Altitude sickness on the drive from Phoenix to Flagstaff could reveal a lot about your health

When Dr. Jan Stepanek, who grew up in Switzerland, was in the military there, he served in the mountain infantry. That means he did a lot of hikes and marches at elevation. During those times, he said he saw plenty of people who didn’t feel well being up that high.

When he came to the U.S. to train in internal medicine, a colleague and future mentor asked if Stepanek would be interested in training in aerospace medicine – a specialty he didn’t know anything about at the time.

Stepanek is now an Internal Medicine and Aerospace Medicine Specialist at Mayo Clinic in Arizona.

He said he gets some strange looks from people when they find out he sees patients dealing with altitude issues in a practice that sits just around a thousand feet above sea level. But Stepanek said his field isn’t just about healthy people climbing mountains – it’s also about common health conditions that can be made worse at altitude.

Stepanek joined The Show and started with what exactly aerospace medicine is.

Full conversation

JAN STEPANEK: So aerospace medicine is a specialty that deals with the human body in extreme environments, be that at extreme altitude, under G forces, flight in space. And that sort of dovetails nicely because there is an overlap between those two specialties, especially in a place like Arizona, where we all live in the lower deserts for most of us.

But if it turns out that we want to escape the unrelenting, broiling oven called Phoenix, we dash up to the high country, and before you know it, you’re at elevations of 8,000-10,000 feet and with that, subject to some of the influences of high altitude.

MARK BRODIE: Yeah. So, what does it do to us? I mean, I think anybody who’s driven, for example, from Phoenix to Flagstaff has felt their ears pop along I-17 along the way. But what does going from this low altitude in Phoenix to the high altitude of Flagstaff in a relatively short amount of time — what kind of impact does that have on our bodies?

STEPANEK: So there’s two versions of events. One is normal adaptation. So if we happen to live at low elevation and drive to altitude, our bodies are going to start to compensate for that change in barometric pressure. So if we go from sea level to 8,000 feet, there is about 25% less ambient pressure, which means less availability of pressure for gas exchange to occur.

So our bodies start to compensate by breathing to excess. And as a result of that, improving our oxygen levels at the expense of carbon dioxide, which, when we go to altitude, that begets some not infrequent sense of dizziness, a little bit of lightheadedness, a bit of shortness of breath for some people who are sensitive, maybe headache, maybe not sleeping as well. But that sort of adapts, and people feel well thereafter after about a couple of days at the very most if they’re not acclimatized.

You know, the symptom that you alluded to with the popping of the ears, that is just good old fashioned volume changes, because as there is decreased barometric pressure and you have any sort of trapped gas, such as in your middle ear, if you don’t equilibrate pressure well, or your ears are stuffed up because you have a cold, that gas expands as we go to altitude, and that makes for the ear pop on I-17.

BRODIE: Are there more — I guess for lack of a better word — permanent changes or permanent impacts that we can see if we are sort of boomeranging between high and low altitudes in a short amount of time?

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Mayo Clinic

STEPANEK: So it’s not that there would be necessarily permanent changes for someone who goes on the weekend up to the high country to recreate, camp or enjoy themselves, but there is adaptations that occur. The higher you live, your body is going to start to not just increase the breathing and sort of adjust the acid-base level in order to suit you better and serve you better and function better at altitude, but it’s also going to start to increase your oxygen levels and, as a result of that, increase your oxygen carrying capacity.

So you’re going to be better off at altitude when you’re there for an extended period of time. But that takes weeks to months to actually occur. So for the weekend warrior, there’s really not much in the way of anything permanent — assuming that people are healthy — that would arise.

BRODIE: You kind of alluded to this, but I want to ask you more specifically: Are there people who are maybe more prone to altitude sickness or maybe not feeling as well, or their body just doesn’t adapt as well to changes in altitude than others?

STEPANEK: Oh, absolutely. And this is really what I do on a daily basis. What we talked about to date is really normal adaptation, which normal bodies, how they adjust and then we start feeling well.

Now there’s conditions where you may not be able to do so because of underlying conditions that preclude that adaptation. Very common would be issues where if you have reduced oxygen carrying capacities. If someone has anemia, that is not going to make for a fun trip to Flagstaff because you’re going to be breathing much, much more, and it’s going to be much more taxing. People who have sleep disordered-breathing — so if someone has, for instance, sleep apnea — then they’re going to have a very hard time adapting.

And, very importantly, also individuals who have right-to-left shunts, so conditions whereby spent blood is shunted from the spent blood side to the fresh blood side. And that may be something that is not strikingly symptomatic at low elevation but becomes much more so when you go to high altitude because the pressures on the right side go up and the pressures on the left side go down when we’re at altitude.

And so that becomes much more of an issue. And individuals may become significantly symptomatic — short of breath and, you know, have problems with lack of oxygen.

The importance, you know, that I see is making sure that healthcare providers have an awareness of the impact of altitude on a variety of health conditions, and the potential value of further investigating some of these because it can lead to the discovery of actually very significant underlying health problems that people may not have been aware of, and that if properly diagnosed, can then long-term alter the trajectory of their health.

BRODIE: I wonder if Arizona is, it seems like sort of the perfect place to both study and practice this field of medicine because there are such big elevation changes in reasonably short distances. Are there other places that are like this, where it might be as interesting to study this field?

STEPANEK: You point out something that is good old-fashioned topography. And there is not that many places where people have, just by a car ride, easy access to going from 1,500 feet to 8,000 feet. We have several million people here in the low deserts at our doorsteps, and if they want to get out of the heat, it’s literally a two, two and a half hour car drive, and you are at elevation 7,000 feet plus.

There’s not that many places in this country where that indeed is the case. And our high country is actually, compared to other locations in this country — be that on the Pacific side or elsewhere in the world — it’s not that easily accessible. So you can find places where you can have high peaks in your backyard, but those high peaks are not accessible by car drive.