If you have any of the following conditions, please read the information provided below before coming to Yellowstone. If you have questions, please contact your health care provider.

Asthma
Diabetes
Allergies and Anaphylaxis
Heart Disease and High Blood Pressure
Seizure Disorders

These conditions have the potential to be negatively affected by the environment of Yellowstone (e.g., altitude; dry, hot summer weather; cold winter weather; smoke from nearby fires, etc.), or by moderate to strenuous course activities. Even if your medical conditions are well managed in your home environments, please be aware that the Yellowstone environment and YAI activities can have different affects on these medical conditions that could lead to potentially dangerous situations. Keep in mind that YAI course locations are remote—often several hours from advanced medical care.

Disclaimer
All content within this document is provided for general information only and should not be treated as a substitute for the medical advice of a doctor or any other health care professional. The author is not responsible or liable for any diagnosis or misdiagnosis made by a reader. The author of this document, Deb Ajango, is an instructor for the Wilderness Medical Associates, American Heart Association, and American Safety and Health Institute. Ms. Ajango has more than 2,000 field days of experience in backcountry environments, has a Master of Science degree from the University of Wisconsin-Madison, and is a Wilderness EMT.

ASTHMA
Asthma is often triggered by an irritant or allergic reaction. Use of a prescription inhaler can usually reverse the effects of an asthma attack. If you have asthma, please bring your inhaler and keep it with you at all times. Consider bringing an extra inhaler.

Common triggers (particularly for Yellowstone) include:

• Pollen (or any similar airborne irritants)
• Smoke (which can include campfires, smoke from distant wildfires, etc.)
• Significant stress (or potentially any strong, emotional response)
• Very cold, dry air
• Dust (possible on windy days)
• Mold (more likely an indoor problem)
• Exercise (or any hyperventilation [fast breathing]; certainly possible for Yellowstone visitors, especially given the altitude)

DIABETES
Diabetics are generally able to participate in all levels of activity, but must take precautions. If you are a diabetic participating in a YAI program, please be aware of the activity; fitness requirements; temperature extremes (heat of summer or cold of winter, dryness, etc.); and have a well planned menu or diet for your time in Yellowstone. Although the altitude around Yellowstone shouldn’t, by itself, create a problem for diabetics, the increased workload (from exercising at altitude) and dry air might. Also, some diabetics have reported having problems with their insulin pumps at altitudes greater than 8,000 feet. Appropriate hydration is very important for diabetics, especially in the dry Yellowstone environment.

If you have diabetes, consider carrying the following with you to Yellowstone: twice as much insulin as is usually needed; extra syringes (or pump); a glucose meter with extra batteries and extra test strips; supplies to treat low blood sugar, such as glucose tablets or gel; other medications, such as glucagon; and a letter/prescription from a doctor (in the event extra insulin is needed). If you are participating on an overnight trip, be prepared to protect your insulin from freezing or overheating.

ALLERGIES AND ANAPHYLAXIS
Common allergens (potentially found at Yellowstone) that can lead to anaphylaxis or anaphylactic shock include:

• Food products (most likely shellfish and other seafood, nuts, and some berries)
• Certain medications (most commonly penicillin and other antibiotics, as well as aspirin and other anti-inflammatory drugs)
• Sulfa drugs (including acetazolamide, or Diamox [a medication used to help acclimatize at altitude]; and silvadene [a medication used to treat burns])
• Bee, wasp, hornet, or yellow jacket stings; spider bites
• Iodine (which might be used to clean a wound or disinfect water)

The best way to prevent anaphylaxis for person with a known history of anaphylaxis is to avoid the allergens that typically cause a reaction. Unfortunately, this is not always possible or realistic. If you have a history of anaphylaxis, bring a dose of antihistamines (e.g., Benadryl) as well as epinephrine, and keep both with you at all times.

HEART DISEASE AND HIGH BLOOD PRESSURE
High altitude puts an added strain on the heart. Although Yellowstone’s altitude is not extreme, visitors will almost certainly experience an increase in heart rate when they first arrive. Angina can be negatively affected by any sustained rapid heartbeat. In fact, going to altitude is not recommended for people who recently have experienced heart problems, have new-onset angina, or have uncontrolled or unmanaged angina.

If your angina is under control and you are able to exert at sea level (without pain), you are less likely to develop symptoms in Yellowstone. Nonetheless, be cautious during your first few days in Yellowstone, especially if you are coming from low-altitude areas. Arrive a day or two early, if possible, in order to acclimatize, and limit exertion levels, at least initially.

High altitude can affect blood pressure. Although not everyone who ascends to 8,000 feet or higher notices a change, many people do experience at least a slight increase in the systolic (higher/contraction) pressure. If you have high blood pressure and it is under control, research suggests that you are at no greater risk of harm than someone who has normal blood pressure. On the other hand, if your blood pressure condition is severe and/or not well controlled, please speak with your physicians before coming to Yellowstone.

SEIZURE DISORDER
If you have a seizure condition that is well managed, your participation in YAI activities should not be affected. Nonetheless, you should be aware of these potential triggers, which you could experience in Yellowstone, and take precautions:

• Low levels of oxygen in the blood
• Dehydration
• Excessive stress (emotional or physical)
• Lack of sleep; fatigue
• Hyperventilation and associated blood pH changes
• Hypoglycemia, especially in a diabetic
• Use of alcohol
• Flashing or strobe lights (known as photosensitive epilepsy. If a patient is photosensitive, a seizure also can be induced by sunlight reflecting off wet surfaces, such as moving water or moving rapidly past flickering sunlight.)
• Missing a dose of anti-seizure medication (typically the most common trigger)