Save yourself from summer meltdown

ST. LOUIS - Folks who will suffer heat-related illnesses this sweltering summer seem to have one thing in common.

"They think they can handle it," said Dr. Mark Levine, an emergency room physician with Barnes-Jewish Hospital in St. Louis. "They're outside and exercising and take a run around Forest Park and think that they don't have to stop and get shade, or they don't want to stop and drink fluids.

"When they get to a point where they're exhausted, weak, even dizzy, they're already in trouble. Your body has started to shut down."

Experts agree that many people overestimate their stamina in the heat, and wait for symptoms to occur before attempting to take precautions. By then, it could be too late.

"Heat-related illness is probably the most common preventable injury that we see across the country," said Dr. Matthew Matava, an orthopedist and associate professor at Washington University School of Medicine.

The real bad guy in the heat conspiracy, Matava says, is dehydration. That occurs when your body has lost too much water and the nutrients that go with it. For inactive people, it's the result of not drinking enough water.

For active people it's the result of not drinking enough water while sweating away what water you have.

Infants, children, the elderly and people with illnesses are most susceptible.

Dehydration can be mild to life-threatening. In addition to dry mouth and sunken eyes, you may also have vomiting, diarrhea, dizziness or the feeling that you can't keep anything down.

Matava, who is also team physician for the Rams, says he sees heat problems especially during training camp, because young players don't drink enough water.

Despite what trainers tell Rams players, "I'll put in five IVs" in training camp, he says.

During the summer, there's a lot of sweating. Trainers watch out for professional athletes, but other competitors, especially children and teens, need to be vigilant about preventing dehydration, Matava said.

The symptoms can be quite scary. For example, dizziness occurs when the heart slows because of dehydration. Your brain isn't getting enough blood and you're struggling to stay conscious.

As the condition worsens, the body stops sweating and internal temperature rises. You may cramp, get nauseated and even black out. By then you should be in an emergency room getting fueled from a plastic bag of saline solution.

What frustrates physicians is that it's so easy to prevent. The key: Drink water regularly, whether you're thirsty or not. "Your thirst centers are inaccurate," Matava said.

To be safe, start drinking a few hours before an event.

Matava added, "The ultimate problem is a complete shutdown of the cardiovascular and neurologic function. You'll have increased sweating and, eventually, your body shuts down and you lose the ability to sweat. You may become unconscious.

"That's what you see: Someone is passed out, it's 90 degrees, and he's not sweating."

Once the problem gets to that stage, it's time for medical help, he said. "Often, the body won't accept water by mouth and intravenous hydration is necessary."

Extra danger from dehydration occurs among people who can't look after themselves very well: children, who are too young to care for themselves, and older people, who sometimes won't take care of themselves.

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Babies tend to sweat less and aren't equipped to handled high heat and sunlight, said Dr. Susan Bayless Mallory, a pediatric dermatologist at St. Louis Children's Hospital. That changes with age, but parents must make sure children are drinking enough water and not getting too much sun, she said.

Babies and young children often suffer more sunburn than heat problems, she said. That happens because parents let young children play in the sun too long, or they take babies outside in strollers that aren't shaded.

"A lot of people just don't think," Mallory said. Even for teenagers, parents should be vigilant, she said.

"I try to tell teenagers who are really fair not to be lifeguards," she said. "They sit out all day in the blazing sun. It's better now because of sunscreens and umbrellas, (but) they have more exposure than they should have."

Teens also have the added problem of overdoing it, especially in competitive sports. Area hospitals report that most heat-related problems among teens are from athletes who play too much and drink too little.

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"The elderly are a bit more sensitive to the effects of heat because of physiologic changes as people get older," said Dr. Julie Gammack, assistant professor of geriatrics at St. Louis University School of Medicine. "The body doesn't regulate sweating and temperature as well. In fact, we find older adults tend not to get fevers when they get ill. Sometimes they actually get lower temperatures."

That means it's often difficult to tell when an older person has become dehydrated.

"The more frail, the more chronic medical conditions a person has, the more medications they're taking, makes them at higher risk for excess heat," she said.

In addition, the body doesn't sweat as much.

"They can't use that as a way to get rid of excess heat when they get hot," she said. "Older adults' skin tends to be drier, (with) not as much perspiration. They may not notice the sweating response to being overly warm as they did when they were younger."

That's compounded when people live alone and face the economic problems of balancing expenses for food, medication and comfort. Often, air conditioning is the first thing to go. Then, for fear or some other reason, they shut up the house and it becomes unhealthy, even deadly.

Also, "There are many diseases of dementia that can cause people to become paranoid or reclusive," Gammack said. "That certainly can be the case that people are fearful. That's why they shut their doors and windows."

In any event, it's essential that someone check on older people living alone.

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HOW WE REACT TO HEAT

The average person:

For most people, dealing with the summer is common sense.

