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High-altitude medicine

When the air gets thin, this doctor can help

TELLURIDE – A doctor here with a background in emergency medicine is treating patients sensitive to high altitude before, instead of after, they get in real trouble.

Dr. Peter Hackett, the founder of the Institute for Altitude Medicine, treats and counsels tourists, second-home owners and full-time residents; lectures worldwide; and does research in high-altitude medicine.

“As far as I know, I’m the only board-certified doctor in North America who practices high-altitude medicine for a living,” Hackett said.

He came by his calling through mountain climbing. He conquered Mount Everest in 1981 and has scaled numerous other peaks in the Himalayas, Alaska and South America.

The complaint of patients who seek out Hackett derives from a law of physics. As atmospheric pressure decreases with an increase in altitude, the volume of a gas (air) increases, leaving less air – and less oxygen – in a given space.

It doesn’t require a huge change in elevation to notice a difference in performance and endurance.

The amount of oxygen in the air is constant at 21 percent, but with less air in a given space there is less oxygen, which takes a toll.

In medicine, 8,000-feet elevation is considered high altitude. But most people can handle it, Hackett said.

In Durango, elevation 6,512 feet, the oxygen content of air is the sea-level equivalent of 16.6 percent; in Silverton, elevation 9,318, the oxygen equivalent is 14.8 percent; on the summit of Mount Everest, 29,000 feet elevation, the oxygen equivalent is 6.8 percent.

At the institute here, elevation 8,750 feet, Hackett sees 25 to 30 tourists per year suffering from mountain sickness, the symptoms of which resemble a hangover. The discomfort, caused when the heart can’t pump enough blood to the body, is minor compared with severe scarcity of oxygen, which can cause pulmonary edema or cerebral edema, either of which can be fatal.

Hackett’s caseload, in addition to one-time visitors, consists of part-time and full-time residents who, as they age, develop problems with blood pressure, breathing or getting a sound night’s sleep.

He also attends to people employed in town who commute from lower elevations, such as Montrose, who need supplemental oxygen. People who find themselves short of breath or who anticipate travel in oxygen-depleted regions consult him from Pagosa Springs, Durango or Cortez as well as from around the world by telephone, Skype or email.

Elite athletes, who generally have performance coaches of their own, aren’t part of his professional world, Hackett said.

High altitude confers some benefits, however, Hackett said. Babies born at high altitude tend to be underweight, but if they spend their formative years at high altitude, they develop bigger lungs and better heart structure.

“We think that in response to a shortage of oxygen, the body creates more blood vessels to move blood,” Hackett said. “Even in people who move to high altitude as adults.”

Everything else being equal, permanent residents of high-altitude places tend to live longer because they have less heart disease because of good blood circulation, he said.

The altitude factor, along with genetics and a tradition of running plays a role in the prowess of Kenyans in long-distance races, he said. The Tarahumaras of Mexico also are known for endurance running.

Hackett received his medical degree from the University of Illinois in Chicago and trained at San Francisco General Hospital. In his first job – helicopter rescue doctor in Yosemite National Park – a fortuitous encounter led him to Nepal.

There, he practiced wilderness medicine, researched high-altitude illnesses and helped found the Himalayan Rescue Association, which he directed from 1975 to 1981.

Hackett’s immersion became complete when he adopted three orphaned Sherpa children, all of whom now live in the United States.

When he repatriated, Hackett was invited by Denali National Park rangers to start the Denali Research Project, a research and rescue center at 14,000 feet on the 20,237-foot peak also known as Mt. McKinley.

Hackett opened the Institute for Altitude Medicine in 2007. The institute is a 501(c)3 nonprofit supported by grants, patient copays and generous people who appreciate the presence of the institute, Hackett said.

He commutes from Ridgway, where he lives with Dr. Ruth Higdon, a surgeon who works part-time in Grand Junction.

Hackett collaborates in research done at the University of Colorado medical center and teaches high-altitude medicine. One recent class brought 150 professional mountain guides to Boulder to learn about the effects of high altitude.

Hackett is just starting to analyze the response of 300 pregnant women to an online survey about the effects of altitude during their gestation period. There is little known about their problems, he said.


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