Well, the problems are not different here, deep in the bowels of Oklahoma, we need to pay close attention to avoiding getting too hot and suffering physically, resulting in poor play and unfortunately a trip to the ER.
Heat exposure can manifest itself in multiple ways including but not limited to heat syncope (fainting), heat cramps, heat exhaustion and heat stroke.
Heat syncope can occur following 2-3 hrs. of physical activity in a hot environment. Symptoms can include a short loss of consciousness, cool and clammy skin, weak pulse and/or decreased sweating. Treatment consists of moving the person to a cool area and cool fluids for rehydration by mouth.
Heat cramps are the result of fluid and electrolyte depletion that result in a slow, painful skeletal muscle spasm lasting several minutes with some reoccurrences. The muscles most often involved are the muscles most used during the activity. Treatment consists of replacing fluid and electrolytes by mouth (sometimes intravenously). The electrolytes (sodium, potassium and chloride) must be replaced.
Heat exhaustion follows prolonged, strenuous activity in hot environments, resulting in significant losses in water and electrolytes. People with heat exhaustion will have elevation of temperature, a pulse of 130-150 bpm, cool and clammy skin, nausea, vomiting, malaise, headaches, dizziness and sometimes confusion and disorientation. Often this event can follow syncope and cramps. Treatment consists of getting the person to a cool environment and replacement of fluids and electrolytes. Most often this will need to be done in an ER where more supportive care can be rendered. Multiple system failure including the heart, lung, kidney, liver, cerebral damage can occur.
Heat stroke has increased morbidity and even death. Heat stroke is a life-threatening medical emergency resulting from failure of the body to regulate the core body temperature. There are 2 types of Heat strokes. The “classic heat stroke” typically can occur in persons with other medical conditions. The “exertional heat stroke” typically occurs in healthy persons undergoing strenuous exertion in a hot environment.
Hallmarks of a “heat stroke” are impaired consciousness, high fever, absence of sweating and any or all the other findings in the other heat related problems. People taking medication for the heart, blood pressure, and other medical conditions are at greater risk of heat stroke. Also, if you are older than 65 you too are at greater risk.
Prevention of heat related issues consist of the following:
1. Start hydration the day before you play.
2. Know what medications you are taking and how they affect your heat tolerance.
3. No alcohol the day before you play. Nothing with alcohol rehydrates you.
4. Drink fluids on every Tee. If you wait until you are thirsty, you are behind in fluids. Start drinking fluids.
5. Monitor the urine. You need to have a good volume and the urine should be “pale yellow” (note: if you don't need to urinate during a round of golf, you are probably not drinking enough fluids)
Treatment in all these heat related issues consist of the following:
1. Move to a cool place- ice-packs to neck, axilla, and groin
2. Place person in a cool/ice water bath ( swimming pool, shower)
3. Remove clothing, spray body with cold water and place in front of a fan.
4. If person is alert, provide cool fluids and electrolytes. (saline solution of salt 4 tsp in gallon of water) drink freely.
5. Monitor mental and physical condition for change, consider moving to ER.
I hope this will help keep us all healthy and injury free while enjoying our summer golf.
G. Bob Fraley, MD has been a member of the Golf Channel Am Tour since February 2008 and has a family practice at Integris Family Care NW in Oklahoma City.
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