Arkansas summers are brutal. Temperatures soar well above 100, and hospitalizations for heat-related illnesses rise. Extreme heat leads to nearly 235,000 emergency room visits and over 56,000 hospital admissions in the U.S. annually. According to the National Weather Service, more people die annually from excessive heat than from any other weather event.
Everyone experiences heat-related complications at some point: dehydration, heat exhaustion, and even heat stroke. However, heat waves pose special threats to those with chronic conditions. With nearly half of all Americans living with chronic disease (a number that has dramatically increased due to COVID-19), it’s important to take extra precautions to stay cool during the next few months.
Dr. William Joseph, a family practice physician at CHI St. Vincent in Little Rock, shares his thoughts on how physicians can help patients stay safe when temperatures start rising.
Biggest Risks: Dehydration, Asthma, and Chronic Lung Disease
Overheating, dehydration, asthma, and chronic lung disease are common chronic conditions that worsen during periods of excessive heat. People with chronic lung disease, for example, experience increased respiratory issues due to high humidity and pollen counts.
“When the heat index rises, patients can become dehydrated more easily,” Dr. Joseph says. “This lowers their blood pressure and puts a strain on their kidneys.”
Heat-Related Illness, or Something More Serious?
People with chronic medical conditions may be less likely to sense and respond to temperature changes and may be taking medications that can worsen the effects of heat. Individuals who are obese or overweight tend to retain more body heat, increasing their likelihood of overheating. Because of the frequency of chronic health conditions in Arkansas, providers must stay vigilant.
“As usual, providers need to pay close attention to the signs and symptoms of heat-related illness and any changes in their patients’ vital signs, physical exam results, and lab work,” Dr. Joseph says.
Symptoms of overheating include:
- Muscle cramps
- Unusually heavy sweating
- Shortness of breath
- Headaches
- Weakness
- Nausea
Who’s More at Risk during Extreme Heat?
Although anyone at any time can experience heat-related illness, some people are at greater risk than others. Some groups who need to pay special attention during hot days include:
- People (especially children) with asthma
- People with heart disease
- Pregnant women
- People 65 years of age or older
- People who are working or exercising in the heat
- Young children or infants
It is also a good idea to check on family, friends, and neighbors who belong to one of these groups, especially if they live alone or lack proper air conditioning.
Which Conditions Are Most Affected?
Heat causes blood vessels to dilate, lowering blood pressure. This makes the heart work harder to maintain circulation, which can strain compromised hearts. Cardiovascular conditions, such as coronary artery disease, congestive heart failure, and arrhythmias, are greatly impacted by the heat.
Excessive heat can also worsen symptoms of multiple sclerosis (MS), including fatigue, vision issues, and weakness. Decreased sweating and impaired thermoregulation caused by Parkinson’s Disease can also increase the risk of heat stress.
Even mental health conditions, such as schizophrenia, bipolar disorder, and depression, can be worsened by excessive heat. Some psychotropic medications can interfere with thermoregulation or suppress thirst, making it harder for someone to know when their body is overheated and making it harder to stay hydrated.
Summer Safety Tips for Managing Chronic Illness
Knowing how to stay safe is key during the summer. Providers can assist patients with learning the most optimal strategies for regulating body temperature, especially for those who frequently work or spend time outside.
“It is critically important that they remain well hydrated, pay attention to the heat and air quality index, and avoid physical activities during the heat of the day,” Dr. Joseph explains.
If the HeatRisk is red or above, staying inside and using a fan or air conditioner is optimal. However, if getting inside is not an option, staying in the shade, taking breaks, and drinking plenty of water can also help prevent overheating. High-sugar, high-sodium, caffeinated, or alcoholic beverages can easily cause dehydration.
Clinics can prepare patient information handouts to remind patients about the risks of being outside during a heat wave.
“We should never assume that patients fully understand the risks associated with high heat indexes or poor air quality. Handouts, online resources, and proactive discussions work well in reminding patients of the associated risks,” Dr. Joseph says.
How Medications and Heat Can Be a Dangerous Mix
“Since dehydration can easily occur during high temperatures, all blood pressure medications and diuretics can put patients at risk,” Dr. Joseph says. “If a patient becomes dehydrated while taking NSAIDs, it can put a significant strain on their kidney function.”
To avoid complications, advise patients on medication to:
- Have a plan for keeping refrigerated medications or electronic medical devices cool in case of a power outage.
- Store medications properly (some may need to be kept out of the heat)
When A/C and Transportation Aren’t an Option
Across the U.S., over 35 million people report living without an air conditioner. In rural pockets of the U.S., especially in Arkansas, people may be unable to afford to replace their A/C unit when it breaks down.
Others may not make enough household income to afford monthly heating and air conditioning payments. Still others lack reliable transportation to a place with A/C, leaving them stuck dealing with the sweltering heat for months.
A KFF report breaks down these disparities in more detail.
The point is that some patients may not have the means to take the necessary precautions we typically recommend during this time of year. However, it is our responsibility as healthcare providers to uncover those social determinants of health and assist our patients with finding resources to accommodate their needs.
“Provider and clinical staff need to be proactive in asking their patients some simple questions about home air conditioning and transportation issues,” Dr. Joseph says. “Providing patients with contact information on transportation assistance programs makes a huge difference for them.”
Helpful Resources for Staying Safe in the Heat
For assistance finding locations with air conditioning, patients can:
- Dial 2-1-1
- Visit the National Center for Healthy Housing’s Cooling Centers by State page.
- Contact their local health department or emergency management agency
For transportation assistance, patients can:
- Utilize the state’s Non-Emergency Transportation Program (for rides to and from medical appointments or other covered medical services)
- Access Southeast Arkansas Transit’s Public Transportation page (for transport to medical appointments, to pay bills, to shop, to work, and to certain community resources)
- Scheduling a ride with North Arkansas Transportation Service
- Search for transportation online through Arkansas 2-1-1
