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Exploring Heat Stress and Heat Stroke, with Dr. William Adams

We explore health conditions elicited by heat, including heat stress, heat stroke, and heat exhaustion, with expert guest Dr. William Adams.

heat stress and heat stroke

In June, Trevor went to Moab for what he thought would be a nice vacation filled with mountain biking with friends. It turned into a stressful, harrowing experience when one friend was evacuated to the hospital by helicopter, and Trevor was left wondering if he’d live.

No, it wasn’t from a crash. It was all about the heat that day. Trevor’s friend had suffered heat stroke. Or was it heat stress? Ultimately, the trip made Trevor wonder what he could have done differently.

Thus, we found experts to help us better understand heat stress, heat stroke, heat exhaustion, and similar conditions elicited by heat. In this episode we try to answer several questions:

  • What are the true definitions of these conditions?
  • What are the causes?
  • What are the physiological ramifications?
  • What can you look for, in yourself or others, to know if serious issues are on the horizon?
  • And what can you do to prevent those early symptoms from turning into a catastrophe?

We’re joined today by Adam Wisseman, a collegiate national championship podium finisher and Trevor’s friend who lived through this ordeal in the heat of Moab. We also hear from Emile Abraham, a former pro and Pan Am Games medalist turned elite coach. Finally we’re joined by Dr. William Adams, the associate director of sports medicine research at the United States Olympic and Paralympic Committee, whose work focuses on investigating the prevention, management, and care of heat-related illness, among other things. He’s the perfect expert for our episode today.

Episode Transcript

Chris Case 00:13
Hey everyone, welcome to Fast Talk your source for the science of endurance performance. I’m your host Chris Case. In June, Trevor went to Moab for what he thought would be a nice vacation filled with mountain biking with friends. It turned into a stressful, harrowing experience when one friend was evacuated to the hospital by helicopter, and Trevor was left wondering if he’d live. No, it wasn’t from a crash it was all about the heat that day job his friend had suffered heatstroke or was it heat stress. Ultimately, the trip made Trevor wonder what he could have done differently. Thus, we reached out to experts to help us better understand heat stress, heatstroke, heat exhaustion, and similar conditions elicited by heat. What are the causes? What are the physiological ramifications? What can you look for in yourself or others to know if serious issues are on the horizon? And finally, what can you do to prevent those early symptoms from turning into a catastrophe? We’re joined today by Adam Weissman, Trevor’s friend who lived through this ordeal in the heat of Moab. We’re also joined by Emile Abraham a past pro and Pan Am Games medalist turned elite coach. And we’re joined by Dr. William Adams, the Associate Director of Sports Medicine Research at the United States Olympic and Paralympic Committee, whose work focuses on investigating the prevention, management, and care of heat-related illness, among other things.

Trevor Connor 01:47
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Chris Case 02:40
Welcome, Dr. William Adams to Fast Talk today. It’s great to have you on the show.

Dr. William Adams 02:44
Thank you very much for having me. I’m looking forward to the discussion today.

Chris Case 02:48
Excellent. This is one of those episodes that was prompted by an experience that Trevor had, and he’s going to talk about that momentarily. But it just got us both thinking about the fact that we knew kind of not that much about this subject. Perhaps it’s going to come up more often as temperatures rise around the world. It’s just one of those things that if you haven’t experienced it, you probably haven’t thought too much about it. If you experience it or if somebody you’re riding with or running with or exercising with falls victim to this, then it’s going to be a pretty scary experience potentially. So we want to explore heat stress, heatstroke, explain those terms. Explain what to do find yourself in that situation, and plenty more today with Dr. Adams. Trevor, I think you do want to start off by sharing a bit of a cautionary tale, which prompted this episode in general.

The Dangers of Heat in Moab

Trevor Connor 03:54
Right. So this is something that happened in June that I can tell you I thought I’d be prepared for this sort of incident because I studied all this in grad school and we learned all about heat stroke and heat illness and what to do and as you’ll hear in the story, I was not nearly as prepared as I thought I was and at one point I basically had a friend that kind of fell apart on the trail and there was a certain point where we thought he was dying and there just wasn’t much we could do

Chris Case 04:26
this is in Moab? correct

Trevor Connor 04:27
Right, so is a trip that I did to Moab in early June was some college buddies we all met up there. A heatwave had hit Moab, which is normally is pretty hot. The other thing about Moab is there is not a lot of protection. There are no trees, you’re riding on rocks and the rocks can kind of bake you from below. Well, the sun is baking from above. And it was insanely hot out. And we were there three days and the first couple days, certainly we were all feeling the heat. My friend Adam he’s like me, he’s got a self-deprecating sense of humor. So he was making fun of himself and his inability to handle the heat. And when we got to the third day, we started with, basically, we’re going up a big climb, and then we’d descend back down, and we’re planning about an hour and a half of riding, he was complaining a bit again, and this time, it was legitimate. Unfortunately, neither I nor a friend that was riding with us noticed i.t I’m kind of embarrassed by this.As a matter of fact, when Adam started complaining and was stopping a few times to rest, we were more making fun of him, and then go, maybe we should get them off the mountain. So I have to own that. But what you’ll hear in this story is how quickly it went from, oh, just a little bit of complaining to something that was quite extraordinary and scary. So basically, we had finished the climbing, and now they’re both much better mountain bikers than me. And I was starting to kill Adam and should have noticed that as well. You know, I’m going, I got Oh, I’m starting to pick up on this whole mountain biking thing and instead of going no, I’m really not something’s not right with Adam. I shouldn’t be beating I’m especially on the descents. So also kind of ignored that cue. But it was basically as we were descending back down, there was a certain point where you could go left and go straight down to the cars or you could go right, and it was a little bit longer and much more technical. So not being a very good mountain biker, I went, I’m going left, I’m taking the easier route down. And Adam said he was going to go with me, and we could tell he was looking a little fatigued. But still hadn’t really noticed anything. Our other friend, Nate he went the hard way. And Adam and I went left we biked, you just go a couple 100 feet. And then you hit a T intersection where you enter, turn right and go down, or turn left and go back up the mountain. And Adam started to go left. And I’m like, Adam, no, we got to go down to the cars. Like no, Adam, that’s back up the mountain. He just kept going no, this way. I was explaining to him and realizing he’s not processing what I’m saying at all. And you know something’s not right when he’s not figuring out that cars are down, we should be going downhill. So I knew something wasn’t right, we turned around. And I just started looking for a good tree that we could go and sit under and rehydrate and then hopefully get him down to the cars. So didn’t go much further, he was still able to ride his bike, he was still able to go over some of the more technical stuff. I found the tree. I pulled over he went right by me and I yelled at him. And it took him a second to process so I got him to come back get under the tree. And that was the point, I could tell something’s not right here. But I still thought just recover for a minute cooldown will be okay. So, got him to start drinking from his water. I took my Camelback and basically dumped the whole thing over his head to cool him down. I thought, let’s give him 15 minutes, and we’ll get out of here. But instead, he progressively got worse. And I realized, I’m not gonna be able to get him on the bike. I also discovered that I didn’t have cell phone reception. So I was basically stuck with what we had and trying to get him down. So my thought was, let’s get him up. Let’s start walking down and see where he’s at. And maybe then try to get him back on his bike and ride down to the car. Got him up, he started walking, and I realized I had to hold him up. He couldn’t walk. He couldn’t keep his balance on his own. And that was the moment where I went, Oh, man, we’re pretty much out of water. I have no cell phone reception. It’s two miles to the cars. And I’m struggling just to get him to walk 100 feet and started to get pretty scared going. What do I do now?

