Altitude Angst

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Magazine by Amy Reinink) Romy Mehlman, a 25-year-old skier from Los Angeles, spent her first day at Beaver Creek, Colo., in bed. "It was the most nauseous and horrible I've ever felt," says Mehlman, who later realized she suffered from altitude sickness. "I spent the day just lying in bed and watching videos."

Mehlman's experience illustrates a notable statistic: A two-year, year-round study conducted by the Colorado Altitude Research Institute in Keystone surveyed more than 3,000 men and women ages 16-87 who attended conferences in Summit County, Colo. More than 25 percent of guests reported symptoms of Acute Mountain Sickness (AMS), or altitude sickness, says Dr. Robert Schoene, a professor of medicine at University of Washington who helped conduct the study.

Most common at 8,000 feet or above, where the oxygen content is half what it is at sea level, AMS leaves many visitors to high-altitude ski resorts gasping for breath. The body responds to the decrease in oxygen by breathing faster, but this often isn't enough. Lack of oxygen makes membranes in the lungs and brain leak, causing headache and nausea. Symptoms usually start within a few hours at altitude.

The good news is that symptoms disappear once the body adjusts to the low-oxygen atmosphere. John Feeney, a physician at Colorado Mountain Medical Center's Edwards branch, says it usually takes three weeks to acclimate to 75 percent of capacity and up to a year to acclimate completely. "The sad part is that even those who have lived at high altitude their whole lives will lose their acclimatization within 10 to 12 days at sea level," Feeney says. However, skiers on a week-long vacation need not despair-most AMS symptoms subside after one to three days at altitude.

While AMS-and its symptoms, such as headache, nausea, vomiting, shortness of breath and sleep disturbance-can make a ski vacation less than enjoyable, it is by far the least severe of possible reactions. More serious conditions are High Altitude Pulmonary Edema (HAPE) and High Altitude Cerebral Edema (HACE).

HAPE occurs only once in every 10,000 skier days, according to data from patients who were examined for HAPE at Vail Hospital over a seven-year period. However, Dr. Steve Yarberry, a physician at the Copper branch of Colorado Mountain Medical Center, says skiers should still watch out for a common HAPE symptom: a severe cough yielding frothy, pink phlegm, which tells skiers it's time to rush to a doctor. This is especially important at altitudes above 9,000 feet.

HACE, even less common, occurs when fluid builds up in the brain, and it can be fatal without treatment. It's marked by severe headaches, a staggering gait, hallucination and confusion. While this serious stage is usually seen only when climbers spend a week or more at altitudes above 10,000 feet, Schoene says skiers aren't immune to HACE. "In ski resort areas, the occurrence of HAPE and HACE are less common than AMS, but they're real threats," Schoene says.

Dr. Joe Ferriter, a physician at Park City Clinic in Park City, Utah, warns skiers that they can get HACE or HAPE without experiencing lesser symptoms. "Altitude sickness doesn't always follow a stepwise pattern," Ferriter says. "It can go straight to the worst kind."

How can you prevent altitude sickness? And what can cure it once it sets in? Here's a comprehensive guide to avoiding AMS:

WHO GETS IT? Whether a skier comes down with altitude sickness has nothing to do with fitness level, age or gender. It depends on three factors: elevation, rate of ascent and individual susceptibility. According to Yarberry, some people's brains simply don't sense the decrease in oxygen, making it hard for their bodies to acclimatize.

The Summit County study found that visitors who had altitude sickness before were almost three times as likely to get it again. However, Ferriter says those who have never experienced symptoms should still exercise cauon. "A skier can visit a ski resort 10 times with no problems, then get HAPE the 11th time up," Ferriter says.

Yarberry warns that even uber athletes are not immune. "The sickest person I've ever seen was a 25-year-old marathon runner," Yarberry says. "It's great to be fit, but all it means with AMS is that you'll be fit and sick."While preseason conditioning may not help, getting a good night's sleep can. Yarberry says pre-existing stress can increase the likelihood of experiencing symptoms.

In addition, people with health problems such as sickle-cell anemia and chronic lung and heart disorders should be careful. "Altitude tends to put a strain on such diseases," Yarberry says. "I'd advise those people to get checked out before they come up."

KEEPING IT AT BAY The best way to avoid altitude sickness is acclimatization. This means taking it easy for the first 24 hours at altitude and moving up as slowly as possible-ideally, only by 1,000 feet per day.

This allows the body to adjust to the low oxygen content by breathing faster, producing more oxygen-carrying red blood cells and forcing blood into portions of the lung normally not used at sea level, Ferriter says. While this ideal may be unrealistic for skiers, even booking a hotel room in Denver the night you fly in for a Vail ski vacation can help ward off symptoms.

In addition, skip the beer and grab a tall glass of water when you first arrive. Staying hydrated plays a major role in preventing altitude sickness, Feeney says. Travelers should drink at least three to four quarts of water per day and limit caffeine and alcohol to prevent dehydration. Since it's a depressant, alcohol slows breathing, making it even harder for the lungs to get enough oxygen. For the same reasons, leave sleeping pills and other depressant drugs at home.

Diet can play a role as well: Experts suggest eating frequent, small, high-carbohydrate snacks during the first few days of your trip. Some recommend getting 70 percent of your calories from carbs while at altitude.

For those with a history of AMS, certain medicines may help prevent symptoms. Diamox is among the most common. Ferriter says the diuretic increases breathing rates, making it easier to get extra oxygen at high altitudes. Studies have also shown the natural supplements gingko biloba and a wild mushroom known as ganoderma luciderm to be effective in curbing AMS symptoms.

BACK TO HEALTH The only true cure for altitude sickness is descent, but this may be less than desirable for skiers on a week-long vacation. If weary travelers are set on staying at altitude, some doctors swear by oxygen as a treatment. "Oxygen is really the cleanest, easiest option for people with altitude sickness," Yarberry says. "We'll have people suck on some oxygen in their condos for a day and watch TV, then they'll be fine to ski the next day." Yarberry says those who have a history of AMS can have a doctor preemptively prescribe oxygen to ward off symptoms.

Ferriter says if symptoms don't subside in 48 hours, a doctor visit is a must for those who plan to stay at altitude. Mild headaches can be eased with aspirin or ibuprofen, but more severe symptoms may require prescriptions.

IN THE KNOW Schoene says the most important element in preventing altitude sickness is education. "The ski industry is reluctant to admit altitude sickness is a problem, fearing that it will turn skiers away," Schoene says. "In fact, what will keep people away is not knowing how to deal with it. If people feel good, they'll want to buy food and liquor and ski-lift tickets, which can't be bad for business."

Many resorts, including Summit County's Breckenridge and Keystone, already offer education, such as posting brochures and making sure their patrollers are well-versed in the issue. Schoene says most programs could be expanded to encompass more skiers. His wish list for altitude-sickness education includes brochures that travel agents and hotel owners hand out as part of reservation packages.

WHEN BAD SYMPTOMS HAPPEN TO GOOD SKIERS Even the most susceptible skiers can enjoy the freedom of the slopes once they learn to take simple precautions against altitude sickness.

While Romy Mehlman never sought medical treatment for her symptoms, she said a friend tipped her off to drinking more water as a way to prevent AMS. "Now I bring more than a liter of water with me on my way up to the slopes," Mehlman says. "Altitude sickness is awful, but now that I know how to deal with it, skiing is no problem."nd hotel owners hand out as part of reservation packages.