fits-all measurement of the level of prostate-specific antigen in a man’s blood. These efforts are now paying off.

That’s why it’s time to re-evaluate the nation’s current approach to prostate cancer. Even though we anticipate 221,000 new diagnoses this year, and 28,000 deaths, recommendations drafted in 2010 and finalized in 2012 strongly discourage PSA screening men without symptoms for this disease.

Those decisions didn’t take into account adaptations that urologists have made to help better identify patients likely to develop deadly prostate cancers. Some tools, called PSA derivatives, were being developed as early as the mid-1990s, and all have been refined since.

The result: Rather than use the historical arbitrary cutoff of a 4.0 PSA reading to define abnormal, we now have tools to adjust our interpretation of readings for age (PSA levels normally rise with age); for race (this, too, affects what is considered normal); and for the size of a man’s prostate, which affects how much PSA he produces. We can test for how fast PSA levels rise over time. And we can analyze how PSA circulates in the bloodstream (free or bound to serum proteins), which can predict prostate cancer risk.

When we use these markers together, these varied interpretations of PSA levels give us a clearer picture of who does, or doesn’t, need further testing.

And we keep refining our approach. Already, a urine test can find and measure the presence of genes associated with prostate cancer. M.R.I. images can help identify high-risk prostate lesions. And tests for the presence or activity, or both, of genes present in prostate tissue can help distinguish which patients can safely defer therapy from those who cannot.

When prostate cancer is found, we also have better actuarial data to help identify those men likely to live long enough for that cancer to become a fatal risk.

Nevertheless, in 2012 the United States Preventive Services Task Force made official its recommendation that no asymptomatic man undergo screening with a PSA test. And that decision grew in importance when the Affordable Care Act elevated the task force’s recommendations from advisory to a basis for Medicare payment policies.

To be fair, measuring PSA as a stand-alone test is far from perfect. Cancer is just one of several conditions that can elevate PSA Using the test alone often led to painful biopsies that found no cancer. And we faced a more difficult problem: Even when a biopsy found cancer, uncertainty remained. If aggressive cancer was present, a decision to treat it was straightforward. But prostate cancer can grow slowly or remain dormant — indolent, in medical parlance. And until recently, we didn’t have the tools to determine whether cancers were likely to spread quickly enough to shorten the patient’s life.

In that circumstance, some patients whose cancers might have grown very slowly chose surgery or other rigorous treatment just to be safe, not sorry. But the price could be high; surgery always involves some risk of complications, including death, and cancer treatment can reduce quality of life.

Adding to the confusion was conflicting data on the effectiveness of prostate cancer screening. Despite strong evidence that the prostate-cancer-specific death rate has decreased since PSA testing started in the 1980s, the two largest studies of the screening produced contradictory results — one saw a decrease in prostate-cancer-related deaths among men screened, the other no advantage. Equally problematic, both were flawed methodologically. Yet instead of acknowledging uncertainty, the task force said PSA testing offered no benefit to anyone.

No increase in cancer mortality has been observed, but that may be a matter of time; aggressive cancers are less treatable. One study concluded that annual prostate cancer deaths may increase as much as 5 percent, for the first time in more than 20 years.

That is what frustrates urologists most: Rather than using refined screening techniques to identify those who will benefit most from treatment, we’re just evaluating fewer men. So the task force needs to re-evaluate its recommendation based on the current state of medical knowledge.

But men should not wait for a government agency to tell them what’s best. My own strongest recommendation is that men insist on a baseline PSA test while in their 40s. From this baseline, a personalized screening regimen that considers risk factors and other indicators can be developed.

Men must understand that screening does not commit them to further testing or treatment, even if abnormalities are found. Screening, followed up with today’s sophisticated tools, simply provides information that helps them and their doctors make sound decisions — which could prolong their lives, or leave them reassured that they have little to fear from an indolent tumor.

