6 Risk Factors for Heat Illness

This is a transcript of a Dr. Jay Show broadcast on 1560TheGame. Dr. J. Michael Bennett is a Board Certified Orthopedic Surgeon and a Fellowship Trained Sports Medicine Physician serving patients from Katy, Fort Bend County, Metro Houston and Southeast Texas from offices in Richmond and Sugar Land, TX. Call 281-633-8600 for an appointment. Our special guest today is Dr. Terence Chang, a family practice physician Board Certified in Sports Medicine from Physicians at Sugar Creek in Sugar Land, TX. Bob Lewis, from 1560TheGame, is also participating.

Here’s the transcript of the fourth portion of the Show:

BENNETT: I wanted to discuss some of the risk factors involved and what puts you at risk when you or your kids go out there into the heat to play.

Some of the risk factors I’ve got written down here are:

Patients that are overweight. If they go out there and they go out in the heat, patients that are overweight have a harder time cooling off their core temperature in the heat because they have a cardiac output issue, meaning that it’s harder for them to cool off their core.
Having poor conditioning. Meaning you are not conditioned or acclimatized; obviously if you go out there into the heat and you’re not used to it it’s going to have more impact. You want to get out there at least a week ahead of time to kind of get used to it.
If you’ve had a history of heat illness before. If you’ve had an episode, like our caller who mentioned her son had passed out, that is a risk factor in itself. I mean if you have a history, then you’ve got to take into consideration all these things and make sure you are doing everything possible to make sure you are staying cool and getting adequately hydrated.
If you currently have an infection or if you’re sick. That can actually cause a big issue in regards to overheating because once again it comes back to cooling off your core temperature. If you’re having a fever, you’re doubling up on your temperature, your core temperature, and I’d assume that would cause some big problems.
Pre-dehydration. This means what Dr. Chang had mentioned earlier in regards to the sugar and caffeine drinks. If you pre-dehydrate yourself, that means you’re not out there competing yet but you’re going to go ahead and load up on a bunch of caffeine and sugar, you’re dehydrating yourself already. Or even alcohol. If you’re going out there and you’re drinking a lot of alcohol, you’re dehydrating yourself slowly, and then you go out there and sit out in 105 degree weather, that’s going to lead to heat illness.
Prescription Medications. I think as well can actually cause an issue with heat issues as far as like having your body be able to adapt to the heat.

LEWIS: What type of prescription medicines do you think would be most at-risk?

CHANG: There’s different types of medicines, but one of the medicines Dr. Jay was talking about, Haldol, is a psychiatric medicine used for certain mental disorders. But in terms of the general population, some to watch would be things like weight loss drugs. Those are stimulants and what they do is constrict your blood vessels and they impair your ability for circulation of the blood and to dissipate some of the heat. Medicines for Attention Deficit Disorder, ADHD, are also based on stimulants.

BENNETT: That’s key. A lot of kids these days are on some sort of medication for ADHD. So that is very key. And if you think about it, he mentioned diuretics and he mentioned medications for ADHD. I mean if these are the people that are competing to get their weights down and they go out into the heat and they’re on certain diuretics, that’s going to be a big issue.

CHANG: One of the more common ones that you can get just over the counter is Benadryl. Benadryl is used as an antihistamine, but it’s one of the older generations of

Benadryl (Photo credit: dcdan)

antihistamines and so it has a larger anticholinergic effect, meaning that it acts on one of the receptors in your body that is supposed to be used for helping you sweat. Benadryl blocks that so you actually have a lower ability, a lesser ability, to sweat. That’s important in a climate like Houston.

LEWIS: I know a lot of people that are on Benadryl, that little pink one that they take to keep the stuffiness away at night and it helps you sleep better. I take one when I’m stuffy and I sleep much better at night but I can’t imagine how many people are taking it.

BENNETT: The perfect storm for heat-illness would be these people that are going out on the boat somewhere and, if they have a cold they’re taking a Benadryl and then they’re drinking alcohol on the boat and they’re dehydrating themselves – I mean that’s a recipe for disaster right there.

CHANG: You have other choices, you don’t have to use just Benadryl. In terms of the side effect profile, Claritin is a better choice. It’s not as strong as Benadryl but you’ve got fewer side effects. So Claritin, if it works for you, that’s the one to go for. You’ve also got Allegra, which just came out on the market over the counter, and I’ve been waiting for that one. Zyrtec does work pretty well but it does have more of an anticholinergic effect than Allegra. So if I was going to kind of rank those, or put them in order according to side effects, I’d do Claritin, Allegra, Zyrtec and then Benadryl if you have to.

BENNETT: That’s good to know. Another thing that I think that’s real important, this is last on the list of risk factors, is underlying chronic disease or traits. You know one big one that a lot of people don’t know about I guess in regards to their own personal histories, is sickle cell trait. And Dr. Chang can go into that more as regards to sickle cell and what it is and how that affects hydration or heat illnesses.

CHANG: Sickle cell is a genetic disorder and you see it most in people that have African descent but sickle cell is where the red blood cell, rather than being in a circular disc

Haplotype Analysis Shows the Independent Origin of the Sickle-Cell Gene in Several Locations. The sickle-cell mutation arose independently several times. S=Senegal type; B=Benin type; C=Central African (Bantu) type; I=Indian/Arabian type. (Photo credit: Wikipedia)

shape, forms and becomes the shape of a moon, or

sickle, and it happens in extreme environments, and so it happens when you are dehydrated, it happens when you are at high altitude, it happens when there’s heat. There are two different kinds: there’s the actual disease itself and there’s the trait. Those that have the disease means you have both genes, from mom and dad, so if the kid has the disease, these kids, you have symptoms rather early. The ones that make it in sports and go pretty far and then have symptoms, they sometimes have sickle cell trait. The NCAA now highly recommends that all collegiate athletes be screened for sickle cell trait because we’ve found that there are a lot of people that have an underlying genetic disorder that they don’t know about and that puts them at high risk for injury.

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