Dr. Kevin Most: Stay away from heat stroke by staying cool this summer

Dr. Kevin Most

Well it looks like summer is finally here, temps in the 90’s and humidity to match. This week we celebrate the 4th of July and with it come picnics, fireworks, and heat, with that comes the possibility of salmonella, burns and dehydration. I am not trying to be a Debbie Downer at all, let’s use this time to make sure we are prepared for any possible concerns and not be known as the Typhoid Mary of the block party.

We all love a great picnic, sitting outside, catching up with friends, and enjoying the weather. As we prepare food for picnics we should also think a little ahead to the time the food will be served and what we need to do between the preparation of the food and the time thru serving the food. Food borne illnesses are common, we hear about the rare salmonella out break at a restaurant in the news but we don’t hear about the local picnic outbreaks as they are not media stories yet happen 100 times more often.

We call it food poisoning which is interesting as the food is just the vector for the illness and the poison actually comes from viruses, bacteria and their toxins. Food poisoning is very common estimates are that we have close to 50 million cases a year, most of which go unreported. However some are more serious, close to 150,000 individuals are hospitalized and 3,000 die each year. With 50 million cases and only 150,000 individuals hospitalized you can surmise that most of these cases can be safely treated at home and that is true.

Salmonella gets a bad rap, right? Any time some gets food poisoning they blame salmonella when in fact there are over 250 foodborne diseases that have been identified.  For the vast majority of cases the culprit is never identified as the individual does not seek medical care.

Before we talk about the illness and treatment, let’s discuss what we can do to prevent the illness. We will often discuss an illness and the preventative ways or things we can do to minimize our risk of getting that illness, this is no different with the exception that our actions protect more than just the individual. We often blame the pasta salad for the illness but we have to realize there are many foods that are prepared or stored wrong can cause illness.

Meat and poultry should be placed in separate bags at the grocery store in order to not contaminate other foods. Keep the meats cold until ready to grill. Make sure you wash your hands before and after handling the products and never put cooked meat back on the same plate that the raw meat came out on. If you have marinated the meat, do not save the marinade for later use, you can pour on the grill but discard all of the remaining marinade as it will have bacteria and viruses in it.

Many appreciate a great medium rare burger, now that is fine as long as the internal temp hits 165 degrees, we know that no one checks the temperature of a hamburger but the burger that is cool in the middle may not be ideal and may need more grill time. Chicken on the other hand should never be under cooked as the possibility of true salmonella is present. So a good rule of thumb is never rush the individual who is on the grill as those few extra minutes may save you some discomfort. Warm food leftovers should be bagged and refrigerated or frozen within 2 hours of cooking to prevent bacteria from growing.

The other big concern is dishes that are meant to be served cold, this may include salads or fruit. The most important thing to do for these is to maintain that they stay cold which will minimize the opportunity for viruses or bacteria to flourish. Salads should be kept cold from prep time until serving is complete. They should be transported with attention to temperature, so placing them on ice for travel as well as placing them on ice when serving will minimize the chance for contamination.

Symptoms for food poisoning include nausea, vomiting, fever, abdominal pain and diarrhea. Now the timing of the illness will vary from individual to individual based what caused the issue. In some cases the symptoms are very quick, within an hour or two and others may not have symptoms for a week or two. The length of time one will have symptoms will vary as well from a few hours to several days. In most cases there is no need to go to a physician as long as you can prevent dehydration. 

Some signs that you may need a physician to look you over are vomiting that you cannot stop or control, blood in your stool, extreme pain, high fever and signs of dehydration, excessive thirst, dry mouth, dizzy or lightheadedness- all signs of dehydration. Muscle cramps as well are a sign that you are not keeping up with electrolytes and fluids.

The importance is trying to keep up with good fluid intake when ill.  Many will tell you to stay on clear liquid diets as this is the easiest for the stomach to absorb and the quickest way to get fluids into the body without an IV. A few caveats, you want to stay away from dairy based products so trying to get you fluids up with milk or milk shakes is not a good idea as the body will not be able to handle the lactose for a few days. Water is a good choice but you are losing electrolytes and need some sugar to maintain your energy. 

