This Month:

• Heat-Related Illness Dean Traiger, M.D., aka Doc-Dean
• Ten Healthy Habits Mike Hunter, aka clearpath

In the aftermath of Hurricane Charley, many people are trying to clean up and get their lives back in order. With no electricity to power air conditioners or fans, many people working in the August summer heat are becoming victims again. This time, to a heat illness.

Overheating (aka hyperthermia or hyperpyrexia) is a very common disorder which can happen to anyone at any time. The summer months are the most likely time, however other issues can be predisposing factors such as illness, medication, too much alcohol, inappropriately warm clothing or dehydration. Geocaching could be considered a predisposing factor as well.

When you get warm, your body sweats to cool itself. As it gets warmer, your body must sweat more. As the sweat on your body evaporates (dries up in the breeze), your body gets cooler. If the weather is hot and also humid, your sweat can't evaporate very well. So, as the humidity goes up, your body doesn't cool off as well. This means that your body's internal temperature begins to rise. When you can't sweat enough to cool your body, you might get a heat illness. Heat illness may cause you to feel tired, to have muscles that are weak, tired or cramping, and to have dizziness, nausea, vomiting or headache. Heat illness may cause you to feel tired, to have muscles that are weak, tired or cramping, and to have dizziness, nausea, vomiting or headache. Heat cramps, heat exhaustion, heat stroke and sunstroke are different heat illnesses. They occur when your body isn't able to keep itself cool enough.

Heat-related illnesses consist of three stages: heat cramps, heat exhaustion and heatstroke. These can range from relatively mild to life threatening. Everyone should learn to recognize and treat the symptoms as soon as possible, especially before earlier stages progress to heatstroke.

A Wise Cacher Knows: By the time you feel thirsty, you are already significantly dehydrated. Older people, especially the elderly have impaired thirst mechanisms and are more likely to dehydrate.

Heat Cramps
Usually seen with intense physical activity along with some degree of dehydration and often profuse sweating. The large muscles, such as the calves, hamstrings, and abdominals are usually affected. Treatment consists of moving the person out of direct sunlight, preferably into a cool, shaded area. Resting is essential. Massage and passive stretching of the affected muscles will bring quick relief to the cramps. Hydrate well, preferably with a diluted sports drink or oral rehydration solution. A teaspoon of salt in a liter of water will also do. If you don't have a rehydration solution, have the person eat lightly salted snacks while drinking water. Don't use salt tablets to rehydrate, as these are too concentrated and often make people nauseous.

Heat Exhaustion
Heat exhaustion is a broad-spectrum illness caused by exposure to a hot environment and development of dehydration. The symptoms include weakness, fatigue, nausea, and headache, the inability to continue activities, decreased appetite and, at times, mild confusion. The victim will have a rapid pulse and their skin may be warm and dry or moist with sweat. Be watchful for signs or symptoms of heat stroke and, if you suspect heat stroke, get the person to a hospital as soon as possible. Treatment consists of moving the victim out of the sun to a shady spot and beginning oral rehydration slowly. Rehydrating too rapidly will just cause nausea and vomiting (which will result in worsening dehydration and electrolyte loss). Have the person lie flat with their feet elevated if they feel dizzy or have fainted suddenly. Have them rest quietly while rehydrating with a sports drink or oral rehydration solution. Remove heat-retaining clothing and wet the person down and fan them to help cooling by evaporation. Place a wet cloth (cool, but not cold) on their forehead or behind their neck. Recovery is usually uneventful, but may take up to 24 hours. Be watchful for signs or symptoms of heat stroke and, if you suspect heat stroke, get the person to a hospital as soon as possible. Heatstroke is extremely serious. Seek medical attention right away while you attempt to cool the person down.

Heat Stroke
Heatstroke is a serious medical emergency, requiring aggressive cooling and immediate evacuation. Heat stroke should always be considered when a person collapses without another obvious cause. Heat stroke is diagnosed by seeing a core body temperature over 104 ° F (40.5 ° C) and mental status changes which can be quite significant. The skin may be hot and dry, although a fit person may still be profusely sweating. The other symptoms and signs are rapid pulse, low blood pressure, loss of coordination, confusion, inability to walk and sometimes bizarre behavior. It's important to remember that heat exhaustion and heat stroke can be seen in the same settings with similar symptoms but heat stroke is different in that the changes are persistent and usually more pronounced.

...heat exhaustion and heat stroke can be seen in the same settings with similar symptoms but heat stroke is different in that the changes are persistent and usually more pronounced. Treatment is essential for survival, 20% (1 in 5 cases) of heat strokes are fatal.

First, move the person out of the sun to a shady spot. Once in a cooler area, elevate the legs and all clothing should be removed to allow the skin to radiate more heat. (This is not a time for modesty - although small strips of cloth may be used to cover genitals). Next, the person should be fanned and a light mist spray of water can be used to improve evaporative cooling. Ice water or cold water immersion, if available, has been shown to be one of the most successful methods of rapid reduction in core body temperature. This is hotly debated in the medical literature, but so far, no studies have shown any significant adverse outcome from using this method. In the absence of water or ice for immersion, ice packs can be used in the neck, groin and underarms (axillae) due to the larger volume of blood passing through these areas.

Light massage can be used to assist return of cooler blood from the peripheral muscles to the core. If the person returns to a level of consciousness that is appropriate, then oral fluids can be given as well. Evacuate the person to a medical facility as soon as possible (even if the person appears to be recovering) for more definitive evaluation for kidney or neurologic damage as a result of the heatstroke.

Aspirin, acetaminophen (Tylenol) or other anti-fever medications are not helpful and should be avoided due to the potential effects they may have on the liver or kidney.

1. Identify climatic conditions in which heat-related illnesses are likely: temperatures of 90 degrees F or higher, and high relative humidity.
2. Get plenty of sleep and eat fruits and vegetables high in potassium to help your body adjust to the heat.
3. Keep cool: Stay out of the sun if you can; seek shade or air-conditioned buildings; wear sunscreen, a hat, sunglasses and baggy clothing that breathes well; schedule demanding activities for cooler parts of the day.
4. Limit physical exertion, especially if activity causes you to be soaked with sweat. If you're dripping with perspiration, this may be a sign that your sweat is not evaporating sufficiently to cool your skin.
5. If you can't avoid physical activities in the heat of day, allow your body to acclimatize by spending an hour or so doing physical activities in the heat over a period of 10 days. Increase the amount of time gradually to allow your body to adjust to the heat.
6. Stay hydrated. Drink a minimum of 3 quarts of fluid per day and increase this to 4 or 5 quarts if you will be exerting yourself. If you will be exercising vigorously or sweating a lot, water alone is not enough. You'll need a sports drink with electrolytes about 1 quart for every hour of exercise.
7. Avoid amphetamines, antihistamines, anti-depressants or other drugs that affect your body's basic functions.