Trevor Connor 09:18
It’s easy to point out the signs but just as easy to miss them. Let’s hear from my friend Adam and some of the things we all missed in the days leading up to his bout of heat illness.

Indicators of Heat Illness

Adam 09:27
Yeah, I’d say there were some indicators, the two days prior to to the incident. Day one. I think this was before you arrived. I arrived and I met up with a buddy Nate. And we went for I think a two-hour ride in the afternoon. It was around 100 degrees out there. And I’d say this ride was probably harder than the ride we did on day three. It was climbing for the first hour 15 hour 20 and then descending back down Near the top of the climb, I was feeling a little off, I was feeling slightly dizzy, definitely overheated. And the thing I did notice the most was on the way up, I was able to maintain, you know, steady-state sort of climbing, no problem. But after about the first five minutes, if I tried to punch it up a steep section, or over a ledge or something, I just couldn’t go. I couldn’t, you know, put out extra power. So I think those are the two things just not being able to actually accelerate, and then near the top feeling slightly dizzy. But after descending, you know, we go back to the car and I was feeling relatively normal, cooled off a bit on the descent, slowed down, drank a little more water. So day two was our longest ride. And this was one where we had a lot of logistical problems. I broke my rear hub, fortunately at the top where we were near the car, and then swap bikes with you. And then I felt pretty good most of the decent. It was really near the bottom of the ride where we’re jumping into the canyon, you kind of get cut off from the breeze there and it gets hotter and hotter the farther you go down. And I’d say the last mile that ride I started to feel a little dizzy again, we stopped at the bottom by the river, I cooled off a bit and then we rode back to town. But after that, I definitely noticed my bike shorts, my jersey, and my gloves were caked in salt. So I definitely lost a lot of electrolytes on day two. I think those two things should have probably told me that, well, maybe day three was a bad idea. You know, just feeling a little off in the heat the first day and then just losing a lot of electrolytes and everything day two definitely primed me for being in a bad spot on the third day.

Emergency Services Got Involved

Trevor Connor 11:47
We kept trying to walk had to kind of stop periodically. And thankfully, and I think this honestly saved him, some mountain bikers coming up the trail ran into us. They saw how bad this was. So they helped me get him underneath this smaller bush, that provided some shade. And by that point, we were carrying him he couldn’t walk. So got him under the bush, they started feeding them some water and pouring some water over his head. One of them had different service from me and was able to get reception. It wasn’t great we actually had to walk a good distance to get it. And we had to call in a helicopter and then walk back to see how Adam was doing and it just progressively got worse. He started going into rigor. So he looked all tense. And so I kind of grabbed his arm and said Adam relax. And his arm was kind of held up above aside at kind of a bent angle. And discovered he couldn’t it was just locked and he couldn’t get his arm to release. He pretty much lost all muscle function at that point. So we were doing everything to keep him going but he knew was bad. And he was starting to get worried that he was going to die there on the mountain. I admit to you, I had my moments of thinking the same thing even though I was telling him no, you’re gonna be fine. We’re gonna get you out of here. It got really scary. And thankfully, the helicopter came in, we flagged it down, they came over, they had me start to spray water over him while they gave him IVs. At that point, he got severe cramping like just absolutely screaming and pain crapping all over his body. They got two IV bags in him there on the mountain. And then we were able to get them onto a stretcher and they flew him out and took them to the hospital where we got several more IV bags. So it was a really scary experience. And I thought I would have been prepared for this and was woefully underprepared. And like I said, I had a moment where I had my friend on my shoulder thinking, I’m watching my friend die. And that’s what has motivated us to say, as you said, Chris, you know, these heatwaves are getting longer and more frequent. We should do an episode about this because I’m sure many of our listeners are going to encounter this either have that horrible experience themselves or like me be riding with a friend who this happens to them.

Trevor Connor 14:36
You’re hearing the story from my perspective, but let’s hear how my friend Adam experienced this day…

What It Is Like To Suffer Heat Illness

Adam 14:41
Yeah, this was a weird one for me. I’ve definitely done plenty of rides where I’ve overheated and run out of water. But they were nothing like this in the past it was you sort of get a dry mouth, you get maybe a little bit of a headache, maybe your reaction time gets a little worse, but it’s sort of a gradual thing towards the end of the ride. So I thought I was pretty good about predicting, you know, how much range I would have left, you know how quickly I needed to finish the ride versus if I could recover on the descent. And this ride definitely showed me that in this case, I definitely had no ability to actually predict how I’d respond. This was past anything I’d experienced before. I think I knew I was in a little bit of trouble. When we were pretty close to the top of the climb, I had began to slow down and stopped in the shade fairly regularly for the last, you know, maybe last 20% of the climb. And I almost never do that. I’m usually like, I just keep going the top and then take the view and then, you know, recover on the way down. And I knew once we get to that trail junction that I need to head down as quickly as possible on the less technical trail, but at that point, I was getting fairly disoriented. I think I completely screwed up which direction I should go at that trail junction. And you guys had to point me the correct way down the trail. And then quickly after that, I went from being confused to being shaky on the bike to knowing I had to get off the bike and walk thankfully because I didn’t want to end up with a concussion. And then as soon as I got off the bike like it was very soon after that I was having trouble walking. I think that’s probably close to the time you double back and came across me at that point. I was super confused. I think I remember you trying to get me a drink and make some more Gatorade. And I was like fumbling around on it unable to open up my Camelback effectively to get out, you know, Gatorade powder to refill my bottle. And after that it Yeah, I think I was basically out of it at that point.

Trevor Connor 17:03
There was actually a whole part that you don’t remember. And we talked about this at the time and you couldn’t remember it all. I started to get the sense that something was wrong with you at that trail junction where we had to go left or right. And you wanted to go back up the mountain. And I kept saying, No, Adam we got to go down and I could just see your brain just wasn’t processing it. So I started looking for a place where I could get you in the shade and pulled you over and I actually dumped my Camelback over your head. So we had you sitting underneath this tree, you had to drink some of your water and then that’s when you said okay, I’m going to try to walk a bit and you were really stumbling.

Trevor Connor 17:52
So with that, Dr. Adams says I proved I’m not an expert on this at all. Throw it to you. And I just want to ask the question, hearing that story. What could we have done differently?

