Live Like the World is Dying by Margaret Killjoy

June 26, 2021 S1E31 - Guy on Heat-related Illness

The host Margaret Killjoy can be found on twitter @magpiekilljoy or instagram at @margaretkilljoy. You can support her and this show on Patreon at patreon.com/margaretkilljoy.

The guest Guy recommended people support the Gray Coast Guildhall on Patreon to support a small town community space: https://www.patreon.com/graycoastguildhall

Transcript

This is an updated transcript, replacing the machine-generated one which was initially posted with the episode.

1:05:45

SPEAKERS

Margaret, Guy

Margaret

Hello and welcome to Live Like the World is Dying, your podcast for what feels like the End Times. I'm your host, Margaret Killjoy, and I use she or they pronouns. Normally I do this like whole intro thing that I record after the conversation. But this is a special—a special episode that I'm just doing as quickly—as quick turnaround as I can because of what's going on in the Pacific Northwest with unprecedented heat. And I want people to have information as soon as possible. So please forgive audio quality on my end, I'm recording this from the best place I had access to internet, which is right next to one of the busiest intersections in all of the tiny town of Asheville, North Carolina. But anyway, this podcast is a proud member of the Channel Zero Network of anarchist podcasts. And normally I put in a jingle here, but I'm not going to. Instead you should just go to Channel Zero Network. I don't even know the website, you just Google it. I mean, come on, who's actually going to type in URL and you can just type things into the search bar. Go check out the Channel Zero Network, there's a ton of shows that might interest you. Okay, so would you like to introduce yourself with your name and your pronouns? And then a bit of your background as relates to heat related illnesses?

Guy

Yeah, thank you. Thanks for having me on. My name is Guy, I use he and him pronouns. I live up in the Pacific Northwest on the Olympic Peninsula. And my background related to this, I have been a wilderness educator and backpacking guide for many years, especially working down in the Grand Canyon for several years. So a lot of exposure to heat there. And I also instruct wilderness medicine courses. And so I teach and think about bodies and how bodies adapt to stress, particularly heat stress in this context. Yeah, that's me.

Margaret

Hurray. I'm so glad that your skillset is about to become very useful away from the Grand Canyon and in the Olympic Peninsula. The rain forest that I believe is not—is it—is it normal for you all to have 109 degree weather? Or is that abnormal?

Guy

That is definitely abnormal. Yeah. We sometimes we’ll cross 100 or triple digits over 100 for one or two days in the summer, usually in late July or August. I cannot remember a time when we hit 108 degrees, and certainly not in late June. It is pretty hot.

Margaret

Yeah, I've—I'm from the Mid Atlantic and now I live in the south on the east coast. And I've, the only time I've been in—I mean, I've been in triple digits. I don't think it ever got hotter than 103/104 the whole time I was growing up. And only time I've been in 110 degree weather was in Death Valley. So I'm worried about you all. So that's why I'm—I don't, yeah, we're going to talk at a later point with someone that you co teach with about more wilderness first aid. But it seems like wilderness first aid is suddenly might become urban first aid in a way that we're not—I'm not really used to and maybe you're not really used to. I guess to start with, do you want to talk about, like, what are the dangers of heat?

Guy

Yeah, so I'll preface this by saying a couple of things. The first is that human—the human body is actually really adaptable and resilient if it has time to adapt to a changing environment. So people can handle really extreme heat if they have time to acclimatized to it. But if we get these big spikes of heat coming in a place where people aren't used to it, we're jumping from the mid-80s, one week to 108 another week, then that becomes a lot more stressful on body. And then add on to that, right, up here in the Pacific Northwest as a culture, as a society, we're not adapted to experience heat. Most people don't have air conditioning. Most people's houses aren't particularly well insulated because, in general, it's a fairly temperate climate. So there's just not the—either the time to adapt on a physiological level or to adapt our environment to really manage and handle this heat. So that said, a few different things happen when we get too hot. So, our body, right, we we sweat, we produce sweat, and that's the primary way that we cool ourselves off. And evaporation is is actually a very effective cooling mechanism. If we have enough sweat, and particularly if there's a breeze that is able to allow that evaporation to continue to cools us off. As our body gets too hot and we start to lose our ability to thermoregulate, we end up seeing a lot of different side effects. And so we used to think of this really clear progression from what we call heat exhaustion to heat stroke. And now it seems more like there's just a lot of different clusters of symptoms that appear when people get too hot. So things like nausea, vomiting, feeling really tired, feeling a little bit disoriented, feeling irritable, some muscle cramps particularly related to exercise, sweating, excessive sweating, but then also maybe some more like chills or pale skin, clammy feeling, as our body just doesn't tolerate the heat extremes very well. And all the symptoms, all those symptoms are unpleasant but fine. And the real danger is when our internal temperature starts to cross 104 or 105 degrees Fahrenheit. And at that point, our brain actually starts cooking. And so we see our mental process change, we don't think as clearly, our personality changes, and we're actually doing long term damage to our brains, and they won't survive that for very long.

Margaret

When you say very long, like what are you talking about there, like five minutes, an hour?

Guy

Oh, no, definitely in the in the hours realm. But the longer that persists, the more damage—the more permanent damage can be done to our brain and to our bodies. Depends on the heat extreme. And then once we lose that, once we start losing that ability to thermoregulate altogether, instead of maintaining a temperature that's elevated but not too high, we just kind of start to run away, and we can't cool off at all. And then—and then we need help from from other people, we need a change of environment, we need to be cooled down really, really quickly.

Margaret

One of the—I asked social media right before this interview, like what advice people had and also what questions people had. And the thing that you just talked about, about how we used to see it as heat exhaustion versus heatstroke is very different. That is one of the things that most people were bringing up is, like, make sure you know the difference between heat exhaustion and heat stroke with the idea, I guess the prevailing knowledge—what I had known prior to five minutes ago when you said otherwise—would be that heat exhaustion is the like, oh, this fucking sucks and I should probably get somewhere cold real quick. And maybe someone can help me get somewhere—not real cold, but like colder real quick—versus heat stroke is like, you know, call a paramedic, like, get taken to the emergency room or whatever because you're about to die or something. Right? And you're saying that the line between these two is not only not a clear line, but it's not even necessarily a specific progression as much as, like, you are just different clusters. Can you tell me more about that?

Guy

Yeah. So heat stroke, heat stroke is really clear. And maybe that I misspoke a little bit there.

Margaret

I might have misheard you.

Guy

Yeah, so so heat stroke is very clear. That's when our internal temperatures reached 104/105, the proteins that our brains start denaturing we start doing—we start getting cell death in our brains and permanent damage. And the easiest way to recognize that in someone is a change in their personality, or change in their thought process. Someone who was previously grumpy and maybe a little irritable, or maybe a little hot, or maybe they were just fine, now they're saying or doing things that don't make any sense. And that's because their brain is not functioning properly anymore. So heatstroke is pretty clearly delineated. The distinction is that there's not necessarily a progression from one to the next. You don't necessarily get this long warning sign of heat exhaustion, and you're feeling bad, and then you feel worse, and then you feel worse, and then it's heatstroke. That happens in some people. But in other people it can just go directly to heatstroke without this preliminary experience of feeling a little bit crappy and under the weather and nauseous and faint.

Margaret

Okay. So what do you do in each of these situations? Whether you're alone, or whether you're with someone who's experiencing these symptoms, like what do you do for someone who's suffering from heat exhaustion symptoms versus heatstroke?

Guy

Yeah, so, so in both cases, the problem is that someone is too hot and so the solution is to cool them down. So heat exhaustion, this cluster of nausea, muscle cramps, I just don't feel good, fatigue, maybe some vomiting, that person wants to be cooled down. So we should get into the shade, we should try to move to a cooler environment, change clothes. But we're not necessarily—we have time to do that. Heat stroke, as soon as we see that change in personality or mentation, we want to cool that person down as quickly as possible. And so the fastest way generally to cool someone down is through some amount of cold water immersion. So—

Margaret

Throw them into lake.

Guy

Throw them in a lake, but probably not throw them because if they have this altered mental status, they can't think as well, we're worried about their ability to swim, right? But get them in running water, get as much of their body in the water as we can while protecting their airway to cool them down quickly. And if we don't have a big body of water we can put them in that's nice and cool, the next best thing is get them as wet as we can, and then fan them. Because that sort of cooling consumes a huge amount of energy, which then cools the body fairly quickly. So if you think about, you get your hands wet, they don't feel that cold, and then you get a breeze moving across your cold hands or your clothes are wet, you get cold really fast, because evaporation takes more energy then simply being immersed in water.

