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Update: The Hidden Dangers of Heat Waves

By Patricia Fennell and Stephen Leon

(Updated 7/31/18)

In the first week of July 2018, a brutal heat wave gripped much of the Northern Hemisphere, smashing temperature records and taking a toll on the health and well-being of people living anywhere from California to Quebec to the Middle East. For many of us, the physical discomfort and shortened tempers were bad enough; the less fortunate among us suffered through health setbacks, some serious, and heat-related deaths were reported from many regions. In the Canadian province of Quebec, more than 70 deaths were attributed to heat. (Quebec has a more inclusive system for reporting heat-related deaths than some other provinces and states, many of which probably undercount the number of deaths in which heat actually was a factor.)

Here in the Northeast, the rest of July was not as bad as that first week, but we continue to see many days with temperatures in the 90s, nights when the mercury fails to drop below 70, and plenty of oppressive humidity. It’s safe to assume we’re not out of the steam bath yet.

(Note: the rest of this article was posted during the July heat wave on the websites of Albany Health Management Associates and Stephen Leon.)

When a summer heat wave settles over us like a shroud, we know what we can expect from the headlines. There will be warnings to stay inside in air conditioning, stay hydrated, and keep physical exertion to a minimum. There will be reports of hospitals taking in victims of heat stroke and heat exhaustion, and of worse, the grim stories of heat-related deaths.

We can also expect a spike in certain types of crimes, regardless of whether they make the headlines. Statistically, we know that some categories of crime do not fluctuate with the air temperature—but we also know that extreme heat does correlate with spikes in physical assault in general, and domestic violence in particular.

Anecdotally, we also know to expect increased incidents of road rage, and more arguments and fights on the street, in bars, and in the kitchens and back bedrooms across from your own rear window. Oh, and we’re sure to see a sampling of Ten Ways to Beat the Heat stories, some of which may be more useful than others, although these lists sometimes carry roughly the same depth and gravity as household redecorating tips.

Beyond the headlines, heat waves affect all of us in ways that are both obvious and unseen—and potentially dangerous. And if extreme heat poses health risks to relatively healthy people, those risks are much more pronounced among the most vulnerable populations: the old, the young, and the chronically ill.

We’re all familiar with the term “seasonal affective disorder,” which refers primarily to symptoms that appear with the onset of winter, including depression, low energy, appetite loss, inadequate sleep, loss of interest in usually enjoyable activities, and so forth. While the causes of SAD are not fully understood, it is generally thought that the reduction in daily sunlight—and with it, the disruption of the internal body clock, and changes in the levels of brain chemicals—is a significant factor.

Some people, however, are more prone to “reverse seasonal affective disorder,” which switches the timing of the symptoms to the onset of summer. And people who don’t do so well with the heat and long days are going to be that much more affected by a heat wave. So are the vulnerable groups generally, especially the chronically ill, who make up over half the population—and are among the most susceptible to the risks of extreme heat, which can both exacerbate their symptoms and even worsen the underlying conditions.

It’s the Inflammation

Although extreme heat can harm us mentally and physically in a number of ways, the biggest culprit is inflammation, which can present in many different forms and affect everything from cognition to digestion to balance to your ability to get a good night’s sleep. And inflammation can cause pain wherever in the body it occurs.

How can we manage inflammation during a heat wave?

Stay hydrated—and limit things that dehydrate you, like caffeine and alcohol.
Exercise moderation, and employ sensible practices with sleep, food, hygiene, etc.
Try not to have big stress-inducing conversations. This isn’t the best time to pick an unnecessary fight with your spouse or make a life-changing decision like moving or changing jobs.
Consider looking at an anti-inflammatory diet. Google it and read up. An anti-inflammatory diet can help anybody—it doesn’t matter who you are or whether you have chronic illness.
Stick to your structures and routines. Prepare ahead of time: gas up the car, make sure you have your basic provisions, get enough cash out of the ATM. Whatever you do for a snowstorm, do for a heat wave.
Stay cool. If you have it, turn on the air conditioning. But don’t go to extremes–find the right temperature setting for your body. Set to the highest temperature that still keeps you cool. Draw the blinds. Use fans to circulate the air, but avoid setting them too close to you while you sleep.

Vulnerability Times Seven

Extreme heat, and the inflammation it causes, also affects us in more specific ways that relate to seven “functional capacities”* we all share: fatigue, pain, sleep, cognition, ambulation, mood, and gut. These capacities are negatively affected by a heat wave, and that goes for everyone—but especially the young, the old, and the chronically ill.

