A cold-weather FYI about heatstroke; follow-up to the Doug Wetzel story

A December FYI for athletes and runners about heatstroke, following up on the Doug Wetzel story.

I realize we’re approaching winter and heatstroke might not be a major concern right now, but I wanted to offer a follow-up to the Doug Wetzel story, the subject of a recent post and the third segment of my latest Roughly Speaking podcast (episode 23). Heatrstroke almost killed Wetzel. Here is additional information from Dr. Valérie E. Cothran, director of the primary care sports medicine fellowship at the University of Maryland Medical Center, where Wetzel was treated.

What kind of warning signs of heatstroke or dehydration might athletes start to notice before it's too late?

Heat stroke may occasionally occur as a progression from milder heat illness to heat exhaustion and then heatstroke, but it often occurs without warning so prevention is key.

Besides just drinking water, what should athletes be thinking about before and during a race, particularly those athletes who are just on the cusp of more competitive environments, preparing for longer distances or generally inexperienced with longer races?

Hydration should not start the day of the competition; athletes should make sure that they are maintaining appropriate hydration leading up to the competition. This means avoiding dehydrating food/drinks (alcohol) the day prior to competition, and wearing appropriate clothing. Clothes should allow the athlete to sweat and also allow the sweat to evaporate. When the body gets too hot, it begins to perspire or sweat to cool itself off. Evaporation is a cooling process. If the perspiration is not able to evaporate, the body cannot regulate its temperature. Also, athletes should appropriately acclimate to warmer environments.

For a decently conditioned athlete, it seems like it didn’t take long for Doug Wetzel to develop heatstroke. Is this common? The morning temperatures in Rock Hall on May 30 ranged from 71 to 77 degrees F.

Athlete conditioning is important and reduces the risk but acclimatization is key. Generally speaking, factors such as possible illness, new medications, poor diet, or pre-competition day hydration can also be factors. Humidity plays a big role as well. When the atmospheric moisture content (i.e. relative humidity) is high, the rate of perspiration from the body decreases. Heat Index and wet bulb globe temperatures can be used to determine "danger times" for exercise. The Wet Bulb Globe Temperature (WBGT) is a measure of the heat stress in direct sunlight, which takes into account: temperature, humidity, wind speed, sun angle and cloud cover (solar radiation). Military agencies and many athletic organizations use WBGT as a guide to managing workload/practice schedules.

Is loss of memory common in severe heatstroke?

Mental status changes (which may include memory loss) are what differentiate heat exhaustion from heat stroke.

Also: In my podcast conversation with Wetzel, he refers to “compartment syndrome.” It is defined and explained here.

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