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Generational Differences in Physicians

Sunday, July 26, 2015 // Uncategorized

This was a recent article on Doximity , a website for physicians, that highlighted generational differences in the way physicians practice medicine.  It occurs in every profession, but medicine is one area where older doctors are very vocal in their criticism of the latest generation.  I remember advising one medical student who was interviewing for residency programs to avoid using the word “lifestyle” to avoid alienating the interviewer.  We think of it as a profession, a calling and they think of it as a job.

New doctors are not kind to their predecessors. Here’s why.

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I had the good fortune of practicing family medicine from the 70s to the early 10s. It was the Golden Age. After doing a family practice residency in a community hospital and serving a short stint as an assistant residency director, I started out in my practice that lasted almost 40 years.

Here is the story of how I got the ball rolling. I was part of a large family practice group. Dr. A was an elderly GP with a devoted patient clientele. His patients loved him. He gave them prescriptions, vitamins, B-12 and cortisone shots. He did use the lab and x-ray but never referred. He would diagnose an MI correctly and then treat the patient with follow-up house calls. He didn’t really know what a cardiologist or most specialists actually did. Maybe he was lucky, but we never heard that many of his patients died. Yet, he was paternalistic and pre-patient education. Our group decided he was a risk and delegated to me the thankless job of convincing him to retire. I was successful, and surprisingly he asked me to take over his patient load.

During my practice career, I saw many, many patients that stayed with me my entire career including Dr. A’s patients. They must have sensed some of their beloved retired doctor in my style of practice, and they stayed with me and referred their family and friends. For most of my career, I had a lot of face to face and hand holding time, very little documentation, and minimal outside interference. I delivered babies for the first decade. I was a care coordinator, gatekeeper, and quarterback. I had a broad knowledge of medicine and a good skill level. I was practical and empiric yet didn’t skimp on testing and referring.

I played by the book we used at the time. I knew everything about my patients. I always worked them into my schedule for emergencies. I treated their infections, their pain, their depression and many other things. I kept them working and when necessary gave them the permission for respite. When frail, I visited them at home or at the nursing facility, never delegating their care. I certified in Hospice and Palliative Medicine and was also able to provide excellent end of life care. And at the end I quickly became computer and EMR savvy and spoke Epic fluently.

What was my reward? Lifelong “friends” that trusted my judgment, lots of positive feedback, and countless letters, gifts and calls of thanks. I had the respect of my colleagues. The ER doctors and specialists were in awe at the scope of my general knowledge, my ability to recall medications and medical histories without referring to the chart, and my thorough dedication to my patients.

Eventually, age, employer micro-management, EMR documentation, and insurance/government regulations got the best of me, and I retired and moved away. My patients could not find another doctor that fit my mold and, therefore, were scattered throughout the area for their care, with most establishing with new young doctors.  My patients still talk about me, send letters and emails, and update me on Facebook. Despite being gone from the scene, I am still special to all my patients. Not so, when it comes to my former colleagues.

Now, not even three years since I left the area, I am regarded by the new generation of doctors in the same way I once regarded Dr. A. The new generation now has their own Golden Age with many advances, new gadgets, digital information, a new idea of work-life balance and evidenced-based medicine.  I hear from my former patients that their new doctors tell them they aren’t going to do things the way I did. The new generation has abandoned much of the old practice style, and they often scoff at our lack of knowledge. No, the new generation is better and plays by the “new” book. But to their dismay, the new generation of doctors has to repeatedly hear my former patients defend my old practice style. And my patients report back to me with the responses from the new doctors:

“Dr. B was old school and needed to retire.” “He used to see drug reps and was known to pass out free samples to help poor patients.”  “He used to prescribe such outdated things like Premarin, vitamin D, and antibiotics.” “He treated UTIs, conjunctivitis, colds, and bronchitis at times without seeing the patient.” “He did routine mammograms, PSAs, vitamin D levels, physicals and other unnecessary things.” “He gave out a lot of pills — for pain, sleep, anxiety, depression.” “ He used to enter the office through his waiting room and sometimes even sit there and visit with the patients. True, he knew his patients and their families well but he  probably broke a lot of HIPPA rules in the process.”

