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Joshua Bozek. Photo courtesy Bozek

By Aidan Johnson

Summer has arrived, and with it warm weather and longer days. However, as kids participate in outdoor activities, it is important for parents, coaches and camp counselors to watch for signs of heat-related illnesses, including heatstroke, sunburns and dehydration.

Dr. Joshua Bozek, emergency medicine physician at St. Catherine of Siena Hospital in Smithtown, discussed how to identify the causes of heat-related illnesses in kids in an exclusive interview June 5.

“The first thing that I usually look for is when the kids are grabbing for their water bottle a little bit more frequently,” Bozek said.

“If they suddenly start feeling kind of weak, more tired … let’s say they’re playing a sport and suddenly they want to go on the bench, that’s a sign that they’re getting a heat illness,” he said, also noting nausea and vomiting, muscle cramps and irritability. He described more serious symptoms such as fainting, severe headaches and cool, clammy skin.

It’s important to remember that some conditions, such as heatstroke, do not only occur outside or on sunny days, but can happen when it’s cloudy or in places like gyms.

If symptoms of heat illness appear to be present in a child, it is important to move to a cooler area, such as a building with air conditioning. He suggested changing to lighter clothing like shorts and a T-shirt and laying the child down with their feet slightly raised.

If the symptoms start to progress even more, Bozek recommended spreading water on their skin, which can help to cool down the blood vessels underneath, though he clarified that this shouldn’t be done to the point where the child is frigid.

Importance of hydration

“As long as they’re not actively vomiting, you want to try to get some fluids into their system,” Bozek said, adding, “If you drink some cold liquid, your esophagus, your stomach, your intestines, until it warms up will help cool you from the inside out.”

However, if symptoms continue to worsen to severe vomiting, fainting or seizure activity, the best option would be dialing 911.

Bozek also discussed preventing sunburn in children, saying, “The number one thing that you can do with kids that are going to be out, particularly when they’re at camp, is making sure that they have adequate amounts of sunblock on and reapplying frequently.”

Hydration once again plays an important role, as when sunburn progresses and the skin gets hot, which dehydrates the inflicted person much more quickly. Therefore, it is important to drink more water than normal, even if the kids are not feeling thirsty.

Sunburns can progress into severe degrees of burns, with blistering being a sign of severity.

“You don’t want to get to the point where you’re actually getting some necrosis of the skin or blisters that become deep, but the main thing is just when it’s very sunny out, if you can do activities that are in the shade or indoors, that’s better,” the emergency doctor added.

Bozek noted the difference between sunscreen and sunblock, with sunscreen used as the generalized “full body preventative measure,” and sunblock being used more “for areas that are at higher risk,” such as the ears and nose, since they’re directly pointing up to the sky.

It’s important to remember to apply sunblock to the lips, as it is possible to develop blisters, or even skin cancer, if left unprotected. Additionally, wearing a hat can keep the sun off of a person’s scalp and potentially cool them down by providing some shade to their face.

Bozek recommends using SPF 50 and above for children.

Kids are more susceptible to sun burning and dehydration due to having more sensitive skin and being able to drink less liquid than an adult, along with not necessarily being able to recognize the symptoms of heat-related conditions as well. 

It is important for everyone to practice safety in the heat and sun, so the fun can continue throughout the summer.

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By Samantha Rutt

Although your backyard pool or local beach may seem like the perfect oasis, they can also pose significant safety risks. Following decades of decline, the Centers for Disease Control and Prevention reports drowning deaths are on the rise in the United States. Based on a study released on May 14, from 2020-22, over 4,500 people died from drowning each year — 500 more per year compared to 2019. 

In all of New York State, Suffolk County holds the third highest rate of drownings at county regulated facilities, sitting only behind New York City and Nassau County, according to data from the New York State Department of Health.

“There was a rescue almost everyday,” former facility manager at the Centereach Pool, Shannon Ryan said. “It is important that everyone knows how to swim, after all, we live on an island surrounded by water.” 

Who is most at risk?

Statistics reveal that children and teenagers are most at risk of drowning. The CDC reports that drowning is the leading cause of unintentional injury death for children ages 1-4 and the second leading cause for children ages 5-14. 

Young children are particularly vulnerable around residential pools, while older children and teenagers face risks in larger bodies of water such as the ocean or lakes.

Additionally, African American children ages 10-14 are 7.6 times more likely to drown in swimming pools compared to their White peers. 

“You may be surprised as to how many people do not know how to swim,” Ryan shared in an interview. “Either not knowing how to swim or oftentimes a parent not paying close attention to their children I’d say is the most common reason we make rescues,” the facility manager said of her experience.

Almost 40 million adults in the United States do not know how to swim and over half have never taken a swimming lesson, according to CDC compiled data. 

What to do in an emergent situation

Though not daily, emergent situations at the pool are frequent. If you or someone near you witnesses a swimmer in distress, it is important to notify a lifeguard immediately. 

