How to Keep Your Cool as the World Heats Up (RERUN)

Karen shares potentially life-saving advice for staying safe in extreme heat as record-breaking temperatures sweep across the country. She explains how heat exhaustion and heat stroke develop, how to recognize early warning signs, and what to do if you or someone else is affected.

Visit our website itchyandbitchy.com to read blog posts on the many topics we have covered on the show.

Episode Transcript

Speaker 1 (00:00):
The content of this podcast is provided for general informational
purposes only and is not intended as nor should it
be considered a substitute for professional medical advice. Hello, this

(00:21):
is Karen Nickel, family nurse practitioner, and you are listening
to Itchy and Bitchy, a podcast that provides answers to
your many unanswered health questions. During the last two summers,
I have aired an episode about heat exhaustion and heat stroke,
and with the Earth's temperature continuing to rise and the
recent record breaking tempts across the country, I felt this

(00:45):
is a very good episode to repeat to remind every
one of the measures you can take to beat the
heat and how to help yourself or someone else who
is experiencing heat exhaustion or heat stroke. On Monday, June
twenty third, twenty twenty five, almost three quarters of the
country's population two hundred and forty five million people sweltered

(01:11):
with ninety degrees fahrenheit about thirty two degrees celsius or
higher temperatures, and thirty three million people, which is almost
ten percent of the country, had blistering one hundred degree
heat about thirty eight degrees celsius. These temps were driven
by something called a heat dome. A heat dome occurs

(01:35):
when a large area of high pressure in the upper
atmosphere acts as a reservoir, trapping heat and humidity. A
heat wave is the persistence of heat, usually three days
or more, with unusually hot temperatures. Our summer temps here
in Knoxville certainly fall under the category of a heat wave.

(01:58):
We have had ninety degree and higher tempts every day
for ten consecutive days this June. If you don't believe
that the world is continuing to heat up. Last year,
on Monday, July eighth, twenty twenty four, more than one
hundred and fifty million Americans were under extreme heat advisories, watches,

(02:21):
or warnings. This summer, the number of people affected climbed
to two hundred and forty five million people, and we're
just a third of the way through the summer. Last summer,
in Phoenix, there were seventy consecutive days with temperatures of
one hundred and ten degrees fahrenheit or higher. Seventy consecutive days.

(02:46):
Also in the summer of twenty twenty four, this dangerously
hot city saw a record high of one hundred and
eighteen degrees fahrenheit or forty seven point seven degrees celsius.
On July seven, twenty twenty four, Las Vegas recorded its
highest temperature when it reached one hundred and twenty degrees fahrenheit.

(03:08):
It was also the first time Las Vegas had five
consecutive days with temperatures greater than one hundred and fifteen
degrees fahrenheit. This year, Las Vegas hit the one hundred
and ten degree mark before mid June. It was one
hundred and twenty nine point three degrees fahrenheit on July seventh,
twenty twenty four, in Furness Creek, California, an aptly named

(03:32):
town with a population of one hundred and thirty six
people that is located in Death Valley National Park. This year,
Furnas Creek hit one hundred and twenty two degrees on
June tenth, and has had temps of one hundred degrees
or higher every day in June, with the exception of
one day, which had a high temp of ninety eight degrees.

(03:56):
The entire country has been experiencing rising tim and there
doesn't seem to be an end anytime soon. Here's the episode.
Since we are all trying to beat the heat this summer.
I thought that reviewing information about heat exhaustion and heat
stroke would be helpful to all of our itchy and

(04:18):
Bitchy listeners. Heat is the number one cause of death
due to weather related events. Heat causes more death than hurricanes, wind, floods, lightning,
cold rip currents, and tornadoes. We are seeing more and
more heat related deaths as our planet heats up. So

(04:41):
what happens to us when the human body is exposed
to extreme heat? As you know, the body is an
amazing organism and it has two important ways to cool
down when your body has extreme heat exposure. The first
mechanism is sweat. Sweat glands on the skin secrete sweat,

(05:01):
and when it evaporates off the body, it cools the
skin down. I'm sure many of you have experienced this benefit.
Increased blood flow is the second mechanism. The brain redirects
blood flow from the core of the body to the
skin where heat can be released. The evaporating sweat helps
cool the blood in the skin, and that cooled blood