Margaret

Okay, how does, um, how does being in a humid environment, impact evaporative cooling and dealing with this sort of crisis?

Guy

Yeah, humidity is a real challenge here. And that's the thing that we're fortunate about here in the Pacific Northwest where our summers are usually pretty dry.

Margaret

Okay.

Guy

But the the more humid the air gets, the less effective evaporative cooling will be. And that means both that just getting someone wet and fanning them won't work as well. But it also means that our body's natural mechanism for cooling, which is sweat, also doesn't work as well. And so there's this concept of the wet bulb temperature which is, rather than looking at what is the temperature on the thermometer, you put a thermometer inside a bulb and you cover it with a damp cloth—now they have mean fancier tools to do this now, but the principle is the same—cover it in a soaking wet cloth. And then they measure what is the temperature that that thermometer reads.

Margaret

When you have a bowl or a bulb.

Guy

Yep, wet bulb temperature. Bulb.

Margaret

Oh, you get the—oh, you put it inside a light bulb is that?

Guy

Any bulb, any sphirical object, right? It's covered in a damp cloth.

Margaret

Okay.

Guy

If the humidity is lower than 100%, the temperature that that thermometer reads is going to be lower than—lower than the air temperature, right? Because there's some amount of evaporation which is cooling the air inside.

Margaret

Interesting. Okay.

Guy

And so this is a way for us to understand what the actual threat of any particular temperature is. Because once we get to 100% humidity, the temperature inside that bulb is going to be exactly the same as it is outside because there's no longer any evaporation occurring and no longer any cooling. And the challenge there—and so this is how wet bulb temperatures are measured. You can look up tables that will tell you relative humidity and temperature and you can find the wet bulb temperature at that intersection. And once we hit about 90 degrees at 100% humidity, or a 90 degree wet bulb temperature—which we could get with either higher temperature and lower humidity or lower temperature and higher humidity—once that wet bulb temperature hits about 90 degrees, humans can no longer effectively function in any kind of meaningful physical exertion outside.

Margaret

Okay.

Guy

And even completely at rest without any exertion people will start to die within hours once you hit about 95 degrees wet bulb temperature.

Margaret

Which is what it would be at like 100% humidity if it was 95 degrees out.

Guy

Exactly. Yeah.

Margaret

As someone who the inside of my house is regularly 90 to 95% humidity during the summer. I know I'm not supposed to be worried about myself today, I'm still mostly worried about y'all. But it actually is changing a little bit my sense of the heat that y'all are facing.

Guy

Yeah.

Margaret

What—I mean, okay, so if it's like—do you have a sense of, like, when they're like, it's gonna be 109 degrees, 111 degrees, 116 degrees in the Pacific Northwest this weekend, you know, or maybe you're listening to this three weeks later, I don't know, whatever. But do you have a sense of, like, what kind of wet bulb temperature that is likely to be for people?

Guy

Yeah, so our humidity usually here in the summer ranges between like 20 and 40%, so not particularly high. And so I ran a couple of numbers before this show and who was looking like this Sunday, when we're supposed to hit about 108 degrees during the peak of the day, that'll probably equate to something around a 75 or 80 degree wet bulb temperature, which doesn't sound that hot, but actually is pretty darn hot and really hard for the body to tolerate.

Margaret

And so what that means is not that everyone is fine, it means that the means by which we can fight this with, like, cold water immersion and fanning and things like that actually have a chance of working is what you're saying?

Guy

Exactly. In places with low humidity, water and evaporation works really well to cool you down. The problem with this, and this is what a lot of climate scientists have been warning about for a long time, is that the tropical parts of the world, as we start to get increases in temperature, which are already close to 100% humidity during the hot season, will get so hot that there's no effective way to cool down. And then we'll see a lot a lot a lot of heat related deaths, because these parts of the world also don't have air conditioning and evaporative cooling is completely ineffective. And so in some ways we're lucky up here so far, because our summers are dry.

Margaret

Yeah, and there's—I mean, a lot of people listening don't have access to air conditioning. But I, but there's—there might be like, you know, I know that some cities are setting up cooling centers and things like that. So there is some access to air conditioning in the northwest. So when you talk about like not exerting yourself and things like that, like you're basically saying, like—basically, because when you exert yourself, your body heats up and that's bad. So it's, like, one of the main things people should do is, like, chill the fuck out and, like, not exert themselves as much as possible.

Guy

Yeah, exactly. That's one of the best things that we can do is, right, stay out of the sun as much as possible, try to stay as cool as possible, and just don't do—don't exert yourself, don't do physical labor. Don't go for runs, try to get out of your job if your job involves heavy, heavy physical labor during these hot temperatures—or organize with your other workers because it's literally putting your life at risk.

Margaret

Yeah.

Guy

To be working in these conditions.

Margaret

Yeah, okay. And then. So if this kind of—not fully covers—but but gets at the idea behind like heat exhaustion, heat stroke. The other thing that at least is on my radar to worry about as relates to intense heat is dehydration. And that's kind of a separate threat, right?

Guy

Yeah.

Margaret

Can you talk about dehydration, also, our mutual friends as you have a good story about dehydration?

Guy

Yeah, I have a lot of rants that I could go on about dehydration. And it's more evil twin, overhydration, also known as hyponatremia. So, hydration is important. Our bodies function better when we're well hydrated. But luckily, our bodies also have this amazing built-in mechanism to help us maintain adequate hydration, which is our sense of thirst. And so, generally, people should drink when they're thirsty, and they should drink a little bit more if they're exercising or if they're in hot weather. And if you're well-hydrated, then you will, you will tolerate heat better and you will be more able to adapt. That said, hydration doesn't prevent heat exhaustion and hydrating doesn't fix heat exhaustion or heatstroke either. The problem is, once you've hit that point, the problem was just that you're too hot and you need to cool down.

Margaret

So it's a separate problem.

Guy

Exactly. They go hand-in-hand. Humans do tend to sweat more, lose more fluids in hot weather and need to replace them. The place where people get into trouble—we have this cultural myth of dehydration as the big killer. And, like, you've probably heard people say "hydrate or die," and there's all these stories about people who—athletes who didn't drink enough water and they died. And that's actually not really the case. Most people stay hydrated enough most of the time. They are getting dehydrated and they have access to water and then don't have vomiting or diarrhea that's sucking water out of them, they can maintain adequate hydration pretty decently. The problem, the area that we actually see a lot more deaths and a lot more severe illness is the opposite. This problem over hydration. And so for the last couple decades until well, like, through the 90s and early 2000s, there was a lot of rhetoric in sports medicine about the importance of hydration, and you have to hydrate and drink, drink, drink, and you have to drink Gatorade, and you have to drink electrolytes because if you don't, then you're gonna die of dehydration. And actually, what we were doing was people were drinking too much water. And that changes the electrolyte balance in our bodies, and it ends up making our cells swell up. And we started getting swelling in the brain that can be fairly rapidly fatal. And so most, most of the exercise related deaths like ultra marathoners, hikers, that we used to think were linked to dehydration, most of those deaths are actually linked to what's called hyponatremia, not enough salt. But the real problem is that you've drunk too much water and you've diluted your salt.

Margaret

Oh, god, so we're telling people exactly the wrong thing to do. Being like, all of those other hikers died, so you better drink more water?

Guy

Yeah, so you'd have to drink a lot. But when people get these benchmarks and they hear like, oh, I should drink, I should drink a liter of water an hour. I should drink two liters of water an hour. I should drink a Gatorade at every stop in this race. People are basing their hydration on some outside metric rather than their own body's sense of whether they need fluid or not. Then we tend to see hyponatremia which is much more deadly and much harder to treat than dehydration. So, like many other things that Western medicine has done, we have invented a problem where there used to be no problem because humans generally are good at knowing what their bodies need and taking care of them.

Margaret

Yeah. Okay. And like—like, I've never drank electrolytes on purpose in my life. Right? Like, I mean, I drink Emergen-C in the morning, but I think I do it for like vitamins, which might also be bullshit, but I don't know. Um, and people are always, like, talking about the importance of drinking electrolytes. And, I mean, this obviously sounds like it ties into it, like, do you avoid hype—hyponatremia—I was gonna just avoid pronouncing that actually. But I failed at that. Do you avoid that better if you are also drinking electrolytes and, like, eating salty snacks and things like that? Is there like—like, how important are like our electrolytes and all this?

