DRHOOK- Mountain high: Altitude sickness can ruin a climb

the handsome doctor John Hong of Charlottesville

Mountain biking is exhilarating, moving, and fun. I am also the world's slowest mountain biker. Lance Armstrong should present me an award for this. While I believe in pushing myself physically, I have my limitations. I don't like looking like road-kill on the side of a bike path. 

We'd never been to Lake Tahoe before our recent trip, and let me quote Funny Girl: "Hello, gorgeous!" (Directed at Lake Tahoe, and not my reflection in the mirror.) I didn't know Lake Tahoe was at such a high elevation because I thought that part of the country was flat as Stone Phillips' affect. So when we went mountain biking in Tahoe, I looked like an extra on a "Quit Smoking" commercial. I needed an oxygen tank while peddling up 2,000 feet.

Was I at risk for High Altitude Disease?

"I'm on the top of the world, looking down on creation..." Sing it, Karen Carpenter. We hear about mountain climbers dying and/or getting sick while trying to make it to the top of Mount Everest. Do you know the barometric pressure (760mgHg at sea level) is only 253mmHg on the summit of Mt. Everest? That low pressure would make VP Joe Biden's head swell more than seems humanly possible. Also, the oxygen gets thinner the higher you go up.

So when is a person at danger of becoming sick at high altitudes? Well, usually above 14,000 feet, although it can occur as low as 8,000 feet. For those who live under 3,000 feet above sea level, quickly going up in altitude can cause swelling in the brain, lungs, and eyes. 

Although– as seen in Tibetans and South American Indians in the Andes– Chronic Mountain Sickness has been observed. Most at risk for altitude sickness are people under age 50, doing physical exertion, rapid rate of ascent, obesity, and those with a history of high altitude sickness. Sickness usually occurs within 8-96 hours of the climb.

Fluid shifting to the lungs is called pulmonary edema, so the lungs are, in a sense, drowning. Needless to say, that makes breathing difficult, especially when lying down. Coughing, shortness of breath, and losing wind quickly when doing physical exertion all are due to the fluid in the lungs. 

Having a swollen head, literally, is bad, bad, bad, and can cause brain damage, if not death. People with brain edema can become very confused. Irritability, acting loopy, headache, dizziness, lightheadedness, and fatigue can occur. Actually a good friend of ours joined us on a bike ride in Tahoe, and I wonder if he had some brain edema because later that night he wasn't making sense.

Poor sleep might occur from breathing problems due to acid-base shifts in the blood and the lack of oxygen. And if someone is biking or hiking up a mountain, the body's demand for oxygen is increased. So a weird phenomenon called Cheyne-Stokes respiration (alternating pattern of slow and then fast breathing) can prevent deep sleep and often awaken a person.

Nausea and vomiting from high altitude sickness can occur as well as bad headaches. A friend of mine skied the upper part of a mountain and had an excruciating headache with nausea. Since he's a doctor, he realized going from sea level to 10,000 feet while doing heavy activities wasn't agreeing with him. So he Bode Miller'd himself off the slopes. 

That's the best treatment for high altitude sickness: come back down to earth. Some meds help, but there's no guarantee they'll work. I know we like to get high on life, but sometimes you have to do it at a lower altitude.


Dr. Hook cracks a joke or two, but he's a renowned physician with a local practice and an interesting website, drjohnhong.com. Email him with your questions.