Articles Included:

Dehydration and Heat Stroke
Extreme Heat: Health and Safety
Heart Awareness
Broken Heart Syndrome Is Real!
Floaters and Flashers in the Eye
May is the Better Sleep Month

Dehydration and Heat Stroke

Dehydration and heat stroke are two very common heat-related diseases that can be life-threatening if left untreated.

What is dehydration?

Dehydration can be a serious heat-related disease, as well as being a dangerous side-effect of diarrhea, vomiting and fever. Children and persons over the age of 60 are particularly susceptible to dehydration.

What causes dehydration?

Under normal conditions, we all lose body water daily through sweat, tears, urine and stool. In a healthy person, this water is replaced by drinking fluids and eating foods that contain water. When a person becomes so sick with fever, diarrhea, or vomiting or if an individual is overexposed to the sun, dehydration occurs. This is caused when the body loses water content and essential body salts such as sodium, potassium, calcium bicarbonate and phosphate.

Occasionally, dehydration can be caused by drugs, such as diuretics, which deplete body fluids and electrolytes. Whatever the cause, dehydration should be treated as soon as possible.

What are the symptoms of dehydration?

The following are the most common symptoms of dehydration, although each individual may experience symptoms differently. Symptoms may include:

• thirst less-frequent urination
• dry skin
• fatigue
• light-headedness
• dizziness
• confusion
• dry mouth and mucous membranes
• increased heart rate and breathing

• dry mouth and tongue
• no tears when crying
• no wet diapers for more than 3 hours
• sunken abdomen, eyes or cheeks
• high fever
• listlessness
• irritability
• skin that does not flatten when pinched and released

Treatment for dehydration:

If caught early, dehydration can often be treated at home under a physician's guidance. In children, directions for giving food and fluids will differ according to the cause of the dehydration, so it is important to consult your pediatrician.

In cases of mild dehydration, simple rehydration is recommended by drinking fluids. Many sports drinks on the market effectively restore body fluids, electrolytes, and salt balance.

For moderate dehydration, intravenous fluids may be required, although if caught early enough, simple rehydration may be effective. Cases of serious dehydration should be treated as a medical emergency, and hospitalization, along with intravenous fluids, is necessary. Immediate action should be taken.

How can dehydration be prevented?

Take precautionary measures to avoid the harmful effects of dehydration, including:

• Drink plenty of fluids, especially when working or playing in the sun.
• Make sure you are taking in more fluid than you are losing.
• Try to schedule physical outdoor activities for the cooler parts of the day.
• Drink appropriate sports drinks to help maintain electrolyte balance.
• For infants and young children, solutions like Pedialyte will help maintain electrolyte balance during illness or heat exposure.
• Do not try to make fluid and salt solutions at home for children.

What is heat stroke?

Heat stroke is the most severe form of heat illness and is a life-threatening emergency. It is the result of long, extreme exposure to the sun, in which a person does not sweat enough to lower body temperature. The elderly, infants, persons who work outdoors and those on certain types of medications are most susceptible to heat stroke. It is a condition that develops rapidly and requires immediate medical treatment.

What causes heat stroke?

Our bodies produce a tremendous amount of internal heat and we normally cool ourselves by sweating and radiating heat through the skin. However, in certain circumstances, such as extreme heat, high humidity or vigorous activity in the hot sun, this cooling system may begin to fail, allowing heat to build up to dangerous levels.

If a person becomes dehydrated and can not sweat enough to cool their body, their internal temperature may rise to dangerously high levels, causing heat stroke.

What are the symptoms of heat stroke?

The following are the most common symptoms of heat stroke, although each individual may experience symptoms differently. Symptoms may include:

• headache
• dizziness
• disorientation, agitation or confusion
• sluggishness or fatigue
• seizure
• hot, dry skin that is flushed but not sweaty
• a high body temperature
• loss of consciousness
• rapid heart beat
• hallucinations

How is heat stroke treated?

It is important for the person to be treated immediately as heat stroke can cause permanent damage or death. There are some immediate first aid measures you can take while waiting for help to arrive.

• Get the person indoors.
• Remove clothing and gently apply cool water to the skin followed by fanning to stimulate sweating.
• Apply ice packs to the groin and armpits.
• Have the person lie down in a cool area with their feet slightly elevated

Intravenous fluids are often necessary to compensate for fluid or electrolyte loss. Bed rest is generally advised and body temperature may fluctuate abnormally for weeks after heat stroke.