I can’t think of another profession where the practitioners from the previous generation are held in such low esteem. Former athletes are still remembered, admired and honored even though the training and equipment have improved the stats. Former pilots are well respected by the current generation of aviators who realize they have it a lot easier nowadays. No one puts down a former teacher or CPA by casting doubts on their ability to read or to add.

Medicine is a field where rapid changes in technology and information make previous treatment and practices obsolete. I get that. Now that I am partially retired, I finally have ample time to read and think and evaluate. I know the “errors” of my ways but knew of no other ways back then. I know much more now about screening and testing and treating diseases.

The point is, that’s the way the medical profession is. Technology and knowledge change from generation to generation. I understand and accept that the new generation of doctors can’t practice with the old knowledge or the old technology or in the old style. They inherit a broken healthcare system and patients with antiquated expectations. I am sure some good things are still said about the departing generation.

I had my Golden Age. But I regarded Dr. A the way the new generation regards me. And the new generation of doctors will in turn be judged in a similar manner by the very next generation of ultra-smart doctors who will be heard to say about their predecessors: “Those millennial doctors were so behind the times. Imagine using toxic drugs and harmful treatments. It’s hard to believe they didn’t capitalize on nanotechnology, gene repair and manipulation, personalized medications, and robots!”

“Dr. B” is a family physician.

Image credit: Shutterstock.com

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New Business: Alamo Heights Care and Concierge

Monday, July 6, 2015 // Uncategorized

Some friends of ours have started a new business. Karel Hoffman, R.N. and Sheila Jackson have started a new business, Alamo Heights Care and Concierge. As the name implies it is to help patients and their families with their medical and living needs. This may be helpful for patients who need assistance and their relatives live out of town. The following are some of the services they offer:

  • Attend doctors’ appointments and communicate with all healthcare providers
  • Research options related to elder care
  • Organize personal documents and assist with bill paying
  • Assist with health insurance issues and questions
  • Manage medications at home; reorder from pharmacy and communicate with physicians when needed
  • Provide routine well-being visits to include medication reminders and blood pressure checks
  • Assist with shopping and errands
  • Communicate with family members on a regular basis
  • Assist with all aspects of moving

Sheila Jackson (210) 240-1743
Karel Hoffman, R.N (210) 410-1528

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Billing Service

Monday, July 6, 2015 // Uncategorized

For 12 years Group One, an electronic billing service in Jefferson, Missouri, has filed claims electronically for services that are not covered by our annual fee. They no longer will be able to do this in the coming months and we are going to bring that in house and have someone local do it for us. I will give you that information in the next newsletter.

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Suntan and Sunburn Free Online First

Monday, July 6, 2015 // Uncategorized

Amy E. Thompson, MD
JAMA. Published online July 02, 2015. doi:10.1001/jama.2015.8045

 

A suntan or sunburn is a sign that skin has been damaged by ultraviolet (UV) rays.

Melanin is the pigment that gives skin its color. People with light skin have less melanin than people with dark skin. When skin is damaged by UV rays, the body makes more melanin to try to protect against further damage. This extra melanin gives suntanned skin its darker appearance.

But a suntan does not provide good protection against the harmful effects of UV rays. In fact, a suntan is a sign that skin has already been damaged, and tanned skin can continue to be damaged when exposed to UV rays.

For people with light skin, exposure to UV rays can lead to sunburn in as little as 10 to 15 minutes. The redness of a sunburn is caused by increased blood flow to skin that has been damaged.

LONG-TERM RISKS

Exposure to UV rays is the leading cause of skin cancers, including basal cell carcinoma and squamous cell carcinoma. These cancers often occur on skin that has been damaged by years of sun exposure, although they can occur on other areas of the body as well.

