Heat and humidity are facts of life during South Florida summers, as is the danger of heat-related illnesses. Don't take the risk lightly. Learn what you should do to prepare for outdoor activities including sports, workouts and yard work.
Michael Swartzon, M.D., a sports medicine physician with Baptist Health Orthopedic Care, joins host, Jonathan Fialkow, M.D. with expert advice on proper hydration and exercise strategies to stay safe when the temperature soars.
Heat and humidity are facts of life during South Florida summers, as is the danger of heat-related illnesses. Don't take the risk lightly. Learn what you should do to prepare for outdoor activities including sports, workouts and yard work.
Michael Swartzon, M.D., a sports medicine physician with Baptist Health Orthopedic Care, joins host, Jonathan Fialkow, M.D. with expert advice on proper hydration and exercise strategies to stay safe when the temperature soars.
Announcer:
At Baptist Health South Florida, it's our mission to care for you when you're injured or sick and help you stay healthy and fit. Welcome to the Baptist Health Talk Podcast, where our respected experts bring you timely practical health and wellness information to improve your family's quality of life.
Dr. Fialkow:
Welcome Baptist Health Talk Podcast listeners. I'm your host, Dr. Jonathan Fialkow. I'm a preventative cardiologist and lipidologist at Baptist Health's Miami Cardiac & Vascular Institute where I'm also Chief of Cardiology at Baptist Hospital and Chief Population Health Officer at Baptist Health. Summer in South Florida means months of hot and steamy weather. It's hard to do much of anything outside without breaking a sweat, and sweating is the way the body tries to keep itself cool. But if temperatures and humidity are too high it may not be enough to keep your body from overheating. People who work or exercise outdoors need to know the warning signs of heat related illnesses and what to do if their body is overheating. My guest today is a sports medicine physician with Baptist Health Orthopedic Care, Dr. Michael Swartzon. Dr. Swartzon is an expert in helping amateur and professional athletes reach their full potential. Welcome back to the podcast Michael.
Dr. Swartzon:
Oh, thank you Dr. Fialkow. I'm very happy to be back here.
Dr. Fialkow:
Okay. It's Jonathan, we're old friends.
Dr. Swartzon:
Okay.
Dr. Fialkow:
Let's keep it informal. And for the listener, just for the purpose of the podcast, we're going to talk obviously about heat related illnesses, who should be particularly worried and what to do about them. So what would be the more common things that you see and that you would want to discuss Michael?
Dr. Swartzon:
One of the most common things we see are cramping of muscles due to heat and dehydration. You're going out there and you're trying to do something and then the muscle just spasms. Sometimes the spasm is just uncomfortable, but occasionally the cramps can reach the level where you physically can't use that muscle, and it hurts so much that, if it's one of the leg muscles, you can't walk or stand on it. It's very unfortunate when it happens. It's scary, but it is temporary and will go away.
Dr. Fialkow:
So muscle cramping in a heat environment is what you're talking about?
Dr. Swartzon:
Correct.
Dr. Fialkow:
We see the athletes sometimes you see them cramped up in the sidelines in some of the hot arenas and hot venues. And that's what's actually happening? It's from the heat?
Dr. Swartzon:
Well part of it is the heat, and part of it is the dehydration that comes with the heat.
Dr. Fialkow:
Ah. Which will certainly be something [inaudible 00:02:37] what we can do about it. Yeah.
Dr. Swartzon:
Right.
Dr. Fialkow:
So if an athlete or someone's very active outside gardening, I guess some other activities, and a muscle cramps, that would be let's say a warning sign to hey stop, do something about it. Right?
Dr. Swartzon:
Correct. I mean if it's bad, you most likely won't be able to continue what you're doing.
Dr. Fialkow:
Yeah.
Dr. Swartzon:
And there's a lesson in this for the person to work on, whether it's stretching, whether it's acclimating to the heat a little bit more slowly, or hydrating better. There usually is a solution to it.
Dr. Fialkow:
So you mentioned it's the most common so I just want to dive into it a little more. So let's say someone's out there and it's Florida, it's the humidity and they haven't had enough to drink, and they start cramping. Do you advocate just take a glass of water and go back? Or do you say, "Hey, stop and take a day off"? Or what would be the most likely scenario that person should do in under that circumstance?