Professional Advice From Dr Adams

Dr. William Adams 18:05
There’s a number of things. I think some of the things that were were out of the control were obviously the heatwave that had occurred during that trip. You know, with that increase in the environmental heat that adds some extra stress and load on the body. Particularly if someone isn’t used to exercising in those environments. And knowing that Moab is typically hot in it of itself, I think that the added heat because it becomes more problematic. Some of the things that I always recommend to just anyone looking to do exercise in hot conditions particularly prolonged exercise, and maybe in a newer environment where they may not be used to, is to make sure that they are really taking advantage of some other effective strategies. Such as hydration and making sure that people are staying adequately hydrated during activity particularly if that activity is going on across multiple days. I think that’s sometimes where we start to see some issues where after repeated days, particularly in hot environments, people may not be adequately replacing enough fluids, whether it be during activity or after activity before the next bout of activity. And you know, progressively over the course of days people become more dehydrated, which can lead to some issues it could exacerbate some of that heat stress that’s imposed on the body which you know, may increase body temperature, it could lead to some other issues, you know cramping and whatnot. Those are some easy strategies that can be done. Other things that I always recommend to individuals as well particularly if they know or they have planned travel to areas that are hotter, make sure that they kind of gradually, you know, phase in that amount of exercise or the amount of exercise in hot environments to slowly adapt those conditions Those are effective and allows the body to adapt and, have those proper adaptations that we could probably talk about a little bit later on in this call. If I had to guess some of the topics related to heat illness. So yeah, those are some, you know, effective strategies that can be done that can be helpful, obviously, with the environment and being in Moab and, how sparse you know, tree cover is there, you know, it’s harder to do activity in the shade or seek shade. Being out in the sun adds some further load onto the body or heat load onto the body, from the radiation from the sun. So it makes it difficult to try to get out of that heat load. So luckily, there are some, shades cover with the bush, as you were describing. Just real briefly, and generally, those are some things that come to mind right away that, could have been done or could have been focused on, and everything

Trevor Connor 21:06
We heard from Dr. Adams, on what he felt we could have done differently. Let’s go back to my friend Adam and hear his thoughts about what we could have done.

Know Your Limit In The Heat

Adam 21:13
I could be completely off about the timeline. But I think the whole timeline for this from like, just from the trail junction, to me, stumbling was maybe five or 10 minutes tops. So it was very rapid from the point where I was still able to ride the bike, maybe I didn’t know which way to go on the trail, but I could still handle the bike I could still react. To I couldn’t even stand up. So it was not something that I could like, just limp back to the trailhead and cool off, it was, oh, crap, there’s only one way out of it. And I’m not, going out into my own power at this point.

Trevor Connor 21:48
Anything else to share about the day of from your experience?

Adam 21:52
So I was trying in the beginning of the climb to you know, ride within what I thought were my limits. And I think had the temperature been much lower, like, you know, say 70 degrees Fahrenheit versus it was probably Upper 80s, when we started the ride, and then rapidly up 90s to 100. I think if the temperature had been lower, I would have been fine. I’m speculating here, but I feel like a lot of the issues were just like, I could not shed heat fast enough. I’d been out on the trail for I think an hour with both you and some of those guys who stopped to help out. Actively trying to cool me off, you know, pouring water on me fanning me. Then the helicopter took me to the hospital where they finally got a temperature reading and my core temperature was about 100.2 degrees Fahrenheit at that point. So it was easily a couple few degrees higher out in the field.

Trevor Connor 22:59
We already cooled you down pretty significantly by that point.

Adam 23:03
Yeah, so I wouldn’t be surprised if that I don’t know, that easily could have been 102 to 103 degrees Fahrenheit, out in the field. And I feel like, if I’d been able to keep my core temperature down, none of this would have happened. Perhaps you know, electrolyte loss. If we had two hot days beforehand, electrolyte loss could have done this. But even with electrolyte loss the days before, if it had been a cooler ride for the third day, I would have been able to, you know, ride my own pace, keep my core temperature reasonable. Not go through so many fluids on the way up and make it down just fine.

Be Extra Observant In The Heat

Trevor Connor 23:45
So the thing that surprised me the most about it was how rapidly it happened and how I didn’t keep up. I was still thinking about us biking out of there. When he wasn’t able to walk I was still thinking about walking him out. When he was losing all muscle function. It’s just he went from a guy who was complaining a little bit but able to ride to have to lay on the ground and completely unable to move in 10-15 minutes. It was shocking how quickly that happened. I don’t know if that’s typical. And if there are early warning signs so that, you know I could have kept up a little better realized how bad it was before it got that bad.

Dr. William Adams 24:29
Yeah, that’s a great point. And from my experience in dealing with patients that have succumb to heatstroke or heat exhaustion, it is surprising to see how quickly someone deteriorates in those environments. And it’s different for everyone that deterioration could present differently depending on the person and everything. And I think that’s the uniqueness of heat-related illnesses, how they are rather individualized as far as how those signs and symptoms present themselves and how quickly, they deteriorate or the changes, you know, within the body that occur and, for some, it’s very, very rapid. For some, you know, it’s a little bit more progressive, but you know, it really depends on the person, I think some of the telltale signs just in general you know, and based on some of the points you’re bringing up in your story is, this is an individual who typically is a, you know, very good mountain biker, and I think some of the early warning signs that could have been observed as well, hey, it looks like he’s struggling, you know, it looks like, I’m kicking his butt if you will. Those types of indications where things just appear not to be normal for that one individual should be something that people should be aware of, and pick up on, to start asking some questions and to start paying attention. You know, I think that’s probably the best advice that I could give just because of how I said how individualized those presentations are with individuals. And most of the time, you know, for with someone, in this case, you know, with some friends, we know how our friends are, we know their personalities and everything. So even some subtle changes retrospectively become apparent, like, Oh, yeah, that wasn’t right. So I think those are some things that can be done proactively knowing like, hey, this isn’t right, or that was odd, or, you know, what they’re saying is odd of them to say or whatnot could be helpful.

Trevor Connor 26:29
Yeah, I think that’s the one thing that I really look back on and say, I completely missed that instead of enjoying the fact that for the first time in my life, I was beating him on a mountain bike, I should have gone. Okay, he’s not riding anywhere close to his normal, he’s stopping and sitting in the shade periodically. He’s probably struggling, there’s probably an issue here. And like you said, looking back, that’s the one big cue that I think I really missed, I could have prevented all this. So want to jump a little into the physiology and what all these things are. And I’m saying that very vaguely because we’ll share two things. One is doing some research for this episode, I saw a lot of different terms heat illness, heat stress, heatstroke, heat exhaustion, heat syncope for passing out, so I didn’t see a ton of consistency. It’s something that really struck me as after they flew him out, they had also sent a ground crew to potentially drive them out of there. And so I was talking with the lead rescue operator explaining to him what happens, because he wanted the story, and said, my friend was suffering from heatstroke. And the guy goes, he didn’t have heat stroke, I go he’s in pretty rough shape and a guy goes, my experiences is most people who get heat stroke don’t survive. And it was kind of shocking to hear him say that. That certainly wasn’t what I learned in school, but I’m not the person that’s on the trail every day trying to rescue people. So interested in what is the terminology you use? And what are the differences between these different things?