(05:25):
is recirculated into the eternal organs and cools down the
body core. There are two factors that can disrupt this
natural cooling process in your body. First, when the temperature
outside your body is hotter than your skin temperature, which
is around ninety five degrees. So if the temperature outside

(05:46):
is over ninety five degrees or inside is over ninety
five degrees, your skin will take in heat versus releasing
heat into the atmosphere. Also, if it's too humid, the
sweat on your skin and can't evaporate to provide cooling,
so the body no longer has that cooling mechanism. So

(06:07):
what does your body do when these processes are no
longer working because it's too hot or too humid or both.
The heart works a lot harder because the heart rate
increases in an effort to push more blood out to
the skin to cool the body. However, when this happens,
the blood pressure drops because as the blood gets pushed

(06:30):
to the wider surface area of the skin to provide
that cooling, the blood pressure gets weaker and weaker as
it gets moved out to further areas of the body.
The drop in blood pressure is a common cause of
injuries because people get dizzy or lightheaded when they sit
up or stand up when the blood pressure is low

(06:52):
and dizziness is an early sign of the body overheating.
The increased heart rate can really tax the heart, so
if someone has a pre existing heart condition, it can
be fatal. Heat exhaustion, otherwise known as heat stress, is
the first problem that can begin when getting overheated, and

(07:13):
during heat exhaustion, the internal temp in the body rises
to one hundred up to one hundred and three degrees
and the symptoms that occur in heat exhaustion include fatigue
and poor muscle function. These are early symptoms and there
are messages from your brain to tell you to rest
and cool down. Find a shady spot, find some air conditioning,

(07:37):
sit down and rest. The other symptoms of heat exhaustion
include nausea, feeling faint or having a sense that you're
going to black out, Sweating profusely from many areas of
the body, moist cool or cold skin coupled with goosebumps
even in extreme heat, a pulse rate that becomes weaker,

(08:00):
rapid headache, and muscle cramping. I have a dear friend
who had many of these symptoms last summer. The most
concerning for her was a severe headache. She went to
her doctor's office to find out what was going on.
They did some blood work. One of the tests was
an inflammatory marker called CrPC reacted protein, and that was

(08:22):
quite elevated. They weren't sure what was going on, and
so no diagnosis was made or treatment initiated. When she
didn't have answers and was quite concerned about the symptoms,
she called me When she told me what she was experiencing.
I said that what she described was consistent with heat exhaustion.

(08:44):
I asked her about her activities prior to the onset
of her symptoms, and she said she had played pickleball
for several hours during the heat of the day. I
instructed her to increase her hydration to an amount that
is half her body weight in ounces of fluid, So
as an example, if someone is one hundred and fifty pounds,
that means seventy five ounces of fluid a day. I

(09:08):
also told her to include electrolyte drinks containing sodium as
part of her fluid replacement. I often recommend noon sports
tabs that spelled in un sports tabs that contain roughly
fifteen calories and two carbon excuse me, two grams of carbohydrates,
thirteen milligrams of calcium, three hundred milligrams of sodium, one

(09:32):
hundred and fifty milligrams of potassium, twenty five milligrams of magnesium,
and forty milligrams of chloride in each tab. Most sports
drinks are high in sugar and don't contain sodium, which
is a key electrolyte to replace if you're sweating a lot,
so noon sports tabs are a good option. In addition

(09:53):
to hydrating, I told her to stay in air conditioning
to avoid heat exposure, and to rest her body by
avoiding exercise. I also instructed her to use ice packs
to her neck, forehead, and or wrists. She implemented all
of those measures and recovered within a day. She was
advised by me to report to the er if her

(10:16):
symptoms didn't resolve with these measures, since heat exhaustion can
easily progress to heat stroke, which is a medical emergency.
I also reviewed with her ways to avoid heat exhaustion
in the future, including hydrating before, during, and after exercise,
and to watch for early signs and symptoms of the

(10:39):
body overheating when she is participating in outdoor exercise during
hot weather, or avoid outdoor exercise altogether when the outdoor
temperature is greater than her skin temp of ninety five
degrees fahrenheit. If she experiences these symptoms of heat exhaustion
in the future, I told her to take the fall

(11:00):
measures cool the body down by moving to a shady
area or to a place with air conditioning. Of course,
stop the exercise of your exercising or whatever activity. Drink
water or a beverage with electrolytes like noon tabs, which
you can just drop into your bottle of water, and
that will help you hydrate. If possible, have someone else

(11:23):
bring you a drink while you rest. If you're wearing
tight confining clothing, loosen or remove it. Remove heavy clothing
or accessories, and apply ice packs or towels soaked in
cold water to your body, placing these on your forehead,
your wrists, the back of your neck, or under your arms.

