Stay Safe During Hot Weather Exercise

If you are a regular reader of these blogs you know that I definitely advocate exercising on a regular basis, but when the summer months turn really hot and humid, you need to be careful to avoid heat related illnesses like heat stroke or heat exhaustion.

Whether you’re running, playing tennis, working in your yard or garden, or going for a power walk, please be careful when the temperature rises.

Exercising in hot weather puts extra stress on your body. If you don’t take care when exercising in the heat, you risk serious illness. Both the exercise itself and the air temperature and humidity can increase your core body temperature.

To help cool itself, your body sends more blood to circulate through your skin. This leaves less blood for your muscles, which in turn increases your heart rate. If the humidity also is high, your body faces added stress because sweat doesn’t readily evaporate from your skin. That pushes your body temperature even higher.

Under normal conditions, your skin, blood vessels and perspiration level adjust to the heat. But these natural cooling systems may fail if you’re exposed to high temperatures and humidity for too long, you sweat heavily, and you don’t drink enough fluids.

The result may be a heat-related illness. Heat-related illnesses occur along a spectrum, starting out mild but worsening if left untreated. Heat illnesses include:

  • Heat cramps.Heat cramps, sometimes called exercise-associated muscle cramps, are painful muscle contractions that can occur with exercise. Affected muscles may feel firm to the touch. You may feel muscle pain or spasms. Your body temperature may be normal.
  • Heat syncope and exercise-associated collapseHeat syncope is a feeling of lightheadedness or fainting caused by high temperatures, often occurring after standing for a long period of time or standing quickly after sitting for a long period of time. Exercise-associated collapse is feeling lightheaded or fainting immediately after exercising, and it can occur especially if you immediately stop running and stand still after a race or a long run.
  • Heat exhaustion.With heat exhaustion, your body temperature rises as high as 104° F, and you may experience nausea, vomiting, weakness, headache, fainting, sweating and cold, clammy skin. If left untreated, heat exhaustion can lead to heatstroke.
  • Heatstroke is a life-threatening emergency condition that occurs when your body temperature is greater than 104° F. Your skin may be dry from lack of sweat, or it may be moist.

You may develop confusion, irritability, headache, heart rhythm problems, dizziness, fainting, nausea, vomiting, visual problems and fatigue. You need immediate medical attention to prevent brain damage, organ failure or even death.

During hot-weather exercise, watch for signs and symptoms of heat-related illness. If you ignore these symptoms, your condition can worsen, resulting in a medical emergency.

WARNING SIGNS:

  • Muscle cramps
  • Nausea or vomiting
  • Weakness
  • Fatigue
  • Headache
  • Excessive sweating
  • Dizziness or lightheadedness
  • Confusion
  • Irritability
  • Low blood pressure
  • Increased heart rate
  • Visual problems

If you develop any of these symptoms, you must lower your body temperature and get hydrated right away. Stop exercising immediately and get out of the heat. If possible, have someone stay with you who can help monitor your condition.

Measuring core body temperature with a rectal thermometer is essential to accurately determine the degree of heat injury. An oral, ear or forehead thermometer doesn’t provide an accurate temperature reading for this purpose. In cases of heatstroke, due to confusion and mental status changes, you won’t be able to treat yourself and you’ll require emergency medical care. The most effective way of rapid cooling is immersion of your body in a cold- or ice-water tub.

In cases of heat exhaustion, remove extra clothing or sports equipment. Make sure you are around people who can help you and assist in your care. If possible, fan your body or wet down your body with cool water.

You may place cool, wet towels or ice packs on your neck, forehead and under your arms, spray yourself with water from a hose or shower, or sit in a tub filled with cold water. Drink fluids such as water or a sports drink. If you don’t feel better within about 20 minutes, seek emergency medical care.

IF YOU HAVE SIGNS OF HEAT STROKE- SEEK MEDICAL TREATMENT RIGHT AWAY

If your core temperature is less than 104° F, but it doesn’t come down quickly, you’ll also need urgent medical attention. In some cases, you may need fluids through intravenous (IV) tubes if you’re not able to drink fluids, or not able to drink enough fluids.

Get cleared by your doctor before you return to exercise if you’ve had heatstroke. Your doctor will likely recommend that you wait to return to exercise or sports until you’re not experiencing symptoms. If you’ve had a heatstroke, you may require many weeks before you are able to exercise at a high level. Once your doctor clears you for exercise, you may begin to exercise for short periods of time and gradually exercise for longer periods as you adjust to the heat.

