019 Discussing Healthcare: Oxygen and Altitude, Statins, PA Slander, and Frustrated Patients


Flight MH370: Did altitude and cabin pressure play a role in the missing aircraft?

The mystery of flight MH370 continues.  First, it is a tragedy that 239 people are missing and their families are left wondering what happened without closure.  My heart goes out to the victims and their families.  But, where is the airplane and what happened?  Nobody knows.  There is some evidence that the airplane had climbed to altitudes around 45,000 ft.  The typical commercial airplane cruises around 30,000 ft.  So, is it possible that the passengers were affected by the airplane traveling at high altitudes?  Commercial airplanes often maintain a cabin pressure equal to about an altitude of 8,000 ft.  That allows for oxygen to be readily available in the air that you breathe on the plane.

Air contains about 21% oxygen.  However, there is more oxygen available at lower altitudes because the air is under more pressure.  As you go further from the surface of the earth the air pressure decreases and the amount of oxygen available per breath decreases.  At 30,000 ft most humans can only survive for a few minutes.  There is a theoretical zone in mountain climbing called the “death zone” which is above 26,000 ft.  This is the elevation that often leads to death.  Mt. Everest is the tallest peak in the world at about 29,030 ft.  Very few people have reached the peak, estimates between 1500 – 5000 people successfully made it to the summit.  Many people use supplemental oxygen to aid in the ascent, but a small number of people have done it without supplemental oxygen.  The climb to the top of Mt. Everest takes 6-9 weeks in order to allow your body to get used to the altitude and lack of oxygen.

So, if there was a sudden loss of cabin pressure at 30,000 or 45,000 ft, then the likelihood anyone could survive more than a few minutes is very small.  Even with supplemental oxygen the sudden exposure to high altitudes for extended periods of time is detrimental.  However, pilots often have special oxygen masks which deliver pressurized oxygen and a pilot could survive and fly the plane at higher altitudes in a depressurized airplane.


Who should take Statin medication?

Jack Rzepka, MD returns to the podcast to discuss statin medications.  He shares the latest guidelines for who should be treated with these drugs according to the American Heart Association and the American College of Cardiology.

Statins are a class of medication used to treat high cholesterol. It is the most common cholesterol medication prescribed, but who should take a statin?  There are guidelines to direct which patients should be taking this type of medication.  The newest guidelines were released in 2013 and represent a shift in the way we think about treating cholesterol.  Instead of focusing on the cholesterol number there is a focus on cardiovascular risk factors.  There are four specific groups that should be treated with statins:

  1. History of cardiovascular disease (heart attack, stroke, etc.)
  2. LDL (bad) cholesterol of 190 mg/dL or higher
  3. Type 2 diabetes with age 40-75
  4. 10 year risk of cardiovascular disease of 7.5% or higher with age 40-75 (there is a formula to assess risk)

There are certainly lifestyle modifications that can be made before trying medication to decrease cholesterol.  A vegetable based diet tends to decrease cholesterol levels significantly.  There are a few good documentaries and books that discuss this topic.

  1. Documentary: Forks Over Knives
  2. Documentary: Fat Sick & Nearly Dead
  3. Book: The China Study
  4. Book: Eat to Live

This can be a very complex issue and should definitely be discussed with your doctor.


Derek Burkum, PA-C

Derek Burkum, PA-C

Are Physician Assistants disrespected in the media?

An interview on The O’Reilly Factor on March 4, 2014 with Ezekiel Emanuel, MD displayed some ideologic differences between Mr. O’Reilly and Dr. Emanuel.  Part of the exchange was a discussion about the increase in urgent care and retail-based clinics.  Mr. O’Reilly contended that as a result there was an increase of medical care by Physician Assistants (PA) and Nurse Practitioners (NP).  Dr. Emanuel did not disagree and added that he does not think that a physician needs to be involved in every patient interaction.  However, Mr. O’Reilly disagrees.  He made the following statement in reference to PAs: “But if I want a strep throat diagnosis, I don’t want Lenny, who just came out of the community college.”  This is without a doubt an opinion that PAs are not qualified to practice medicine…or was he just trying to get a rise out of Dr. Emanuel.  Either way it did not give PAs a good name.

Here is the actual interview (2:25 is the referenced part of the interview):

There was another reference to PAs that was not flattering in the Milwaukee Journal Sentinel on February 27, 2014 where the author claims that  PAs are part of the opioid pain medication problem in the United States.  The article was titled “Millions of painkiller prescriptions written by non-doctors.”  The article doesn’t put the blame completely on PAs, but they are included in a group of non-physician medical providers, including: optometrists, dentists, and NPs.  There is data to support the author’s argument, but the data is not presented well and left me wondering if the data was accurate.

Derek Burkum, PA-C takes issue with the bad press.  He claims that PAs are highly educated and have a lot to add to medical care.  Listen to the podcast to hear his opinion.

How have the changes in healthcare affected you?

Jason Wilson called from Des Moines to express his frustration with the changes to his insurance plan.  Specifically, he is paying much more for his prescriptions.  Jason is not the only person to experience this issue.  Others have approached me with the same problem.  Tell me what you think about Jason’s comments.

About the Author

I am Joshua Lewis, MD, the creator of Discussing Healthcare, LLC and a board certified Emergency Physician who currently practices in the Phoenix, Arizona area. I hope you will gain meaningful insight into our healthcare system through the information provided by Discussing Healthcare. Thank you for your interest and I encourage you to contribute by calling, emailing, or leaving comments on the website.

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