Guy

Um, so the answer is twofold, like many things. So electrolytes are important. We should have salty snacks. And our body needs electrolytes to function well. That said, there's just no correlation between drinking electrolyte solutions and a lower onset of hyponatremia. There's plenty [inaudible] of extreme athletes, ultra marathoners in hot places who are drinking mostly electrolyte solutions. And the real risk factor is just the volume of fluid—the volume of fluid drunk. So if people like electrolyte drinks, they should drink them. I drink them sometimes. And it makes me feel better, I think.

Margaret

Yeah.

Guy

But not to prevent hyponatremia and we shouldn't think that we're fixing the problem of low electrolytes by drinking electrolyte drinks, because what we're actually doing is just adding too much more fluid to a system that's already over hydrated.

Margaret

Okay, so just trust your body and drink—is this like how, like, one of the main things you learn in like street medic stuff is that just water for everything? Like, you know, it's like chemical weapons and you fix it with water.

Guy

Yeah, water's great. It's amazing. So just water and not too much of it. If you're thirsy uou should drink a little more if it's really hot out. You should eat salty snacks.

Margaret

Yeah. Okay. So if you want to focus on electrolytes, focus on salty snacks instead of Gatorade.

Guy

I mean, you can drink Gatorade, if you like sugar which is what Gatorade is, and other electrolytes drinks are fine. It's not like they do harm—unless you drink too much of them and you think you're helping problem. Yeah.

Margaret

Okay. Now this is—I'm really glad to like be, like, mythbusting in or whatever and like getting past that, like, stuff you can quickly Google on the internet, you know? So I have a lot of other questions from people. This is—I think everyone's—I already said this, everyone's really worried. Um, what um—and actually, we've been talking about this a lot. We've definitely been talking about things primarily from the point of view of, like, not having access to, you know, air conditioning and things like that, right. Oh, actually, before we leave dehydration, what do you do about it? What do you do if—both where there is a doctor available and where there isn't a doctor available for both dehydration and the problem that shall not be named?

Guy

Right? Yeah, hyponatremia. Or we could just call it overhydration which is—

Margaret

You call it hyponatremia and I'll call it over hydration.

Guy

Right. That's perfect. Um, so dehydration, the problem is those not enough water and so the solution is they should drink some water.

Margaret

Okay, cool.

Guy

And the way that—and the tricky thing here, right, is that we see people, and it's hot out, and they've been exercising, and they say they've got a headache, and they feel kind of nauseous, and they don't feel good, and they're kind of grumpy. And we think, oh, you must be dehydrated, I'm going to give you water. It turns out that the symptoms of hyponatremia are pretty much exactly the same as the symptoms of dehydration with a few exceptions. And so we really actually should be talking to our friends, talking to the people we're interacting with, and asking them some basic questions. How much water have you been drinking?

Margaret

Mhmm.

Guy

Oh, you had two liters this hour, two liters the hour before, a liter before that, you've had six liters all day and you haven't been doing much. That's a lot of water. Probably shouldn't give you more water. So the treatment for hyponatremia in its mild form is just withhold water. A couple of the things that we could look for an ask about is someone who's over hydrated, who has hyponatremia, is likely going to have pretty clear urine, and they're going to be peeing a lot. They're going to say, yeah, I just have to pee all the time and I really got to drink water, it's really important to drink fluid and I'm peeing and all the time. That's a good indication to say, you should stop drinking water.

Margaret

Okay.

Guy

Until you're no longer peeing all the time. Dehydration, that person wants water. That's the problem is there's not enough and so they should drink some water. And, right, we might also inquire about the urine and then they could say, I haven't been peeing very much, it's been really dark yellow, it's been smelly. Those are good indications that someone is dehydrated. On the mild side of either of these, it just takes time to fix. If you're dehydrated, you should drink water and rest. And if you're over hydrated, you should rest and stop drinking water.

Margaret

Okay.

Guy

Once once it gets more severe, once we see mental status change, someone is no longer behaving like themselves, that just means that their brain is angry because it's not getting what it needs. Either it's not enough water in the case of dehydration, or there's swelling and pressure building up because of this hyponatremia. And in those cases, that person really needs to go to a hospital.

Margaret

Okay, what would the hospital be doing? And I know I'm not like trying to encourage everyone to do everything by themselves, but I feel like it's like useful to, like, break open the black box with like medical stuff.

Guy

Yeah, so dehydration—dehydration, they're gonna be rehydrating via IV. That's a thing that we can do in the back country or without access to a hospital. We don't have IVs, but we can rehydrate someone gradually just by drinking water and reducing exertion. And as long as they're not continuing to lose fluid either through sweat or through diarrhea or vomiting, then we can probably fix that problem. Hyponatremia is—there's unfortunately not much outside of a hospital setting once it's advanced to the stage that someone's mental status is changing, there's not much that we can do. And this is one of the reasons it's more fatal than dehydration and exercise context.

Margaret

We can't bloodlet them with leeches?

Guy

Yeah, we can't do that. What they end up doing it a hospital is giving someone a lot of saline intravenously to change the electrolyte balance of their blood, and we just can't do that quickly or effectively orally. So we can definitely give someone salt but we should know that if they're—if it seems like a severe case of hyponatremia or overhydration, that really what they need is a hospital intervention. And we should prioritize getting them to that hospital instead of trying to do it ourselves. Because there's just not much we can do unless we're, that's right, that's way above my paygrade is measuring someone's blood pH and blood chemistry and tinkering with it and injecting different solutions into them.

Margaret

And so this sounds like these are problems related to heat but the—but dehydration and overhydration are like more‚less directly the problems that we're like specifically worried about this coming weekend, because it sounds like it's like more athletes and things, like people who, like, are fucking with things in that way? Or is this, like, are a lot of the people who are potentially going to die because of a massive heatwave, is it mostly heatstroke or is it also dehydration and over hydration?

Guy

Yeah, so in—globally in heat waves the largest deaths are heatstroke related, or heat stress related, and largely in in populations over 60 years of age just because as we age, our bodies just become less adept at thermo regulating, and we're having a hard time adapting the stress.

Margaret

Okay.

Guy

Certainly people who are really worried about the heat and think that the solution is to drink a lot, a lot, a lot of water all day long are putting themselves in danger of hyponatremia. And certainly as someone who's working outside and sweating a lot and doesn't have access to water, or maybe they're houseless and don't have shelter and don't have a place to stay cool and don't have good access to clean water quickly could see dehydration set in and be exacerbated by the heat. The major killers, statistically, are heatstroke.

Margaret

Okay. What—what should someone who's listening to this who is experiencing homelessness or someone who cares about people who are do besides, like, I mean, I guess, like, pressure cities into having cooling areas, invite people if you have AC, like, inviting people in? You know, like, or are there, like, specific—yeah, what would you suggest?

Guy

Yeah, so there's like, there's a couple—I mean, those are both really important and great and we should do that. A couple of other things that that we can do, that anyone can do, to to adapt to heat better, right, maintaining good hydration, but not too much. Salty snacks, all of these things will help with our water balance. Staying in the shade as much as possible and then trying to have a water source, even if it's just spray bottle and like the ability to spray yourself down. Right, spray your face down, spray your clothes down with a little, like, $1 spray bottle you get from the dollar store and you fill up and you can just spritz yourself and evaporate and that will cool you down. Right, damp bandanas around the neck, on the head, even getting your clothes soaking wet in this more dry environment will work because all the evaporation of those clothes—that clothing is going to cool your body quite a bit. Another thing that we see in urban environments is usually with all of the pavement and the asphalt and the buildings and the lack of tree cover, we'll see temperatures that are 10 to 15 degrees higher in urban centers than they are in surrounding forests or green areas. And so thinking about, is it possible to get to a park, is it possible to get to a place with trees that has shade and the plants are through evapotranspiration are helping to cool the area a little more and they're absorbing less heat than these big blocks of concrete that just absorb solar energy and radiate it back out at you? Those will make a big difference. And then thinking about—thinking about kind of the mechanisms by which we gain heat and we lose heat. And so certainly radiation from the sun would heat us up really fast and we can partially mitigate that by wearing light colored clothes that covers all of your skin. So loose fitting long t-shirt, long pants, a big hat, you're actually going to be staying cooler in clothes like that then you will be in shorts and a t-shirt.

Margaret

Does humidity affect that? I have this like general conception that, like, dry heat places are all about cover yourself from the sun, giving yourself shade through clothes is important, whereas like more humid places, more tropical places, it seems like people tend to go with like just less clothes—maybe to like really make it as easy as possible to do the little bit of evaporative cooling they can do. Or am I like just totally off base about this?