Fatigue may have little or nothing to do with the amount of sleep you get. You can have physical, mental, or emotional fatigue regardless of your sleep patterns—and inflammation affects fatigue too.
Inflammation can bring on pain anywhere in your body. And when the barometric pressure changes, that creates swelling—in the joints, in the gut, and elsewhere.
Heat waves disturb normal sleep patterns. The extra light in summer already affects circadian rhythms, and heat waves occur during the maximum light periods. Heat, humidity, and the inflammation they cause exacerbate the disruption.
As for cognition, there is some science to back up the popular understanding that people don’t think as well in the heat. People have more trouble finding words, focusing, what we might call “staying on point.” And it affects the short-term memory. You can’t find the car. People also are more prone to make careless (and potentially deadly) mistakes while driving.
Ambulation is affected by many things, notably, the inner ear. As we age, balance becomes more of an issue. Heat and inflammation can throw off balance, which affects walking and other types of movement, including going up and down stairs.
Heat waves affect mood. In extreme heat and humidity, all of these functions can act upon each other negatively. And regardless of or in addition to these factors, the brain experiences inflammation on its own. All of this makes us irritable. We’re hot and uncomfortable, and we’re not thinking well.
The gut is already having an inflammatory response, and the heat makes us want to eat less. We change our diet, not necessarily for the better, and we move and exercise less—all of which is a recipe for digestion problems.

Make It Easy on Yourself

You can manage your functional capacities during a heat wave without overwhelming yourself. Think about which capacities typically are your problem areas. Rank them, and work on one or two at a time. For example:

Sleep: Try to create a reasonable sleep schedule. Give yourself time to rest. Keep your room dark. Avoid overhead lighting. Give your brain the message that it’s time to wind down.

Cognition: Avoid mental activities that strain your brain. Minimize distractions so your brain can do the work it has to and then rest. Work for 40 minutes and then take a break. Calm your neurology.

Mood: Manage your mood by expecting the things that are likely to happen, so they won’t throttle you. Expect people to cut your off in traffic. Expect people to be cranky. Expect that you will be more emotional. If you’re vulnerable (and aren’t we all) to feeling low or anxious or unsettled, expect it and be ready to manage it.

*Fennell, P.A. (2012). The Chronic Illness Workbook: Strategies and Solutions for Taking Back Your Life. Third Edition. Albany, NY: Albany Health Management Publishing.

Thanksgiving

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Stories of lasting friendship, and a message to an old buddy’s daughter

***

Last September, Mark summoned up the courage to jump out of an airplane.

And I couldn’t even get up enough nerve to play and sing “For a Dancer” in front of 30 people.

I can play “For a Dancer” on the piano, and I have an okay singing voice, so I could have pulled it off. I got the idea because Mark’s sister, Jane, played a song for the occasion, one she had been practicing, and she performed admirably, even though I could tell she was nervous and shaking and struggling to follow the sheet music in a couple of places. It still sounded lovely.

I gave up trying to read sheet music a long time ago (I’m terrible at it) because I can play by ear, but at the gathering last Saturday, my courage just was not there. Maybe I worried that performing the song would seem like a distracting ego trip—I certainly didn’t want it to be about me. But “For a Dancer” did seem fitting. The event was almost over, and some people had left, when I finally sat down on the piano bench and played a couple of verses. No singing. I was surprised that most of my friends didn’t recognize what I was playing—see, singing the words would have been so much more meaningful! When I stopped, a few people thanked me and asked if it was something I had written. Across the room, someone I didn’t know made a remark about Jackson Browne.

I discovered the music of Jackson Browne and David Bowie when I was in high school, and I think it was Mark who introduced me to both. He was very passionate about finding interesting new things happening in music and art; another friend recently found and shared a Bowie album review Mark wrote for the school newspaper. Senior year, while our high school building was being renovated, we had classes in a half-dozen buildings scattered around downtown Pittsfield, an arrangement they called “open campus.” It meant, among other things, that we were free to go to the public library for study hall (or for any other period we decided was “free”). I think the library had some contemporary albums you could listen to on the house audio equipment and headphones. If I didn’t listen to Browne’s Late for the Sky album there, I certainly did at home. And one evening, lying on a blanket under the stars at Tanglewood, I listened to him play “For a Dancer” live, and the song’s simple elegance and melancholy left its mark on me.

The arc of my long friendship with Mark began in high school, when he and I and a handful of other friends and girlfriends would hang out together just like any other teenagers—in class, at sports events, at parties, at Boys’ Club dances. We scattered for college but always visited one another, and mostly spent summers back in Pittsfield. It was during those years, on one particularly sweltering summer night, that we went for a midnight swim that resulted in our most enduring story. Leaving our clothes piled next to the cars we had arrived in, we set out for the middle of Onota Lake. Good swimmers all, we nonetheless agreed to have names for a periodic “check-in” to make sure everyone was fine. Mostly, we chose goofy sounds—except for Dick, who couldn’t think of one, so his handle was “I don’t know.”

