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MARK HOUSTON: Welcome to Doc Talk, a weekly podcast featuring Monument Health physicians addressing medical topics. Tune in to your health with Monument Health.
MARK HOUSTON: And as we get ready for summertime... Um, speaking of the heat, one of the big things that's on this list, uh, is heat stroke. And I was, I was pretty fascinated by, by this, uh, because I don't, I don't think I really know what it is. Can you explain heat stroke?
JOHN TRONNES, M.D.: So I mean, it's a big topic as far as heat stroke, because there are, you know, from mild to severe versions of it. Um, but in general, it's just internal body temperature is raising higher than it should be, which causes the body's physiology to do all sorts of weird things, causing it to shift fluid and things like that to places where it ought not to be, to try to cool your core temperature down. Um, and that'll lead to low blood pressure, passing out, end-organ damage, things like that.
MARK HOUSTON: And I think a lot of people, when they're outside and they start to to feel this way, I don't know, I really don't know how many people understand that, oh, this is... something's really wrong, right? So what are some of the initial signs of when you're outside, you're doing yard work? It's ninety eight. You should have got up earlier to do it, obviously, or waited until later. But what's... what are some of the first signs you'll feel when heat stroke comes on?
JOHN TRONNES, M.D.: So your body will, you know, manage heat by sweating, things like that, and trying to dissipate heat. But there will be a point sometimes where the body will stop sweating. That's oftentimes a bad sign where it's like, oh, things are getting a little bit too far. And then lightheadedness, black spots in your vision, things like that.
MARK HOUSTON: So stopping sweating.
JOHN TRONNES, M.D.: Mhm.
MARK HOUSTON: What if you're somebody that doesn't... well, your body would normally do?
JOHN TRONNES, M.D.: Everybody's body should sweat.
MARK HOUSTON: Right. Are there ever instances where some people can handle it better and they don't as much?
JOHN TRONNES, M.D.: Yeah, some people handle heat better, and those people might not be as prone to heat stroke as other people. But no, I mean, everybody's going to sweat to some degree, certain parts of the body.
MARK HOUSTON: And then what's, what's the first step you should take if you start to notice this happening?
JOHN TRONNES, M.D.: I mean, if you're out in the heat and you're feeling lightheaded, you're getting kind of black spots in your vision, I mean, get to some place cool. You know, if you can get inside with air conditioning, or if you can get under a shady spot and try to hydrate as much as possible. Um, the interesting thing with it is that your temperature will actually go up, so your internal body temperature will go up, but the external sources that will often do, like temperature scanners or even oral or ear temperature, won't always be super accurate. So I learned a lot about heat stroke from doc who managed the Saint Paul Marathon. And the Saint Paul Marathon, uh, happens in July in Minnesota, where the humidity is eighty percent.
MARK HOUSTON: Have they thought about maybe a different time? I don't know.
JOHN TRONNES, M.D.: I think they should, but heat stroke left and right happens out there. And they'll have, you know, human-shaped tubs full of ice to get people into. And he says every person that comes through his tent has to have a rectal temperature done, because that's the most accurate way to find out. Oh, is this person's core temperature actually getting up to those scary one hundred and three, one hundred and four, um, points? And so, you know, if you get inside and you're trying to cool down and, you know, ice on the head, you can even do ice baths and drinking water, and you're just still feeling lightheaded, you know, vision's poor, people will get wobbly and shaky towards the end there and get weak, getting into an ER where we can give people cold fluids and things like that to get their temperature.
MARK HOUSTON: So that would be the step. You would recommend people going to an ER or an urgent care right away to get in when that's happening?
JOHN TRONNES, M.D.: Yeah, yeah, for sure.
MARK HOUSTON: All I heard when you were saying this, really going back to the whole rectal temperature thing in a marathon... see, another reason not to run.
JOHN TRONNES, M.D.: Yeah, yeah. Uh.
MARK HOUSTON: All right. Well, that... that again, we, we don't, I mean, we have a good, what, three and a half, four months out of the year maybe where, where it can be serious here, right? But I suppose heat stroke could happen, like, in the wintertime indoors somewhere too. Is that... would that be...?
JOHN TRONNES, M.D.: I've never seen that.
MARK HOUSTON: Really.
JOHN TRONNES, M.D.: No. It has. It's more of an outdoor, under the sun.
JOHN TRONNES, M.D.: Yep. Yeah. Body exertion. Um, I've seen some mild cases. Um, they have a, I think a half marathon in Deadwood, um, in the summer, and every once in a while we'll get some, because apparently they like to do a marathon and then go downtown and drink alcohol, which isn't great for your body's internal temperature or heat stroke. And that's when they'll start coughing and vomiting. We'll see that sometimes when people get into bad heat stroke. And so, no, it's... I haven't seen a ton of cases here in South Dakota since I've been working here for two years. But really, yeah, that tends to be the big ones, is where people are physically exerting themselves out in the heat. And oftentimes inadequate hydration will play a role into that as well.
Episode 146: Summer Child Safety
MARK HOUSTON: So shade and hydration would really be the two big things you can do. I mean, even if you have to be out in the sun, make sure you've got a gallon of water with you to just keep pouring back.
MARK HOUSTON: I suppose another big issue that happens here in the summertime, and again, we don't have huge windows for this, but heat exhaustion and heat stroke and things like this... When kids are out playing, I don't think a lot of times you think about that, because if you remember when we were growing up, we'd go out, we'd play, you'd get really terribly sunburned, which of course is another big thing. Big deal. You've really got to be careful of, of what we've learned can happen as you get older. Um, but how do you, you know, what steps do you take to, to prevent that when it's a nice ninety degree July day and your kid wants to be outside the whole time?
