... about beating those summer ills

A government study released in June concludes that extreme heat kills on average 120 people in Toronto, 121 in Montreal, 41 in Ottawa and 37 in Windsor each year. Add to that pollution, the harmful effects of the sun and patients' lack of initiative to protect themselves from its harmful rays, and the health risks increase significantly. According to the Canadian Dermatology Association 60-70% of skin cancers could be prevented if Canadians practised proper sun protection.

With extreme heat, UV index and smog warnings rampant this summer season, many of your patients need to take precautions to stay healthy and avoid becoming a statistic. Here are some tips on how patients can beat the heat and still enjoy the summer sun.

FEELING HOT, HOT, HOT
The signs Heat illness — which varies from heat cramps to exhaustion and heat stroke — happens during unusually high temperatures and humidity. "Many people don't recognize the signs of heat illness," notes Tracy Braun, the national first aid coordinator for the Canadian Red Cross. But it's important for all your patients to recognize what these signs are in order to halt the progression of heat illness. Advise them to watch for dehydration, light-headedness, muscle cramps in the stomach, legs and calves, and an increased heart rate. The symptoms get worse as the heat illness progresses. For instance, stomach cramps can lead to nausea, and light-headedness can become a headache. "A key thing patients need to watch for," says Ms Braun, "is when they start drinking a lot and urinating less frequently. This can signal a progression in the illness."

Prevention & treatment "The best treatment is prevention," says Dr Janice Harvey, an associate clinical professor with the department of family medicine at McMaster University and an FP with a subspecialty in sports medicine. "Patients who have had heat illness in the past are more predisposed to it," she adds. "So it's important to prevent against it." She recommends you tell patients to keep well hydrated, avoid being outside during the hottest times of the day, between 10am and 4pm, or at the very least from high noon to 2pm, and keep inside with the air conditioner on. Avoiding caffeinated drinks like cola, coffee or tea is key. "For every caffeine drink a patient has, he or she should replace it with a full eight ounces of water," says Dr Harvey. For those who might unknowingly get heat illness, you can tell them simply drinking some water, lying down and resting and applying cold compresses can help cool the body down. "Patients can apply ice packs to areas where they lose heat the fastest — those same places you cover up first in the winter like the groin, head, neck," adds Ms Braun.

Breathe easy Air pollution combined with extreme heat and humidity can mean more respiratory problems for some of your patients. Ozone — one of the common chemicals found in smog — irritates the respiratory system and causes inflammation of the bronchial tubes, explains Dr Susan Tarlo, a professor of medicine and public health sciences at the University of Toronto. She explains that air pollution usually affects people with a chronic disease such as diabetes, respiratory problems like asthma, or cardiac disease. The elderly, young children and endurance athletes will also feel the effects more. Patients who fall under these categories might feel short of breath and have trouble breathing when air pollution is high (an air quality index of 51 or higher). Dr Tarlo suggests telling these patients to get inside in an air conditioned environment and optimize their medication for lung disease.

Cover up The sun-kissed glow cherished by teens and Hollywood types isn't the safest of beauty routines. Many of your patients might be among those who aren't doing all they can to prevent skin cancer. Some of your patients might come to you asking 'How much is too much sun?' "The answer to that question depends on the individual," says Dr Cheryl Rosen, the head of dermatology at the Toronto Western Hospital and an associate professor at U of T. "It all adds up." The message to get across to patients, she stresses, is "when you are out in the sun, protect yourself as much as you can." Patients can do that by following some simple rules. Use sunscreen — Dr Rosen recommends anything over SPF 30 that is broad spectrum. Dr Rosen adds that it's important for patients to be sure to apply enough sunscreen at the outset and then reapply it regularly. They should also seek shade, or get sunburned. Dr Rosen says that you can suggest cold compresses or a topical steroid cream to ease the pain. "Advil or motrin can help with the pain as well," she adds.

The big C The importance of sun protection today is to ward off skin cancer in the future. Many patients are aware of the connection between too much sun exposure and cancer but fail to make the appropriate lifestyle changes to cut down on their risk. Keeping that in mind, many patients might be curious to know what the early signs of skin cancer are and what they can look for in order to catch it early and increase their chance of survival. "I tell patients to look for things like a sore that doesn't heal," says Dr Rosen, "a change in a mole, either the shape or the border becoming asymmetrical, an area of the skin that seems to be red and scaly." Dr Rosen calls this the A, B, C, D, E of skin cancer: Asymmetry, Border, Colour, Diameter and Evolution. She also adds that sun-exposed areas, like the back in men and the back of the calf in women, are more affected by basal cell and squamous cell carcinoma — the two most common kinds of skin cancer. Melanoma, the third type, is the more rare but most serious form.