At one point Chris decided to stand on George’s shoulders so that it would look, to the next car that came around the bend and momentarily trained its headlights on the middle of the lake, as if Chris were walking on water. And that is exactly what the occupants of the next car saw—but they were not amused. So on came the flashing lights and out came the blue searchlight that probed the lake in a sweeping motion from one end to the other. I still remember waiting underwater for the light to pass overhead, then coming up for air and doing it all over again. We drifted this way and that, waiting for the cops to leave, which they finally did. We eventually swam back to our cars, though Chris had entertained the idea of swimming instead to the public beach to look for something in Lost and Found to wrap around himself before walking home.

The group stayed in touch for a while. In the early years there were letters (try to explain this to the kids …), holiday weekends home, visits to apartments in Boston, New York, and Buffalo, and class reunions every five years. But geography, new families, and years take their toll on old school friendships. I saw less and less of everybody until it pretty much ended. George left for Colorado, Mark for California. I saw Mark in 1989 when I flew to Los Angeles for a conference, and drove out to his house in the suburbs one evening for dinner with him and his wife Diana. Their daughter, Phoebe, had not been born yet. We told stories, we laughed, we had a great time. We probably talked about art (Mark was working as an engineer but longed to work as an illustrator, which he eventually did). And I remember watching Mark make homemade croutons. I’ve always made my own croutons since that night.

Prior to 2016, I hadn’t seen anyone from the old gang since the last class reunion, in 2001. Then, early last year, Chris sent around an e-mail titled “Cheese Dogs” (don’t ask) as a conversation starter about an upcoming class reunion, teasing us with references to funny moments from our school days. One by one, we responded with stories of our own.

Before long, the “Cheese Dogs” thread took on a life of its own. Soon our whole high school experience was being replayed on our laptop and iPhone screens. Every class, every teacher, every awkward date, every strange thing one of our classmates did, every zany night out—all reconstructed in hilarious detail. People everywhere have their own stories—ours are not uniquely funny, or even unique, but they are unique to us. And like photographs tucked away in a drawer for decades, they were a joy to share all over again. And like time travelers, there we were: wondering what to do with a fallen streetlamp after Chris’ car skidded on an icy road and into a snowbank; playing soccer hungover because the game was postponed by a day, but Margo’s party was not; watching in shock as a classmate, trying to close the Venetian blinds for a movie in chemistry class, yanked the whole thing out of its casing and watched helplessly as it smashed into thousands of dollars worth of Pyrex glassware. And of course, swimming nude in Onota Lake and ducking the police searchlights.

Reconnected, we all vowed to make it back to Pittsfield for that weekend in July, and most of us did. And what an amazing reunion. I had all but forgotten what awesome friends I made all those years ago in high school. Our e-mail group has remained active ever since. Not everyone is so lucky; I do know people who couldn’t wait to leave everything about high school behind, for whom high school was like one three- or four-year-long root canal.

As the official reunion event ended and many of us agreed to meet for a nightcap at my hotel, Mark asked me if I could give him a ride. Prior to the weekend, I had told everyone I was in the middle of a divorce, so it wouldn’t come up as a surprise. Mark and Diana had divorced several years earlier. He wanted to ride alone with me to find out how I was doing, and to share his experiences. And Mark is so funny and easygoing about everything, talking about divorce with him was anything but a downer. We were having such a good time, we stayed in the parked car for another 10 minutes before going into the bar.

At the gathering this past Saturday, we retold the midnight-swim story with four of five participants present—Chris, Dick, George, and me. We even remembered our check-in sounds. Everyone got a nice laugh out of it. I also met Phoebe, now a graduate student, for the first time. Later, I learned that she had had considerable difficulty letting go of the anger she felt toward her parents over their divorce.

That got me thinking about my own children, but also about Phoebe, and whatever between her and her father may have been left unreconciled. If I could say one thing to her, it is this:

I don’t know enough about you or your life to understand what you have gone through or how you feel. All I do know is this: If you’ve been married for any length of time, and especially if there are children, divorce is difficult for everybody involved. It doesn’t matter if it’s his fault or her fault, or everybody’s fault or nobody’s fault. It’s no fun for the kids and it’s no fun for the parents. It breaks their hearts to tear their children’s lives apart, but for one reason or another, they have reached the conclusion that there is no other choice. Mark loved you, but I’m sure you know that. He made that clear to us as well. You know what else about him, that you might have heard once or twice these past couple of months? When you talked one-on-one with him, it was as if you were the only other person in the world. We all try to be that much in the moment, but Mark did it effortlessly. And for me, it was a blessing to have that last 20 minutes in the car with him, as he shared his own difficult experience with me to make sure I didn’t feel like I was going through it alone.

On the night before Thanksgiving, at the home in Laguna Beach he shared with Corrin, his partner, Mark Warren Peronto died suddenly, unexpectedly, of a heart attack. Last Saturday, we gathered in Williamstown to toast his memory and tell stories celebrating his life—and to watch a video of him skydiving, smiling from ear to ear as he fell to Earth.