If you tan frequently or have a history of severe sunburns, you are also at an increased risk of melanoma, the most dangerous type of skin cancer.

Exposure to UV rays increases the risk of premature skin aging and may also increase the risk of eye problems such as cataracts, macular degeneration, and corneal damage.

Indoor tanning is not a safe alternative to sunbathing. Tanning beds, booths, and lamps produce a similar amount of UV radiation as the sun. Skin damage (a tan or a burn) from indoor tanning increases the risk of skin aging, skin cancer, and eye problems, just like damage from sunlight.

HOW TO PROTECT YOURSELF

  • Apply broad-spectrum, water-resistant sunscreen with an SPF of 30 or higher before you go outside.
  • Use plenty of sunscreen—about 1 oz (2 tbsp) for your whole body.
  • Do not use sunscreen that is past its expiration date.
  • Reapply sunscreen after 2 hours in the sun and after swimming or sweating.
  • While outdoors, wear sunglasses and a hat with a wide brim (about 4 in) all the way around it.
  • Wear protective clothing (tightly woven long-sleeved shirts and long pants or skirts offer the most protection).
  • Limit your time in the sun and seek shade, especially between 10 am and 4 pm.
  • Do not use tanning beds.
  • Remember that skin damage from the sun can occur on cloudy days.

IF YOU GET A SUNBURN

Pain from a sunburn is usually worst between 6 and 48 hours after sun exposure. A cool bath, cool compresses, and over-the-counter medicines like ibuprofen or acetaminophen can help. Drink water to stay hydrated. If your skin is not blistered, apply moisturizing cream or aloe vera gel to help with discomfort.

Extreme sunburn can lead to shock, dehydration, and other serious reactions. If you experience rapid heartbeat, rapid breathing, dizziness, fainting, nausea, chills, fever, or headache with a sunburn, call your doctor right away.

Box Section Ref ID

For More Information

To find this and previous JAMA Patient Pages, go to the Patient Page link on JAMA’s website at jama.com. Many are available in English and Spanis

DERMATOLOGIST, DR. SCOTT DUNCAN’S ADVICE ON SUNSCREENS

I recommend them for any sun exposure, but UV light
intensifies 2 to 3 fold when above an angle of about 45 degrees, due to
having less of the ozone to traverse (the ozone layer is only about 3 feet
thick).

I tell patients to try to avoid exposure when your shadow becomes shorter than your height.

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Mosquito Repellants

Monday, July 6, 2015 // Uncategorized

While we are grateful for the recent rains, one downside is a rise in the number of mosquitoes. We have not had any West Nile Virus reported this year, yet.  The following advice on insect repellants is reprinted from The Medical Letter:

DEET — The topical insect repellent with the best documented effectiveness is N, N-diethyl-m-toluamide (DEET).2 Applied on exposed skin, DEET repels mosquitoes, as well as ticks, chiggers, fleas, gnats and some flies. DEET is available in formulations of 5-100%, but increasing the concentration above 50% has not been shown to improve efficacy. A long-acting polymer-based DEET formulation developed for the US Armed Forces (US Army Extended Duration Topical Insect and Arthropod Repellent – EDTIAR) containing 34% DEET (Ultrathon lotion) has been shown to protect for 6-12 hours.

DEET can damage clothes made from synthetic fibers and plastics on eyeglass frames and watch crystals. Toxic and allergic reactions to DEET have been uncommon, and serious adverse effects are rare.

According to the CDC, DEET is probably safe in children and infants >2 months old; the American Academy of Pediatrics recommends using formulations containing no more than 30% in children. Toxic encephalopathy has occurred, usually with prolonged or excessive use in infants and children that sometimes included ingestion of the product. Rash ranging from mild irritation to urticaria and bullous eruptions has been reported, and patients find that some DEET formulations feel uncomfortably oily or sticky on their skin. One study found that applying DEET regularly during the second and third trimesters of pregnancy did not result in any adverse effects on the fetus.3

PICARIDIN — Picaridin is used against flies, mosquitoes, chiggers, and ticks. In a controlled field trial, picaridin 19.2% was as effective as the EDTIAR formulation of DEET in preventing mosquito bites.4 It is available in concentrations of 5-20%.5 Picaridin appears to be better tolerated on the skin than DEET, and it does not damage fabric or plastic.