“In an emergency situation it is first that the lifeguard or facility staff activates EAP [emergency action protocol] which involves making necessary whistle codes and assessing the victim for any further medical attention,” Ryan said. “Usually, thankfully, additional care like CPR or rescue breathing is avoided thanks to the in-depth training our guards practice.” 

Advice from a lifeguard

Ryan, who has also spent a handful of summers as a senior lifeguard at Cedar West Beach in Mount Sinai, shared some helpful tips for those looking to the waters this season. 

“It is important to know how to swim and if you don’t, to take the right precautions by wearing a floatation device or having parental supervision or assistance,” Ryan said.

She emphasized the need to stay hydrated, sunblocked and knowing where help can be found, if needed.

“Especially in the dense heat of the summer, is it important to stay hydrated. We have seen people who are in the sun all day without proper fuel or shade and these are the situations to look out for,” Ryan said. “Wearing sunblock for UV protection and knowing where first aid and all the guard towers can be found are great ways to help protect yourself when you are by the water.”

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Pixabay photo

Summer is often a time to enjoy the beach, barbecue or to simply catch up on outdoor chores. But with increased activity and heat, the summer sun can also be a trigger for chest pain, or angina. For those who have coronary artery disease, or at risk for developing the disease, those hazy, hot and humid days can be potentially life-threatening. With approximately 9 million patients in the U.S. having symptoms, angina is a serious condition occurring when there is reduced blood flow to the heart and can serve as a precursor to a future heart attack.

Robert Pyo, MD, Director, Interventional Cardiology and Medical Director, Structural Heart, at Stony Brook Heart Institute, offers some tips for protecting your heart during the summer heat.

Your Heart in the Heat

Sweating is one of the ways your body rids itself of excess heat. But as temperatures and humidity climbs, there’s so much water vapor in the air that sweating (evaporation) becomes increasingly difficult and your heart, in trying to cool your body down, winds up working overtime.

Further attempting to shed heat, your body reroutes blood flow from the warmer environment of your internal organs to the cooler surface of your skin, causing your heart to beat faster and pump harder and putting significantly more strain on not just your heart but on your lungs, kidneys and cardiovascular system. The higher the uptick in heat and humidity, the greater the burden on your heart and the greater the risk. In fact, on a hot day your heart may have to circulate two to four times as much blood each minute as it does on a cool day.

Beating the Heat and Protecting Your Heart 

Some easy but effective strategies for staying heart-safe this summer:

  • Keep cool. Stay indoors or in the shade as much as possible during peak sun hours of 10 a.m. to 4 p.m. Chilled air is the best way to cope with the heat. Cold compresses applied to your ‘pulse points’ — the areas where your veins are closest to your skin’s surface, including wrists, neck, temples and armpits — can assist in cooling down. Extreme exertion, whether in hot weather or not, can bring on angina.

  • Stay hydrated. Hydration helps the heart to more easily pump blood. Drink water before, during and after going outside in hot weather. Avoid caffeine and alcohol as both of these may increase dehydration. And, be mindful of sports drinks that may contain high amounts of caffeine and/or salt as they have the potential to place stress on the heart.

  • Eat water-rich foods. You get about 20 percent of your water from the foods you eat. A hot weather diet that emphasizes cold soups, salads and fruits can both satisfy hunger and provide extra fluid.

  • Protect your skin. Sunburn affects your body’s ability to cool down and increases dehydration. Wear a wide-brimmed hat, wraparound sunglasses, and lightweight, light-colored, loose-fitting clothing. Apply plenty of broad-spectrum or UVA/UVB protection sunscreen with SPF 30 or higher to all exposed skin 30 minutes before going out. Reapply every couple of hours.

Who’s At Risk for Heat-Induced Chest Pain? 

While anyone’s health can be at risk in extreme heat, soaring temperatures and humidity are particularly stressful for those who already have a weakened heart. In addition to individuals with cardiovascular disease, hot weather precautions are especially important if you’re an older adult, are overweight, have a history of high blood pressure, high cholesterol, diabetes, lung or kidney disease or stroke. Medications such as diuretics (water pills), beta blockers, antidepressants, antihistamines and decongestants may also make you more vulnerable to the heat. It is important to talk with your doctor to fully understand your individual risk factors and take precautions.

“If you’re experiencing chest pain symptoms, the Stony Brook Chest Pain Center is where you want to be,” says Dr. Pyo. “Our dedicated heart care specialists and state-of-the-art advances in critical protocols are a powerful combination that can save critical treatment time when it matters most.”

Making Every Minute Count 

The key to avoiding damage to your heart, is getting treated as quickly as possible. Angina is often the first symptom of heart disease, but in addition to chest pain, discomfort can also occur in such easy-to-ignore places as your shoulders, arms, neck, jaw, abdomen or back. Angina may even appear to be indigestion.

Although for some people their chest pain symptoms might be ongoing but stable for years, for others, there are no red flags at all — allowing blood flow to eventually become completely blocked and a heart attack to occur out of seemingly nowhere.

