(Health Advisory)

Some common health issues that people face during the summer season in India 

• Heat-related physical illnesses (such as prickly heat, heat edema, heat tetany, heat exhaustion, heat stroke etc.) 
• Dehydration (due to less water intake and/or excessive sweating & water loss) 
• Food poisoning (with stomach upset, vomiting, loose motions) 
• Skin infections and other skin problems (including sunburn, sun tan, dandruff etc.) 
• Exercise-related problems 
• Psychological problems (impacts on mood, sleep, work, productivity) 
• Mosquito-borne diseases (such as dengue, chikungunya and malaria) 
• Other problems (environmental, vehicle engines, fuels, excessive use of ACs in cars/houses/offices) 

Certain high-risk groups / individuals more prone to heat-related health problems:  

• Elderly people 
• Infants and young children
• Outdoor workers (like construction workers, factory workers, street vendors, security guards, policemen, farmers) 
• Outdoor sportspersons / athletes / travellers (especially during peak hours of heat) 
• People with chronic conditions (like Diabetes, heart disease, chronic respiratory / liver/kidney disease, obesity etc.) 
• Individuals on certain medications (like diuretics, antihistamines, drugs affecting sweating/temperature control) 
• Pregnant women 
• People with limited access to cooling facilities (like those living in poorly ventilated spaces and without access to fan/AC) 
• Alcoholics, those taking illicit drugs (substance abuse) 
• Destitute persons 

Dehydration

• Key signs: Dry mouth, dry eyes, dry skin, reduced sweating, muscle cramps, headache, nausea, palpitation etc. 
• Precautions to avoid dehydration
  • Drink an adequate amount of water and other beverages throughout the day 
  • Limit the intake of caffeinated and alcoholic beverages 
  • Consume foods with high water content (such as fruits and vegetables) 

Specific dietary recommendations for the summer season 

• Consume foods that are hydrating and light on the stomach (such as fresh fruits, salads, seasonal vegetables, cereals, yoghurt, and grilled or steamed vegetables) 
• Take plenty of liquids. Relish on cold beverages such as seasonal fruit juices, lassi, chhachh, milk shake, shorbets, thandai, lime water, coconut water, herbal tea etc. 
• Avoid heavy, spicy, oily and junk foods as they can cause discomfort and indigestion during hot weather
• Take small but frequent meals 

Higher risk of food poisoning  during the summer season 

• During the summer season, the risk of food contamination and bacterial growth increases due to the higher temperatures 
• Consuming improperly stored or contaminated food, especially in outdoor settings or from unhygienic food stalls, can lead to food poisoning, which commonly manifests as stomach upset, vomiting and loose motions 
• Young children and elderly people are generally at a higher risk of developing dehydration, electrolyte imbalance and other complications due to frequent loose motions. So, they need prompt and proper care, including intake of adequate liquids/ ORS solution and other symptomatic treatment. 
• If there is no improvement with initial home-based remedies, medical assistance should be taken without delay for proper diagnosis and management, especially in such vulnerable age groups 

Some effective ways to prevent food poisoning in hot weather 

• Maintain good hygiene practices (daily bath, hair shampoo, nails-cutting)  
• Wash hands thoroughly before handling or eating food 
• Store food properly at the right temperatures 
• Avoid consuming any such food that appears stale, expired or spoiled 
• Avoid consuming food from unhygienic food stalls (including various street foods unless you are pretty sure about hygiene) 
• Ensure that perishable foods are cooked and consumed fresh 

How to manage and stay cool during extreme heat waves 

• Avoid exposure to heat waves and hot outside temperatures. Go out under the hot sun only when it is very necessary. 
• Keep your house, office etc. cool by making suitable arrangements (such as use of fans, coolers, air-conditioners etc.) 
• Ensure adequate ventilation of fresh air in your living space. Use of curtains and chiks can help tackle the heat.  