How can heat stroke be prevented?

There are precautions that can help protect you against the adverse effects of heat stroke. These include:

• Drink plenty of fluids during outdoor activities, especially on hot days.
• Water and sports drinks are the drinks of choice; avoid tea, coffee, soda and alcohol as these can lead to dehydration.
• Wear lightweight, tightly woven, loose-fitting clothing in light colors.
• Schedule vigorous activity and sports for cooler times of the day.
• Protect yourself from the sun by wearing a hat, sunglasses and using an umbrella.
• Increase time spent outdoors gradually to get your body used to the heat. During outdoor activities, take frequent drink breaks and mist yourself with a spray bottle to avoid becoming overheated.
• Try to spend as much time indoors as possible on very hot and humid days.

If you live in a hot climate and have a chronic condition, talk to your physician about extra precautions you can take to protect yourself against heat stroke. Return to top of page

Extreme Heat: Health and Safety

Heat-related deaths and illness are preventable yet annually many people succumb to extreme heat. Historically, from 1979-2003, excessive heat exposure caused 8,015 deaths in the United States. During this period, more people in this country died from extreme heat than from hurricanes, lightning, tornadoes, floods, and earthquakes combined. In 2001, 300 deaths were caused by excessive heat exposure.

People suffer heat-related illness when their bodies are unable to compensate and properly cool themselves. The body normally cools itself by sweating. But under some conditions, sweating just isn't enough. In such cases, a person's body temperature rises rapidly. Very high body temperatures may damage the brain or other vital organs.

Several factors affect the body's ability to cool itself during extremely hot weather. When the humidity is high, sweat will not evaporate as quickly, preventing the body from releasing heat quickly. Other conditions related to risk include age, obesity, fever, dehydration, heart disease, mental illness, poor circulation, sunburn, and prescription drug and alcohol use.

Because heat-related deaths are preventable, people need to be aware of who is at greatest risk and what actions can be taken to prevent a heat-related illness or death. The elderly, the very young, and people with mental illness and chronic diseases are at highest risk. However, even young and healthy individuals can succumb to heat if they participate in strenuous physical activities during hot weather. Air-conditioning is the number one protective factor against heat-related illness and death. If a home is not air-conditioned, people can reduce their risk for heat-related illness by spending time in public facilities that are air-conditioned.

Summertime activity, whether on the playing field or the construction site, must be balanced with measures that aid the body's cooling mechanisms and prevent heat-related illness. This pamphlet tells how you can prevent, recognize, and cope with heat-related health problems.

What Is Extreme Heat?

Temperatures that hover 10 degrees or more above the average high temperature for the region and last for several weeks are defined as extreme heat. Humid or muggy conditions, which add to the discomfort of high temperatures, occur when a "dome" of high atmospheric pressure traps hazy, damp air near the ground. Excessively dry and hot conditions can provoke dust storms and low visibility. Droughts occur when a long period passes without substantial rainfall. A heat wave combined with a drought is a very dangerous situation.

During Hot Weather

To protect your health when temperatures are extremely high, remember to keep cool and use common sense. The following tips are important:

 Drink Plenty of Fluids During hot weather you will need to increase your fluid intake, regardless of your activity level. Don't wait until you're thirsty to drink. During heavy exercise in a hot environment, drink two to four glasses (16-32 ounces) of cool fluids each hour.

Warning: If your doctor generally limits the amount of fluid you drink or has you on water pills, ask how much you should drink while the weather is hot.

Don't drink liquids that contain alcohol, or large amounts of sugar?these actually cause you to lose more body fluid. Also avoid very cold drinks, because they can cause stomach cramps.

Replace Salt and Minerals

Heavy sweating removes salt and minerals from the body. These are necessary for your body and must be replaced. If you must exercise, drink two to four glasses of cool, non-alcoholic fluids each hour. A sports beverage can replace the salt and minerals you lose in sweat. However, if you are on a low-salt diet, talk with your doctor before drinking a sports beverage or taking salt tablets.

