The patient: George, a middle-aged businessman with an active lifestyle and generally excellent health.

Why he came to see me: George had been on a four-day ski trip to Alta, Utah. After a few days of hard skiing at altitudes of between 8,500 and 10,500 feet (which is quite high!), he began to feel weak and suddenly fatigued, and had to quit early on his last day. Even after a good night’s sleep after returning home to Connecticut, he felt “wiped out.”

How I evaluated him: On physical examination, George displayed the classic signs of anemia. He had delayed capillary refill of the fingernail beds (when I squeezed his fingertips, it took too long for his fingernails to return to their regular pink color)…and blanching of the retina (in looking at the rear surface of the inside of his eyes with an ophthalmoscope, I could see a lighter-than-normal color).

I performed conventional screening blood work, including a complete blood count (CBC)…a serum metabolic panel, which measures a lot of things including sugar (glucose) level, electrolyte and fluid balance, and kidney function…as well as an iron panel. Although the serum studies came back well within normal limits, the complete blood count showed a decrease in hemoglobin, the protein in red blood cells that transports oxygen.

After reviewing his family history, George and I determined that he had a genetically related type of anemia called thalassemia minor. This disorder can be found in individuals of Mediterranean ancestry and often only becomes apparent or active in response to stress, either physical or psychological, often at high altitude. Bingo!

How we addressed his problem: Since George’s iron was normal and prescribing supplemental iron for his form of anemia could not only be non-productive but harmful, I prescribed a few days of less physical activity, fiber rich foods, and plenty of bedrest…and to stay aware of the fact that being at high altitudes kicks in this genetic defect.

The patient’s progress: George recovered nicely after a week and has decided to confine his upcoming ski trips to lower elevations.

To learn more, visit Dr. Andy Rubman’s website,