Don’t take chances with chest pain. If you or a loved one experience any red flag symptoms, don’t wait; call 9-1-1 and get help.

To see a Stony Brook chest pain specialist, call the Chest Pain Center at Stony Brook Heart Institute at (631) 44-HEART (444-3278).

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It is very important to stay hydrated and drink plenty of fluids, especially if you have a history of stone formation. METRO photo
Once you’ve had one stone, your risk for others increases

By David Dunaief, M.D.

Dr. David Dunaief

Kidney stones can have no symptoms, but more often they present with the classic symptoms of blood in the urine and colicky pain. This pain can be intermittent or constant, and it can range from dull to extremely painful, described by some as being worse than giving birth, shot or burned. The pain may radiate from the kidneys to the bladder and even to the groin in males, depending on the obstruction (1).

Stones are usually diagnosed through the symptoms and either abdominal x-rays or non-contrast CT scans.

Unfortunately, the first line treatment for passing kidney stones — at least small ones — involves supportive care. This means that patients are given pain medications and plenty of fluids until the stone(s) pass. Usually stones that are <4mm pass spontaneously. Location is an important factor as well, with stones closest to the opening of the urethra more likely to pass (2).

Generally, if you’ve passed a kidney stone, you know it. In the case of a stone too large to pass naturally, a urologist may use surgery, ultrasound, or a combination of methods to break it into smaller pieces, so it can be passed.

Unfortunately, once a patient forms one stone, the incidence of others increases significantly over time. The good news is that there are several lifestyle changes you can make to reduce your risk.

Hydrate, hydrate, hydrate

First, it is very important to stay hydrated and drink plenty of fluids, especially if you have a history of stone formation (3). You don’t have to rely on drinking lots of water to accomplish this. Increasing your consumption of fruits and vegetables that are moisture-filled can help, as well.

Calcium from diet vs. supplements

One of the simplest methods is to reduce your intake of calcium supplements, including foods fortified with calcium. There are two types of stones. Calcium oxalate is the dominant one, occurring approximately 80 percent of the time (4). Calcium supplements, therefore, increase the risk of kidney stones. When physicians started treating women for osteoporosis with calcium supplements, the rate of kidney stones increased by 37 percent (5). According to findings from the Nurses’ Health Study, those who consumed highest amount of supplemental calcium were 20 percent more likely to have kidney stones than those who consumed the lowest amount (6). It did not matter whether participants were taking calcium citrate or calcium carbonate supplements.

Interestingly, calcium from dietary sources actually has the opposite effect, decreasing risk. In the same study, those participants who consumed the highest amount of dietary calcium had a 35 percent reduction in risk, compared to those who were in the lowest group. Calcium intake should not be too low, for that also increases kidney stone risk. Changing your source of calcium is an important key to preventing kidney stones.

Watch your sodium intake

It’s important to reduce sodium for many reasons, but we’ll provide one more here. Again, in the Nurses’ Health Study, participants who consumed 4.5 g sodium per day had a 30 percent higher risk of kidney stones than those who consumed 1.5 g per day (6). The reason is that increased sodium causes increased urinary excretion of calcium. When there is more calcium going through the kidneys, there is a higher chance of stones.

Limit animal protein

Animal protein also may play a role. In a five-year, randomized clinical trial, men who reduced their consumption of animal protein to approximately two ounces per day, as well as lowering their sodium, were 51 percent less likely to experience a kidney stone than those who consumed a low-calcium diet (7). These were men who had a history of stone formation. The reason animal protein may increase the risk of calcium oxalate stones more than vegetable protein is that animal protein’s higher sulfur content produces more acid. This acid is neutralized by release of calcium from the bone (8). That calcium can then promote kidney stones.

Reverse blood pressure naturally

Some medical conditions may increase the likelihood of stone formation. For example, in a cross-sectional study with Italian men, those with high blood pressure had a two times greater risk of kidney stones than those who had a normal blood pressure (9). Amazingly, it did not matter whether or not the patients were treated for high blood pressure with medications; the risk remained. This is just one more reason to treat the underlying cause of blood pressure, not just the symptoms.

The most productive way to avoid the potentially excruciating experience of kidney stones is to make these relatively simple lifestyle changes. The more changes that you implement, the lower your likelihood of stones.

References: 

(1) emedicine January 1, 2008. (2) J Urol. 2006;175(2):575. (3) J Urol. 1996;155(3):839. (4) N Engl J Med. 2004;350(7):684. (5) Kidney Int 2003;63:1817–23. (6) Ann Intern Med. 1997;126(7):497-504. (7) N Engl J Med. 2002 Jan 10;346(2):77-84. (8) J Clin Endocrinol Metab. 1988;66(1):140. (9) BMJ. 1990;300(6734):1234.

Dr. David Dunaief is a speaker, author and local lifestyle medicine physician focusing on the integration of medicine, nutrition, fitness and stress management. For further information, visit www.medicalcompassmd.com.

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