Guy

No, no, I think that that seems accurate to me. I think that the more humid it becomes, the more difficult it is to stay cool and the less the problem is, like, direct solar radiation and more the problem is just that ambient air temperature. All of the moisture hanging out in that air that's holding onto heat and then transferring it to you. I've been lucky to spend—well, I grew up in Indiana which was very humid—but I've been lucky to spend most of my life in places with fairly dry heat, which I much prefer.

Margaret

Yeah, like, I'm just coming at this, like, entirely from this, you know, we refer to it as like, oh, it's just the Baltimore soup, you know, in August or whatever. Okay, um, yeah, a lot of people talked about a lot of different like water methods of cooling—besides, I mean, obviously the, like, get into an air conditioning building is, like, the most bulletproof means or whatever, right? But, um, like, people talk about, like, what, like sleeping on intentionally wet sheets, like spraying your—like wearing wet socks, or even damn clothes when you're trying to sleep. One person was talking about, like, wet the bottom of your curtains and leave the window open so that it, like, wicks up the water and then it evaporates. So just basically doing anything that you can to encourage evaporative cooling?

Guy

Yeah, exactly. Yeah, that's the kind of the biggest thing. Um, and right, it depends on if you're trying to cool yourself or your house, less energy to cool yourself. Oftentimes, here in the northwest, it's actually more effective to, as soon as the temperature starts climbing in the morning, close all the windows, trap all the cool air from the night in the house, and rely on your insulation rather than thinking that a cross breeze from outside 100 degree temperature is going to cool your house. But that only goes so far. And so there's also the swamp cooler method, which doesn't work in humid places for the same reason. But you can make kind of DIY swamp coolers by putting a wet sheet over a box fan and then blowing the air through that wet sheet.

Margaret

Okay. That kind of answers one of the questions that someone asked, which is like, you know, obviously whenever bad things happen, only one bad thing happens at a time. But let's say for some weird reason, a bunch of dry heat might cause fire. And, you know, obviously, the West Coast has been blanketed in smoke for the past several years. And, like, so if smoke it means you got to keep your window shut. You're saying then you just like basically focus on air movement within the house with fans and like personal cooling through dehydration?

Guy

Yeah, yeah, absolutely. Through evaporation. Yeah, like I would—so when there's, when it's not smoke season, which it thankfully is not yet, although I think it'll be coming earlier this year based on our temperatures. When it's not smoke season, I'll open all the windows at night once things cool off, because we do get a big temperature swing here, even in the summer it cools off at night, and close them in the morning and try to capture some of that cold air during the night. During smoke season, just keep it all closed. Stay inside and focus on that evaporative cooling if you need to. So get yourself wet, sit in front of a fan. If you don't have electricity, right, people have been keeping themselves cool with fans for 1000s of years before electricity. Big hand fans are really quite effective at moving a lot of air quickly without much exertion.

Margaret

Okay, so the trade off would be worth it of the exertion of physical motion for the like evaporative cooling?

Guy

Yeah, absolutely. Yeah, it doesn't take that much work to fan yourself or a fan a friend, as long as you're able to get yourself wet, right? If you're just fanning hot air across yourself, that's not going to do any good.

Margaret

Does that tie into the—one of the questions I got that I just, you know, it's like a piece of information that people have that I don't know one way or another, I've never heard of it before. Someone asked if fanning is bad and extreme heat, how do you pull yourself off? It's probably only saying it's like—you're suggesting it's probably only bad if the if you're not causing evaporative cooling, if you're not—if there's no water on you.

Guy

Exactly, yeah. And I looked that one up because I had actually never heard that before. And it actually is—I think it's a CDC—it's some government guideline. I think it's from the CDC. And it's just really, it's this example of policies and advice being written in a way that's totally robbed of context and is more confusing to people than not, which often is the case. If you're just moving hot air across someone, that definitely will be worse because air—there's some amount of convection, right. But we also create a little bubble around ourselves—and this happens all the time—a little bubble of temperature of air close to our skin that's close to our skin temperature. And so it will be slightly cooler than 108 degrees outside if we're effectively sweating and evaporating some, it'll be slightly warmer in cold temperatures. And if that air is not being disturbed, then it'll help us thermoregulate just a little bit. And if we're moving really hot air across that, then that'll heat us up faster in the same way that sticking your hand or your foot in an ice cold stream or moving water, you're gonna get a lot colder than sticking that foot in the same temperature water that's not moving. Build up a little insulated layer. But that only—but you just fix the problem by adding water and then it's not a problem anymore, because evaporation is much more powerful at cooling.

Margaret

Okay.

Guy

Yeah.

Margaret

So if people don't have much access to water, basically it's, like, get access to water. If you can't get access to air conditioning, you just need access to water. Is that kind of pretty much the deal?

Guy

Yeah. I think that's the the big thing. And so it's, certainly we should have water to drink, maintain good hydration, but having water that you can use to cool yourself down—whether that's a stream or a river or a lake, or whether that's just carrying some extra water with you, know that you don't need it to drink so you can use it to wet your clothes down.

Margaret

And would Gatorade be more effective for this? Like it has electrolytes in it. And I know electrolytes are good when it's hot out.

Guy

Um, for cooling yourself down?

Margaret

Yeah.

Guy

No, no.

Margaret

Oh interesting.

Guy

The only good thing Gatorade is for is, yeah, lots of sugar.

Margaret

You're gonna fuck up my chance for a sponsorship.

Guy

Yeah Gatorade actually got us into this whole bind with hyponatremia because they sponsored sports medicine conferences from the 90s to the early 2000s and all the studies came out saying how important hydration was and we realized that people are dying all over the place because they're drinking too much Gatorade.

Margaret

Oh my god, it's literally the plot of Idiocracy. Great, cool. That makes me feel really good about the world. Fuck. Okay. Oh, do you know much about, like, dealing with pets? Like, I guess, like what, like most animals don't sweat? Are we the only animals that sweat? Like, what's the deal with keeping pets cool?

Guy

Yeah, I don't know as much about pets. Dogs sweat, but only through their feet. They do sweat some but they just don't—right, yhey're mostly covered in hair so they're not going to as effectively be able to cool themselves down. Cats are the same. I don't know about other animals. But, right, you're not gonna sweat if you're covered in hair because it won't be effective at all.

Margaret

Okay.

Guy

And so for pets, it's really, I mean a lot of it is the same. Stay inside, stay in cool, shady areas, right? Get some damp clothes or damp bandana or something on them. We could, like, wet down a sheet or a bed, like a dog bed, ust get it damp and put that on the floor for them to sleep on. I've heard of people putting a couple ice cubes in water bowls. I don't know whether that is actually effective at cooling your dog down, but they probably like it. And then avoiding exertion the same way. Yeah.

Margaret

Okay. Well and okay with the cold water and maybe it doesn't help but it it tastes better to them or something, like, people have questions. I have questions. I don't know enough about this. Like it seems like, would be drinking like ice cold water kind of shock your system? Like if you're—even if, like, someone has heat exhaustion or god forbid heatstroke and you don't have access to a hospital or whatever. Is it, like, is there an ideal temperature? Do you only want it a little bit colder than their body? Or is it like, we would put them on a fucking glacier if you could?

Guy

Yeah, absolutely. The big problem with heatstroke is someone's brain is cooking. And so we want to stop the cooking as quickly as possible. And we do that by putting them in cold water. And there's just not much evidence that putting someone in cold water from an overheated position does any kind of damage to them. We're not going to make someone hypothermic with 30 minutes in cold water when they've been overheated. We're not gonna—we're—yeah, they might gasp a little bit. When we get that cold water on our skin we have an involuntary gasp reflex and then we adjust to the water temperature, but it's not going to do any damage. And same with drinking ice water. The temperature of the water doesn't make a huge difference in changing the temperature of our bodies. But it's not like drinking ice water will cool us faster than drinking warm water. But I know that I'm more likely to drink water when it's hot out if the water is cold and refreshing, and so—

Margaret

Right.

Guy

So the way to stay adequately hydrated, ice water is great. You can stick around your forehead and call yourself down.

Margaret

Yeah, okay, so—like sticky—so like getting the ice water on you is probably more important than getting ice water in you in terms of—

Guy

Yeah, if you only have enough. Yeah, but I mean, I just, you know, you get that big glass of ice water and it's condensing on the outside and outside is super cold. Yeah. You could hold on to it and stick that jar on your forehead until you—til you've drink it.

Margaret

Okay. So I'm not gonna get the story about dehydration out of you?