Dr. Swartzon:
It depends on the severity. If it's something that's light, sometimes you can walk it off or stretch it and after a little bit of rest, and as you suggest some water, you're able to continue. Other times it's something that requires some foam rolling, some time, maybe a hot bath to let the muscles relax. There's a lot of people have those new percussion guns that can kind of help work any fascial release. Those can be helpful in that particular instance.
Dr. Fialkow:
So cramping, again an early sign let's say of potential dehydration, and obviously affects the person. The part of the body that's cramping. What would be some of the more severe, let's say, heat related concerns that we'd want to educate the listeners about?
Dr. Swartzon:
Right. So there are different forms of heat related illness. They really go from being very mild, to being extremely serious and life threatening. Unfortunately sometimes you don't know which one you have, because if you have the most severe one you wouldn't know.
Dr. Fialkow:
Hmm.
Dr. Swartzon:
Occasionally you'll start noticing with people who are in the early stages, you'll get lightheaded. You'll have already been sweating for a long time and you might faint or pass out or collapse. Obviously that's serious because if you're running outdoors, you could collapse in the wrong place. Not only hurt yourself with the fall, but put yourself in harm's way, whether it's a crossing of a street or next to someone else and injure somebody. So that's certainly not something anyone will want to go through. If it's a little lighter you'll just end up with a very massive headache later on that day, and that's from the dehydration. Your blood vessels in your brain are just trying to recover and the heat is just causing it to malfunction a little bit.
Dr. Fialkow:
So someone, and again, I think we both recognize this is extremely common.
Dr. Swartzon:
Mm-hmm.
Dr. Fialkow:
Someone's outside, again we will say exercising, gardening, taking a walk or whatever it is, and they feel a little lightheaded. What do they do? What do they do initially, and is there a level of severity to say, "Hey, I better get to an emergency room" or something?
Dr. Swartzon:
Very good question. So the first thing you want to do is get yourself out of the sun and the heat. So either in the shade or indoors in an air conditioned place, if possible. If there's a fair nearby that can kind of help you cool off, drinking cold water, and most importantly try and get some help. I mean obviously a doctor or nurse would be ideal, but even just having someone there in case you don't do well to call an ambulance can be very helpful and can save your life. Because one of the things that happens is, as the dehydration or the heat illness just goes from you getting a headache, you can start having a lot more serious neurological issues.
Dr. Fialkow:
Yeah.
Dr. Swartzon:
Like seizures and your body temperature rises to the point where you can die. And it's not something that is easily recognizable, and you don't know how fast it's going to happen. And you mentioned the example of someone gardening outdoors, certainly that person should be covered well with clothing and be wearing a hat. But sometimes even just being a spectator, or going to one of the outdoor malls, and you may not realize it. But maybe you didn't eat too much, you didn't sleep that well the night before, you had a bunch of caffeine or you're on diuretics, and all of a sudden you're in an increased risk for having a heat related illness.
Dr. Fialkow:
Huh. And that's great advice. I think the take home point is take it seriously, don't just shake it off. And if you have someone available, make sure you're not alone and you have someone watching you. And obviously if it gets real severe go to the hospital, call 911 which is important.
Dr. Swartzon:
Yeah.
Dr. Fialkow:
So you started mentioning, which I like the direction, these recommendations are true for anyone.
Dr. Swartzon:
Anyone.
Dr. Fialkow:
Anyone can get a heat related illness, but are there certain populations in whom we would want to take extra precaution? And we'll talk to, again, elaborating on more some of the things people can do to avoid it afterwards. So one of those you mentioned, diuretics. Explain that a little bit more, some of the populations we want [inaudible 00:08:37].
