Medicine for the Outdoors
Medicine for the Outdoors

Dr. Paul Auerbach is the world's leading outdoor health expert. His blog offers tips on outdoor safety and advice on how to handle wilderness emergencies.

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Mountain & Wilderness Medicine World Congress Abstracts Part 2

As I noted in my first post about the Mountain & Wilderness Medicine World Congress, sponsored by the Wilderness Medical Society and the International Society for Mountain Medicine in Aviemore, Scotland from October 3-7, 2008, there were many excellent abstracts presented. The following are mentions of more of these:

A large proportion of the indigenous and traveling populations in South America chew or drink a tea of the coca leaf to abate the symptoms of altitude sickness. In “An investigation into the use of coca for altitude sickness,” Robert Conway and colleagues performed a survey to attempt to determine if a traveling population from the West to Peru or Bolivia had knowledge of coca and/or used coca tea to prevent or treat altitude sickness. While they were able to gather responses that might indicate (1) that there may be a trend toward higher does of coca tea being associated with less mountain sickness (an effect not associated with chewing the leaf), and (2) that there does not appear to be an addiction to the leaf in the quantities taken, the project failed to find sufficient significant evidence to support the hypothesis that coca is protective or an effective treatment for altitude sickness. It is possible that a randomized, blinded study with sufficiently high numbers of individuals might determine different conclusions.

One abstract was an announcement by Chris Smith and Denzil Broadhurst from Medex and Medical Expeditions that the “Travel at High Altitude” booklet, written for laypersons, is now available. The booklet may be downloaded free of charge from the Medex website. It is intended to be relevant to all persons who might travel to high altitude – family holidays, adventure challenges, and expeditions. It covers the world’s high altitude regions, altitude related illnesses, things to do before traveling, and what to do once at altitude.

Persons with diabetes may wish to travel to high altitudes. Depending on the type and severity of diabetes, a diabetic may need to self-inject with insulin. In “Acute hypobaric hypoxia does not affect the insulin requirement in well-controlled diabetics,” Xonzita Leal and colleagues investigated a small number of type 1 diabetics. Using a hypobaric pressure chamber to experimentally increase the altitude to the equivalent of 5,000 meters (16,400 ft) for a few hours, the study subjects were evaluated for levels of body chemistries and hormones to determine if the effects of insulin were different than those observed at sea level. No significant differences were found in any of the parameters measured between a condition of normal oxygen content in the blood and lowered oxygen content (due to the simulated ascent). The investigators very importantly noted that the study has an important limitation imposed by its design, in that the exposure to hypoxia was intense and of a brief duration, so can not be extrapolated to a real mountain situation, where there are additional variables of diet, exercise, individual acclimatization, cold, and fatigue. I very much agree – until a study is done that realistically approximates the true alpine environment for a much longer period of time, no effective clinical conclusion should be drawn about insulin requirement at altitude.

Dominique Jean and colleagues reported on “Climbing Everest with type 1 diabetes.” This account of a single well-trained and experienced climber who lead his expedition without any adverse medical event, maintaining excellent glycemic control. There does not appear to be any a priori reason why diabetes should preclude a person from high altitude adventures, although as the presenters noted, all cases should be individualized.

More abstracts to follow…

photo of bagpiper courtesy of

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Dr. Paul S. Auerbach is the world’s leading authority on wilderness medicine.