KYLE LEMLEY, M.D.: Hydration, hydration, hydration, really. Um, you know, water is great, but the hotter it is, where you're sweating more and more, you need to start having electrolyte replacement. So like Gatorade, Powerade, any kind of electrolyte kind of a drink is, is better when you're sweating more like that. Um, and then making sure that you're taking breaks to, to stay hydrated. Um, kind of the early onset of, of those heat-related injuries, or just heat cramps. So if you notice your legs are cramping or your arms are cramping, that's kind of the first sign that, hey, I'm maybe not be as hydrated as I thought and maybe losing more electrolytes than I thought. I should chill out for a little bit, maybe even stop for the day, but at least get hydrated. Make sure they go away before you keep going.
MARK HOUSTON: Well, how do you, how do you recognize that in like really young kids that may not understand what, what's happening? How do you, as a parent, recognize that?
TAMRA LEMLEY, M.D.: I mean, if they're still in diapers, you're... excuse me, you're watching for just kind of their urine output. Are their diapers as wet as they normally would be? They're nice and plump, you know, right, when you change them? So if you're noticing a decrease... or even a toddler, like, are they going to the bathroom? Is their pee turning a darker color than what it normally... is would be, you know? Are they not wanting to keep playing, right? Or are they getting tired? Sometimes kids will complain even of, like, a headache.
TAMRA LEMLEY, M.D.: Um, what I was going to add to that is, um, we're definitely in a drier climate up here. It's not nearly as humid, and so it's a lot easier to not recognize how much you're sweating because it evaporates so quickly. Versus, like, we grew up in the South, that, you know, one hundred and ten percent humidity. So you knew you were losing all this fluid because your clothes were just drenched with sweat if you were outside. So you, I think, thought about drinking a little bit more just because you knew you were sweating. Whereas up here, I mean, maybe the armpits of your shirt are wet, but that's it. Like, you're not just covered in sweat. And so kids don't have that, like, physical reminder of, no, you've actually, you know, lost a lot of, um... yeah, fluid. And so...
MARK HOUSTON: Well, and we don't, and we don't feel, you know, because we're eight months out of the year we're in jackets and flannels... in a flannel now and it's early June. But, uh, I don't think we think about it a lot of instances because it's just a nice day, right? And we get to be out in it.
KYLE LEMLEY, M.D.: Right.
KYLE LEMLEY, M.D.: And then, um, going back to, to the question, you can get heat exhaustion and then heat stroke. So what... yeah, what are the... what's the difference?
KYLE LEMLEY, M.D.: Right. So the easiest way to think about the difference is: are you sweating or not? Like, is your skin moist or is it not? So if you're starting to have headaches and dizziness or other symptoms other than just cramping, but you still have moist skin, then you're at heat exhaustion. Um, if you're starting to lose consciousness, but you're going to have dry skin for sure, that's a heat stroke. Um, and obviously both of those can be life threatening. Both of those are really serious. You need to get to an emergency room, because at that point you're probably so dehydrated, you're probably not going to be able to just replace it orally, um, with just fluids and that kind of stuff. So, um, just making sure that you still have wet skin versus dry skin is the easiest way to think about the difference.
MARK HOUSTON: Oh, that's... okay. Very interesting. Yeah, I wouldn't have, I, I guess I wouldn't have made that connection.
KYLE LEMLEY, M.D.: I'm not the smartest person. I have to have easy ways to remember stuff, so... well...
MARK HOUSTON: Is there recommended sunscreens now? Because, boy, the debate on this has been just everywhere, right?
KYLE LEMLEY, M.D.: SPF fifteen to thirty is really all that you need.
MARK HOUSTON: Really.
KYLE LEMLEY, M.D.: They're looking at, they're still doing more research to see if anything greater than fifty is even helpful or not. But most people are good with fifteen to thirty. Um, that's kind of the big, the big one. And then, what is it... oxybenzone?
TAMRA LEMLEY, M.D.: Yeah, oxybenzone. You don't want that in your sunscreen. It can mess with your kid's hormones, is what they've shown in the research.
KYLE LEMLEY, M.D.: But any sunscreen is better than no sunscreen. So even if it has oxybenzone in it, it's okay. But if you could find it without it, that would be better.
KYLE LEMLEY, M.D.: That would be better.
TAMRA LEMLEY, M.D.: And then the other thing, like, for babies, um, like six months and under, you can't put sunscreen on babies. So it's just not recommended, period. So then you're looking at protective clothing, barrier, sun hats, the long-sleeve swim shirts, sitting in the shade under the umbrella, that type of deal. So even if you were going out to the lake or the beach, like, having a little beach umbrella so that you're just blocking the sun's rays from the baby.
MARK HOUSTON: Okay.
TAMRA LEMLEY, M.D.: And then even after that, like above six months, toddlerhood age, the barrier clothing, like all the swim shirts and things, are going to be kind of your best bet. You don't have to remember to reapply if they're wearing a long-sleeved shirt, sort of deal. Yeah.
TAMRA LEMLEY, M.D.: Um, I will say that the quality matters on those. Um, they do wear out after so many washings, I don't think they're as effective. Um, we actually had one of our sons, we were out at a lake, like, doing a lake day one year and had on swim shirt. Um, but his... it was a white one, and I just think it had been used too many times, and he ended up sunburning through it. Um, I wasn't thinking, hadn't paid attention... and if they had their sun shirts, their swim shirts on, I didn't sunscreen underneath them. So, yeah. Okay. But just something to kind of think of as well.