Wear Appropriate Clothing and Sunscreen

Wear as little clothing as possible when you are at home. Choose lightweight, light-colored, loose-fitting clothing. Sunburn affects your body's ability to cool itself and causes a loss of body fluids. It also causes pain and damages the skin. If you must go outdoors, protect yourself from the sun by wearing a wide-brimmed hat (also keeps you cooler) along with sunglasses, and by putting on sunscreen of SPF 15 or higher (the most effective products say "broad spectrum" or "UVA/UVB protection" on their labels) 30 minutes prior to going out. Continue to reapply it according to the package directions.

Schedule Outdoor Activities Carefully

If you must be outdoors, try to limit your outdoor activity to morning and evening hours. Try to rest often in shady areas so that your body's thermostat will have a chance to recover.

Pace Yourself

If you are not accustomed to working or exercising in a hot environment, start slowly and pick up the pace gradually. If exertion in the heat makes your heart pound and leaves you gasping for breath, STOP all activity. Get into a cool area or at least into the shade, and rest, especially if you become lightheaded, confused, weak, or faint.

Stay Cool Indoors

Stay indoors and, if at all possible, stay in an air-conditioned place. If your home does not have air conditioning, go to the shopping mall or public library?even a few hours spent in air conditioning can help your body stay cooler when you go back into the heat. Call your local health department to see if there are any heat-relief shelters in your area. Electric fans may provide comfort, but when the temperature is in the high 90s, fans will not prevent heat-related illness. Taking a cool shower or bath or moving to an air-conditioned place is a much better way to cool off. Use your stove and oven less to maintain a cooler temperature in your home.

Use a Buddy System

When working in the heat, monitor the condition of your co-workers and have someone do the same for you. Heat-induced illness can cause a person to become confused or lose consciousness. If you are 65 years of age or older, have a friend or relative call to check on you twice a day during a heat wave. If you know someone in this age group, check on them at least twice a day.

Monitor Those at High Risk

Although any one at any time can suffer from heat-related illness, some people are at greater risk than others.

• Infants and children up to four years of age are sensitive to the effects of high temperatures and rely on others to regulate their environments and provide adequate liquids.
• People 65 years of age or older may not compensate for heat stress efficiently and are less likely to sense and respond to change in temperature.
• People who are overweight may be prone to heat sickness because of their tendency to retain more body heat.
• People who overexert during work or exercise may become dehydrated and susceptible to heat sickness.
• People who are physically ill, especially with heart disease or high blood pressure, or who take certain medications, such as for depression, insomnia, or poor circulation, may be affected by extreme heat.

Visit adults at risk at least twice a day and closely watch them for signs of heat exhaustion or heat stroke. Infants and young children, of course, need much more frequent watching.

Adjust to the Environment

Be aware that any sudden change in temperature, such as an early summer heat wave, will be stressful to your body. You will have a greater tolerance for heat if you limit your physical activity until you become accustomed to the heat. If you travel to a hotter climate, allow several days to become acclimated before attempting any vigorous exercise, and work up to it gradually.

Do Not Leave Children in Cars

Even in cool temperatures, cars can heat up to dangerous temperatures very quickly. Even with the windows cracked open, interior temperatures can rise almost 20 degrees Fahrenheit within the first 10 minutes. Anyone left inside is at risk for serious heat-related illnesses or even death. Children who are left unattended in parked cars are at greatest risk for heat stroke, and possibly death. When traveling with children, remember to do the following:

• Never leave infants, children or pets in a parked car, even if the windows are cracked open.
• To remind yourself that a child is in the car, keep a stuffed animal in the car seat. When the child is buckled in, place the stuffed animal in the front with the driver.
• When leaving your car, check to be sure everyone is out of the car. Do not overlook any children who have fallen asleep in the car.

Use Common Sense

Remember to keep cool and use common sense:

• Avoid hot foods and heavy meals?they add heat to your body.
• Drink plenty of fluids and replace salts and minerals in your body. Do not take salt tablets unless under medical supervision.
• Dress infants and children in cool, loose clothing and shade their heads and faces with hats or an umbrella.
• Limit sun exposure during mid-day hours and in places of potential severe exposure such as beaches.
• Do not leave infants, children, or pets in a parked car.
• Provide plenty of fresh water for your pets, and leave the water in a shady area.

Hot Weather Health Emergencies

Even short periods of high temperatures can cause serious health problems. Doing too much on a hot day, spending too much time in the sun or staying too long in an overheated place can cause heat-related illnesses. Know the symptoms of heat disorders and overexposure to the sun, and be ready to give first aid treatment.