What Are The Different Heat Illnesses?

Dr. William Adams 28:13
Yeah, no, that’s a great question. There’s a lot of terminology that’s used. And sometimes it can get a little confusing definitely to understand what’s being referred to in certain situations. So if we kind of look at the terminology, we can kind of break it down a little bit. And hopefully, I can explain things and it can provide some clarity to those tuning in. So you know, we have heat illness or exertional heat illness, that term is really describing a constellation of other medical conditions is an umbrella term, it’s really describing a series of other medical conditions, that kind of lump within that grouping there if that makes sense. And if we’re thinking in the exertional realm, and when I say exertional realm, this is in situations where people are doing physical activity, or they’re exercising, you know, they’re producing metabolic heat through the movement of their muscles. You know, you really have four primary conditions that we deal with in a sports medicine route. We have heat syncope, which I’ll explain here in a second, we have heat exhaustion, we have exertional heatstroke, which is different than classic heat stroke, which I’ll explain here as well and what those differences are, and then we have exercise-associated muscle cramps and at one time, that term used to be called heat cramps, but that term is no longer used, at least in the contemporary literature because evidence has shown that the environmental heat does not in fact cause the cramping. Now, environmental heat may be responsible for certain things that actually cause cramping but the heat itself does not cause cramping. So they have re-termed that condition to be exercise-associated muscle cramps. So if we look back at those four kinds of primary conditions, and let’s start with, you know, heat syncope, and if you look at the word syncope, it’s describing a fainting episode. And that’s really what it is, it’s a fainting episode. And what happens, especially when you’re being exposed to environmental heat, whether it be, you know, exercising, or if you’re exposed to that heat stress for a long period of time, particularly if you’re stationary, think of like a soldier, for example, who’s out and in the heat and they have to be at attention or, you know, they’re not really moving. What happens is, you know, blood pools in your lower extremities it pools in your legs, because gravity works within the body. And what can happen is if you’re out exercising in the heat, and you suddenly stop, or if you’re standing statically, for a long period of time, you can have this pooling of the blood in the lower extremities, which diverts away from the heart and the brain, and you have that fainting episode. The heat exacerbates that a little bit just because if you’re exercising and say you are out, doing a marathon, for example, you finish and you suddenly stop well all the Blood is all in your legs, you know, still, because you were just exercising. In those situations, especially when it’s hot outside and you are most likely dehydrated, and if you’re dehydrated, you have a lower amount of blood volume in your body. So if you have low, if you have a lower blood volume, you have a lower volume of blood that can go back to the heart and the brain. And if most of that’s being pulled in lower extremities, you kind of create this situation where you have a fainting episode, that condition is relatively benign, you know, you have a fainting episode. From a treatment perspective, you know, getting someone laying down your raise their legs up 12 inches off the ground and promote that blood flow back to the core and the heart. And typically, they’ll recover very quickly and from a management perspective, after that, it’s really more of Okay, hey, let’s replace some fluids.

Dr. William Adams 32:01
Exercise associated muscle cramps, or you know, previously termed heat cramps. Is, just that it’s a muscle cramp. And, you know, I think most of us who are recreationally active or former athletes, I’m sure at some point in our careers, we’ve had a situation where we’ve had a muscle cramp and it’s a tight, tonic contraction, you can see that muscle contracting very, very painful. And that’s what it is. And there are a few kinds of theories of thought as far what causes that. And hopefully, after this explanation, you can kind of see how the heat may be potentially involved. But the two theories are really, you know, volume depletion, so dehydration electrolyte losses and that triggers a series of physiological reactions that cause that cramp. There’s another kind of frame of thought, where it’s more centrally mediated and centrally mediated meaning coming from the brain and the higher-order systems within our body. And with fatigue over time, particularly during prolonged or, an extreme exercise that is fatiguing on the muscles. So those are kind of like the current kind of theories surrounding what causes this. And if you look at some of the literature, some of the more recent literature, you know, it may be more of a combination of both of those factors that may be involved, you may have some, you know, central and peripheral fatigue of those working muscles, that’s combined with say, volume depletion from dehydration. And that sets off a series of responses that causes that muscle cramp to occur. Now move from the heat perspective of why used to be called heat cramps, you know, again, if we’re out exercising in a hot environment, we’re gonna have a higher sweat rate to help with body temperature regulation. And as we lose more body water, our body has to adapt. So we undergo a series of adaptations to help maintain central pressure. And if we lose a lot of body water, we may be more predisposed to cramping. So if we’re exercising in a hot environment, we have an increased sweat rate, we’re gonna lose more body water, which may predispose someone to cramping, you know, there and so that’s how heat kind of factors into that condition of itself. From a management perspective, that condition is still relatively benign, you’re gonna have a muscle cramp and, you know, the best way to treat that is to put that muscle under a passive stretch. And then to really address maybe some factors responsible for causing those cramps if they may be more related to hydration, making sure that people are replacing those fluid losses, maybe adding in some electrolytes as well to help offset some of those losses that occur in sweat and everything. But you know, that’s a good way to manage that condition and then to be proactive moving forward to make sure that people are prepared going forward with other exercise or physical activity events in hot environments.

Dr. William Adams 35:16
Our last two conditions are, heat exhaustion and exertional heat stroke and those are a little bit more severe. So, heat exhaustion. By definition, if you look at the technical definition of heat exhaustion it is one’s inability to continue exercising in the heat due to cardiovascular insufficiency. So basically, what that means is, during exercise in a hot environment, particularly prolonged exercise, endurance exercise. Our bodies are in constant competition for demands. And in this case, looking at cardiovascular demands, so as we’re exercising, we need blood flow going to our working muscles. So if I’m out running a marathon, I need a lot of blood flow going into my legs to make sure that I’m providing oxygen and nutrients to my muscles in my legs to keep myself running. While at the same time, if I’m exercising, I’m producing body heat. And as we’re exercising our bodies need energy. And unfortunately, our bodies are pretty inefficient at using the energy we have stored in our body, where we only utilize 10-15, maybe 20% of the energy that we have. And that percentage, you know, depends on what literature you’re reading. But a very small amount of the energy that we have in our bodies is used to actually do mechanical work, while the rest of the energy that we break down is actually given off in the form of heat. So we increase our body temperature because we’re having heat that’s being produced by us breaking down energy during exercise. Well, to get rid of that body heat, we have a few mechanisms, have conduction we have convection, and conduction, meaning a transfer of heat between the direct content of two solid masses. So if I put my hand on my desk right now, for example, my desk feels a little bit cooler, because the temperature is about 70 degrees where my office is, but my body temperature is higher than that. So by touching the desk, I’m transferring heat from my body to the desk. And if I remove my hand, after a minute or two and put it back there, I can see that, hey, that part of that desk is warmer than the rest. So that’s a good example of what conduction is. Convection, meaning the movement of air or fluid in the heat transfer that occurs through the movement of air or fluid. So think of, you know, going into a swimming pool, for example, and we have a circulating body of water, well, we’re gonna lose a lot of body heat, because that water is drawing heat away from our bodies. So that occurs with body temperature regulation with the transfer of blood to our skin to be removed from the air going over our skin surface. We have evaporation of sweat from our skin surface, which is our most effective way to lose body heat when it’s hot outside. Now we have radiation, which is the load from the sun. And that really depends on the environmental temperatures in it of itself. So we have all these mechanisms, so going back to heat exhaustion, so our muscles are requiring blood flow to do mechanical work. But we also need to get rid of the body that we’re producing so that blood flow goes to the skin. And then by means of convection, we can help reduce some of that body heat that’s being produced. Now that’s in compliments to evaporation of sweat from the skin surface, which has some different physiological mechanisms. But all in all, as we’re going through that process, you know, our bodies are competing for those two processes, right to continue exercise and to then regulate body temperature. Well, over time, that puts a lot of strain on our cardiovascular system. And at some point, it gets to the point where our bodies can no longer continue exercising because the cardiovascular system can’t keep up. So that’s a very long explanation when heat exhaustion is, you know, some risk factors, one of the primary risk factors is is dehydration because that exacerbates the thermal regulatory strain within our body as well as the cardiovascular strength in our body. But you know, from a treatment perspective, getting those individuals out of that heat stress of getting them out of the sun to the shade, you know, helping them replace fluids, considering somebody cooling options, you know, maybe helpful to help them recover. Typically, that recovery is relatively quick in a sense of looking at, you know, within the day, the 24 hour period, most people recover as long as they address the factors that may have been responsible. So in the case of dehydration, replacing those body water losses, etc.

