252 ~ Light on the horizon – Part 5 ~

This flight to Cape Town, although necessitated by the senior pulmonologist, is more of a quandary than appears to be…

Since we’re dealing with a multimorbidity dysfunctional, unstable autonomic nervous system, as well as one identified lung disease followed by another / other unknown ones.

In order for you to gain a comprehendible understanding, let’s expound the situation with a comprehensive article composed by Dr. Jeremy Feldman

Lung Disease at High Altitudes

(Image copyright reserved)

A common question we receive from our readers and patients is whether it is safe for patients with chronic lung disease to travel to higher elevations?

For the sake of this discussion we will use 5,000 ft. or greater as high altitude. This is an important question since many of the tourist attractions are either at higher elevation or require driving across mountains that exceed 5000 ft.

High Altitude Physiology

The lungs have evolved to compensate for changes that occur as elevation increases. Above 5,000 ft. of elevation, there is less oxygen in the air. This triggers a response to breathe more (increased ventilation).

The normal heart also pumps more blood to compensate for the reduced oxygen that is carried in the blood. Over time the body makes more red blood cells which helps increase the amount of oxygen that the blood can carry.

The pulmonary arteries respond to high altitude by constricting or squeezing (vasoconstriction). This leads to the right side of the heart having to work harder.

Additionally there is a tendency for the lungs to accumulate more water with ascent to higher altitude. This can further affect breathing.

These changes described above have important implications for patients with chronic lung disease.

For example, patients with pulmonary hypertension may be particularly sensitive to the vasoconstriction (squeezing more tightly) that occurs.

This leads to increased work for the right side of the heart. Many patients experience fluid retention and increased fatigue that can take several weeks to improve.

Patients with pulmonary fibrosis (scarring in the lungs) may not be able to increase their breathing rate effectively and they may also experience worsening pulmonary hypertension.

Oxygen, Does it Help?

Many patients with chronic lung disease will need to wear oxygen when they travel to higher elevations. If you drop your oxygen saturation at night or during exercise at lower elevation then you will certainly benefit from oxygen at higher elevation.

For patients who are borderline we have a high altitude simulation test (HAST) that can determine if you will need oxygen.

Patients that do need oxygen with travel to higher elevation will still experience many of the physiologic changes of being at higher elevation.

The 1-5 liters/min of oxygen delivered via nasal cannula can blunt the effects of elevation but does not completely reverse these changes. My advice to patients is to avoid higher elevations if at all possible. The more severe your lung disease the more important this is.

Apart from lung disease, Dr Robertson explains air flights from the Dysautonomia point of view :

Airplane flights and exercise

More similar than you think..

The nervous system plays a vital role in compensating for lower amounts of oxygen at high altitudes. The autonomic nervous system and cardiovascular system work in tandem to compensate for this change. Receptors in the body sense when there are lower amounts of oxygen available. The body compensates by hyperventilating, which increases oxygen in the body.

The autonomic nervous system signals the heart to beat faster to circulate blood on a greater scale. Blood is shunted to where it is needed most, by the constricting and dilating of vessels. A proper balance keeps blood pressure stable and important areas of the body well oxygenated.

In Dysautonomia, the body cannot adapt quickly to the changes needed and “mountain sickness” results. Dizziness occurs from blood not being shunted properly, which leads to a general lack of oxygen. Pulsating headaches occur often, possibly from irritation of nerves around dilated blood vessels. Fatigue, nausea, amd syncope are also possible side effects. Dehydration is a potential risk at sustained high altitudes.

For patients with Dysautonomia, air flight may produce a similar effect on the body as extreme physical exercise.

Taking all the above into consideration, currently I am experiencing dyspnea (SOB – shortness of breath) / labored breathing at rest. Every simple task and step is a battle for air, let alone performing exercise – be it little or extreme (not due to being. deconditioned)

So how do we possibly reach an agreeable decision my mind wonders as I pray for guidance in the best direction and weigh the opportunities vs the obstacles. But the latter seems to press in heavier.

Not long after, Dr U final word coincides with my incertitude…

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