Ah summer! Beaches, barbecues, and endless opportunities to overdo it in the heat!
With the heat of the summer being in full swing many of the blogs are filled with great tips on how to manage fatigue during the summer swells. A couple of you guys asked me to throw in my 2 cents, which I’m of course happy to do!
Heat isn’t just a problem for MS, it’s also huge issue when caring for patients who have any type of head trauma, brain bleed, or infection. Sometimes we intentionally cool the people down to preserve brain tissue and reduce brain injury. Other times the brain itself looses it’s ability to regulate body temperature and the body’s core temperature can shoot up to dangerously high levels. I’ve spent many nights watching over critically ill neurology patients, trying to get them cooled down enough so that they have the best chance at recovery as possible. Now I’m the one that has to be cooled when the summer temperatures soar up, luckily I had that on-the-job experience! There are a few basic steps that I learned in the ICU that can easily be applied to MSers too:
1. Cool from the inside out. In the ICU we use cold IV fluids through central lines and IV catheters. For us MSers, drinking ice cold water can have a very similar effect. This also has the added benefit of keeping us hydrated! I get sick of drinking a lot of water so I like to get creative with flavored water. Gatorade is great too, but keep in mind it has a lot of sodium.
2. Strategically place ice packs. The back of the neck, armpits, groin, and behind the knees are the best places to put ice packs when you are trying to cool someone off in an emergency. These areas have a large blood supply that is close to the surface of the skin. In someone who is up walking around the back of the neck is really the most practical option which is why cooling towels and neck wraps are great. Doing a cannonball into a cold pool, or taking a cold shower also does the trick!
3. Wrap the upper body in cooling pads. In the ICU we use machines that constantly circulate cold water through pads that wrap around the torso. Cooling vests use the same principle, except they only stay cold for a certain period of time. Dave Bexfield of Active MSers is the authority on cooling vests, and has done extensive testing on several different types of vests. You can see his recommendations here.
So really, what is it about the heat that makes us feel so darn awful?
When myelin is damaged by MS it causes an interruption in sending impulses through nerves. During relapses new myelin destruction is occurring and as a result we can experience a wide variety of new symptoms such as vision loss, numbness, tingling, trouble walking and nerve pain. In Relapsing-Remitting MS there are periods of remission during which symptoms improve or disappear all together. However, even though you feel better the nerves are sill damaged. Over time the nervous system finds ways to work around the damage and to compensate (because it’s pretty badass like that), but it does require more effort than normal to conduct electrical impulses. Heat and humidity slow impulses down even further, making it that much more difficult to get signals from the brain and down through damaged nerves. This is why Uhtoff’s Phenomenon, pseudoexacerbations, and fatigue can occur if you get overheated. But don’t feel too bad, even olympians experience a sharp decline in their performance in hot conditions and have to adjust their training schedules accordingly. See that, you’re basically an olympian!