Medicine can alter your reaction to heat

Hot enough for you? Don't get mad at us; we're as tired of that question as you are.

Heat exhaustion and heat stroke are striking people around the country, especially children, the elderly, athletes and people taking certain common medications.


If your body were an automobile, you wouldn't get far when the water in your radiator boiled away. Ignore the warning light, and you could easily blow the engine.

The body doesn't come with an "idiot light" or a gauge to signal overheating, but overlooking the warning signs of heat exhaustion could lead to a serious medical emergency. Heat stroke can result in brain damage or even death.


First, let's clear up the differences between heat exhaustion and heat stroke. Heat exhaustion occurs as a result of a loss of fluid. This may occur as a result of not drinking enough to replace sweating losses. The person becomes weak and may feel nauseated, anxious and lightheaded.

When a crowd gathers and stands around for some event in hot weather, some folks are overcome by heat exhaustion and they faint. Their pulses are weak and slow, their skin is pale and clammy, and their blood pressure is low.

Heat stroke, on the other hand, happens when the body's normal means of losing heat shut down or can't cope with extreme temperature. The onset of symptoms may be sudden, with headache, weakness and disorientation signaling an imminent loss of consciousness. The skin is hot, usually dry, and flushed. The pulse is fast and hard, and the body temperature is elevated. Children and pets have died from heat stroke when they were left in a closed car. Heat stroke requires emergency medical attention.

Many medications make matters much worse. Drugs that slow sweating are especially dangerous. They disable the body's "radiator" and make cooling more difficult. Anti-depressants such amitriptyline (Elavil), desipramine (Pertofrane and Norpramin), doxepin (Sinequan), imipramine (Tofranil) and nortriptyline (Pamelor) are especially dangerous in this regard.

Over-the-counter anti-histamines and motion sickness medicine can also make people more vulnerable to the heat. An athlete taking diphenhydramine (Benadryl) or clemastine (Tavist) to relieve congestion might end up in the hospital because the body can't get rid of the excess heat generated by vigorous exercise.

Prescription heart medicine such as atenolol (Tenormin), nadolol Corgard) and propranolol (Inderal) can also make it harder to keep up with the strain of the heat.

Diuretics, often found in blood pressure medicines, may deplete the body of minerals and fluid, predisposing people to heat exhaustion. Alcohol is also a diuretic and makes heat exposure more dangerous.

Q: I read your column about using vinegar soaks to treat toenail fungus. A few years ago, my youngest son had a fungus on his fingernails which made them thick. He also had numerous warts.


The doctor offered to burn them off, but instead we tried the suggestion of a friend to soak in a mild Clorox and warm water solution. Within a few weeks, both warts and fungus were gone.

A: This is not the first time we've heard that dilute bleach solutions may be helpful against nail fungus. One reader with crumbly, decayed-looking toenails tried her cardiologist's recipe: "a five-minute-a-day soak in a solution of warm soapy water with a little Clorox added." The doctor had used this home remedy himself with good results.

If the bleach solution causes skin irritation, obviously the treatment should be discontinued. Anyone who would like more home remedies, especially for fungus and warts, may send $2 with a long (No.10) stamped, self-addressed envelope to Graedons' People's Pharmacy, No. R-75, P.O. Box 52027, Durham, N.C. 27717-2027 for a copy of Graedons' Guide to Home Remedies.

Q: What is "ginkgo biloba"? My friends all say it is great for improving memory. I could use the help, but I wonder if it would interact with the Coumadin I take.

A: Ginkgo biloba is the scientific name for an ancient tree with a long history in Chinese medicine. The traditional use for the leaves was for asthma and chilblains (swollen, painful or itching hands and feet) due to damp cold climates.

Ginkgo extract is often prescribed in Europe. Here, you may find it at the health food store or pharmacy, where it is sold as a dietary supplement. Whether or not your memory is good, it is smart of you to ask about interactions. Because ginkgo extract can keep platelets from sticking together, it might well interact with your Coumadin (warfarin) to thin the blood too much and lead to hemorrhage. It would be dangerous for you to experiment yourself.