IR3535 — In the US, IR3535 is available in concentrations of 7.5% and 20% in combination with sunscreen. The CDC does not recommend use of products that combine a sunscreen with an insect repellent because the sunscreen has to be reapplied more often than the repellent. Some studies found IR3535 in concentrations ≥10% to be effective against mosquito bites for several hours6; 2 studies found that the 7.5% concentration was ineffective.7,8

OIL OF LEMON EUCALYPTUS (OLE) — OLE (pmenthane 3, 8-diol [PMD]) is the main byproduct of lemon eucalyptus hydrodistillation. In field studies against malaria-transmitting mosquitoes, OLE provided up to 6 hours’ protection against mosquito bites.6 The labels of these products state that they should not be used in children <3 years old.

CITRONELLA — Citronella-based insect repellents provide short-term protection against mosquitoes (less than 1 hour), and are probably not effective against ticks.

ESSENTIAL OILS — Essential oils, including clove, geraniol and patchouli, provide limited and variable protection against mosquitoes. High concentrations may be more effective, but can be irritating to the skin.9

PERMETHRIN — A synthetic pyrethroid contact insecticide, permethrin is used on clothing, mosquito nets, tents and sleeping bags for protection against mosquitoes and ticks. It remains active for several weeks through multiple launderings.

CONCLUSION — DEET-containing insect repellents can prevent mosquito and tick bites and are generally safe. Picaridin appears to be as effective as equivalent concentrations of DEET and may be better tolerated. Wearing protective clothing treated with the insecticide permethrin in addition to using DEET or picaridin on exposed skin as a repellent may offer the most effective protection overall against mosquito and tick bites.

  1. CDC. 2012 West Nile virus update: September 4. Available at www.cdc.gov/ncidod/dvbid/westnile/index.htm. Accessed September 5, 2012.
  2. Advice for travelers. Treat Guidel Med Lett 2012; 10:45.
  3. R McGready et al. Safety of the insect repellent N,N-diethyl-M-toluamide (DEET) in pregnancy. Am J Trop Med Hyg 2001; 65:285.
  4. SP Frances et al. Field evaluation of repellent formulations against daytime and nighttime biting mosquitoes in a tropical rainforest in northern Australia. J Med Entomol 2002; 39:541.
  5. Picardin – a new insect repellent. Med Lett Drugs Ther 2005; 47:46.
  6. LI Goodyer et al. Expert review of the evidence base for arthropod bite avoidance. J Travel Med 2010; 17:182.
  7. SP Frances et al. Comparative field evaluation of repellent formulations containing deet and IR3535 against mosquitoes in Queensland, Australia. J Am Mosq Control Assoc 2009; 25:511.
  8. MS Fradin and JF Day. Comparative efficacy of insect repellents against mosquito bites. N Engl J Med 2002; 347:13.
  9. Y Trongtokit et al. Comparative repellency of 38 essential oils against mosquito bites. Phytother Res 2005; 19:303.
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CGMUS Patient Portal

Monday, July 6, 2015 // Uncategorized

At long last our software has a functional patient portal that will allow us to send you secure messages and your results.  When you have blood work done you will get an email with the following letter which will include your PIN.

 

Patient: ____________________________________________________

RE: Patient Portal Access and Registration PIN

We are pleased to announce the implementation of a Patient Portal, a way of communicating securely with you and a way for you, as our patient, to securely communicate back to us! We encourage you to use the Patient Portal to review any office visit notes and messages we may send to you.