Dr. Swartzon:
Anyone taking a medication that can affect the water content in their body, whether it's a specific blood pressure medication or something on your kidneys, you need to just be careful. Especially if the medication's new. If you've been on it for a while, chances are your body has already adapted. The biggest people that are at risk, people that have not spent much time outdoors are at a very significant increase risk. People who are coming to us from up north. So if you have family coming to visit you and you're used to being on your boat all the time, and they're not, you need to watch out for them. Make sure they're wearing a hat, they're getting hydrated, they're wearing their sunscreen. Be a good friend, be a good family member. If you they're just having a fun day on the boat fishing, and sometimes there's alcohol involved in those events, that can even increase the risk of dehydration. So you go out trying to have a fun event, whether it's golfing or fishing, and then you end up having trouble later on that day. And that's not something we want.
Dr. Fialkow:
Yeah. That's great recommendations, and the kind of the populations that I guess we necessarily wouldn't think about. I would think off the top of my head people with cardiac conditions, et cetera. But yeah, as you're saying there's many other circumstances probably much more common. And then I always think of the cardiac patients, again, the warnings of the hot tubs if you have a cardiac condition. It's the same type of thing, right? It's the heat of the hot tub can cause these types of concerns.
Dr. Swartzon:
Raise your body temperature. Exactly. And so that's why the solution is to lower your body temperature as quickly as possible. One of the biggest at risk populations is pediatric patients or kids.
Dr. Fialkow:
Oh, elaborate on that a little bit. [inaudible 00:10:33]
Dr. Swartzon:
So the body mass ratio that we have versus kids is different. They can't regulate the heat the same way we can. Not only that, adults tend to have, especially ones who are trying to exercise and have a little bit more of a budget, they tend to buy the clothes that are the moisture wicking expensive athletic wear. Whereas kids typically still wear cotton t-shirts, and the cotton t-shirts do not air out very well for them. So they get soaked and they retain the heat, and especially if they're not used to being outdoors, that's a population that I worry about. It takes them longer to acclimate to the heat than most adults. So for sure pediatrics, watch your kids, watch your grandkids. Make sure they're staying hydrated and make sure they get out of the sun when they can.
Dr. Fialkow:
When you work with your athletes, for example, now who are in shape and have high endurance and stuff. Do you ever discuss with them that maybe you shouldn't take a run when it's a hundred degrees out or the humidity is 90. Do you get into those specifics with even high performance folks in your business?
Dr. Swartzon:
For sure. For sure. Every sport that's outdoors has an emergency action plan based on the weather, right? So it's not just if a hurricane comes. We look at training camp for the Miami Dolphins and at race day for the Miami Marathon, we have a what's called a wet bulb thermometer. And it's basically it measures not only the heat, but also the humidity, the wind. And it's a little bit more advanced than a heat index, but if you look at a weather app it'll tell you the feels like temperature. It's basically a very scientific version of a feels like temperature.
Dr. Swartzon:
And if it's over a certain temperature, and that varies per sport, we will completely change... For example with the Marathon, we will first in a caution we will tell the runners that the temperature is high and they need to be cautious. And when we think it's very high, we stop the timer so that no one feels they have to rush to compete. Obviously people value the race time, but we value their lives more than the race time. In football for training camp what we would do is we would take more breaks. We would make them take their helmets off, occasionally if they're wearing all their pads we'll switch them to a shirt and shorts. And if it's hot enough we take the practice indoors.
Dr. Fialkow:
Wow.
Dr. Swartzon:
So this is even professional athletes who are the pinnacle of our fitness level have significant changes to their schedule based on the heat.
Dr. Fialkow:
Highly monitored, high attention paid even in those situations.
Dr. Swartzon:
Highly monitored.
Dr. Fialkow:
So again, I really appreciate as always your expertise, and it's really fascinating to take something relatively simple which is it's hot in Florida and send these important messages to the listeners. You did mention through the conversation a few things, but let's just go through specific things about how to avoid heat related illnesses. You said when you start feeling it, whether it be lightheaded or headache or cramping. Obviously get in a cool environment, drink cold water, air conditioning preferable. And obviously if you have more significant symptoms seek more advanced help. But what kind of precautions would you specifically say to someone who's going to be outside to avoid heat related illnesses? And let's break it down to people new to let's say south Florida, those visiting, but also people who live here might take it for granted.
