Melanie Cole, MS (Host): Summer days in the Santa Clarita Valley can be very hot, with high temperatures commonly in the 90s and often triple digits. What common sense steps should you take to stay healthy and safe? Welcome to It's Your Health Radio with Henry Mayo Newhall Hospital.

I'm Melanie Cole, and joining me today to highlight summertime safety is Dr. Oliver Sahagun. He's an Emergency Medicine Physician on the medical staff at Henry Mayo Newhall Hospital. Dr. Sahagun, it's a pleasure to have you join us today. I'd like you to start by sorting out for us the heat related illnesses that people are susceptible to, heat exhaustion, heat stroke.

Can you tell us a little bit about those and what differentiates them?

Oliver Sahagun, MD: Hi, you guys. Happy to be here. Thank you so much for having me on. Summer months are approaching and it's going to get very warm and it's important that we're all aware of heat related illness. Heat related illness exists on a spectrum. It could be as mild as a heat rash, but it could be as severe as a heat stroke.

When somebody is dealing with heat related illness, it's important that we recognize that the symptoms that are associated with the particular illness so that we can treat appropriately and make sure that there's full recovery of the patient. I like to think of heat related illnesses existing on the spectrum, which is, usually on the mild end is a heat rash where you get a rash that's itchy that could be easily treated to something a little worse, which is heat edema, which is a swelling of the legs, which could also be treated.

But then it can get worse. You can get heat cramps. You can get heat exhaustion and ultimately heat stroke, which is a life threatening condition; which if not treated appropriately, you can die. And so, you know, as we continue this talk, I'm happy to get more into the details in terms of how to prevent it and how to treat this.

Host: Well, let's start with prevention then. You're an emergency room physician. This has got to be something that you have seen in your years as a physician, people coming in with various degrees, as you say, on the spectrum of heat related illnesses. So, let's start with prevention. How do we stop it from happening in the first place?

Oliver Sahagun, MD: Well, number one, we can't tell mother nature to turn off the heater, turn off the sun. So we have to be very aware. In the summer, fortunately, in places like Southern California, specifically here in Santa Clarita, where I work here at Henry Mayo; we know that the summer is going to be very warm.

And so, we all look at the weather and we know what's going to be very warm. And so when we know what's going to be very warm, number one, if we don't need to be outdoors and we try to stay indoors and try to stay cool. That's easier said than done when we're involved in certain things, if we have children and they have activities that are outdoors, or we want to stay healthy and do some things that are outdoors, and we know we're going to be outdoors, there's a variety of things that we can do.

One is, to wear appropriate clothing, loose clothing. If we're going to be outdoors and we know that it's going to be warm out there, it's important to hydrate. I always tell, my patients or people that I have these conversations with is, should try to pre-hydrate, if it's particularly warm outside and we know we're going to be doing any sort of exertional activity, stay hydrated while we're out there, and it's important to pulse hydrate, for, those individuals that are on certain medications or certain medications we'll, essentially increase our body temperature more than we think, so it's important to have these conversations with our doctors before the summer approaches to find out if you're on the appropriate medications and when you should be taking them, not taking them.

Also protection from the sun itself on our skin, so, any sort of skin protection, like sunscreens are really important.

Host: Well, that was a very comprehensive answer with great advice. Now, when we're talking about treatments, if somebody does feel that they are susceptible, first, I'd like you to speak about the symptoms, the red flags. How do we know that we're headed in that direction? And then what do we do?

Oliver Sahagun, MD: If it's particularly warm out there, even if we're not doing any exercise, our body it has to be in what's called homeostasis, and that basically means that it's happy at a certain temperature. If our body heats up because we're outdoors and we're exposed to the sun, the body doesn't want to heat up. And so the way the body cools itself down is through sweating. Sweating is a very complex mechanism that bodies go through that dilates blood vessels in the skin. And what that does is that it results in water evaporating from our skin and it's the water evaporating from our skin that cools us down.

The issue with that is that if we're using water as a means to cool ourselves down through the process of sweating, then we're taking away water from other parts of the body that need it, particularly maintaining blood pressure to perfuse all of our organs. And that would be, primarily our brain.

And so if our brain is not getting adequate perfusion, meaning there's not enough blood going there because we are losing water through our skin to cool ourselves down; then we started experiencing the symptoms consistent with that. And so we would feel weak. We would feel lightheaded. We'd be feel dizzy.

We'd also lose water in our intestinal tract. So we may be nauseous or vomit. If we lose enough water in our body, ultimately says I can't sweat anymore, then you would get really hot and you would stop sweating. That could lead to what the symptoms consistent with heat stroke, where you get disoriented, confused, you can have seizures. And that's an emergent medical condition that requires immediate attention.

