Friday, March 21, 2014


I admit that I love skiing! But then so do the hundreds of thousands others. And they are probably more avid then I and probably better at it too.

Mountain sports have an inherent fact that most of us ignore as we expectantly run to the ticket windows. Ah for that cold icy fresh air first stoking the warm fire of desire. The chairlift awaits and the gondola beckons but there is something amiss, just ever so slightly that you cannot put your finger to it.

So let me count the ways that, that amiss has some physiological ramifications to it.

I first became aware when my daughter would wake up at a resort in the Colorado Rockies and start heaving up her last night’s dinner. No fun there. I was annoyed (imagine) that she was really not interested in skiing but wanted to veg out in the room. Then it became certain even to the most resistant one (me) that every vacation a similar episode developed. What was happening? Just about then, the resort started offering a canister full of oxygen for purchase. I bought several of them and gave them to everyone in our family. Guess what happened? No more heaving! No more complaints! She was the first one out with her skis and poles.

Okay so what happened? It appears that when a sea-level dude or "dudette" comes over to a 8000 foot elevation without acclimatization the hypoxemia (low oxygen levels) in some generates a gastric regurgitation (upchuck). Additionally I was noting myself a tiny residue of headache and always filtered that through the lens of a difficult work period prior to a vacation (taking care of all the sick ones that required attention immediately for the time period I would be away). But those two to three whiffs from the canister cured that too. No more headaches. Voila, amazing two problems solved with one swing of the bat.

Then I started thinking about other possibilities that might also be at play:

A friend of mine with a labile hypertension controlled with low dose anti-hypertensive medicine ended up in the emergency room after being airlifted due to a hypertensive crisis. His blood pressure was sky high and fear of strokes was a significant consideration. Thankfully it was resolved with additional medication. The next year, he told me that he carried extra blood pressure medicine when he went to more than the mile high resort and lo and behold a similar occurrence was at hand but one he was prepared for (he is a physician). The logic from this suggests that hypoxemia (low oxygen levels) seem to drive the vaso-constrictive mechanisms of the arteriolar system, with an associated rise in the heart rate and respiratory rate as a compensatory mechanism. (You will notice shortness of breath when you walk the mile in your ski boots carrying your skis and poles at that high altitude).

Another visual at the airport one time while returning from our vacation, I observed a young woman in the wheel chair being pushed to the gate for departure. I found out that she had been hospitalized with a blood clot and was returning home from a miserable “vacation.” That was sad in itself, but what of this blood clot? I wondered.

It turns out that similar to the risks of developing a blood clot in the long flight a similar mechanism migh be at play in a mountainous resort for sea level dwellers. The high altitude with its marginalized oxygen levels associated with dry air that saps the moisture from within the body at rest (and more with exercise) and the vaso-constrictive phenomenon, I mentioned earlier can be a doozy for a blood clot in the leg. Add to that potential a mutation of the Factor V Leiden mutation present in 5% of the population and or the less common Prothrombin mutation that are promoters of blood clots the results can be terrifying and hurtful. (I am not going to mention all other risk factors such as age>65, existence of cancer, birth control pills, obesity etc. Suffice it is to say there are many other issues that can predispose a person to developing blood clots)

When all the factors are present, what makes the clot itself? Imagine a blood flow through a smooth blood vessel. The flow is linear. The “stuff” red and white cells and platelets all stay in the middle of the stream while the “liquid” as in plasma surrounds the core. A disruption due to a crossed leg, a injury can impair the linear flow and the platelets “fall-off” to the sides and with the other ingredients mentioned as in dehydration (thickens the blood and slows the flow) hypoxemia (causing compensatory vaso-constriction) and the last hammer (Factor V Leiden mutation) makes factors in the blood including platelets “stickier,” you now have the set up for the disrupted blood flow and piling on of the clotting factors around the nidus of the platelets and ouch, the leg hurts. The higher risk is that one of those clots can run the venous blood stream and end up in the lung with compromised breathing and endanger life. To prevent is simple, Drink plenty of water, invest in a canister of oxygen and use it and take a baby aspirin (81 mg) provided your doctor (not some “provider” but the real critical analytic decision maker) agrees to the use of this medication based on your history.

Oh and I might not have mentioned that skiing is a dangerous sport because there are inherent risks of falls and crashes that can cause broken bones, separated shoulders, ACL (Anterior Cruciate Ligament in the knee joint) tears and other sundry eventualities that twitter friends like @hjulks in the Orthopedic field know all too well and how to manage and fix.

Mitigating risks is easy once you know the hazards.

Skiing/snowboarding without a helmet does not prevent accidents but may save you from a brain injury. Now that you have chosen your "bling" on what to wear and show off, don't forget the "thing" that protects your noggin. Skiing and snowboarding under control can also save you from visiting the orthopedic department, the hematology department and the neurosurgery department.

Enjoy your vacation!
Know the risks!
Prepare in advance!
Have a ball!

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