When you exercise in hot weather, keep these precautions in mind:

  • Watch the temperature.Pay attention to weather forecasts and heat alerts. Know what the temperature is expected to be for the duration of your planned outdoor activity. In running events, there are “flag” warnings that correspond to the degree of heat and humidity. For example, a yellow flag requires careful monitoring, and races are canceled in black flag conditions.
  • Get acclimated.If you’re used to exercising indoors or in cooler weather, take it easy at first when you exercise in the heat. It can take at least one to two weeks to adapt to the heat. As your body adapts to the heat over time, gradually increase the length and intensity of your workouts.
  • Know your fitness level.If you’re unfit or new to exercise, be extra cautious when working out in the heat. Your body may have a lower tolerance to the heat. Reduce your exercise intensity and take frequent breaks.
  • Drink plenty of fluids.Dehydration is a key factor in heat illness. Help your body sweat and cool down by staying well-hydrated with water. Don’t wait until you’re thirsty to drink fluids. If you plan to exercise intensely, consider a sports drink instead of water. Sports drinks can replace the sodium, chloride and potassium you lose through sweating. Avoid alcoholic drinks because they can actually promote fluid loss.
  • Dress appropriately.Lightweight, loose fitting clothing helps sweat evaporate and keeps you cooler. Avoid dark colors, which can absorb heat. If possible, wear a light-colored, wide-brimmed hat.
  • Avoid midday sun.Exercise in the morning or evening, when it’s likely to be cooler outdoors. If possible, exercise in shady areas, or do a water workout in a pool.
  • Wear sunscreen.A sunburn decreases your body’s ability to cool itself and increases the risk of skin cancer.
  • Have a backup plan.If you’re concerned about the heat or humidity, stay indoors. Work out at the gym, walk laps inside the mall or climb stairs inside an air-conditioned building.
  • Understand your medical risks.Certain medical conditions or medications can increase your risk of a heat-related illness. If you plan to exercise in the heat, talk to your doctor about precautions.
  • Choose and alternative form of exercise. If you are a runner – maybe try cycling as you create your own cooling effect by moving air over your body – or maybe give swimming a go – but beware of swimming laps in a hot (> 84° F) pool – as you can quickly overheat swimming in water that warm.

I do recommend that you continue to exercise on a regular basis even through this hot month of August, just be smart about it by following these recommendations.

If you have any questions about this blog or your health in general, please feel free to contact me at:  drtomball@performancehealthcenter.com

 

Share This With Your PCP!

Unfortunately the following saga is way too typical in our office. Last month I saw a new patient who had severe low back pain (LBP) for over 2 years. The pain was so severe she was living on pain meds, going right home from work and going to bed. She was not participating in life and was extremely frustrated. She had seen her Primary Care Physician (PCP) from the onset of her pain. She was referred to multiple specialists for advanced testing, injections and more medications, none of which gave her any real relief or hope.

Finally after two (2) years, at the repeated encouragement of Lyn Rome, her hair stylist, she came into my office, explained in detail all she had been through and the frustration of living with pain. My exam ruled out all the “red flags” or pathological causes of her pain. My diagnosis was dysfunction of her left Sacro-iliac joint and sciatic nerve entrapment. Simply put, the largest joint in her body (in the butt area) was stuck and the longest and thickest nerve in the body which goes from the low back to the toes was not gliding properly. Of course she also had muscles spasms because her muscles were short and tight to protect the joint that was not moving, setting up a visors cycle of pain that kept perpetuating itself.

I felt confident I could help her, but since she was skeptical and nervous from her prior medical treatments I recommended a 2 week trial of chiropractic care to see how she would respond. I wish all of my patients responded so quickly, but after 2 treatments she had significant decrease in pain, stopped the pain meds and didn’t have to go right to bed after work. Obviously the trial of care was successful and she is on the road to recovery.

Two (2) years of her life was wasted because of ignorance (or bias) on the part of her PCP. Unfortunately this is a scenario I see all the time at our office, but it shouldn’t be that way. Any competent medical doctor who keeps up with the literature should know that chiropractic care has been well documented as an effective treatment for LBP. (It is not the only condition we treat, but the most researched). There really is no excuse for collaboration between your PCP and the chiropractic profession for the best interest of the patient, especially for the treatment of LBP.