Dr. Swartzon:
Right. So first you want to remember the change in seasons. So if you've been out and it's been, not that winter and Florida's that cold, but it's certainly much cooler than in the summer unless-
Dr. Fialkow:
Come on Mike. When it's 55 degrees the furs come out.
Dr. Swartzon:
So you want to know what you're getting into and where you've been. Prepare yourself, make sure you're well hydrated and rested before you're going out in the heat. Make sure you're wearing the appropriate clothes. Some people may think that's a tank top shorts and flip flops, but normally if you're going to be in the sun for a very long time, sometimes wearing long sleeve pants and a hat can be even more advantageous if it's the correct type of clothing. You want it to be a little bit more loose. A lot of people like wearing these tight neoprene type braces and body suits because they think it's going to help with cramping, but it really can increase your risk of heat illness. So for the fitness person, prepare. For the person who's going down here on vacation, it's the weekend, they want to go down to one of the farms or do something outdoors, just be mindful of what you're doing. Have the water, take breaks, be with other people. That's really the safest, because someone is going to recognize that you're not doing well and get you the help if it gets to that.
Dr. Fialkow:
Last question, and I think it warrants its own section of a conversation, is the aspect of hydration.
Dr. Swartzon:
Yeah.
Dr. Fialkow:
Hallmark of everything you said. Are there tips to know to be well hydrated? Anything to look at for a person to say "I am well hydrated"? And the second part I'd ask is there anything specific to say regarding water versus sports drinks with electrolytes, or what is that vehicle hydration in most cases?
Dr. Swartzon:
So to answer the latter part, the rule of thumb that we have is if you are exercising or outdoors for less than an hour, regular water will be sufficient. If you're exercising for more than an hour, you're planning to be outside all day, you should have some carbohydrate, electrolyte beverage. There's a lot of brand names out there. There's ones that are ready made. There's ones that you can premix. The brand doesn't matter. But you should alternate the type of drink and not only drink water if you're spending more than an hour outside.
Dr. Swartzon:
As far as the first part of your question, the best way to measure how hydrated you are is whether you're urinating, right? You go to the bathroom, you go pee. If you're peeing, that's a good sign. You got to look at the color of your pee. If it's very yellow and you're not getting a lot of it, and you notice that this is the first time you've gone to the bathroom all day, you are well behind on your hydration status. If you are peeing freely so to speak, and you have mostly clear or light yellow urine, you're in pretty good shape. And so that's a very quick, easy way to get a 20,000 foot view on your hydration status.
Dr. Fialkow:
Our bodies are fascinating things.
Dr. Swartzon:
Yeah.
Dr. Fialkow:
Our bodies will tell us what's safe for us to do and what's not, which is great. Well, this was wonderful as always. I think the information's very helpful, and you're always able to articulate it in a way that resonates. Any final comments? Anything you want to reiterate? Anything we didn't touch on that you think is relevant, especially given your expertise in sports medicine?
Dr. Swartzon:
Well, certainly you want to try and plan your activities. You know when the hottest parts of the day are. If you want to do something outdoors, do it at 7:00 AM or 7:00 PM. You're going to be in a much better shape to avoid heat illness when you're not doing things in the hottest part of the day. You want to look at your medical history. If you have some issues you can always talk to your doctor and say, "Are there any medications? Is there anything I'm concerned?". We didn't go into the skin aspect of it, but certainly certain medications can increase your risk of getting sun burn from being outside. You want to get it acclimated to the heat. So if you do plan on starting a workout routine, or you are going to go out for boat season, try and ease into it one step at a time instead of doing it all at once because that's what you remember you did at the end of last summer. So just plan ahead for you and your family and your friends so that everyone has a good, safe time.
Dr. Fialkow:
Watch the temperature, know your fitness level, plenty of fluids, dress appropriately. All great tips and can really make a big difference in avoiding heat related illnesses, especially in our South Florida summer heat. So thanks again, Michael.
Dr. Swartzon:
Absolutely Jonathan.
Dr. Fialkow:
And to all our listeners, if you have any comments or suggestions for future topics, please email us at baptisthealthtalk@baptisthealth.net. That's baptisthealthtalk@baptisthealth.net. We'd love to hear from you. Thanks for listening, and stay safe.
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