Heat Stroke

Heat stroke occurs when the body is unable to regulate its temperature. The body's temperature rises rapidly, the sweating mechanism fails, and the body is unable to cool down. Body temperature may rise to 106?F or higher within 10 to 15 minutes. Heat stroke can cause death or permanent disability if emergency treatment is not provided.

Recognizing Heat Stroke

Warning signs of heat stroke vary but may include the following:

• An extremely high body temperature (above 103?F, orally)
• Red, hot, and dry skin (no sweating)
• Rapid, strong pulse
• Throbbing headache
• Dizziness
• Nausea
• Confusion
• Unconsciousness

What to Do

If you see any of these signs, you may be dealing with a life-threatening emergency. Have someone call for immediate medical assistance while you begin cooling the victim. Do the following:

• Get the victim to a shady area.
• Cool the victim rapidly using whatever methods you can. For example, immerse the victim in a tub of cool water; place the person in a cool shower; spray the victim with cool water from a garden hose; sponge the person with cool water; or if the humidity is low, wrap the victim in a cool, wet sheet and fan him or her vigorously.
• Monitor body temperature, and continue cooling efforts until the body temperature drops to 101-102?F.
• If emergency medical personnel are delayed, call the hospital emergency room for further instructions.
• Do not give the victim fluids to drink.
• Get medical assistance as soon as possible.

Sometimes a victim's muscles will begin to twitch uncontrollably as a result of heat stroke. If this happens, keep the victim from injuring himself, but do not place any object in the mouth and do not give fluids. If there is vomiting, make sure the airway remains open by turning the victim on his or her side.

Heat Exhaustion

Heat exhaustion is a milder form of heat-related illness that can develop after several days of exposure to high temperatures and inadequate or unbalanced replacement of fluids. It is the body's response to an excessive loss of the water and salt contained in sweat. Those most prone to heat exhaustion are elderly people, people with high blood pressure, and people working or exercising in a hot environment.

Recognizing Heat Exhaustion

Warning signs of heat exhaustion include the following:

• Heavy sweating
• Paleness
• Muscle cramps
• Tiredness
• Weakness
• Dizziness
• Headache
• Nausea or vomiting
• Fainting

The skin may be cool and moist. The victim's pulse rate will be fast and weak, and breathing will be fast and shallow. If heat exhaustion is untreated, it may progress to heat stroke. Seek medical attention immediately if any of the following occurs:

• Symptoms are severe
• The victim has heart problems or high blood pressure

Otherwise, help the victim to cool off, and seek medical attention if symptoms worsen or last longer than 1 hour.

What to Do

Cooling measures that may be effective include the following:

• Cool, nonalcoholic beverages
• Rest
• Cool shower, bath, or sponge bath
• An air-conditioned environment
• Lightweight clothing

Heat Cramps

Heat cramps usually affect people who sweat a lot during strenuous activity. This sweating depletes the body's salt and moisture. The low salt level in the muscles may be the cause of heat cramps. Heat cramps may also be a symptom of heat exhaustion.

Recognizing Heat Cramps

Heat cramps are muscle pains or spasms?usually in the abdomen, arms, or legs?that may occur in association with strenuous activity. If you have heart problems or are on a low-sodium diet, get medical attention for heat cramps.

What to Do If medical attention is not necessary, take these steps:

• Stop all activity, and sit quietly in a cool place.
• Drink clear juice or a sports beverage.
• Do not return to strenuous activity for a few hours after the cramps subside, because further exertion may lead to heat exhaustion or heat stroke.
• Seek medical attention for heat cramps if they do not subside in 1 hour.

Sunburn

Sunburn should be avoided because it damages the skin. Although the discomfort is usually minor and healing often occurs in about a week, a more severe sunburn may require medical attention.

Recognizing Sunburn

Symptoms of sunburn are well known: the skin becomes red, painful, and abnormally warm after sun exposure.

What to Do

Consult a doctor if the sunburn affects an infant younger than 1 year of age or if these symptoms are present:

• Fever
• Fluid-filled blisters
• Severe pain

Also, remember these tips when treating sunburn:

• Avoid repeated sun exposure.
• Apply cold compresses or immerse the sunburned area in cool water.
• Apply moisturizing lotion to affected areas. Do not use salve, butter, or ointment.
• Do not break blisters.

