Extreme Heat Takes a Toll on Our Health and Life

A woman drinking water on a warm day. (iStockphoto/Thinkstock)
A woman drinking water on a warm day. (iStockphoto/Thinkstock)

There are two kinds of people. People who like heat in moderation and those who like heat in extreme. Then there is a third group of people who like extreme cold weather. Nature took care of this group by turning them into polar bears.

I am a person who likes heat in moderation. My friends say I should be the last person on earth (that is little far fetched, isn’t it?) to complain about heat.

I was born and raised in Musoma and Mwanza on Lake Victoria. I would call the weather in those two places is not bad. Nice and warm all year round. Then I went to a boarding school in Dar-es-salaam, on the shores of Indian Ocean. Wow, the weather is hot and humid. White shorts and shirts were the norm on weekends. On school days, khaki shorts and white shirt.

Those were the days. I was young and healthy. Heat wasn’t a big deal. I didn’t have hairy legs or varicose veins sticking out of my ugly legs. I didn’t have all the scars from childhood injuries showing off from my multi coloured legs. Wearing shorts was cool.

Now things are different. Once you get to male or female menopause, your tolerance for heat is not the same. Your kidneys start to pack-in if you do not drink enough water. And among the aging population, extreme heat causes a substantial number of deaths.

For example, the European heatwave of 2003 resulted in more than 70,000 deaths, About 30 per cent of which were attributed to heatstroke, hyperthermia or dehydration. Canadians too die of extreme heat. Reports indicate that extreme heat recently contributed to 106 deaths in Montréal, Quebec, and 156 deaths in Vancouver, British Columbia.

People who have chronic physical conditions (cardiovascular, pulmonary, renal and neurologic disease, diabetes and obesity) and those with mental illness are vulnerable to extreme heat. Older people, children and people who are very physically active in the heat are also at higher risk for heat-related illness.

Common drugs such as antipsychotic agents, antidepressant medications (e.g., selective serotonin reuptake inhibitors, lithium), diuretic agents, antihistamines, anticholinergic agents and anti-Parkinson agents can increase risk by interfering with thermoregulatory mechanisms, says an article in the Canadian Medical Association Journal (CMAJ July 10, 2012).

What is heat exhaustion?

Heat exhaustion is the most common heat illness, says the CMAJ article. Although the patient may have hot skin and be flushed and sweating, his or her core temperature is below 40°C.

What is heatstroke?

In heatstroke, the core temperature is above 40°C, the patient’s mental status may change, and he or she may become incoherent or unconscious, says the article. In classic heatstroke, the skin is usually hot, red and dry. In exertional heatstroke, there is profuse sweating after high-intensity physical activity.

Heatstroke is a medical emergency. It can progress rapidly to multiorgan dysfunction and death. Treatment must be immediate and consists of rapid cooling (evaporative cooling for classic heatstroke; ice-water baths for young adults and people with exertional heat stroke). Careful attention should be paid to the patient’s hydration and electrolyte balance to restore blood pressure and tissue perfusion.

Death from heat exposure is preventable by increasing fluid intake and reducing activity levels during hot weather. Cool or air-conditioned environments for people most vulnerable to heat also helps. Some communities have heat alert and response systems that include issuing public health messages, opening cooling centres and extending hours for public swimming pools.

Enjoy the summer but be careful.

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Heat Wave and Heat Stroke

Hot days are here. Some like it hot. Others find it unbearable. But hot days can be dangerous. Especially during a heat wave.

What is a heat wave?

Three or more consecutive days during which the air temperature is more than 32.2 degrees Celsius. Because of the global warming, the intensity of the heat waves is expected to increase over the years to come.

What is a heat stroke?

“Heat stroke is a life-threatening illness characterized by an elevated core body temperature that rises above 40 degrees Celsius and central nervous system dysfunction that results in delirium, convulsions, or coma”, says an article in the New England Journal of Medicine (NEJM).

Extreme heat can cause other minor to moderate ill effects called heat stress and heat exhaustion. If not controlled or prevented then these conditions can lead to heat stoke and eventually death.