Here is it how it works:

  1. We collect your personal email address and enter that into our computer system.
  2. We register you for the Patient Portal and assign you your own unique PIN.
  3. To complete the registration process, log into the CGM PATIENTPORTAL at https://phr.cgmus.com/.
    1. Please use Chrome as the web browser of choice for this site.
  4. The first time you access the Patient Portal, you will be required to “Create your account”, which is where you will need your PIN (noted below).
    1. If you lose your PIN, you may contact your doctor’s office to have it provided to you.
  5. Select “Create your account”, where you will be asked to enter your PIN, the first three letters of your first name, the first three letters of your last name, and your date of birth.
    1. NOTE: when creating your account or when using the Forgot Password function are the only two times that you need your PIN. Your password is used for login to the portal.
  6. Click “Next”, and you will be asked to create a password for your Patient Portal account. a. Enter a Password that you will remember.
  7. If you forget your password, you may select the “Forgot Password?” link on the homepage of the Patient Portal.
    1. NOTE: Your doctor’s office will not know your password and will not be able to change it for you. You must use the “Forgot Password?” link to recover your password.
  8. Back at the login screen you will enter the following details to login:
    1. Email Address = your personal email address that you provided to your doctor’s office.
    2. Password = the password you just created.
  9. You now have access to the Patient Portal, and you are on your way to communicating directly, and securely, with your doctor! a. NOTE: You may only send messages from the Patient Portal to someone who has a specific secure email address.

Every time we send you a secure message, via the Patient Portal, you will receive a notification in your personal email account. This way, you know when you have something new in your Patient Portal in-box. In these emails sent to your personal account, you are provided with the URL/hyperlink to the Patient Portal. Each time you access the Patient Portal (after your initial login) you are asked to login with your personal email address and your password (the password you entered during account creation at first login).

  • The URL for the Patient Portal is https://phr.cgmus.com/.
  • REMEMBER: The Patient Portal is not the place to report to us any emergency concerns. If you are experiencing any emergency, please dial 911. o The Patient Portal messages we receive from you will be checked throughout the day on regular business days.
  • We will be using the Patient Portal for the following purposes and as applicable:
    • Sending you a summary of your recent office visit (FUTURE USE)
    • Providing you with a URL to review any patient-specific education resources (FUTURE USE)
    • Informing you of other medical items, such as lab results

 

We look forward to communicating with you on-line!

CGM PATIENTPORTAL Registration PIN: __________________________

Thank you,

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Dr. Wallace Joins the Practice

Monday, July 6, 2015 // Uncategorized

Dr. Jennifer Wallace joined the practice April 1. She has been busy getting her office and exam rooms in order and meeting with new and existing patients.

Dr. Wallace graduated from Texas A+M. She received her medical degree from the University of Texas Health Science Center at San Antonio and did her residency there in Internal Medicine. She is board certified in Internal Medicine. We had previously worked together in my former practice, San Antonio Internal Medicine Group. We are proud to be able to serve Aggies and Longhorns.

Our receptionist, Sieglinde expanded her hours to take care of the increase in paper work. Our nurse, Cathy has been busier at certain times as one would expect. In addition, she is studying for her RN degree. We have not yet added additional personnel, but anticipate doing that as Dr. Wallace’s practice fills up. If you wish to refer a patient to Dr. Wallace, just call Sieglinde and she will set up an introductory meeting or refer the individual to our website: personalphysicianmd.com.

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Preventing Mountain Sickness

Wednesday, July 1, 2015 // Uncategorized

This article tells a lot about mountain sickness, but doesn’t discuss a lot of the pharmacology of what can be done to prevent it.  Taking acetazolamide (Diamox) and going slow are keys to preventing it.

Climb Every Mountain, Without Altitude Sickness

Planning ahead can help prevent elevation-related health problems

As more travelers opt for adventure at high elevations, concern is growing about altitude-related illnesses. WSJ’s Laura Landro joins Tanya Rivero to explain how to reach the heights safely.