Heat Rash Heat rash is a skin irritation caused by excessive sweating during hot, humid weather. It can occur at any age but is most common in young children.

Recognizing Heat Rash

Heat rash looks like a red cluster of pimples or small blisters. It is more likely to occur on the neck and upper chest, in the groin, under the breasts, and in elbow creases.

What to Do

The best treatment for heat rash is to provide a cooler, less humid environment. Keep the affected area dry. Dusting powder may be used to increase comfort.

Treating heat rash is simple and usually does not require medical assistance. Other heat-related problems can be much more severe.

Heart Awareness

Call 911 if you or someone you know experiences any of the following symptoms. Getting help immediately is the best survival tactic!

Heart Attack symptoms:

• Feeling of discomfort in the chest that lasts more than a few minutes, or goes away and comes back. This discomfort could feel like squeezing, pain, uncomfortable pressure or fullness.
• Pain or discomfort in other areas of the body, jaw, back, one or both arms or stomach.
• Shortness of breath that can occur with or without a feeling of discomfort in the chest.
• Feeling nauseous, lightheaded and/or breaking out in a cold sweat.

Cardiac Arrest symptoms:

• Sudden loss of responsiveness, even to gentle shaking.
• No normal breathing for several seconds.
• No movement, pulse or coughing.

Stroke symptoms:

• Sudden weakness or numbness that occurs in the face, arm, or leg, usually on one side of the body.
• Sudden confusion, difficulty speaking or understanding, or confused speech.
• Sudden difficulty seeing in one or both eyes.
• Sudden problem with walking.
• Dizziness.
• Loss of balance or coordination.

For more info: www.stroke.org or www.americanheart.org

Broken Heart Syndrome Is Real!

by Maeve Ostrowski, RN

We’ve all heard the phrase, she broke his heart or, he died of a broken heart! Recently, I read an article in the Baltimore Archdiocese newspaper, The Catholic Review, Feb 16, 2006) that pondered the question, Can love really weaken your heart? I was immediately riveted to the page, number 27.  I quote, "The heart is more than a muscle that pumps blood, it is also a messenger to and from the brain." Studies show that heart conditions can change after a great emotional event.

The scientific explanation offered by Johns Hopkins physicians is that when the body is hit with a huge stressor such as grief, fear, anger or migraine, the heart is stunned with a huge amount of adrenaline. This causes chest pain, shortness of breath and related signs and symptoms that can mimic a heart attack.

Doctors named the broken heart syndrome based on the fact that intense emotional or physical stress causes temporary yet severe heart weakening. For 5 years they have seen enough patients to cause them to chronicle an actual syndrome. While people robbed at gunpoint, being in an auto accident, surprised by news of a sudden death have been afflicted, doctors say that over the course of the 5-year study, no one has experienced the syndrome a second time. Although , they report that nearly half of the patients who arrive at the ER, believing themselves to be suffering a heart attack, have lost a loved one recently and are in real cardiac distress.

 Women over 60 account for 95% of patients, a phenomenon doctor?s can not yet explain. But, because the condition can last for a few weeks, doctors caution anyone sitting at home with severe chest pain and/or shortness of breath to seek treatment at a hospital immediately. For, while none of their patients has died from broken heart syndrome, severe symptoms left untreated may well cause death.

The good news is that the large amount of adrenaline flowing through the body and causing the heart attack symptoms is usually resolved quickly, unlike the real thing that can damage the heart muscle permanently. For those afflicted with a broken heart, you won?t die from one, but that kind of broken heart may strike again. What remedy is there for you? In the words of Henry David Thoreau, There is no remedy for love, but to love more.

What do Floaters and Flashers in the Eye Indicate?

Sometimes you may see small specks or clouds moving in your field of vision. They are called floaters. You can often see them when looking at a plain background, like a wall or the blue sky.

Floaters are actually tiny clumps of gel or cells inside the vitreous humour, the clear jelly-like fluid that fills the inside of your eye. While these objects look like they are in front of your eye, they are actually floating inside your eye. What you actually see are the shadows they cast on the retina. The retina is the nerve layer at the back of the eye that senses light and allows you to see. Floaters can have different shapes: little dots, circles, lines, clouds, or cobweb shapes.