Guy

Uh, well, I'm trying to think of what our friend would be talking about. The story that I do have is—and this is just more of a general warning story about tunnel vision and people who are convinced that they're right about something, and they don't look at all the facts. But I was, several years ago, I was guiding in the Grand Canyon and I ran into a couple of people who were in fairly substantial distress. And they were a day behind their schedule, they'd gone about four miles, maybe five miles in about 24 hours. And they were convinced that—there was only one person who is really having trouble. And he was nauseous, he didn't feel good, little unsteady on his feet, really classic, pale, kind of pale, clammy skin, really classic heat exhaustion symptoms. And his friend who claimed to be a guide with him was convinced that he had altitude illness because he was nauseous and had a headache and because the rim of the Grand Canyon is 7000 feet, which is not actually very high as far as altitude illness goes. But they were convinced that they had altitude illness and so they were descending into the canyon where it got hotter. And the only solution, they thought, was to keep going down because if they dropped an elevation, then they'd fix the altitude illness problem.

Margaret

Okay.

Guy

And so I tried to talk to them and convince them that it wasn't altitude illness and that, in fact, it was extremely hot and they weren't a climatized to the heat, because it was springtime and they had just come from the Midwest where it was 40 degrees outside and now it was 100 degrees in the canyon. And they wouldn't listen to me. And I ended up running into a couple paramedics on the trail who were hiking behind me and caught up and overtook me. And they had also encountered this person after I did, stopped them, did a full assessment, knew it was heat exhaustion, tried to convince the people to stop and rest and turn around. But they weren't having any of it. They were convinced that it was altitude illness. I ran into a ranger later on who also tried to convince them to turn around. And I don't know what happened to them. He clearly didn't die because I would have heard about a death in the canyon, but certainly didn't have a good time. And I think the big takeaway there is we, as humans, I think as soon as we think we've identified what a problem is, then we start trying to solve it. And then we ignore all of the other evidence that suggests that could be a different problem. And so I think anytime that you're feeling bad, or your friend is feeling bad, or they're feeling sick, and you think you know what's going on, it's worth stopping and asking yourselves, especially if they're not getting any better.

Margaret

Mm hmm.

Guy

Is it actually this thing? Is it actually dehydration? Maybe it's hyponatremia and I should stop giving this person a water.

Margaret

Yeah.

Guy

Is it actually altitude illness, or maybe it's really hot out and you feel crappy and you should be in the shade and lie down and rest and fan you until you feel better instead of trying to rush down to drop in elevation and, yeah.

Margaret

If you had a whole group of people, we have five people, and they're all exposed to the exact same—you know, you're all hiking together, roughly the same amount of exertion, etc. Is everyone gonna get heatstroke at the same time? Or is it like fairly personal about that?

Guy

There's a pretty wide range in human tolerance for heat and exertion. So yeah, it can be all over the place. I would say that, right, the hotter it gets, the higher the probability of heat exhaustion or heat stroke is. But it's, but human bodies are really amazing and they're really adaptable, right? We think of 105 degree internal temperature, like you stick a thermometer in someone's mouth, when it read the 105 we say, medicine says that heat stroke. Their brain's dying. But there are also some ultra marathon athletes who run in really hot weather who have recorded internal temps of 105. And they're totally fine.

Margaret

God, okay.

Guy

And that's probably because they've acclimated to that over a long time and they've actually been able to change their physiology and what their bodies used to. So people, people have really different responses. And so we should be looking at, how are people doing? And asking our friends and looking for these little telltale signs. Oh, yeah, this person's a little grumpier than usual and they're kind of ornery, and they look a little pale, and they're kind of slower to respond. We should check in, how are you doing? How are you feeling? Rather than thinking that the objective conditions are what's going to dictate when, yeah. Yeah.

Margaret

Okay. Yeah, that kind of answers—or it starts to answer one of the questions that a couple people asked which is, like, basically, what do you do if you're someone who just hates heat? Right? Like I definitely have friends who like—they—you know, I'm always—I don't hate heat the same way I hate being cold, you know? You think that's, like, just like a lifetime acclamation and, like, basically, the answer is slowly acclimatize rather than suddenly have a—what's it called, like a heat hell, a heat bulb? I dunno, it's some horrible name for what's happening to you all? Don't have the bad thing happen.

Guy

Is it "heat dome"? They keep inventing new names for weather phenomena that have actually been around forever. You know, not that this particular heat wave has been around forever. It's certainly new. But I just think about the, like, Arctic bomb polar vortex. Now that we're finally all paying attention to the weather.

Margaret

Yeah.

Guy

With all these new terms about it instead of, I don't know, stopping emitting carbon and planting a lot of trees.

Margaret

That'd be a lot of work.

Guy

Yeah, it'd be a lot of work. It's a lot easier to name all the problems and make some add revenue off of driving clicks to your website. But I digress. Yeah, some people don't like heat. I think that as a person who doesn't like heat and who also guided in the desert for many years, I think the acclimatising makes a big difference. And slowly, right, go to a new environment—if you're not being confronted by one of these heat waves—you go to a different environment, and you don't do your normal level of exertion. You just rest and you hang out and you expose yourself to the temperature, and then you go and you cool off. And then you do it again. And then you do it again. And you'll become more used to that, and especially if you're using other techniques to keep yourself cool. It's interesting—I think that I get grumpier with heat here in the Pacific Northwest than I ever did when I was guiding in the desert. And I think it was—I think a lot of it was acclimatising. And having an orientation of, I know I'm in a hot place here and so I need to change my behavior and I need to change how I'm managing my body so that I can stay cool. Whereas it gets hot right here and I think, I should just be able to do all the things I can normally do. And now I feel terrible. And I'm mad at everyone just because I'm too hot.

Margaret

Yeah. So it's like—maybe part of the whole answer is like actually change your pattern of behavior. Which actually ties into both the "we're all gonna die because of global warming if we don't do anything," and then also the, like, what you talked about, about the person who was, you know, walking further and further down because they were like, no, no, no, no, it's climate sickness, you know, or whatever—or not climate—altitude sickness. And then like, I know that when I do cognitive behavioral therapy, like, the thing that we have to throw away first is I tell—I tell the therapist, what's wrong and then therapist, it's, like, able to specifically say, "Now I know what isn't wrong." Like, that's your narrative. That's the thing that you, like, have been telling yourself.

Guy

Yeah.

Margaret

And clearly telling yourself this didn't work, so... And, yeah, which we need to do as a society, we need to actually change our patterns in the same way that y'all in the Pacific Northwest should avoid exertion and, as you suggested at the very beginning, work with your coworkers to collectively avoid exertion, you know?

Guy

Yeah. Yeah.

Margaret

Just easier said than done from someone who's a remote worker on the East Coast but... Okay. Oh, sorry—there's one more—people talk—there's like one question left: food, drug, medications to avoid, are caffeine and alcohol like absolutely terrible anathema if you take, like, different, you know, different medications? Is this going to impact the degree to which you're sensitive, and are the things that people can do about that?

Guy

Yeah, um, there's certainly some risk factors. In general, caffeine and alcohol both just don't help the body adapt to any kind of changing environment. And so cold, hot, altitude, all of these things, caffeine and alcohol aren't going to make us feel better. Whether that's a huge risk factor, I'm not convinced. I'm still gonna drink my coffee in the morning, but I'll probably make a cold brew. And, but I'm not going to drink coffee all day, and I'm not going to sit in the sun drinking beer all day. Some other medications—some allergy medications and decongestants have some linkage to just reducing the body's ability to thermoregulate and to cool down. Now, I'm definitely not a doctor. And so if people are taking medication they should look at that medication specifically and look it up and just Google that medication and heat exhaustion or heatstroke and see what—see if there's a contraindication or an extra risk factor there. We'll probably get better information from that than from broad and general statements from the—

Margaret

Wait I thought this podcast is—this past guest is your doc—not just your doctor, but everyone is listening.

Guy

Yes.

Margaret

We are both doctors. I thought that was the basis of... okay. Okay, um, makes sense. Do you have any, like, final thoughts? Like things about, like, you know, how are you feeling about this whole thing? Or, you know, things that we missed talking about all of this?

Guy

Yeah, no, I really enjoyed this conversation. I think we hit, like, we had a lot of topics. I can kind of nerd out about physiology and bodies and illnesses for a while. So it's been fun to do this with heat. I'm going to make a weird plug, which is, I really believe in umbrellas in the summer for sun protextion. So like, silver, reflective, or light-colored umbrellas, just thinking of other prevention techniques. So you can kind of carry your portable shade with you, and thinking particularly about houseless people people who can't access cool areas. Get a cheap, bright colored umbrella, and you've got your own shade, and it'll help. So I just wanted to throw that one in there. I hiked with an umbrella in the Grand Canyon all the time.