June 29, 2015 1:31 p.m. ET

As more travelers seek out adventure at high elevations, altitude sickness is an often overlooked risk.

At popular destinations far above sea level, from the peaks of Nepal and the Pacific Crest Trail to the tourist attractions of Peru, the air gets thinner the higher you ascend. People often experience headaches, dizziness, and fatigue from a condition called acute mountain sickness before their bodies eventually adapt to lower oxygen levels in the blood. Untreated, it can progress to a potentially fatal swelling of the brain. And when people ascend in altitude too quickly, they can suffer a swelling of the lungs that can also lead to death.

Researchers are still uncovering some of the mysteries of altitude-related health problems. Genetic factors seem to make some people less susceptible to altitude sickness. People over 50 have a slightly lower risk, perhaps because the brain shrinks slightly as it ages. Men and women seem to be equally at risk, although symptoms might be more severe in men. And, interestingly, people’s fitness levels seem to have little to do with who is susceptible.

“Altitude illness is caused by the interaction of genes and the environment, and it can happen to the sedentary executive or the triathlete,” says Peter Hackett, director of the nonprofit Institute for Altitude Medicine in Telluride, Colo.

Climbers ascend Mount Kilimanjaro in Tanzania, which has an elevation of 19,341 feet. ENLARGE
Climbers ascend Mount Kilimanjaro in Tanzania, which has an elevation of 19,341 feet. Photo: Karen Kasmauski/Corbis

The most common preventive advice is to adjust gradually to higher elevations, which can take three to five days, Dr. Hackett says. Stop ascending if symptoms occur and head for a lower elevation if they get worse, he says. And avoid alcohol and strenuous exercise for the first 48 hours. Some doctors prescribe a drug such as acetazolamide to prevent mountain sickness, although side effects, such as dizziness and dry mouth, might be unpleasant.

People may feel symptoms of altitude sickness starting at about 5,000 feet—about the elevation of Denver. Real problems typically begin between 8,000 feet, the elevation of Aspen, Colo., and 10,000 feet, roughly that of Breckenridge Ski Resort. As many as 50% of people can develop acute mountain sickness at these heights, according to the Altitude Research Center at the University of Colorado Anschutz Medical Campus in Aurora.

An estimated 30 million people a year visit U.S. resorts and mountain towns in that range of altitudes, putting them at risk for mountain sickness, says Robert Roach, the center’s director. He says the average traveler may not learn about the risks because altitude illness isn’t widely discussed in the travel and tourism industries.

ENLARGE

Resorts, tourism authorities and travel companies often provide information and warnings about altitude illness on their websites. The Colorado Tourism Office says it rarely receives complaints from visitors about altitude sickness unless they are climbing the state’s highest peaks, known as 14ers, which are over 14,000 feet in elevation. “For those who struggle with altitude sickness we often recommend they spend a night or two in Denver before heading to our higher elevation mountain towns to ease into the higher altitude climate,” a spokeswoman says.

The number of people participating in traditional ice and mountain climbing rose 16% in 2014 from three years earlier, according to the nonprofit Outdoor Foundation. Colorado had a record number of visitors last year, with increases in Denver and the high-country resort communities, the tourism authority says. And visitors to Nepal have doubled over the last decade, with trekking and mountaineering among the top reasons, according to government statistics.

Acute mountain sickness might go unrecognized because it is easily confused with fatigue or migraine, says Paul Auerbach, a professor of emergency medicine at Stanford University. If headache and other symptoms start, experts recommend people descend at least 1,000 feet, which can bring quick relief. Supplemental oxygen can help, but it isn’t always available. Dexamethasone, a drug in the steroid family, is considered effective in rapidly relieving moderate to severe symptoms. But prolonged use can bring on side effects, including sleep problems and muscle weakness.