(11:43):
Those can be particularly effective places for cooling the blood.
Coming up after this break, I will discuss the difference
between heat exhaustion and heat stroke. Stay with me, Welcome

(12:13):
back everyone. As promised, I'm going to talk to you
about the difference between heat exhaustion and heat stroke. The
body does a really good job to try to cool
you off, but if these mechanisms to cool down start
to fail, the body temperature continues to rise. As I

(12:33):
mentioned before, heat exhaustion occurs when the body temperature is
one hundred to one hundred three degrees fahrenheit. Heat stroke
occurs when the body temperature reaches one hundred and four
degrees fahrenheit. At this point, multi organ failure can happen.
It's serious business. The organs that are affected first are

(12:58):
the heart, kidneys, gut, and brain. Your heart is pumping
very hard to help cool you off, and as the
heart rate increases I mentioned before that the blood pressure
drops and as a result, oxygen is not getting to
the organs, including the heart itself. The kidneys are impacted

(13:21):
because the brain sends a signal to the body to
send less blood to the kidneys to slow the dumping
of liquid via urine in order to preserve as much
liquid as possible. But the kidneys begin to fail due
to the reduced blood flow, resulting in reduced oxygen to
the kidneys. In an effort to cool your skin, blood

(13:45):
is diverted from the gut, decreasing oxygen to the gut,
and when that happens, the gut starts to fail and
leaky gut occurs, which is when bacteria leaks from the gut,
and it can cause sepsis, which is an infection all
over your body because infection occurs in the bloodstream. Once

(14:06):
the brain is affected, things get really dire. The body's
internal thermometer is in the part of the brain called
the hypothalamus. Once this part of the brain is infected,
the cooling mechanism message from the brain shuts down and
the body temperature continues to rise. The skin gets clammy

(14:27):
and cool and delirium begins. The fastest way to cool
people off in this situation when someone's got heat stroke
symptoms is to give them an ice bath, and this
is what they use in the er to cool people down,
a modified ice bath. Some people may be concerned that

(14:49):
it could be dangerous to do something that causes a
rapid drop in body temp, but the overheating of the
body is more dangerous than the rapid cooling treatment. The
best thing to do is to cool the body down
as fast as possible, and an ice bath will do
just that. If you are helping someone who has symptoms

(15:12):
of heat stroke, you can provide body cooling using the
techniques recommended by up to date. Up to Date is
an evidence based, physician authored clinical knowledge system that is
frequently updated and used by many clinicians, including myself, to
help provide the appropriate care for their patients. So if

(15:33):
you are helping somebody with heat stroke, the first thing
to do is to contact emergency medical services immediately before
starting an ice bath. Assess the person's airway and circulation,
make sure they are breathing, and have a pulse. Move
that person to a shaded area. Half fill a tub

(15:56):
or a waiting pool with water and ice. I should
cover this surface of the water at all times, so
you should have floating ice over the entire surface of
the water at all times. Cover as much of the
body as possible, but not the head with ice water.
If complete coverage is not possible, cover the torso as

(16:18):
much as possible. I want to get to that core
of the body. Keep the neck and head above the water,
and place a towel soaked in ice water over the
head and neck while the body is being cooled. Do
not block the airway. Keep the towel off the nose
and the mouth. You want to vigorously circulate the water

(16:38):
throughout the cooling process, so stir the water around while
you're cooling this person. If ice water immersion is not
feasible giving the constraints of the environment, if you're in
a place where that just is not possible you don't
have a tub, then cool the person using the best
available means. These may include any of the following three methods.

(17:00):
One is to fill a cooler with ice, water and
twelve towels. Place six icy wet towels all over the
person's body, leaving them in place for two to three minutes.
Then place those back into the cooler and replace them
with the other six towels that have been in the cooler.