After a day or two on fluids advancing to a BRAT diet is a god idea. The BRAT diet consists of Banannas, rice, applesauce and toast. Essentially a bland diet that is easy on the stomach. A day on this will help the stomach and intestines reset and be ready for regular foods in most cases

So with food poisoning it is all about preparation, presentation and preservation. Being careful thru each of the steps and you will keep yourself healthy and those who eat with you as well. You never want to be known as Typhoid Mary

What is a 4th of July without fireworks ? We all enjoy and remember sitting on blankets watching the fireworks as kids, the opportunity to hang out with family and friends is a fond memory for all of us. Many of you may remember getting the opportunity to hold a sparkler in our hands and in some cases run with one, before being told to stop. Little did we know that the sparklers had a temperature of 1,800 degrees F and were hot enough to melt gold, none the less the damage they can do to skin or eyes. Each year we have more than 15,000 firework related injuries and unfortunately some deaths as well.

The injuries are often burns and concussion like injuries as well as eye injuries. Blindness and 3rd degree burns happen every year and can be life changing but also avoidable. One in 4 injuries from fireworks is suffered by an innocent bystander.

The importance of watching young children with sparklers must be on the top of your list. Young individuals do not understand they are  dangerous and are at an age where they cannot understand the risks of these are.

Fireworks in Illinois are illegal but we all know it is a short drive to Indiana where they can be bought legally. Illinois continues to have strict rules about fireworks where sparklers are about as far as they go for legal use. Now we all know that many will bring fireworks back from other states and end up using them in our neighborhoods so it is our responsibility to use them safely.

Hopefully individuals have planned for the use of fireworks and have a responsible adult in charge of the activities.  The adult should be ready to deal with the fireworks safely as well as the individual who may be injured with the use of these. Knowing how to treat a burn, knowing how to treat an injured hand and important knowing how to handle an eye injury.

The biggest message is enjoy the professional fireworks in your municipality and refrain from any home use fireworks, do not let children have sparklers.

This is also the first good stretch of hot weather and taking a minute or two to discuss what we need to do and look for regarding temperature changes, amazing that 5 months ago we had temperatures that reached 22 below and wind chills at 50 below and now we will have temperatures that have heat indexes that will approach 100 degrees. The body is amazing that it can handle a 150 degree swing. In the winter our body changes to maintain heat as well as it can, in the summer the body works to cool itself at all times protecting the key organs needed for life.

Just a few points on heat related illnesses. Sweating is good, this is the way the body cools itself. Placing fluid on the skin acts as a cooling agent as air blows over the skin causing evaporation, this allows for the body heat to be dissipated. This concept works great when the outdoor humidity is low enough. As the humidity rises the ability for the sweat to evaporate decreases and the cooling mechanism does not work as well.  Relative humidity levels that approach 90% makes the sweating mechanism for cooling really not work well.

The spectrum for heat related illnesses is wide, it goes from minor inconvenience to life threatening and some times that window or time frame is short. It is good to know what to look for and how to treat or handle the individual.

The individual with early heat exhaustion will be sweating, sometimes profusely as the body try’s to cool itself. They will be thirsty, may feel weak, have a headache, some with nausea and muscle cramping. These signs show that this individual is dealing with heat regulation and fluid balance. These patients can often be treated at home or on site. The immediate goal should be to get the individual into a cool environment and replenish the fluids that have been lost. Removing excess clothing and placing wet cool towels will also help these individuals cool. Fluids can be water but a combo with sports drinks is important. You want to refrain from alcohol or caffeine based fluids in these patients.

The other extreme is heat stroke. This condition is life threatening and needs immediate emergency treatment. Attempting to care for these individuals in the home may not be a good idea, these patients should receive 911 treatment then ER treatment as soon as possible. In Heat Stroke the body’s ability to cool itself shuts down, the body stops sweating and the core body temperature continues to rise. The rise in internal temperatures can cause organ damage and in some cases death if not treated promptly. 

The heat stroke patient will often have dry skin, slurred speech and show signs of agitation. Their skin will be flushed they will be rapidly breathing an they will have a high heart rate. These patients need emergent treatment that will cool the body quickly in a controlled environment where organ function can be monitored.

Prevention is the key, stay well hydrated, plan on fluid sources before going out for the day’s activities. Think about timing activities based on the temperature for the day.

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