Floaters are caused when the vitreous humour or gel starts to thicken or shrink. The vitreous gel pulls away from the back wall of the eye, causing a posterior vitreous detachment. It is a common cause of floaters. This usually starts to happen when people reach middle age. Posterior vitreous detachment is more common for people who:

• Are nearsighted, meaning they can?t see far away
• Have undergone cataract operations
• Have had YAG laser surgery of the eye
• Have had inflammation inside the eye.

The appearance of floaters may by alarming, especially if they develop suddenly. You should see an ophthalmologist right away if you suddenly develop new floaters, especially if you are over 45 years of age.

The retina can tear if the shrinking vitreous gel pulls away from the wall of the eye. This sometimes causes a small amount of bleeding in the eye that may appear as new floaters. A torn retina is always a serious problem, since it can lead to a retinal detachment. You should see your ophthalmologist as soon as possible if:

• Even one new floater appears suddenly
• You see sudden flashes of light.

Other symptoms, like the loss of side vision, should also occasion a trip to the doctor.

Floaters can get in the way of clear vision, which may be quite annoying, especially if you are trying to read.

You can try moving your eyes, looking up and then down to move the floaters out of the way.

While some floaters may remain in your vision, many of them will fade over time and become less bothersome. Even if you have had some floaters for years, you should have an eye exam immediately if you notice new ones.

Flashing lights or lightning streaks are caused when the vitreous gel rubs or pulls on the retina. You may have experienced this same sensation if you have ever been hit in the eye and seen stars.

The flashes of light can appear off and on for several weeks or months. As we age, it is more common to experience flashes, but the sudden appearance of light flashes, should nonetheless, be taken as a warning sign.

Some people experience flashes of light that appear as jagged lines or heat waves in both eyes, often lasting 10 to 20 minutes. These types of flashes are usually caused by a spasm of blood vessels in the brain, which is called a migraine.

If a headache follows the flashes, it is called a migraine headache. However, jagged lines or heat waves can occur without a headache. In this case, the light flashes are called ophthalmic migraine, or migraine without headache.

When an ophthalmologist examines your eyes, your eyes will be dilated with drops. During this painless examination, your ophthalmologist will carefully observe your retina and vitreous. Because your eyes have been dilated, you may need to make arrangements for someone to drive you home afterwards.

While not all floaters and flashes are serious, you should always have a medical eye examination by an ophthalmologist to make sure there has been no damage to your retina.

Deborah L Bohlman, RN, compiled this article from an article by The American Academy of Ophthalmology.

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May is the Better Sleep Month

In the 2006 Better Sleep Month survey, only 25 percent of respondents rated the quality
and quantity of their sleep as excellent. That means that 75 percent need to take action to
improve their sleep.

Five Tips to Improve Sleep and Mood:

Treat your body right. Good nutrition makes a difference. Get adequate rest, exercise, and balance work and play. For the best sleep, avoid exercising or eating near bedtime including limiting intake or avoiding caffeine, nicotine and alcohol - they all interfere with restful sleep.
Schedule time for sleep. Just like we manage our many ?to-dos?, sleep is an appointment that you can not miss. When the quality of your sleep improves, so does your mood, thus the quality of your life. Tonight?s sleep can determine how your tomorrow will be, so it should be at the top of any daily agenda.
Create a sleep sanctuary. The best sleep environment is uncluttered, dark, quiet, and cool (ideal temperature is around 65 degrees). Your bed is not a desk, dining room table or a couch, so it?s best to turn off the television and keep the food and laptop out of the bed. Most importantly, always sleep on a comfortable mattress and pillow.
Ease your anxious mind. Wind down before bed. Take a bath, meditate, do whatever you need to do to relax and wipe away the day?s stress. If you find your mind racing while trying to go to sleep, keep a pad of paper next to your bed and jot down what?s on your mind. If you find yourself unable to sleep after 20 minutes, get out of bed, go into another room and engage in a calming activity until you feel ready to sleep.
Take it day by day. Changing your schedule and attitude about sleep isn?t going to happen overnight. It requires lifestyle changes, dedication and practice. Just like improving any aspects of our health, making sleep a priority and minding your mental health takes time. Remember that the return on investment will be a happier, healthier life. www.bettersleep.com

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