TMC PULSE

t m c » p u l s e | j u ly 2 0 1 6 19 lose heat from sweat as well." A number of other factors can also increase a person's risk, including age, being out of shape, certain medications, such as those to manage blood pressure and antihistamine allergy medi- cines, and underlying medical conditions. Jotwani also noted that one of the biggest factors in managing heat illness risk is acclimatization—or simply getting used to the heat. "For athletes, the highest risk of heat illness is that first week of practice," Jotwani said. "Our bodies will get used to the heat, their bodies will adjust when they have a little time, but it can be a major issue if you are really pushing yourself the first day." Symptoms of heat illness include nausea, headache, dizziness and muscle cramps. If a person starts having mental issues— they're confused, disoriented, acting strangely—it can indicate that the illness has progressed beyond heat exhaustion to heat stroke. "It can get very serious," Jotwani said. "Especially if it's not rec- ognized by someone around them and they're not cooled quickly, heat illness can lead to organ failure, breakdown of muscles and kidney damage." To prevent heat illness, make sure to hydrate before and throughout outdoor activities and to take occasional breaks in a shaded or air conditioned area. If someone starts exhibiting signs of heat illness, get them cooled off—into the shade, indoors, into an ice bath, if necessary—and rehydrated. Jotwani also empha- sized the importance of starting off slowly as the weather warms up and getting used to the heat. "The number one thing is getting used to and acclimatizing to the weather before pushing yourself exercise-wise," he said. "If you do that, we encourage people to stay active and enjoy the outdoors even in the summer. Being physically active is one of the healthi- est things you can do." Ensuring you cover all exposed parts of the body is essential for full protection. Commonly neglected areas are the ears, the back of the neck, the back of the hands and any exposed scalp. Furthermore, studies by the Centers for Disease Control and Prevention (CDC) have shown that even when people apply sunscreen, most don't apply enough. "The rule of thumb is that to cover your body, you should use about a shot glass of sunscreen," Drucker said. Additionally, sunscreen should be applied 30 minutes before going out into the sun and reapplied every two hours, whether it's cloudy or sunny. Sun exposure can raise your risk of skin cancer, and it has a cumulative effect, so even small amounts of unpro- tected exposure have consequences. "For 10 minutes a day, going from your house to the car or your car into a building, 10 minutes a day adds up to over an hour a week," Drucker said. "It is important to put sunscreen on every morning." For children in particular, Hunt recommends special clothing for additional protection. "UV protective swimwear can be tremendously helpful to keep their skin safe and reduce the effort needed from parents to fre- quently reapply sunscreen," she said. "Also, don't forget to protect them with hats and UV-safe sunglasses." Between an endless variety of sunscreen brands and types, from sprays and lotions to sticks and creams, what type of sun- screen is best? Drucker has a simple response to patients who ask that question. "The best one is the one you will use," she said. "You have to find something that feels good on your skin. If it leaves you feeling too oily or too dry, you're not going to like it and you're not going to want to use it." A high school football team is practicing outdoors on a typical Houston summer day. As temperatures soar into the 90s, one player starts acting strangely. Complaining of a headache, he seems disoriented and is having trouble walking straight. "Are you OK?" his teammates ask. "What do you need? When did you last drink water?" Here in Houston, where the average high temperature hits 90 degrees in June, July and August, heat illness is common. This doesn't mean Houstonians should confine themselves indoors all season long. With proper precautions, it's possible to enjoy being active outdoors all year round. "In the summer, the number one issue on our radar is looking for problems surrounding heat illness," said Vijay Jotwani, M.D., a Houston Methodist primary care sports medicine physician. Jotwani described Houston as having "the perfect setup" for heat-related illnesses. "In addition to the heat from the sun, Houston has high humid- ity levels," he said. "High humidity inhibits the body's ability to The rule of thumb is that to cover your body, you should use about a shot glass of sunscreen. — CAROL DRUCKER, M.D. Professor of Dermatology at The University of Texas MD Anderson Cancer Center

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