Forester Pass, in California, is the highest point on the Pacific Crest Trail. The pass is 13,153 feet above sea level. ENLARGE
Forester Pass, in California, is the highest point on the Pacific Crest Trail. The pass is 13,153 feet above sea level. Photo: Alamy

Studies have shown that ibuprofen can help prevent acute mountain sickness. But some doctors are concerned that alleviating symptoms of a headache may mask mild forms of altitude illness that could turn more serious.

At higher elevations, and with longer exposure, acute mountain sickness can progress to potentially fatal high altitude cerebral edema, a swelling of the brain that makes people confused, uncoordinated and even delirious. Another condition that can bring on death even more quickly is high altitude pulmonary edema, which causes fluid to accumulate in the lungs. It commonly strikes young, fit men who quickly ascend from sea level to altitudes above 8,000 feet for reasons not fully understood. Dr. Roach, of the Altitude Research Center, says men may be more likely to attempt such trips and have been more closely studied than women.

“It is always striking how people will go on vacation and put their lives in danger” says Jeffrey Gertsch, an assistant professor of neuroscience at the University of California, San Diego School of Medicine who conducts research on altitude illness. An avid climber, Dr. Gertsch says he has suffered cerebral edema twice. Hiking at California’s Mount Whitney, which rises 14,500 feet, he says he often sees climbers head straight to the top the first day. As a physician who has worked at Mount Everest, he says he has seen climbers drink alcohol the evening they arrive, which can cause dehydration and make illness worse.

Research funded by the U.S. military may eventually help in better understanding and treating altitude sickness. Dr. Roach’s center at the University of Colorado has identified several genes that may protect against altitude illness and researchers there are working on a blood test that could be used to identify which soldiers are at risk in high-altitude combat areas. Elevations in Afghanistan, for instance, can range up to 24,000 feet.

The center also is looking into new ways to protect armed forces personnel from getting sick. For example, they are studying whether the anti-inflammatory properties of quercetin, a member of the flavonoid family that is found in many fruits and vegetables and sold in supplements, could prevent the swelling in the brain that causes high altitude cerebral edema.

Frank Karle, an emergency physician in Erie, Pa., traveled to Nepal in 2012 to work at a Mount Everest base camp. After developing acute mountain sickness, he was evacuated by helicopter. Dr. Karle, 39, hopes to go back to Everest, but says he will take more time to become acclimatized the next time. ENLARGE
Frank Karle, an emergency physician in Erie, Pa., traveled to Nepal in 2012 to work at a Mount Everest base camp. After developing acute mountain sickness, he was evacuated by helicopter. Dr. Karle, 39, hopes to go back to Everest, but says he will take more time to become acclimatized the next time. Photo: Frank Karle

Frank Karle, 39, an emergency physician in Erie, Pa., traveled with Dr. Auerbach to Nepal in 2012 on a Wilderness Medical Society trip to work at the Mount Everest base camp in Nepal. He participated in a study that tested varied doses of acetazolamide to prevent acute mountain sickness. He had a history of migraine headaches, but had climbed to 10,000 feet on previous trip without suffering any illness.

Dr. Karle initially felt fine after landing in Nepal, where the group planned a nine-day hike to the base camp—altitude 17,598 feet. As the group climbed higher each day, he began to have intermittent headaches but assumed they were related to his migraines and dismissed the symptoms. He began taking ibuprofen in addition to the study drug.

Finally, his headache returned and “became far worse than the worst migraine I ever had.” The trip leaders diagnosed a severe case of acute mountain sickness with possible brain swelling, and gave him dexamethasone and oxygen. He was evacuated by helicopter and spent the night in a hospital in Kathmandu, where he was treated with intravenous fluids and antibiotics for an upper respiratory infection. Dr. Karle worked with Dr. Auerbach to write up his experience for the journal Wilderness & Environmental Medicine last year.

Dr. Karle says he has had no lasting effects from the illness and hopes to go back to Everest. Next time, he says, he will be more careful about the rate of ascent and take more time to acclimatize.

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