Dave S wrote:

I am trying to think what would cause a problem with altitude and a VP
shunt.. and unless there is air in the shunt... which is HIGHLY
IRREGULAR in a chronic VP shunt then this shouldnt be an issue. Absent
of free air, altitude shouldnt be a major problem.

Well, The problem is not 'air' in the shunt but, the fact, that, it is
over-draining. This is slightly analgous to a toilet bowl and, when it
gets flushed, no water being left in the bowl. In other words, her
shunt is draining faster than, the production of CSF(Cerebro-Spinal
Fluid) within the cranial cavity.

Air being present can expand at altitude and if inside the skull can
cause all sorts of problems.. Something like this was experienced by my
colleagues on an aeromedical crew with a neurosurgery patient, but it
was a freshly placed shunt, and air underneath a craniotomy flap had not
absorbed yet.

While my fiance's shunt was placed in Feb.'04, she has had the headache
problem, going on 9mos. now.

I've developed headaches on long cross country flights at 10-11,000
feet.. and I don't even have a shunt. Hypoxia in and of itself can do
that to a healthy person.

I am aware of Hypoxia. That is why, I am hoping that, the flight plan
doesn't have, climbing to cruising altitude of 10,000ft. in it.

To answer your question, for a flight in the area of the country you are
specifying, expect altitudes no higher than 8,000 ft.. Prevailing
winds are from the west.. so the higher you go, the more headwind you
have to fly against heading the MI from the east coast. Cabin altitudes
in pressurized planes are in the 8-10k ft range.

Presuming that, the planes are not pressurized(I am picky about having
to fly CRJ series of commercial planes which are built in Toronto. I
don't trust them since, there is no regulations about inspections prior
to their sale to U.S. airlines. The french Airbus planes are more
trustworthy, in addition that, I get sick on the CRJ's), I would hope
that, apart from any obstacles 5,000+ft. that, they don't have to fly
above that.

On a practical basis, the Angel Flight guys are used to flying folks who
may need oxygen routinely and know that altitude compounds the problem,
so they are accustomed to not pushing it up as high as they may without
a patient/rider. Any special requests can be communicated by the
coordinator to the Angel Flight pilots.. such as limiting max altitude..
for whatever reason. The pilot is made aware of the request when he
accepts the flight (as in, he accepts the flight knowing the request if
it's been communicated properly)

Dave

Presuming it may not have been communicated properly, would it be
prudent of me to double-check it with the pilot or, would that be,
excessively picky?

Christopher