By Kenneth Cayce, IV, M.D.
Every year we hear of athletes who have fallen victim to heat problems. Did you know the dog days of summer and early fall can actually be bad for your health? Extremely hot days have resulted in an increase in the incidence of heat illnesses. No matter how fit you think you are, you can experience heat illnesses if you’re not prepared. Heat illness can be mild (heat cramps), moderate (heat exhaustion or heat syncope), or severe (heatstroke).
Mild heat illness or heat cramps are the painful muscle contractions often occurring after exercise. These cramps occur most commonly in the calf or hamstring, however any muscle can be affected. When these painful cramps occur, the pain is relieved by stopping the exercise, and massaging or stretching the muscle. Some athletes have even increased their dietary salt intake days before an athletic competition to prevent heat cramps. This may be an effective method, although does not guarantee that heat cramps will not occur, and may not be suitable for all athletes.
Moderate heat illness, or heat exhaustion, occurs in athletes with an elevated body temperature ranging from 100.5 to 103.9 degrees Fahrenheit. Heat exhaustion can occur during or soon after exercise. Signs of heat exhaustion include: headache, dizziness, fatigue, irritability, anxiety, chills, nausea, vomiting, and heat cramps. Body temperature must be returned to normal, approximately 98.6 degrees, to prevent progression to heatstroke, an extremely serious condition. Treatment includes immediately stopping the activity, going to a shaded area or cool environment, drinking cold water, and spraying the athlete with a cool mist. Placing a bag of ice under the armpits, around the neck, and around the groin are effective techniques to aid in temperature reduction. Knowing the symptoms of heat exhaustion is crucial.
Heat exhaustion can quickly progress to heat stroke if the athlete does not recognize the symptoms and immediately seek treatment.
Heat syncope or exercise-associated collapse is another form of moderate heat illness. Heat syncope can occur during or shortly after exercise. The primary symptom of heat syncope is passing out, or loss of consciousness. Loss of consciousness should always prompt immediate medical care, regardless of the cause. Low blood pressure during, or after exercise, in addition to extreme heat are the major causes of heat syncope. Treatment includes lying the athlete down on their back with their feet propped up. By raising the athlete’s feet above their head, blood flow will be increased to their head and the athlete should regain consciousness.
Severe heat illness, or heatstroke, occurs when the body reaches a temperature greater than 104 degrees and the athlete exhibits at least one of the following symptoms: altered mental status, seizures, or coma. Heat stroke is a medical emergency. Symptoms common to heat exhaustion, in addition to a temperature of 104 degrees or greater, also constitute heat stroke. If an athlete meets these criteria, 911 or your local emergency response team should be immediately called and the athlete should be transported to the emergency department for life saving care. Until EMS arrives, the following techniques may aid in the treatment of the athlete. Placing the athlete in an ice water bath or “tub” until the body temperature is 102.2. If no tub or bath is available, placing bags of ice on the athlete’s neck, under arms or groin is beneficial. Avoid any medications to “treat heat stroke” as these medications can cause liver or kidney damage in this state. Drinking cold water is the preferred treatment, provided the athlete is conscious and able to drink.
After appropriate treatment, the athlete should not participate in sports and avoid physical exertion for at least 24-48 hours. Throughout the season, the athlete will need to be carefully monitored because he/she has an increased risk of having another heatstroke in the future.
Preventing heat illness is as important as the treatment. There are five keys to the prevention of heat illness.
1. Get used to the heat and humidity for 10-14 days prior to competition. This allows the body time to compensate for the extreme environment. The first 4-5 days are the most important because during that time the sweat composition changes which allows the body to get rid of heat better.
2. Clothing should be light colored and lightweight.
3. Medications that decrease heat loss such as antihistamines and ephedra compounds should be stopped. Ask your sports medicine physician which medications can be used or changed to prevent heat illness.
4. Activities should be planned based on temperature and humidity. Do not schedule activities if the temperature and humidity are both high.
5. Hydration for sporting events should be as follows: 16 oz of water or sports drink 2 hours before exercise. During exercise drink 20-40 oz of water or sports drink every hour (that can be divided in 5-10 oz every 20 minutes). After exercise, drink 32 oz of water or sports drink per each pound lost during exercise by weighing yourself before and after exercise.
Summer and early fall months are a great time to enjoy the outdoors, and with these five steps for prevention, you can make your summer and fall safer. Remember heat illness occurs because your body is not able to efficiently get rid of heat. Prevention is always the best medicine. Keep the athlete on track for a sensational season. For heat illness, or any other sports medicine/ primary care issues, contact the experts at Cincinnati SportsMedicine and Orthopedic Center.
Editor’s Note: Kenneth Cayce, IV, M.D., is a Primary Care/Sports Medicine Physician at Cincinnati SportsMedicine and Orthopedic Center. Dr. Cayce is currently accepting new patients by calling (513) 891-3200 for an appointment.