Margaret

And so goth. I'm really excited about that. Well you said bright colored. But you know...

Guy

Mine was silver. It was nice and reflective. But really anything that will reflect rather than absorb heat.

Margaret

Could you tape an emergency blanket to on or something?

Guy

Yeah, sure. Absolutely. Yeah. And then—and then beyond that, I just think that it's going to be hot here this week. People up here are, I think, probably simultaneously freaking out more than they need to and not enough. By which I mean, a couple of days of extreme heat are going to be challenging for people and we should take care of each other and look out for marginalized and vulnerable people. But we're probably not going to see a lot of deaths, huge, huge problems with a short heatwave like this. However, we should be freaking out about the fact that it's 108 degrees in the Pacific Northwest in June. And this is really, like, where we are headed as a planet. And so we need to be thinking and adapting right now and thinking about how can we—first of all, right, stop emitting carbon and lock as much carbon as possible in the ground. And second of all, how can we change our environments and our behaviors to live in a hotter world? And working 40 hours a week in an urban concrete metropolis is not going to be tenable a couple decades from now when—right, think about the—think about Texas, right? And last summer they got that big cold wave and then they last electricity and we had all these deaths because people could no longer to heat their homes. And we're gonna see the same thing with heat waves as well, where we have brownouts and blackouts, because there's too much electrical demand with the air conditioners running. And so we need to be thinking about, how can we keep ourselves cool without relying on air conditioning? How can we change our behaviors and our patterns to do that? And how can we plant a shit ton of trees?

Margaret

Yeah.

Guy

Because really, not only because they fix carbon, but because trees cool the environment down, the local environment. They, right, evaporation is a major cooling effect. And trees of evapotranspire huge amounts of moisture when they're photosynthesizing. And all that moisture cools an area down. And so how can we convert these giant, awful concrete metropolises into beautiful forest gardens where we can survive and have food to eat. And also so that we can cool the areas where people are concentrated down. We, right, we see this with just disparities in heat related deaths across the country, where people who are lower income or marginalized or of color live in areas that are more paved and have less access to green space, and they get hotter. And they're more exposed to environmental extremes. So yeah. We should—we should take care of each other in the coming week and stay cool. And we should plant a lot of trees and stop trying to pretend we can continue living as normal when it's not normal anymore.

Margaret

I like that because it covers—you know, most this podcast is about what most of this episode has been about, like what to do in the very immediate short term, right, to solve this problem, or make it through this problem. But the solutions like absolutely have to be long term and ongoing. And I like that you tied that into that. Um, do you have—do you have anything that you want to, like, shout out, like anything you want to plug, any—I don't know whether your medic trainings are public or if people want to, like, follow you do you do social media stuff? Anything?

Guy

No, not really. I'm pretty pretty nonexistent on the internet. Don't really have any social media. But yeah, we do street medic trainings on and off in the Pacific Northwest, we haven't done one in a while. Hopefully will again. I will plug, actually, because I'm in the process of moving up all the way to the peninsula. And there's an amazing new community project forming in Quilcene. People bought an old theater there a couple of years ago, the Gray Coast Guild Hall. They're just starting some big fundraising campaigns right now to replace the roof and do a bunch of infrastructure upgrades so that it can be a community gathering space and a resource, and hopefully a place that people who are all thinking about how do we how do we actually live together throughout this climate changing world in the long term can encounter each other. And so, Great Coast Guild Hall could definitely use some dollars if you Google that or look it up they have a Patreon. I don't know if they've launched their big Kickstarter fundraiser yet. But yeah.

Margaret

Yeah, and one of the reasons I'm excited about that project is because it's, you know, it's a, it's a social center—will be a social center—and it's like collectively operated, and it's within a pretty small town. And so it's a pretty major percent of that town's, like, social and cultural, like, life or something like that in a kind of really interesting way. Yeah, so it's, I agree, it's absolutely worth supporting. Normally I do this whole, like, separate outro but and so I'm gonna make you stay on the call as I do my outro. So that way, all of my files are in one place so I can edit this as quickly as possible. But thanks, everyone, for listening. And if you want to support this podcast, you can do so by supporting currently me on patreon at patreon.com/margaretkilljoy. But in the very near future that same Patreon will switch over. You won't have to do anything on your end to support a larger collective effort that's going to be doing more podcasts and more zine publishing, called Strangers in a Tangled Wilderness. And I'm very excited about moving to a more collective structure. It makes—just, you know, many hands make light work as long as many hands don't make everyone grouchy and get in each other's way. And in particular—and also you can tell people about the podcast and that's the main way—and you can, you can thank us by telling people about it. But in particular I want to thank Sean and Hugh and Dana and Chelsea, Eleanor, Mike, Starro, Kat J, The Compoun, Shane, Christopher, Sam, Natalie, Willow, Kirk, Hoss the dog, Nora, and Chris for making this possible. And, yeah, thanks so much. And I hope everyone is doing as well as they can with everything that happens and stays safe. And it seems like maybe one of the main messages about this is that, well yeah, I guess Guy already said it: you don't have to freak out as bad about this one specific thing, but we need to freak out more about the larger things.

SPEAKERS

Margaret

Guy

Margaret

Hello, and welcome to live like the world is dying your podcast for what feels like the End Times. I'm your host, Margaret killjoy, and I use she or they pronouns. Normally I do this like whole intro thing that I record after the conversation. But this is a special, a special episode that I'm just doing as quickly as quick turnaround as I can because of what's going on in the Pacific Northwest with unprecedented heat. And I want people to have information as soon as possible. So please forgive audio quality. on my end, I'm recording this from the best place I had access to internet, which is right next to one of the busiest intersections in all of the tiny town of Asheville, North Carolina. But anyway, this podcast is a proud member of the channel zero network of anarchist podcasts. And normally I put in a jingle here, but I'm not going to instead, you should just go to channel zero network. I don't even know the website, you just Google it. I mean, come on, who's actually going to type in URL and you can just type things into the search bar. Go check out the channel zero network, there's a ton of shows that might interest you. Okay, so would you like to introduce yourself with your name and your pronouns? And then a bit of your background as relates to heat related illnesses?

Guy

Yeah, thank you. Thanks for having me on. My name is Guy, I use he him pronouns. I live up in the Pacific Northwest on the Olympic Peninsula. And my background related to this, I have been a wilderness educator and backpacking guide for many years, especially working down in the Grand Canyon for several years. So a lot of exposure to heat there. And I also instruct wilderness medicine courses. And so I teach and think about bodies and how bodies adapt to stress, particularly heat stress in this context. Yeah,

Margaret

that's me. Hurray. I'm so glad that your skill set is about to become very useful away from the Grand Canyon in the Olympic Peninsula. The rain forest that I believe is not is it? Is it normal for you all to have 109 degree weather? Is that abnormal?

Guy

That is definitely abnormal. Yeah. We sometimes will will cross 100 or triple digits over 100 for one or two days in the summer, usually in late July or August. I cannot remember a time when we hit 108 degrees, and certainly not in late June. It is pretty hot.

Margaret

Yeah, I've I'm I'm from the Mid Atlantic. And now I live in the south on the east coast. And I've The only time I've been in. I mean, I've been in triple digits. I don't think it ever got hotter than 103 104 the whole time I was growing up. And only time I've been in 110 degree weather was in Death Valley. So I'm worried about you all. So that's why I'm I don't Yeah, we're going to talk at a later point with someone that you co teach with about more wilderness first aid. But it seems like wilderness first aid is suddenly might become urban first aid in a way that we're not. I'm not really used to and maybe you're not really used to. I guess to start with, do you want to talk about? Like, what are the dangers of heat?