Heat strokes can occur due to exposure to high environmental temperature or from strenuous exercise.

The NEJM article says that the most complications of heat stoke are those falling within the category of multiorgan-dysfunction syndrome. That means many systems of the body are affected – brain (encephalopathy), muscles (rhabdomyolysis), kidneys (acute renal failure), lungs (acute respiratory injury), blood (bleeding complications).

Who is prone to heat stroke?

Usually very young or elderly persons and in those who have no access to air conditioning, says the article. It is also common among persons with chronic mental disorders or heart and lung problems.

How can we prevent heat stroke?

Heat stroke can be prevented. Authors of the NEJM article propose the following actions to prevent heat stroke:

-acclimatize yourself to heat
-schedule outdoor activities during cooler times of the day
-reduce your level of physical activity
-drink additional water
-consume salty foods
-increase the amount of time you spend in air-conditioned environments.

We cannot change nature. But we can adapt to our environment and create conditions to protect ourselves.

Prevention is better than cure! Enjoy the summer and stay cool!

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Summer Heat

The heat is on! The air conditioners are going crazy! And the people are asking: Hot enough for you?

Many of us have been waiting for this kind of weather. But is it healthy? Is it safe?

Some of you may remember the heat wave of Chicago in 1995. Many people died. About 20 years ago, heat also claimed the lives of 88 people in Memphis, Tenn. Most of these deaths are due to heat stroke. Heat stoke is dangerous and deadly but fortunately, preventable.

The vast majority of people affected by the immense heat are the elderly with medical problems such as mental illness, lung diseases, or heart disease. Social isolation is another factor. People who live alone and /or are confined to bed are at higher risk compared to those who have access to transportation, nurse visitors or social services, Having an air conditioner helps. But not many elderly people can afford it.

Memphis has adopted a protocol to prevent death from dehydration and heat stroke amongst the sick and elderly and the public in general. At the beginning of summer, officials organize surveillance of emergency departments in the area to see if heat-related visits have increased.

Once temperature starts to rise, media print or broadcast general public advice to increase fluid intake, to reduce physical activity, and to seek medical help for heat related problems.

Visiting nurses, Meals on Wheels workers, and letter carriers help out in finding people who live in isolation and are at increased risk of heat stroke.

Our temperatures may not rise to a level of heat waves seen in Chicago or Memphis but the danger is still there for people of any age group who do not maintain adequate fluid intake during summer months. Especially people with medical conditions.

Effective treatment for heat stroke depends on rapid diagnoses and rapid cooling. Otherwise, a chain of events will lead to irreversible injury and death.

The blistering sun is also damaging to our skin if it is exposed to the sun for prolonged periods of time on a regular basis. The damage is cumulative, starting with sunburn and progressing over a period of time to skin cancer.

There are three types of skin cancers: Basal Cell Cancer, Squamous Cell Cancer and Melanoma. First two are very common and can invade local tissues but are not fatal. Melanoma is not that common but can be fatal if not detected early and excised.

Can we prevent skin cancer? Yes! The Canadian Cancer Society recommends the following preventive measures:

1. Avoid prolonged exposure to the sun especially between 11 a.m. and 4 p.m.
2. Wear protective clothings, such as long-sleeved shirts, and wide brimmed hats.
3. Use a sunscreen with a SPF of 15 or higher to absorb ultraviolet rays.
4. Seek prompt treatment of any skin abnormality.

Summer is time for out door activities and fun. Children are out of school. Many adults take holidays during this time to enjoy family life. When we are having fun, it is hard to remember the dos and the don’ts. So let us make it simple by remembering two facts:

1. Skin is the largest organ of our body and has many important functions to protect us from environment.
2. About 60 percent of our body is water. Water and salt is vital to the survival of our cells and tissues.

So let us treat our skin with respect and keep our systems well lubricated with water and have fun!

Start reading the preview of my book A Doctor's Journey for free on Amazon. Available on Kindle for $2.99!