Now there is even more proof! In the May 2018, on-line edition of the JAMA (Journal of the American Medical Association), a new studies found that “usual medical care plus chiropractic care reported a statistically significant improvement in low back pain intensity and disability at 6 weeks compared with those who received usual care alone.” In a study of 750 people, from the ages of 18-50, the addition of including chiropractic care documented statistically significant improvement included less reported pain, less disability, more patient satisfaction and less pain medications used. Across the board including chiropractic care reduced pain and suffering.The conclusion of this study states, “this trial provides additional support for the inclusion of chiropractic care as a component of multidisciplinary health care for low back pain, as currently recommended in existing guidelines”. Note the words…as currently recommended in existing guidelines.

The number one cause of disability worldwide is LBP! At least 20% of Americans will have LBP lasting at least 1 day over the next 3 months. LBP is the 2nd reason why patients visit their PCP. The direct cost of LBP in 2010 was $34 billion, and adding in lost work and productivity costs the US economy up to $200 Billion. At the present time only 8-14% of the US population receives chiropractic care annually. So why aren’t PCPs referring to chiropractors. Getting historical, there have been excellent studies validating chiropractic care and multiple government reports recommend a greater utilization of chiropractic care.

As far back as 1993 the Ontario Ministry of Health published what is called the Manga Report. The Manga Report’s conclusion was to make chiropractors the gatekeepers for treating LBP for many reasons concluding: “On the evidence, particularly the most scientifically valid clinical studies, spinal manipulation applied by chiropractors is shown to be more effective than alternative treatments for low back pain. Many medical therapies are of questionable validity or are clearly inadequate; there is no clinical or case-control study that demonstrates or even implies that chiropractic spinal manipulation is unsafe in the treatment of low back pain. Some medical treatments are equally safe, but others are unsafe and generate iatrogenic (doctor-induced) complications for low back pain patients. Our reading of the literature suggests that chiropractic manipulation is safer than medical management of low back pain; and there is an overwhelming body of evidence indicating that chiropractic management of low back pain is more cost-effective than medical management.”

Then in 1994, the US Agency on Health Care Policy and Research (AHCPR) released Clinical Guidelines for Management of Acute Low Back Pain. These Guidelines were created an expert panel to provide PCPs with recommendations on the assessment and treatment of LBP. Again the conclusions included:
• Conservative treatment such as spinal manipulation should be pursued in most before cases considering surgical intervention;
• Prescription drugs such as oral steroids, antidepressant medications and colchicine are not recommended for acute low back problems.

The benefits of chiropractic care both in human suffering level and economic savings is well documented and recommended by multiple government agencies. I still don’t understand why the chiropractic profession is not getting more referrals from the medical profession. Going back to the patient in the first paragraph, in her words she lost 2 years of her life and had lost hope of ever being able to function and doing the most basic activities like walking with her husband or sitting in a restaurant. My bias is that she should have been referred for chiropractic care after the pain lasted for 2 weeks while following her PCPs advice. When the pain persisted and multiple therapies failed, at the very least her PCP could have said I don’t know much about chiropractic health care, but since you are not feeling better why don’t you give it a try.

I don’t fault the present generation of medical doctors. Chiropractic care is not part of their educational curriculum. I have seen this first hand. For eight (8) years family practice residents first at University of Vermont and then Tufts had a one (1) day rotation at my office. I asked each resident in all your years of medical school and residency how much did they learn about chiropractic health care. The answer across the board was “nothing”. Then I’d ask how much did they learn about the musculoskeletal system? The answer across the board this time was “not much”. Then I’d ask my final question which was how many vertebrae are in the spine? In 8 years only 1 Family Practice Resident was able to rattle off the correct answer which is 24.

Then the medical resident spent the day with me watching me interact and treat my patients. At the end of the day across the residents would say how impressed they were. They didn’t realize the scope of chiropractic practice and the benefits of manipulation. My advice was always the same. When you finish your residencies and hang up your shingle to practice, meet a few chiropractors in your community, find one or two that you feel comfortable with and refer your patients to them. Unfortunately this type of rotation at a chiropractic office was and still is a rare event in the training of medical residents.

Hopefully you have read down this far. The only way your PCP is going to know about this new study (and historical guidelines) is if you share this article with them. Please email your PCP and attach this article. Ask if he/she has read the new JAMA study on the significant benefits of including chiropractic care in collaboration with “usual medical care” for patients with low back pain? If not the link is here: Effect of Usual Medical Care Plus Chiropractic Care vs Usual Medical Care Alone on Pain and Disability Among US Service Members With Low Back Pain: A Comparative Effectiveness Clinical Trial

Sharing this article with your PCP this will help build bridges between the two professions and the winner is you, the consumer of health care.