Host: What do we do? If we are with somebody or it's happening to us, but as a parent, if we see this happening to our children or someone we love, what do we do? Do we put them in cool water? Do we, how, what are we supposed to do?

Oliver Sahagun, MD: So heat related illness, like we talked about is a spectrum. It takes a while for us to reach the most extreme end of the spectrum, which is heat stroke. Luckily enough for us, most of the time we're can experience symptoms that are going to prevent us from getting into this extreme end of the spectrum, we're going to feel weak, lightheaded, dizzy, we're going to get heat cramps, we're going to get thirsty, and that's a sign to us that our body needs water.

For young, otherwise healthy people, or even middle aged and some older people, we can recognize those symptoms and know what to do. Unfortunately, there are the very young or the very old who may not mentate very well and may not recognize those symptoms, and those people that's really, really important that they're with somebody so we can recognize those symptoms.

But essentially, if you're experiencing any symptoms that are consistent with dehydration, you should get yourself into a cool environment. If you're outdoors and you can't get indoors, find a tree, find some shade. You need to lie down because when you're supine, you're against the force of gravity. Now it's easier for blood to go to your brain.

And when your brain receives blood, then you can mentate and think more clearly and find out what it is you need to do. If you can orally rehydrate, meaning taking fluids via the oral route, which is drinking, then we should do that. Sometimes we're obtunded and we don't recognize that we can drink water.

Sometimes we've lost so much water from the intestinal tract, it's hard to digest that water. And in those cases, you need IV fluids. And in those situations you would need to go to the nearest emergency room. But for most people, lying down in a shaded area in the supine position, loosening your clothing, orally hydrating with water, preferably, an electrolyte solution like Gatorade or Powerade, those are sports drinks, would be sufficient, for approximately 30 minutes.

But if you're at the point where you're approaching heat stroke or you're not sweating because you've lost so much water, you're obtunded, you're worn to touch, then you should get into a shaded area, lie supine. There should hopefully be somebody there with you and you should call 9-1-1.

Melanie Cole, MS (Host): Wow, great advice. Now you mentioned sports drinks. Are they better than water? Do you care if we, either one?

Oliver Sahagun, MD: So water is great and that's probably the first thing you should be drinking. When we sweat, we're not only sweating water, we're sweating electrolytes. But if we're not significantly dehydrated, water by itself is perfectly fine as a source of rehydration. Usually that's when it's not so warm or you're doing just mild to moderate exercise.

Both of those processes, of course, are going to increase your body temperature, and by increasing your body temperature, your body doesn't want to be there, so you're going to sweat to cool your body down. But if you're doing moderate or significant exertion, or it's very warm outside, an electrolyte solution would be far superior to water because you're not only replacing the water that you lost, but you're replacing the electrolytes.

A lot of these electrolyte solutions also have sugar in them. And it's important that your body replenishes itself, not only with water, but also with electrolytes and some sort of caloric intake, which would be in the form of simple sugars that these electrolyte solutions have.

Host: Thank you for clearing that up. And now you mentioned sunscreen, which certainly these kinds of things are not going to protect us from heat related illnesses, but they are going to help protect us from burns and sunburn and such. So can you just speak a little bit, because I think one of the questions many people have is, can you use sunscreen on babies?

And if not, then, you know, there's sun protective clothes, Dr. Sahagun, but when it's so hot, as we're talking about, you don't feel like you want to put your baby in those kind of warm clothes.

Oliver Sahagun, MD: The sunscreens are perfectly safe in most people, including, young children. There are a variety of sunscreens out there. Some have organic substances, some have inorganic substances. Most people can tolerate these well, and they don't have any sort of intolerance or allergic reaction to these substances.

But when people do, usually it's to the organic stuff and not the inorganic stuff. If you develop any sort of reaction when you apply these creams, redness, swelling, find out exactly what you're using, and you may want to try something different. But the benefits provided by these sunscreens, far outweigh any potential detriments, which, you know, include these allergic reactions only because they're so rare.

But it's important that we use these sunscreens if we're going to be outdoors, and just about anybody, we all have different pigments. And it's really important that they're used in everybody, but especially in people who are lightly pigmented because they can burn more easily. The effects of the sun, the sun has radiation in two different times, ultraviolet A and ultraviolet B rays.