When To Involve EMS

Dr. William Adams 40:03
Now heatstroke, for example, that’s the last condition that we’ll chat about real quickly, that’s a medical emergency. And if that’s not properly cared for quickly and efficiently, that could lead to some catastrophic outcomes and everything. And with heatstroke, we have two different types of heatstroke, we have classic heatstroke, which classic heatstroke is really more related to incidents involving infants or the elderly. So you know, every year, unfortunately, you’ve seen the news how infants pass away because they were left in the car and their caregiver, you know, left the car without it running and ran in real quick to do something, it’s hot outside. And in all that, or in the case of like a heatwave an elderly persons living at home by themselves, they don’t have air conditioning, and it gets really hot in their house. So classic heatstroke is really just referring to the failure of the thermoregulatory system. So the thermoregulatory system is unable to adapt to that heat load. And the reason that it typically affects the elderly and infants is because, in infants, the thermoregulatory system isn’t well developed at that stage of life. You know, they’re not efficient sweaters. And there are other factors that just aren’t allowing them to thermoregulate. In elderly populations, those thermal regulatory mechanisms, that we have those degrade over time as we age, and they lose some of that ability. So that’s typically where we see that. Now exertional heat stroke is exertion-based, like I said, it’s someone exerting themselves physically to get to a very hyperthermic state. I mean, we typically see that in athletic settings, we’ll see that in the military setting, we’ll see them in occupational settings quite a bit in different contexts. But it’s kind of the same kind of the pathophysiology is similar with the breakdown within the body. But like I said, in this case, you’re physically exerting yourself to increase body temperature to a very high level, but your body is unable to dissipate effectively. And it leads to other physiological responses in the body that can break down proteins and tissues and cells that can lead to bad outcomes.

Did Adam Suffer Heat Stroke?

Trevor Connor 42:35
So yeah, no, thank you, that was a fantastic explanation. And I do remember that from my graduate courses, and that really what you’re dealing with is your blood is doing double duty, it’s both trying to fuel the working muscles and trying to dissipate heat. And then on top of that, if you’re sweating a lot, you have that potential for your blood volume to go down, which means it’s an even greater strain, you add all that together, and this is when you can start encountering these issues. So with those definitions, I have to ask what do you think happened with my friend? Was it just heat exhaustion? Or do you think he actually suffered heatstroke?

Dr. William Adams 43:17
Um, that’s a great question. And you know, without having an assessment of his internal body temperature, it’s really difficult to say so if we look at some signs and symptoms. And we’ll start with exertional heat stroke, for example. Exertional heat stroke is really diagnosed with two specific kinds of criteria, you have extreme hyperthermia, and that level of hyperthermia is usually above 40, or 40.5 degrees centigrade. So if you transfer that to Fahrenheit, usually that internal body temperature is 104. and above. Now, depending on the literature, you read, some people say the threshold is 40 degrees Celsius so 104 degrees Fahrenheit. Other literature suggests that that threshold should be 40.5 or 105 degrees Fahrenheit. And there’s really no empirical evidence to suggest which one is correct. I myself as a clinician, and as someone who discusses this topic with people, I always error on the side of caution and I use the lower threshold because I’d much rather be more conservative in making sure that the proper treatment and care is done after that assessment of body temperature than anything but you know. Looking at an internal body temperature of 104 to 105 degrees Fahrenheit, but also with altered mental status. Now altered mental status can take a number of forms, which I think it adds to the complexity of the condition. Where altered mental status could mean that someone may be confused or they may be irritable or they may be exhibiting, aggressive behavior or they may be unconscious. You know, so there’s a whole host of different ways that someone can present as altered mental status. Going back to my point before, if you know, this case with your friend, you know your friend, you know your friend’s personality and you know, if you start to observe that there’s some changes to that, that could be some telltale signs. Now in my experience with the exertional heatstroke patients that I’ve had the opportunity to treat, most of those have been in road race settings. You know, one of the ones I typically try to go and volunteer for is the Falmouth Road Race in Cape Cod every year. And you know, we’ll see 15 to 20 heatstroke patients each year during that race because of the distance and the temperatures and whatnot. But with 12,000 runners, it makes it hard to know everyone, there we take a much more conservative approach because we don’t know if someone is exhibiting altered mental status or not. So if we suspect it, then we’ll treat them. But you know, those are the two ruling considerations for exertional heatstroke. Now, with heat exhaustion. Typically, their internal body temperature is below that 40 degrees Celsius threshold or below 104 degrees Fahrenheit, which is good, because that’s a good delineating factor to differentiate those two conditions. And typically, with heat exhaustion, people may experience some altered mental status, but that may be more mild. And again, that’s gonna be more individualized. And it could present differently. So you know, I guess to answer your question, without having an assessment of their internal body temperature, it’s really hard to say if it was heat exhaustion or exertional heatstroke, because of some overlap, particularly with the altered mental status part of things. And based on the story, you know, it did appear that there were some signs and symptoms of altered mental status along the way. But, you know having the need for that other objective measure is needed to really come to an inaccurate diagnosis.

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Your Body’s Regulatory System

Trevor Connor 48:06
So I want to switch gears here a little bit and ask a question because I do know from the research, there seems to be a regulator, particularly inexperienced athletes, where, they’ve done these studies to see the impact of heat, and there’s a fairly consistent temperature where athletes will shut down, they’ll slow down or ease up. Sorry, fairly consistent core temperature, where athletes will ease up. So there does seem to be some sort of regulator in our bodies where the body says core temperature has gotten too high, you need to back down. What causes athletes to go beyond that point?

