“Summertime and the livin’ is easy. The fish are jumpin’
and the cotton is high.”
~George Gershwin
This quote always reminds me of a romanticized summer full of lazy days
and gentle breezes blowing in from the shore. Here in South Georgia, we
are lucky to experience that day just once or twice a year. Summer days
in Georgia are hot. Most often, they are a sticky, wet, wool blanket kind
of hot. Days that cause the air conditioner salesman to celebrate and
the repair man to curse. The heat in the South is abrasive and overwhelming
due to the high temps and high humidity. My advice to those among you
who have a choice about whether or not to go out in the heat is simple:
don’t! To those of you who have to work or choose to play outside
in the dog days of summer, the following precautions can’t be stated
strongly enough. Unless you are a Cicada buzzing in a tall pine tree,
you are constantly flirting with heat illness, and it is not a condition
to be taken lightly.
Dangers of heat illness
First off, the dangers of heat illness to your health cannot be over emphasized.
In recent years, several professional and college athletes have succumbed
to heat stroke. Between 1995-2009 there have been 31 deaths in the United
States due to heat injury in high school football alone. These are athletes
in peak physical condition, folks, so you can imagine how easy it would
be for all of us weekend warriors to experience it. High school athletes,
especially males, are at the highest risk of suffering exertional heat
illness. Heat injury is preventable with a basic understanding of the
causes, degrees of heat illness, signs and symptoms, and prevention strategies
necessary to avoid it.
Cause of heat illness
To understand how to prevent heat illness (and why my dog digs a huge hole
in the summer under my azaleas), it is best to understand how our bodies
process high temperatures. Heat can act on the body or dissipate from
the body in four ways: conduction, convection, radiation and evaporation.
Conduction is just direct contact with something. Convection is loss of
heat as air passes over the skin. Radiation is direct sunlight. Evaporation
is removal of heat from the body by perspiration.
Normally evaporation, most commonly through sweating, allows for great
heat exchange and maintains the body’s temperature. In the South,
however, the sun is relentless, the wind is absent and the humidity averages
greater than 85 percent. This trifecta leads to the body’s inability
to cool itself because of an ironic circumstance: with increased heat
during exercise, our body sweats to cool down, yet perspiration does not
evaporate in the humid air. It just sits on the skin, essentially trapping
the heat in our pores.
Bring down the heat
Heat illness can run the gamut from mild heat cramps to heat stroke, a
true medical emergency. Decades ago, when my wife and I had just begun
dating, she called my parents’ house, and my father told her that
I was unable to come to the phone due to the fact that I was writhing
around on the floor. After a robust game of tennis in the middle of July,
I had come home and collapsed with heat exhaustion. Luckily, my parents
knew how to handle it and soon brought my body temperature down with cold
packs and lots of hydration. Not everyone who suffers such an episode
will have the knowledge or opportunity to recover as easily as I did.
The common denominator with all heat illness is the body’s inability
to keep itself at a safe temperature. Recognizing the early signs of heat
illness will keep it from progressing into a situation that can rapidly
become dangerous.
Early signs of heat illness
Mild heat illness usually manifests itself as heat cramps. This can be
painful cramping in the stomach, arm or leg muscles caused by not properly
replacing fluid and electrolytes during intense exercise. Most people
have experienced this type of episode and know to find a way to cool down
and hydrate before their body temperature escalates further.
Moderate heat illness, which can manifest itself as a loss of consciousness
or heat exhaustion, is also brought on by intense exercise in the heat
without proper fluid replacement, but the biggest difference is that instead
of just cramping, the individual starts to exhibit systemic signs and
symptoms such as weakness, fatigue, fainting, dizziness, nausea and vomiting.
Core body temperatures in someone with moderate heat distress can reach
up to 104 degrees.
Severe heat injury, often called heat stroke, is a medical emergency when
the core body temp is greater than 104 degrees and can lead to organ failure
and death. Heat stroke is usually preceded by a person’s inability
to sweat, nausea, vomiting, confusion and seizures.
Provide immediate treatment
The steps of treatment for all the different levels of heat illness are
to immediately remove the stricken person to a cool, shaded area, remove
tight clothing, give fluids if the patient is conscious, soak in an ice
bath (which is extremely important for moderate to severe exertional heat
illness), and reassess frequently. With severe heat injury, 911 should
be called immediately, but the aforementioned treatment protocol should
be initiated while waiting for EMS.
Steps to prevent heat illness
Prevention is the key to heat illness. With a little common sense, an athlete’s
risk of heat injury can be greatly reduced.
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Camel Up, as I like to say. Keeping well hydrated cannot begin right before the
athletic event. In the hot summer, athletes should be constantly drinking
water and electrolyte replacement, such as Gatorade and Powerade. Stay
away from caffeinated drinks as they can promote dehydration and drinks
with high sugar content as they can cause stomach cramps. A general recommendation
is to drink 24 ounces of fluid two hours before an event and an extra
eight ounces 20 minutes before the event.
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Proper clothing. These days, great technical fabrics wick the perspiration away from the
body and are highly recommended.
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Acclimate. It can take a few weeks for the body to acclimatize to the heat. During
this initial period, take frequent breaks, try to exercise earlier in
the morning or later in the afternoon, and stay out of the direct sunlight.
Gradually increase activity over 10 to 14 days.
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Weigh yourself. Normally if time permits, regular food and fluid intake will restore hydration
status, however, if the athlete is exercising for multiple days in a row,
monitoring hydration status is important for performance and preventing
chronic dehydration. Even mild dehydration of three to five percent body
weight can significantly affect an athlete’s performance. By weighing
before and after a workout, the athlete can replenish fluid loss by drinking
around 1.5L of fluid for every kilogram of body weight loss.
I hope everyone has a great summer, and be careful.