And, the effects of this radiation on our bodies, is both acute and chronic, meaning something can happen short term and something can happen long term, and the short term, radiation effects from the sun is that we get sunburned, and that's very painful. The long term effects that it can cause photoaging or sunspots, but it could also lead to different kinds of cancer. And so it's really important that we protect our skin with these sunscreens. My advice would be to get the broad spectrum sunscreens that protect against both ultraviolet A and ultraviolet B radiation. And to apply it, without hesitation. Most of these companies will say that, if you're not sweating or you're not swimming, that applying these creams can last eight to ten hours.

My advice would be that if you're sweating, some companies will say that these are waterproof, they're not, they're water resistant and ultimately they'll come off if you're swimming or you're sweating. But just, apply it every couple of hours because it's certainly going to help you, with both the short term and long term effects of sun radiation.

Host: Dr. Sahagun, we could talk for a very long time, you and I, because there are so many aspects to summer safety and doing what you do for a living; I'm sure you see so many interesting things. As we wrap up, I'd like you to offer your best advice and a summary. And when you're giving us that, please include safety in the water, because we've talked about heat related illnesses, which people think, oh, I'm going to jump into a pool or go to the beach, and then I don't have to worry about those things, but there are hazards there, and while we don't have time to talk about all of them, because there's a lot of them, give us a little bit of a quick summary of safety, pool safety or beach safety, and our little ones, because that's really where we have to be extra careful. And wrap it up with your very best advice for summertime safety.

Oliver Sahagun, MD: Everybody wants to be in the pool in the summer, especially the little ones. And although it's fun, there's a lot of risk. Many families teach their kids how to swim early. They get exposure, but that doesn't mean that there's no further danger. When we swim, we're burning the same, if not more calories than we would be if we were tossing a baseball or, doing basketball.

The reason we don't notice it is because one of the ways that our body helps cool down we talked about is sweating, but the other one is just being exposed to something that's cooling. And when we're in the water, we're cooling ourselves down, but that doesn't mean that we're not getting dehydrated. And with dehydration, comes a lot of the things that we talked about on this spectrum.

You could get heat cramps. If you're a three year old or you're a four year old, and you're swimming and your parents are looking from afar, and there's nobody in the pool with you; this heat cramp could be enough to prevent you from paddling to the ledge and you can sink and drown. So it's important that you're always swimming with somebody, but a multitude of other things can happen.

You can get weak, lightheaded, and dizzy. My advice always is, is that if you're going to be swimming, you swim with another individual so that you guys are watching each other. Preferably somebody who's older age who can help with any sort of rescue effort in case, something were to happen while you were in the water.

So it's really, really important. And even if you're in the water, you still have to hydrate. There are so many protective measures that we could take in that the government is actually very active in trying to prevent these drownings, and these include any number of things. Number one is, if you have young children, make sure that all doors are locked so that your children don't get out and get into the pool, accidentally. If the door is open for whatever reason, make sure you have an alarm in that door so that an adult in the house is alerted to the door opening so that the children don't accidentally get out, those, especially those who can't swim.

In my opinion, and I've seen this many times in the emergency room is, sometimes adults will leave a young child in charge of the younger kiddos so that they don't get out and get into the pool. But too many times these children are distracted with other things, watching TV, playing video games, and they don't notice these young children getting out.

And so it's really important that if you're going to leave somebody in charge of your own kiddos, if you own a house with a pool, is that it's somebody older and that you trust and who's very responsible. In addition, if you're having a pool, it's really important that you have a gate. And these gates are specifically for pool safety that only taller or older individuals can open from top up and children can't get in and they have swinging gates so that they automatically close.

And then the other things that we talked about is that if you are going to allow them to swim, make sure you have eyes on them, make sure they're swimming with somebody else, making sure they stay hydrated, during the process and afterwards. That would be my, recommendations on pool safety.

But in general, we want to have fun. Summer is a great time of the year, especially in Southern California, where we can engage in organized and unorganized activities, hiking and playing sports and watching our children play organized sports. My advice there is have fun, but stay hydrated and understand the dangers of the sun as they relate to heat related illness and, and, radiation exposure.

And so in summary, prehydrate, stay hydrated. You want to post hydrate, meaning after you're done, drink a little more, wear loose fitting clothing, and have some fun.

Host: Thank you so much, Dr. Sahagun. What an educational episode this was. You're so informative and thank you again for joining us and sharing your incredible expertise for summertime safety. You can learn more about summertime safety at Henry Mayo's free online health library found at library.henrymayo.com.

And that concludes this episode of It's Your Health Radio with Henry Mayo Newhall Hospital. Please always remember to subscribe, rate, and review It's Your Health Radio on Apple podcasts, Spotify, iHeart, and Pandora. Until next time, I'm Melanie Cole.