FLUIDS: Drink something. Water is best, but sports drinks are OK, too. Alcohol and caffeinated drinks can even increase dehydration.

HEALTH CONCERNS: Symptoms of overheating include dizziness, weakness, fatigue, dry mouth and dark, infrequent urination. You may or may not feel thirsty. If symptoms seem troublesome, consider going to an emergency room. Often, when symptoms get to that point, the body is shutting down. If you take a gulp of water and you vomit it back up or it causes pain, you need to get help. Some medications can increase your risk of sunburn or interact with the sun to cause rashes or other side effects. Check with your doctor or pharmacist to find out if any of the medications you are taking can cause these side effects.

HEAT: Obesity and illnesses such as diabetes can be trouble in the heat. Extra fat is an insulator, so obese people can have more problems with heat than others. Remember that when you exercise.

SUN: Wear sunscreen; an SPF of 30 is recommended. Also, wear a wide-brimmed hat, light-colored clothing to reflect sunlight and sunglasses with UV protection to help shield your eyes from the damaging rays.

Infants and young children:

Unlike adults, infants can't complain other than to cry. They can't protect themselves from the heat, and their skin is too fragile for direct sunlight.

FLUIDS: It's easy to forget the children need fluids, and a dehydrated baby may not cry. Breast milk and formula will do for infants, but older children need water.

SUN: Here's a rule to go by: If the skin on their shoulders feels the same as the skin on their behinds, they're not ready for direct sunlight. Shoulder skin toughens up over time; skin on the behind never gets old. So be very careful in the sun. Dress them in light, airy clothing and keep them out of the sun. Children under a year old should always be shaded, with an umbrella if necessary. The next alternative is sunblocks-use substances with zinc oxide or titanium oxide.

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OLDER CHILDREN AND TEENS:

Young athletes can play hard and sweat a lot.

FLUIDS: After an hour of physical exertion, kids should drink sports drinks that are less than 5 percent sugar. Doctors seem to prefer Gatorade.

HEAT: Most heat-related emergency-room visits for children are for teen athletes, say area doctors. Teens often just drink water, then compete or even work for hours at a time. Getting some rest and time to cool off are important.

SUN: Limit sun exposure, especially from 10 a.m. to 4 p.m. Allow play in early mornings and after 4 p.m. Have kids wear the heaviest sunscreens or sunblocks available. Tanning is a big problem with teens, too. Many still don't realize it causes cancer. Educate your children or introduce them to sunless tanning booths, experts say.

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ATHLETES:

Athletes may think they're indestructible because they're in good shape. Actually, they're in more danger of dehydration than nonathletes because of overexertion.

FLUIDS: Athletic and active people sweat more, and their bodies use fluids faster because of the exertion. People in this category should drink a lot of fluids (sports drinks if they will be exercising for more than an hour), take frequent breaks and find shade. Professional athletes are told to drink 8 ounces of water every 15 minutes two to three hours before exertion. Weigh yourself before an event, then weigh again afterward. If you've lost weight, replace each pound with a pint of water.

HEAT: If you're just starting to work out and aren't used to the summer heat, work lightly outdoors a little at a time over a couple of weeks until your body is used to the outdoors. Then go full-steam. Wear synthetics made for heavy sweating. Cotton doesn't suit high-exertion sports or activities-it holds water, which holds heat in the body. Remove headgear when you're not using it-it can hold heat, especially football helmets in summer practices. Don't work out in the heat of the day; the hottest time is between 10 a.m. and 4 p.m.

HEAT EXHAUSTION: If someone collapses from cramping or heat exhaustion, call an ambulance and get to an emergency room. It's past time where drinking and resting are a remedy.

SUN: Wear waterproof sunscreen of SPF 30 or higher. Consider UV-protected clothing.

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FOR OLDER PEOPLE

The elderly are generally more sensitive to the effects of heat. As people age, they don't sweat as much and their body temperatures may not respond properly to dangerous heat or cold. And some blood-pressure medications can cause sun sensitivity.

FLUIDS: Regardless of whether they're thirsty, older people should drink more fluids-even small amounts frequently. At the least, they should have a glass of fluid with each meal and one between meals. If the urine darkens, that can mean a person is running low on fluids. Some vitamins and medications discolor urine, but dehydration will produce much darker fluids or no urine at all. Some medications-water pills, for example-can exacerbate dehydration.

HEALTH CONCERNS: Watch for signs of confusion, exhaustion, nausea, headaches, cramping and other uncommon maladies.

BEHAVIOR: Reclusive behavior often results from dementia, depression, loneliness and economics. This can cause people to fail to look after themselves.

HEAT: Look in on older friends, relatives and neighbors. Often older people will turn off air conditioners because they're too expensive to run. Some social agencies can help. The other option is to get them to cooler places during the heat of the day-a mall, a friend's home, anyplace that's not sweltering.

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(c) 2005, St. Louis Post-Dispatch. Distributed by Knight Ridder/Tribune News Service.