(17:22):
Continue this rotation every two to three minutes. Again, don't
put the towels over the nose and mouth. The other
option is to douse the patient continuously with cold water
using a shower or a hose. The third option, if
ice is available but no tub, place the person in

(17:43):
a tarp or a sheet. Cover the person with a
large amount of ice, and then wrap the tarp or
sheet around them. Replenish the ice as soon as the
moderate degree of melting occurs. Remember to keep the tarp
or the sheet off the nose or mouth to make
sure the airway is clear. I will put all this
information on our website itchyanbitchi dot com as a blog,

(18:07):
so if you want to review it, it will be there.
So who is it highest risk for this happening? Adults
age sixty five are older because they just don't sweat
as much as younger people, and they tend to have
decreased blood flow due to age and some health conditions,
so the cooling mechanism of pushing blood flow to the

(18:28):
skin doesn't work as well. Older adults who are physically
fit have bodies that can cool down more than those
elderly people who are not fit, so routine exercise to
stay fit will help protect you in the heat. Those
who have a physical job that requires strenuous activities or

(18:50):
wearing heavy protective clothing and hot environments are at higher risk.
Many factory workers work in buildings lacking air conditioning and
they often and wear heavy clothing. Those who participate in
strenuous sports outside in the heat, like long distance running
or football players who practice in the summer and are

(19:12):
wearing heavy gear. People who have obesity are at higher risk.
Or if you have a bad sunburn because the skin
just doesn't function right with a sunburn. Also, people who
take certain medications such as diuretics which are designed to
eliminate fluid from the body, beta blockers which slow the

(19:33):
heart rate so blood can't be redirected from the core
to the skin as well, or people who take antihistamines
which have a drying effect on the body. So can
we adapt to the new normal of hot temperatures? Are
we going to be able to adapt to our changing world? Well,
there is some research that shows the human body can

(19:56):
adapt to heat. Researchers basically see this in extreme athletes
who do long endurance exercise in high temperatures. Those people
start their cooling mechanisms earlier and their cardiac fitness allows
the heart to more efficiently do what is needed to
cool the body. So it is possible to adapt physically,

(20:21):
but not realistic to think that all people can do this,
that all people can be athletes, extreme athletes who do
a lot of endurance training in high heat. So practical
behavioral methods are needed, including having ac at home and work,
having cooling centers available, and good hydration. Be smart about heat.

(20:47):
We can't change the weather, and our planet is getting
hotter and hotter. However, there are some practical behavioral methods
we can implement to reduce the risk for heat exhaustion.
When it's hot outside, stay in a cool place when
the heat index climbs. If you don't have air conditioning

(21:07):
at home, find out if there's a cooling center in
your area. Also, public libraries, malls, and movie theaters are
usually air conditioned and may provide some relief during the
hottest parts of the day. Never never ever leave a child,
or a baby or a pet and a hot car,

(21:30):
even for a few minutes. Don't do it. Temperatures in
cars can rise rapidly. Wear light weight and light colored clothing.
Dark colors attract and absorb heat, which can increase your
body temperature. I really need to listen to this advice

(21:50):
because I wear a lot of black. It was all
those years of living in New York City. But I'm
going to change my ways even better than just getting
light colored clothing, lightweight clothing. Get that clothing that has
a high upf to protect you from UV rays as well.
Where a lightweight sun hat. If you're going to be

(22:11):
in the sun, keeping the sun off your head and
face can help control your body temperature. Wear sunscreen when
in the sun to avoid sunburn. Stay hydrated. When it's
hot outside, your body can become dehydrated before you even
notice signs. Keep a bottle of water with you and
drink from it frequently. You can also keep something like

(22:33):
noon tabs as I discussed earlier, to drop into your
water bottle to provide electrolyte replacement when you're sweating when
it's hot outside, limit outdoor workouts to early morning or dusk,
or consider joining a gym that has air conditioning. Swimming,
which I love, is also a great way to get

(22:53):
exercise when it's hot outside. As I said earlier, our
world is heating up and we are seeing more and
more heat related desks. So please please keep yourself and
your loved ones safe by using these measures so you
can enjoy the warm weather months and prevent a heat
stroke tragedy. Thank you for listening. Wherever you listen to

(23:16):
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website is Itchy andbitchy dot com, where there are blogs

(23:37):
with some of our subjects available for you to read.
As always, thanks to Forest Winsle, our producer and composer
of our theme music, and the person who does all
the behind the scenes work to make this podcast possible.
Thank you Forest. Forest has completed his first very successful
year at Peabody Music Conservatory and he's on to his
second year soon. I am so very proud of him.

(24:00):
Remember that your health is in your hands.