Dr. William Adams 48:56
That’s a great question. And to your point, the brain regulates temperature, pretty tightly and it maintains our prime temperature within a specific range, you know, particularly when we’re at rest, but also when we’re exercising, the body responds accordingly to make sure that we’re promoting the proper means to help dissipate that body heat and everything. And, you know, with the kind of the regulator, as you’re discussing, there’s kind of two kinds of frames of thought if you will, as far as what causes someone to stop exercising when they get to a certain body temperature. There’s an anticipatory kind of frame of thought where, you know, someone’s exercising you know, they’ll anticipate or the body anticipates where their temperature could be exercising at that intensity and as an anticipatory mechanism, the body will then regulate intensity to help attenuate that raised body temperature. And the other would be more kind of reactive whereas the body temperature gets, you know, hotter and hotter, the intensity will, decline to, regulate and to prevent that continued rise or continued rate of rise in body temperature. The rate of rise and body temperature is most associated with exercise intensity. So, the higher the exercise intensity, the more energy our bodies need, the more body heat that’s being produced. So, it’s a factor of exercise intensity, so the body will you know, adjust accordingly. But to answer your question, how some athletes can override that? That’s a great question. You know, I don’t know if there’s a real good answer within the literature, how some athletes are able to exercise above those thresholds. There is a recent study that was published, I want to say last year, by Sebastian Racinais, and some others, that looked at body temperature responses during the World Championships in Qatar in 2019. And they found that some of these athletes were able to have internal body temperatures, well above 40 degrees centigrade. And there were still able to exercise, and, you know, they were able to finish and be fine. And some athletes are able to do that, I think, with training, especially at that elite level, their bodies adapt to that stress. And they’re able to respond accordingly. So there may be some elite athletes are able to exercise and have their body temperature exceed that 40, or that 40.5 threshold. And they’re able to regulate effectively, just based on how well their bodies adapt to that training and that training, stress, and that heat stress that they will train to help promote some of those adaptations. So, you know I can’t say, what causes that extent. But to go back to the question there, I think there are some situations where people can override those initial mechanisms to, you know, slow down or just stop, the mind is a very powerful regulator. And I think some people are able to kind of fight through that initial response of the body telling it to slow down and they’re able to, continue exercising, and in some situations, they will succumb to exertional heatstroke for doing that. But, again, I’m not really sure If there’s anything in the literature that really fully explains that ability to do so. But it can it can occur.

The Influence Of Peer Pressure

Chris Case 52:47
Well, Dr. Adams, in your experience, is this a function of people not speaking up because they don’t have insight? Or they’re embarrassed and they don’t ask for help? Because they don’t want to ask for help maybe they’re embarrassed or shamed?

Dr. William Adams 53:05
that’s a good question. And I don’t have a really good answer for that particular question. But I could expand on it a little bit. So looking at risk factors for heat illness, or exertional heat stroke, you know, we have intrinsic risk factors, so intrinsic, in this case, meaning those risk factors are internal to our bodies. And we have extrinsic risk factors. So risk factors that are external to our bodies. So, intrinsic risk factors could be those could be factors such as lower hydration or dehydration, giving you low physical fitness, it could be a lack of heat, the climatization and climatization is really just a fancy term. That means that the body is undergoing a series of physiological adaptations, over the course of days when there’s repeated exposures to environmental heat, during exercise, and really, climatization is really a process in which one improves their thermal tolerance to exercise in those environmental conditions. So someone not climatized that’s an increased risk factor for exertional heatstroke, you know, recent illness, sleep deprivation, etc. So there’s a number of internal factors that can be modified and addressed. But there’s also external factors that come into play as well. So external factors that could be simply the environmental conditions. So going back to the story, you know, a heatwave coming into to Moab and even though Moab is hot, you know, there’s a heatwave coming in and it’s hotter out, well, that’s just an increased environmental load that is placed on the body that prevents the body from dissipating heat as it as effectively as it would be if it was cooler out. Some other external risk factors are you know, having to wear protective equipment. So think of like the football player, or the goalie in women’s field hockey, for example, that are covered from head to toe with protective equipment as part of their sport. It makes it harder to dissipate body heat because you’re encapsulating some of the body and preventing it from being able to evaporate sweat from the skin surface in those areas that the equipment’s covering. Some other external factors could be peer pressure. So in an athletic setting, think of like peer pressure from coaches or other athletes, someone may not want to stop or take a break, or slow down because they have that external pressure placed on them to continue no matter what. And going back to our intrinsic risk factors, some people have a warrior-type mentality where they’re going to push themselves and keep pushing themselves no matter what because that’s just their mentality and how they approach situations. So, you know, those are some factors that come into play. So maybe in this same case, there were some factors that were related to the continue to drive to keep going and everything, but again, not knowing that exactly with the individual, it’s hard to say. That’s how these risk factors kind of come into play. And they all interrelate and everything and increase the risk profile.

Trevor Connor 56:29
So I did find one relatively interesting study from 2020 that addresses this. So it’s called profiling collapsing half marathon runners emerging risk factors results from the Gotham Burg half marathon. So they interviewed 13 athletes who had collapsed during the half marathon to figure out what was going on? And what were some of the motivators and really asking them, why you’re probably feeling the cues, why did you ignore them? And the three things that were cited the most by these athletes were personal performance, other athletes are trying to keep up with other runners, and the size of the audience. So if there were a lot of people on the side of the road, they felt that pressure to keep going and not quit.

Dr. William Adams 57:25
Yeah, that’s a good example of at least the peer pressure that extrinsic factor, and then the internal motivation to keep going. So that’s a really good example of how those factors can come into play, and potentially increase someone’s risk of heat-related illness. So you know that that’s a good example right there to use.

What To Watch For When Exercising In The Heat

Chris Case 57:46
Right? Well, that’s been a wealth of information on the definitions, the explanations, the risk factors, all of that, let’s turn it to the more practical side here. You’re out on a trail, or you’re with a friend out on a trail or you’re in a race. Take us inside that setting, if you would, Dr. Adams, what are the indicators you should look for in yourself? Or in somebody else to know that they’re in trouble?

