Family Medicine Vital Signs

What could be better than a winter trip to the mountains? For many skiers and snowboarders visiting Utah, the answer is absolutely nothing. They plan travel and lodging, prep their equipment, get their passes, and hope for the legendary Utah powder to be abundant during their stay.

Unfortunately, while all of the standard preparations may be checked off, time and time again people forget about the altitude here in Utah and how it can affect them. They wonder why they feel miserable their first day or two without connecting that their body may not appreciate flying in from sea level in the morning and taking a tram to 11,000 feet the same afternoon.

Acute Mountain Sickness (AMS) presents as a headache in addition to other symptoms including fatigue, trouble sleeping, nausea, and dizziness. Most people describe feeling as if they are coming down with a virus, or how they would feel with a hangover. Not exactly what you want heading out for a day in the mountains.

The air is thinner at altitude, and by about 6,000 to 8,000 feet, physiologic changes occur that we need about 12-72 hours to adjust to. The good news is that we can, and do, acclimatize. However, the rate of ascent, the altitude gained, the sleeping altitude, the duration of exposure, and exertion level all affect the severity of these changes. Most of these main risk factors are modifiable, but some people are still more susceptible to AMS than others. In fact, acute mountain illness is not related to physical fitness, and the strongest predictor for acute mountain illness is prior episodes of acute mountain illness.

So how does altitude affect our visitors?

Keeping in mind that it is extremely rare for a visitor to Utah to develop the more severe, potentially life-threatening effects of altitude that impact the lungs (high altitude pulmonary edema) or the brain (high altitude cerebral edema,) AMS is fairly common.

If you have been here before, and have never had a problem, then follow these simple rules for your first two to three days here: stay hydrated, limit or avoid alcohol, get a good night’s sleep, and have fun.

If you are new to Utah: follow the same advice, but ease into your trip and watch for symptoms (you can treat symptoms with some ibuprofen if needed)

Had a problem in the past, or are concerned you might? Focus on acclimatizing. Here is what you’ll be dealing with: Salt Lake City is only about 4,500 feet high, but Park City is around 7,000 feet, and the town of Alta is around 8,500 feet. The highest point at Park City is 10,000 feet at the top of Jupiter Peak, Alta’s highest spot is 10,550 feet, and Snowbird’s summit of Hidden Peak (at the top of the tram) is 11,000 feet.

I recommend you spend your first night in Salt Lake City. The next day, either explore the city or head up to Park City/Deer Valley, but spend the second night in Salt Lake. Then explore the resorts up Big or Little Cottonwood canyons the second day. This way you are spending more time at a higher altitude while you exert yourself. Third night in Salt Lake City and then head to whichever resort you choose to sleep and ski for the rest of your week.

Had a problem in the past and can’t spend time in Salt Lake City adjusting to the altitude? There are some pre-medications that can help. Diamox (acetazolamide) is well known and accepted as an option to facilitate acclimatization and avoid AMS symptoms. You can ask your physician about this before you travel, and plan to start the day before arrival. You shouldn’t use this if you have an allergy to sulfa, and it tends to make carbonated beverages taste flat. Interestingly, studies out of Stanford have shown that ibuprofen may be as effective as acetazolamide. The data on ginkgo biloba is mixed, but has some evidence to show less chance of AMS when used 2-3 days prior to travel and during your stay.

When in doubt, if you are not improving in a day or so, you can always “go low” and decrease your sleeping altitude by sleeping in Salt Lake City. If you are not improving, or are having more trouble breathing, issues with balance, judgment, or function, you need medical evaluation. Fortunately, there are medical providers at each of the resorts who can help determine the reason for your symptoms and how best to help you.

See you on the slopes.

Theodore S. Paisley, M.D. is a board-certified family medicine physician who also specializes in sports medicine. Ted completed both his residency in Family Medicine and a fellowship in Sports Medicine at the University of Utah.