Guy

Yeah, so I'll preface this by saying a couple of things. The first is the human The human body is actually really adaptable and resilient if it has time to adapt to a changing environment. So people can handle really extreme heat, if they have time, to climatized to it. But if we get these big spikes of heat coming in a place where people aren't used to it, we're jumping from the mid 80s, one week to 108 another week, then that becomes a lot more stressful on body. And then add on to that right up here in the Pacific Northwest as a culture as a society we're not adapted to experience. Most people's houses aren't particularly well insulated, because in general, it's a fairly temperate climate. So there's just not the either the time to adapt on a physiological level or to adapt our environment to really manage and handle this heat. So that said, a few different things happen when we we get too hot, so our body, right we we sweat, we produce sweat and that's the primary way that we cool ourselves off and evaporation is is actually a very effective cooling mechanism. If we have an up sweat, and particularly if there's a breeze that is able to allow that evaporation to to continue to cools off, as our body gets too hot, and we start to lose our ability to thermo regulate, we end up seeing a lot of different side effects. And so we used to think of this really clear progression from what we call heat exhaustion, heat stroke. And now it seems more like there's just a lot of different clusters of symptoms that appear when people get too hot. So things like nausea, vomiting, feeling really tired, feeling a little bit disoriented, feeling irritable, some muscle cramps, particularly related to exercise, sweating, and excessive sweating, but then also maybe some more like chills or pale, pale skin, clammy feeling, as our body just doesn't tolerate the heat extremes very well. And all the symptoms, all those symptoms are unpleasant, but fine. And the real danger is when our internal temperature starts to cross 104 or 105 degrees Fahrenheit. And at that point, our brain actually starts cooking. And so we see our mental process change, we don't think as clearly our personality changes, and we're actually doing long term damage to our brains, and they won't survive that for very long.

Margaret

When you say very long, like what are you talking about there, like five minutes an hour,

Guy

oh, no, definitely in the in the hours realm. But the longer that persists, the more damage the more permanent damage can be done to our to our brain and to our bodies. Depends on the heat extreme. But so and then once we lose that, once we start losing that ability to thermo regulate altogether, instead of maintaining a temperature that's elevated, but not too high, we just kind of start to run away, and we can't cool off at all. And then and then we need help from from other people, we need a change of environment, we need to be cooled down really, really quickly.

Margaret

One of the I asked, asked social media right before this interview, like corner what what advice people had and also what questions people had. And the thing that you just talked about, about how we used to see it as heat exhaustion versus heatstroke is very different. That is one of the things that most people were bringing up is like, make sure you know the difference between heat exhaustion and heat stroke with the idea, I guess the prevailing knowledge and what I had known prior to five minutes ago, when you said otherwise, would be that heat exhaustion is the like, Oh, this fucking sucks. And I should probably get somewhere cold real quick. And maybe someone can help me get somewhere. Not real cold, but like colder real quick. Versus heat stroke is like, you know, call paramedic, like get taken to the emergency room or whatever, because you're about to die or something. Right. And you're saying that the line between these two is, is not only not a clear line, but it's not even necessarily a specific progression as much as like, you are just different clusters. Can you tell me more about that?

Guy

Yeah. So heat stroke, heat stroke is really clear. And maybe that I misspoke. A little bit there.

Margaret

I might have misheard you. Yeah, yeah,

Guy

so so heat stroke is very clear. That's when our internal temperatures reached 104 105 are the proteins that our brains start denaturing we start doing we start getting cell death in our brains, and permanent damage. And the easiest way to recognize that in someone is a change in their personality, or change in their thought process and see someone who was previously grumpy and maybe a little irritable, or maybe a little hot, or maybe they were just fine. Now they're saying or doing things that don't make any sense. And that's because their brain is not functioning properly anymore. So heatstroke is a is pretty clearly delineated. The distinction is that there's not necessarily a progression from one to the next you don't necessarily get this long warning sign of heat exhaustion and you're feeling bad and then you feel worse, and then you feel worse, and then it's heatstroke. That happens in some people. But another people it can just go directly to heatstroke without this preliminary experience of feeling a little bit crappy and under the weather and nauseous and faint.

Margaret

Guy

Yeah, so, so in both cases, the problem is that someone is too hot and so the solution is to cool them down. So heat exhaustion This cluster of nausea, muscle cramps, I just don't feel good fatigue, maybe some vomiting, that person wants to be cooled down. So we should get into the shade, we should try to move to a cooler environment change clothes. But we're not necessarily we have time to do that heat stroke, as soon as we see that change in personality, or mentation, we want to cool that person down as quickly as possible. And so the fastest way generally to cool someone down is through some amount of Coldwater immersion. So, throw them into like, throw them in a leg, but probably not throw them because if they have this altered mental status, they can't think as well, we're worried about their ability to write but get them in, get them in running water, get as much of their body in the water as we can while protecting their airway, to cool them down quickly. And if we don't have a big body of water, we can put them in, it's nice and cool, the next best thing is get them as wet as we can, and then fan them because that sort of cooling consumes a huge amount of energy, which then cools the body fairly quickly. So if you think about you get your hands wet, they don't feel that cold, and then you get a breeze moving across your cold hands or your clothes are wet, you get cold really fast, because evaporation takes more energy, then I'm simply being immersed in water.

Margaret

Okay, how does, um, how does being in a human environment, impact evaporative cooling and dealing with this sort of crisis?

Guy

Yeah, humidity is a real challenge here. And that's the thing that we're fortunate about here in the Pacific Northwest, where summers are usually pretty dry. Okay. But the the more humid the air gets, the less effective evaporative cooling will be. And that means both that just getting someone wet and fanning them won't work as well. But it also means that our body's natural mechanism for cooling, which is sweat also doesn't work as well. And so there's this concept of the wet bulb temperature, which is rather than looking at what is the temperature on the thermometer to put a thermometer inside a bulb and you cover it with a damp cloth. Now they have mean fancier tools to do this now, but the principle is the same. covering a soaking wet cloth. And then they measure what is the temperature that that thermometer reads.

Margaret

When you have a bowl or a bulb. So yep, wet bulb temperature bulb, oh, you get the Oh, you put it inside a light bulb is that it?

Guy

any any bulb any any any spiracle object, right? It's covered in a damp cloth. Okay? If the humidity is lower than 100%, the temperature that that thermometer reads is going to be lower than lower than the air temperature, right, because there's some amount of evaporation which is cooling the air inside.

Margaret

Interesting,

Guy

okay. And so this is a way for us to understand what the actual threat of a any particular temperature is. Because once we get to 100% humidity, the temperature inside that bulb is going to be exactly the same as it is outside because there's no longer any evaporation occurring and no longer any cooling. And the challenge there. And so this is this is how wet bulb temperatures are measured. You can look up tables that will tell you relative humidity and temperature and you can find the wet bulb temperature at that intersection. And once we hit about 90 degrees at 100% humidity, or a 90 degree wet bulb temperature, which we could get with either higher higher temperature and lower humidity or lower temperature and higher humidity. Once that wet bulb temperature hits about 90 degrees, humans can no longer effectively function in any kind of meaningful physical exertion outside. Okay, and even completely at rest. Without any exertion. People will start to die within hours once you hit about 95 degrees. wet bulb temperature,

Margaret

which is what it would be at like 100% humidity if it was 95 degrees out. Exactly. Yeah. As someone who the inside of my house is regularly 90 to 95% humidity during the summer. I know I'm not supposed to be worried about myself today. Still mostly worried about y'all. But it actually is changing a little bit my my sense of the heat that y'all are facing. Yeah. What I mean okay, so if it's like, like, do you have a sense of like when they're like it's gonna be 109 degrees 111 degrees 116 degrees in business. cific Northwest this weekend, you know, or maybe you're listening to this three weeks later, I don't know, whatever. But do you have a sense of like, what kind of wet bulb temperature that is likely to be for people?

Guy

Yeah, so so our humidity usually here in the summer ranges between like 20 and 40%, particularly high. And so I ran a couple of numbers before this show, and who was looking like, this Sunday, when we're supposed to hit about 108 degrees during the peak of the day, that'll probably equate to something around a 75 or 80 degree wet bulb temperature, which doesn't sound that hot, but actually is is pretty darn hot and really hard for the body to tolerate.

Margaret

And so what that means is not everyone is fine, it means that the means by which we can fight this with like, cold water immersion, and fanning and things like that actually have a chance of working is what you're saying.

Guy

Exactly in in places with low humidity, water, and evaporation works really well to pull you down. The problem with this, and this is what a lot of climate scientists have been warning about for a long time is that the tropical parts of the world, as we start to get increases in temperature, which are already close to 100% humidity, during that season, we'll get so hot that there's no effective way to cool down. And then we'll see a lot a lot a lot of heat related deaths, because these parts of the world also don't have air conditioning. cooling is completely ineffective. And so in some ways we're lucky up here so far, because our summers are dry.

Margaret

Yeah, and there's, I mean, a lot of people listening don't have access to air conditioning. But I, but there's there might be like, you know, I know that some cities are setting up cooling centers and things like that. So there is some access to air conditioning in the northwest, okay. So when you talk about like not exerting yourself and things like that, like you're basically saying, like, basically, because when you exert yourself, your body heats up, and that's bad. So it's like, one of the main things people should do is like, chill the fuck out and like, not exert themselves as much as possible.