Dr. William Adams 58:16
Oh, Yeah that’s a great question. I’ll start with the second part, with what to look for in someone else, I think it’s easier to observe than to look more internally, within ourselves. Because I think sometimes it’s hard to deal with, you know, everyone being different, and personalities are different, etc. But, I think, if you’re out with some friends, you’re on the trail, or you’re running a race with some people or whatnot. I think some things you can be on the lookout for just some subtle changes, this could be subtle changes to their personality, it could be subtle changes to their ability to keep moving could be some subtle changes in maybe their, appearance. You could be running a road race, and then all sudden you start to see someone and they started running with an intelligent gait and you know, like, Oh, they may be hurt muscle, they may have a muscle cell to injury. Upon asking them they may say, Oh, no, no, I’m fine. But some of those subtle changes could be indicators that hey, something may be going on. Or you may be talking to someone and say you’re running a marathon. I know I’ve run a number of marathons and half marathons and I love it because you get to meet people and you meet people you’re running your pace and talk to them and you can use them as motivation throughout but some other factors that can come into play as you know. If that situation arises and you’re running with someone or you’re biking with someone and having some good conversations and all sudden some of the conversations or the responses to certain things or questions or whatever start become a little odd, you know? Or not within the context of the conversation, you know, those would be some things to at least pay attention to or some potential indicators that something may not be going well. Internally, I think it’s a little harder, to be honest with you. I think some people may be more in tune with their bodies than others. And I think in those situations, they may know that I’m just going downhill for whatever reason. Or my heart rates through the roof, or, I just have tunnel vision or, whatnot, those are just some examples that, one may, experience or something else. So, I think it’s harder to think more internally, because, I think it’s harder for people to put their body and their responses into context, sometimes, especially if they don’t know their body well, or how their body responds to certain stimuli or stressors. So yeah, I think a little bit harder from that perspective versus observing someone else that may be struggling.

Chris Case 1:01:13
Given that, perhaps it’s also challenging to talk about what to do when to stay in the race when to pull out? Are there things you can do to come back from where you’ve gone to, so to speak, in terms of that level of risk? What pieces of advice would you have here, both for the athlete or the friend that you might be training or racing with?

Best Advice to Avoid Heat Illnesses

Dr. William Adams 1:01:41
Yeah, I mean, I think there’s a couple of things, I think going back to looking internally, within ourselves if we’re out exercising. I think listening to your body, right, and especially this becomes more problematic for someone who may be the more of the warrior mentality type, where, hey, my body is telling me to slow down or telling me to take a break or telling me to do something, I should probably listen to it versus trying to push through that barrier that has come up within our body. The other things that people can do are be proactive, right? So even within yourself, or if you’re with a group or whatever, be proactive, where, hey, it’s gonna be hot off today, let’s go out and we’ll go do a trail run, for example, or we’re gonna do a mountain bike, well maybe plan strategically plan like, Hey, we’re gonna be going for 20 minutes. And then hey, we’re gonna stop and take a, 5-10 minute break, try to drink some water. Or, thinking proactively and plan and being strategic with some of these things that can be effective, so having modified work to rest ratios as it gets hotter outside, so taking some breaks, drink some water, finding some shade, changing when you go out to do your run, for example, maybe go out early in the morning, before the sun comes out, or, later in the evening, when it gets a little cooler out. Those are some things and some strategies that can be pretty effective in those scenarios. Now, again, those are training scenarios. When it comes to like competition and races, it becomes a little bit difficult. I think, from a race and competition perspective, I think, externally some proactive changes can take place, with rescheduling things. So, for example, think back to the Olympics, the past couple of weeks, which has been, amazing to watch and the gold medal match for women’s soccer between Canada and Sweden It was supposed to occur at like 11am or 12pm, in Japan, but seeing how hot it was supposed to be during the start of that match, they rescheduled it to the night time, the next day. So it was no sun it was dark out to get rid of some of that heat load from the sun. Similarly with some of the marathon events, moving the marathon events up an hour for the women’s marathon to start a little bit earlier in the day to get done earlier before we get too hot. So those some practical changes that can happen organizationally, they can help mitigate some risk within the athletes participating in some events. Going back to listening to your body, right, if you’re really struggling and you’re running a half marathon, for example, maybe that day is just not your day, maybe it’s not your day to PR. So, listen to your body take some time, consider like a run or jog, walk, scenario or something like that to kind of help mitigate some of those changes of body temperature. It may be,, helpful and to make sure that, you know, you’re hydrating, appropriately and what not.

Tips To Keep Yourself Safe In The Heat

Trevor Connor 1:05:07
Emile Abraham’s race professionally in Europe and Trinidad and Tobago, which is down on the equator, so he knows heat, let’s hear his thoughts and how to protect yourself from those hot days on the bike.

Emile Abraham 1:05:18
Well, heat exhaustion is, not just an enough for now thing. You have to pre-hydrate, pre-prepare, and make sure that your body stays cool. Your body is like a radiator in a car that you have to be able to produce water to your head, behind your neck. This is the reason that a lot of riders you may see if you go to a race, and it’s really hot out. They would put like a stocking of ice right up to the top part behind the neck, upper back. Because I think that’s one of the most beneficial points on your body. That helps your system acknowledge the cooling of the body and your head and stuff like that. So these are places that if you feel like your body is starting to burn up from the inside, you definitely want to wet your head and behind your body, behind your neck, and keep that body cool. And make sure you hydrate for at least 48 hours in advance. Because you can’t wait day to start hydrating. So you know, just make sure that you just drink that water 48 hours in advance, and with the wetting and all that you should be somewhat okay.

Being Stuck In The Worst Case Scenario

Trevor Connor 1:06:43
So let’s talk quickly about the worst-case scenario where I found myself so you’re out in the middle of nowhere, you’re with a friend or you’re by yourself, you or your friend didn’t listen to all the signs, and you’re now so either they or you yourself are in the heat exhaustion heading towards heatstroke. What do you do at that point?

Dr. William Adams 1:07:04
Activate EMS and obviously, in this situation, it was very complicated because of cell service and all that. So it makes it really, really hard, right? But thinking of strategies going forward. You know, if you’re with someone, and they’re deteriorating, and you think it may be a potential case of exertional, heatstroke, or whatnot. One, getting them out of the sun, if possible, getting them to get some fluids, if they can consume fluids, or if there’s fluids available, you using some of that to dump over the body to help kind of cool the body down, especially when you’re in remote settings. Activating EMS to get you know, advanced medical care on-site as quickly as possible is going to be helpful to reduce the risk of potential long-term morbidity if it is in fact exertional heatstroke. So I think those are some things to think about. And again, it’s really setting specified in the scenario here, you know, mountain biking out in Moab, it becomes very complicated, because how remote that is, the lack of tree cover, you’re only able to carry so much, water and fluids with you. Thinking of ways to get around that and coming up with an action plan. As far as, hey, if things kind of go sideways, what’s my action plan? How am I going to contact? You know, EMS? You know, how am I going to do this, do I have the supplies needed to do this or to provide fluids or cooling, etc. So, there’s a number of things that can be done. But I think having an action plan going into those things can be very helpful.

Takeaways From Dealing With Heat Illnesses

Trevor Connor 1:08:45
So the two things I would say I learned in this experience, is one, know how to find on your phone, your longitude, and latitude. I was very glad one of the people we were with was able to do that because we had to call him the helicopter. But if we were trying to describe, you know, this isn’t like saying, well, we’re at the corner of x road and y road. This was we’re out in the middle of nowhere. And one of them was able to find the longitude and give that to the helicopter that helped immensely. And the other thing I would just recommend is don’t sit there and go, well, let’s see how this plays out before you call the EMS. I think it’s, get on the phone to get them there, you can deal with the insurance of the ambulance bills later.