For more information please contact me at drbradweiss@performancehealthcenter.com

“Rest and Relax” vs “Fight or Flight”

“Rest and Relax” (PNS) vs “Fight or Flight” (SNS)…. I am writing this Blog the week before Super Bowl LII, while most sports fans are thinking AFC vs NFC and which is stronger and who will over power the other.  Well, I want you to consider in your own mind which system in your body is overpowering the other?

What do I mean by that?  Well, we all have both a Parasympathetic nervous system (PNS) and Sympathetic nervous system (SNS), both of which are regulated by our Central Nervous System (CNS).  Which ever one is dominant in you may influence your overall health.  People who are more SNS dominant may have trouble relaxing, they may have hypertension, muscle tension, irritability, and difficulty with digestion and/or elimination.  There are a host of health-related problems from being too SNS dominant, but for the sake of this blog I will highlight how it effects our overall nutritional intake and absorption.

Have you ever switched your focus from what you are eating to how you are digesting? Are you really absorbing all the nutrients from your foods?

The parasympathetic nerves come from the cranial nerves and include the vagus nerve. The PNS nerves perform the following digestive functions:

  • Stimulate the activity of the stomach
  • Inhibit the release of glucose
  • Stimulate the release of the gallbladder to release bile needed to digest fat
  • Stimulate the activity of the intestines
  • Trigger peristalsis, which helps prevent constipation
  • Trigger enzyme production in the pancreas (pancreatic enzymes to break down carbs, protein and fats)
  • Signal if satiated
  • Signal if hungry
  • Need for more stomach acid (HCL), enzymes, bile and peristalsis

The sympathetic nerves do the opposite, including:

  • Inhibit the activity of the stomach
  • Stimulate the release of glucose (increasing blood sugar levels)
  • Inhibit gallbladder function (inhibiting the release of bile for fat digestion)
  • Inhibit the activity of the intestines

Stress impairs our digestive process. Digestion is a parasympathetic nervous system process (PNS) also known as the “rest, digest and repair” nervous system. For maximum health we should be in the PNS 80 percent of the time and the other 20 percent of the day we should be in the sympathetic nervous system (SNS), also known as the “fight or flight” nervous system. Now what percentage of the day do you think you are in PNS versus SNS? What about when you are eating? Resting? Sleeping? We should be in the parasympathetic nervous system when eating but rarely do we sit, relax and focus on eating a meal as they do in most areas of Europe.

If you are a typical type-A personality, over-doer in life, then you may struggle with taking time out of your weekday for a relaxing meal and unplugging. What is the difference? Eating in the parasympathetic nervous system versus the sympathetic nervous system. Digestion is turned off when you are in the sympathetic nervous system. Many of us are living life as a race leading us to be in the sympathetic nervous system 80 percent of the day instead of 20 percent, causing a domino effect of health problems.

So, we know the vagus nerve highly influences the PNS so our vagus nerve needs to be strong in order to help in the digestion process. Remember, we get our amino acids, essential fatty acids, vitamins and minerals from the food we digest and break down, which helps build enzymes, hormones, muscles, bones, blood and our gut biome.

We need to support our vagus nerve and (PNS) to improve our digestion and gut health if we want to be healthier, since good digestion leads to a healthy gut, which results in reduced inflammation and an improved immune system (70% of our immune system is in the gut!).

Stop, pause, slow inhales, long exhales and reset. Take some deep breathes in and out, focus and unplug. Other techniques to boost your PNS: gargling, humming, singing, cold showers, meditation, mindful yoga, and connecting with loved ones.

Our digestion is as important as our diet. To nourish ourselves, we must support our digestion, but also our brain, as the brain communicates to the gut and the gut communicates back to the brain. Anti-inflammation is key to our bodies’ repair, recovery and regeneration, but it doesn’t happen if we are not in the parasympathetic nervous system more often during the day and all night.

Chiropractic adjustments can strengthen your PNS since it deals directly with your nervous system.  Every function of your body is controlled by your central nervous system, and these functions can be disrupted by misalignments in your spine. These are called subluxations. A subluxation creates interference in the function of your spinal nerves, and this can result in impaired functioning of your organs and endocrine system.

So, slow down, take some deep breaths and get regular chiropractic adjustments to keep your vagus nerve and your PNS strong and healthy.

If you have any questions about this blog or your health in general, please feel free to contact me at: drtomball@performancehealthcenter.com