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!
No comments:
Post a Comment