Dr. William Adams 1:09:33
That is actually a good point you know, I never thought of and to be honest, like I don’t even know how to find the latitude longitude on my phone. So that might be something good for me to look into. Especially, you know where I am and my joy for being outside, and hiking in the wilderness, and whatnot. So, you know, that’s a great point. And you know, I think thinking of those things and having a plan in place is really effective because, having an effective plan in place, just expedites the timing to proper medical care if there’s a situation that does arise that needs advanced medical care.

Trevor Connor 1:10:15
That’s actually what scared me after the incident. That is why I’m saying, don’t wait too long, you just pull the trigger and call. The ground rescuer who said, what he sees with people that suffer heatstroke up there as they go into comas, and they don’t come out. So you don’t want to wait till your friends are in a coma, then it’s way too late.

Dr. William Adams 1:10:42
Yeah, I mean, in with heat-related illness and exertional heat stroke, you know, it all comes down to timing. If someone’s gonna succumb to exertional heatstroke, it’s how quickly you can cool the body down. And evidence and research has repeatedly shown that if we can reduce someone’s body temperature as quickly as possible, and oftentimes we use the golden half hour. So if we can reduce body temperature quickly, within 30 minutes, we typically have very positive outcomes from the patient. So you know, in that case, how quickly can we have an intervention or human intervention in this case.

Chris Case 1:11:21
For anyone out there that’s, that’s listening and has an iPhone, the easiest way to find your GPS coordinates, there is a compass app on your phone, pre-loaded. If you open that up, it’ll tell you your bearing, of course, since it is a compass, your location, your elevation, and your latitude and longitude. So it’s actually pretty easy assuming you have service of some kind of thing, I don’t know maybe it works without service because it’s running off GPS and not cell service. So good thing to know for sure, depending on the model of phone you have, etc.

Trevor Connor 1:12:03
Before we give our take home, so let’s hear my friend Adams final thoughts on his experience in Moab,

Adam 1:12:08
I think I’d be real careful about back-to-back days, I think I’ve got a much better feel for my limits. If it’s like a one-day sort of like, you know, I’m relatively fresh. And I’m planning you know, doing like a two-hour ride in the heat. Because I’ve done plenty of those. It gets regularly up 95-100 degrees around Salt Lake City in the summer. And I can usually gauge I’m good for an hour in this temperature or good for an hour or hour and a half. But that’s when I’m just riding the weekends after kind of sitting around in an air-conditioned office all week. Just to back to back days. I don’t know if I can predict how recovered or, or not. I am after a couple days of stress like that.

Trevor Connor 1:12:56
And it’s now a couple months later any lasting effects or do you feel like you fully recovered from this?

Adam 1:13:03
Oh, I feel like I fully recovered. And I think a lot of that stuff. Thanks to you and to those guys on the trail and Nate for getting all the help out there quickly. When I was walking out of the hospital, you know, I’ve been I was I think there for about three, four hours. And in that time, they put about four and a half liters or five liters of IV fluid in me a gram of potassium a gram of magnesium. I turn it around to where I could walk and still felt like crap, but I could function. And when I was walking out of there, one of the nurses was like, yeah, usually we don’t have people get airlifted here and then walk out that afternoon. So my case is fairly rare. I did get follow-up bloodwork about a week later like they recommended and all my electrolytes were back in normal ranges. All my kidney functions looked normal again. The one thing I did notice is a little lingering dizziness for especially the first week afterward. And for about two weeks afterward, when I would stand up quickly or something I would feel a little bit dizzy. And I think that was due to some effect of that heat exhaustion. But after about two weeks, I’d say I felt completely normal. Probably a good thing. My bike was stuck in the shop for six weeks waiting for a new hub because it’s impossible to get parts right now. So I was forced to take time off the bike. We also had really bad smoke for a while in Salt Lake anyway, so I still rode my road bike on the trainer inside a few times, and then got back into weightlifting and felt pretty normal and I think I’m 100% back to where I was at this point.

60-Second Take Homes

Chris Case 1:14:51
Well, Dr. Adams, thank you again for all this great information I want to leave us with, you know our 60-second take homes like we normally do. I’ll start with you. You’re probably going to take all the good answers because you know everything about the subject and we don’t. But yeah, Dr. Adams, give us the most important take-homes from this discussion today.

Dr. William Adams 1:15:12
Yeah, no, there’s a lot of good takeaways from this discussion. So a little daunting for me to kind of wrap up, and kind of hit on the main things, but I think one of the things that is probably in line with the last thing we were just discussing is, having an action plan. So if you’re, training, or if you’re out for a hike or out mountain biking. In Moab, for example, based on the story that we were kind of going back and forth on. Having a plan as far as what to do in the event of a potential medical emergency is going to be essential for expediting, access to mental care, to treat whatever potential medical emergencies that may arise. So I think for me, that’s probably the number one take-home is be prepared, and to do that the front end work in order to be prepared.

Chris Case 1:16:08
Trevor, I’m sure you have a lot of thoughts here as well.

Trevor Connor 1:16:11
Well, I think that was the big take home to be prepared. You don’t want to be where I was where you have a friend resting on your shoulders. And you’re fearing that your friend is dying, and there’s absolutely nothing you can do. That’s just not a place you want to be. You also don’t want to be in that place where you’re going through this yourself. And there’s no plan to I think the thing I would add is, it is surprising how quickly this can happen. And so watch for those signs, particularly if you’re out in the heat. If you’re in a situation like this, watch yourself, watch your friends. And if you start seeing the signs, take action earlier, don’t get behind it. Because you get behind it. It goes really to really bad places.

Trevor Connor 1:16:57
Chris, any thoughts?

Chris Case 1:16:59
I think the only thing I can really add here, given the fact that luckily, I’ve never experienced either of these things. But you know, I just would encourage people not to cave, I guess you could say to that peer pressure to speak up if you think something’s going wrong. We do talk a lot on this program about the seriousness with which a lot of people take their sports and their training and their racing. And that’s great. But if you take it so far that you’re not willing to take a moment to assess whether you’re dealing with something as serious as this, then maybe you’re pushing too hard and too far. So don’t be embarrassed, don’t be ashamed, speak up if you need help. And I think that could buy you time or just completely eliminate the risk that one of these conditions is going to develop. Dr. Adams again, thank you. Thank you for being on Fast Talk. It’s been a pleasure. Thank you for your wisdom here today.

Dr. William Adams 1:18:06
No, thank you again for having me. And it was a great discussion. So I’m very grateful to have been invited to join the show today.

Trevor Connor 1:18:14
We really enjoyed having you. Thank you.

Chris Case 1:18:17
That was another episode of Fast Talk. Subscribe to Fast Talk wherever you prefer to find your favorite podcast and be sure to leave us a rating and review. The thoughts and opinions expressed on Fast Talk are those of the individual. As always, we’d love your feedback. Join the conversation at forums fast talk and discuss each and every episode. Become a member of fast talk laboratories fast talk and become a part of our education and coaching community for Dr. William Adams, Adam Weissman, Emil Abraham, and Trevor Connor. I’m Chris Case. Thanks for listening.