Guy

Yeah, exactly. That's one of the best things that we can do is write we stay out of the sun, as much as possible, try to stay as cool as possible. And just don't do. Don't exert yourself, don't do physical labor. Don't go for runs, try to get out of your job if your job involves heavy, heavy physical labor during these hot temperatures or organized with your other workers, because it's literally putting putting your life at risk. Yeah. To be working in these conditions.

Margaret

Yeah, okay. And then. So if this kind of not fully covers, but but gets at the idea behind like heat exhaustion, heat stroke. The other the other thing that at least is on my radar to worry about as relates to intense heat is dehydration. And that's kind of a separate threat. Right? Yeah. Can you talk about dehydration, also, our mutual friends as you have a good story about dehydration? Yeah,

Guy

I have a lot of rants that I could go on about dehydration. And it's it's more evil twin overhydration, also known as hyponatremia. So, so, hydration is important, our bodies function better when we're well hydrated. But luckily, our bodies also have this amazing built in mechanism to help us maintain adequate hydration, which is our sense of thirst. And generally, people should drink when they're thirsty, and they should drink a little bit more if they're exercising or if they're in hot weather. And if you're well hydrated, then you will, you will tolerate heat better and you will be more able to adapt. That said, hydration doesn't prevent heat exhaustion and hydrating doesn't fix heat exhaustion or heatstroke either. The problem is, once you've hit that point, the problem was just that you're too hot and you need to cool down. So it's a separate problem. Exactly. They go hand in hand and do tend to sweat more or lose more fluids in hot weather and need to replace them. The place where people get into trouble. We have this cultural myth of dehydration as the big killer. And like you've probably heard people say hydrate or die and there's all these stories about people who athletes who didn't drink enough water and they died. And that's actually not really the case. Most people stay hydrated enough, most of the time, they are getting dehydrated and they have access to water and then don't have vomiting or diarrhea that's sucking water out of them, they can maintain adequate hydration pretty decently the problem, the area that we actually see a lot more deaths, and a lot more severe illness is the opposite. This this problem over hydration. And so for the last couple decades until well, like through the 90s and early 2000s, there was a lot of rhetoric in sports medicine, about the importance of hydration, and you have to hydrate And drink, drink, drink, and you have to drink Gatorade, and you have to drink electrolytes. Because if you don't, then you're gonna die of dehydration. And actually, what we were doing was people were drinking too much water. And that changes the electrolyte balance in our bodies, and it ends up making our cells swell up. And we started getting swelling in the brain that really rapidly fatal and so most, most of the exercise related deaths like ultra marathoners hikers that we used to think were linked to dehydration. Most of those deaths are actually linked to called hyponatremia. Not enough salt. But the real problem is that you've drunk too much water and you've diluted your salt.

Margaret

Oh, God, so we're telling people exactly the wrong thing to do. I mean, like all of those other hikers died, so you better drink more water?

Guy

Yeah, so you're allowed to drink a lot. But when people get these benchmarks, and they hear like, Oh, I should drink, I should drink a liter of water an hour rest drink two liters of water an hour, I should drink a Gatorade at every stop in this race. People are basing their hydration on some outside metric rather than their own body's sense of whether they need fluid or not. Then Then we we tend to see hyponatremia which is much more deadly and much harder to treat than dehydration. So like many other things that Western medicine has done, we have invented a problem where there used to be no, because humans generally are good at knowing what their bodies need and taking care of them.

Margaret

Yeah. Okay. And like, like, I've never drank electrolytes on purpose in my life. Right? Like, I mean, I drink emergency in the morning, but I think I do it for like vitamins, which might also be bullshit, but I don't know. Um, and people are always like, talking about the importance of drinking electrolytes. And, I mean, this obviously sounds like it ties into it, like, do you avoid hype? hype bone night? ceria I was gonna just avoid pronouncing that actually. But I failed at that. Do you avoid that better? If you are also drinking electrolytes and like eating salty snacks and things like that? Is there like? Like, how, how important are like our electrolytes and all this?

Guy

Um, so the the answer is twofold. Like many things, so electrolytes are important. We should have salty snacks. And our body needs electrolytes to function. Well. That said, there's just no correlation between drinking electrolyte solutions, and a lower onset of hyponatremia. There's plenty of extreme athletes, ultra marathoners and hot places who are drinking mostly electrolyte solutions. And the real the real risk factor is just the volume of fluid and formed the volume of fluid drunk. So if people like electrolyte drinks, they should drink them. I drink them sometimes. And it makes me feel better, I think. Yeah, but to prevent hyponatremia and we shouldn't think that we're fixing the problem of low electrolytes by drinking electrolyte drinks, because what we're actually doing is just adding too much more fluid to a system that's already over hydrated. Okay,

Margaret

so just trust your body and drink is this like how like, one of the main things you learn like street medic stuff? Is that just water for everything? Like, you know, it's like chemical weapons and you fix it with

water. Now all these great, it's amazing or whatever. So just water and and not too much of it. You should drink a little more, if it's really hot out. salty snacks.

Margaret

Yeah. Okay. So if you want to focus on electrolytes, focus on salty snacks instead of Gatorade.

Guy

I mean, you can drink Gatorade, if you like. Sugar and other electrolytes drinks are fine. It's not like they do harm. And if you drink too much of them and you think you're a problem. Yeah. Okay.

Margaret

Now this is I'm really glad to like be like myth. bussed in or whatever. And like getting past that, like stuff, you can quickly Google on the internet, you know? So I have a lot of other questions from people. This is I think everyone's I already said this, everyone's really worried. Um, what um, and actually, we've been talking about this a lot. We've definitely been talking about things primarily from the point of view of like, not having access to, you know, air conditioning and things like that, right. Oh, actually, before we leave dehydration, what do you do about it? What do you do if both where there is a doctor available and where there isn't a doctor available for both dehydration and the problem that shall not be named? Right? Yeah. hyponatremia overhydration, which is, you call it hyponatremia? And I'll call it over hydration?

Guy

Right? Go? That's perfect. Um, so dehydration, the problem is those not enough water. And so the solution is they should drink some water. Okay, cool. And the way that and the tricky thing here, right, is that we see people and it's hot out, and they've been exercising, and they say they've got a headache. And they feel kind of nauseous, and they don't feel good. And they're kind of grumpy. And we think, oh, you must be dehydrated, I'm going to give you water. It turns out that the symptoms of hyponatremia are pretty much exactly the same as the symptoms of dehydration with a few options. And so we really actually should be talking to our friends talking to the people we're interacting with and asking them some basic questions. How much water Have you been drinking? Hmm, oh, you had two liters this hour, two liters the hour before liter before that you've had six liters all day and you haven't been doing much. That's a lot of water. Probably shouldn't give you more water. So the very the treatment for hyponatremia. And its mild form is just with hold water. A couple of the things that that we could look for an ask about is someone who's over hydrated was hyponatremia is likely going to have pretty clear urine, and they're going to be peeing a lot. They're going to say, Yeah, I just have to pee all the time. And I really got to drink water, it's really important to drink fluid time pee and all the time. That's a good indication to say you should stop drinking water. Okay, until you're no longer peeing all the time. Dehydration, that person wants water. That's the problem is there's not enough and so they should drink some water. And right, we might also inquire about the year and then they could say I haven't been paying very much it's been really dark yellow, it's been smelly. Those are good indications that someone is dehydrated. On the mild side of, of either of these. It just takes time to fix. If you're if you're dehydrated, you should drink water and rest. And if you're over hydrated, you should rest and stop drinking water. Okay, once once it gets more severe, once we see mental status change, someone is no longer behaving like themselves. That just means that their brain is angry because it's not getting what it needs. Either. It's not enough water. In the case of dehydration, or there's there's swelling and pressure building up because of this hyponatremia And in those cases, that person really needs to go to a hospital.

Margaret

Okay, what what would the hospital be doing? And I know I'm not like trying to encourage everyone to do everything by themselves, but I feel like it's like useful to like break open the black box with like medical stuff.

Guy

Yeah, so dehydration, dehydration, they're gonna be rehydrating via IV. Oh, that's a thing that we can do in the back country or without access to a hospital. We don't have IVs but we can rehydrate someone gradually just by drinking water and reducing exertion. And as long as they're not continuing to lose fluid either through sweat or through diarrhea or vomiting then we can probably fix that problem hyponatremia is there's unfortunately not much outside of a hospital setting once it's advanced to the stage someone's mental status is changing. There's not much that we can do and this is one of the reasons it's more fatal dehydration and exercise context