• Keep your living space clean and wet-mopped. Sprinkling of water in and around your house can be helpful. 
• Take cool showers 
• Wear proper clothes (loose, cotton clothes, preferably light-coloured) 
• Avoid plastics and non-breathable types of clothes 
• If needed, place wet towels on the body 
• Drink plenty of liquids and cold beverages 
• Avoid strenuous physical activities during extremely hot period of the day 
• Do not hesitate seeking medical assistance in case of any symptoms or concerns  

Sports and exercise during summer season 

• Prepare well for sports and exercise during summer season 
• Ensure that your place of exercise (gym or home) has cool environment 
• Prefer to do exercise or playing in early mornings or late evenings when there is less heat 
• Wear loose, cotton clothes for a comfortable exercise 
• Drink small quantities of water/other liquids frequently during exercise/playing. 
• In place of sports/exercise, use other fitness options such as Yoga, meditation, dancing etc. 

General approach to handle cases with heat related illnesses 

• Minor heat related problems can be tackled easily at home or workplace by taking simple measures like: 
  • Moving away from the hot environment to a cooler area 
  • Providing support for cooling down (fresh air/ AC/ cooler/ fan/ hand-held fan/ cold sponging) 
  • Give plenty of liquids to drink (cool water, lime water, ORS solution etc.) 
  • Symptomatic management and first aid including some home-based remedies such as: 
    • In prickly heat: Put simple or medicated talcum powder or apply calamine lotion 
    • In mild, local skin infection: Use an over-the-counter available anti-septic cream or antibacterial powder 
    • In sun burn and sun tan: Apply cold milk, aloe vera gel, cucumber slice, natural yoghurt or cool water 
• However, in major heat related problems, though an initial first-aid or on-site care may be provided, it would need further medical management by a doctor in a health facility, for which the affected person should be taken to a nearby doctor or hospital without any delay. 
  • Initial first aid: 
    • Moving away from the hot environment to a cooler area  
    • Bringing the person’s body temperature down (through removal of any tight clothes, applying water/wet cloths/ice packs to the skin, and use of fan/cooler/air-conditioner etc.) 
    • Giving adequate liquids to drink (if the person is fully conscious and able to drink liquids)  
    • Providing other symptomatic and supportive management 
  • Take the person to a nearby doctor or hospital urgently for further appropriate treatment without any delay 
    • Continue the first aid during the transfer of the person to hospital 

Prickly heat (Heat rash) 

• How does it happen? 
  • Prickly heat occurs when sweat and humidity provide for bacterial growth and infection on the skin 
  • It can affect anyone though we see it very commonly among children, women and fat persons. 
  • It is an itchy, reddish skin rash which is usually seen on those areas of skin that are normally clothed and covered (such as armpits, groin, below the chin and the upper parts of chest and back) 
  • Repeated scratching of skin in an attempt to relieve itching can lead to further skin injury or even infection. 

• Preventive measures:  
  • Stay in cool area of your home/office and avoid exposure to hot and humid environment 
  • Maintain good personal hygiene and bathe daily (or twice daily) 
  • Put talcum powder on skin after taking bath 
  • Wear cotton clothes (including undergarments) and avoid plastics or excessive clothes 

• Treatment of prickly heat: 
  • Don’t scratch the skin (In case of a child, his/her nails may need to be trimmed) 
  • Keep the affected area clean, cool and dry 
  • Use an anti-itch cream/powder, lotion or medicated talcum powder on the affected area (such as calamine lotion) 
  • Apply cool, wet compresses over the rash 
  • You can use available over-the-counter anti-allergic drugs 
  • But if it is severe or not responding, consult your doctor or skin specialist 

Sunburn and other related skin issues 

• A sunburn looks like a patch of darkened skin peeling away. It may be red or reddish in colour, feels hot to touch, and is generally painful. We may see multiple such patches in a person. 
• Protecting skin from sunburn and other related skin issues: 
  • Avoid prolonged exposure to direct sunlight (especially during peak hours like 10 am to 4 pm) 
  • Before going out in the sun, apply sunscreen with a high SPF 
  • Wear protective clothing (such as hat and sunglasses) 
  • Protect your baby/child from intense heat and ultraviolet light 
• Management of sunburn: 
  • Take cool baths/showers frequently to relieve pain associated with sunburn 
  • Use soothing moisturizers (as available over-the-counter). Mild painkillers can be taken, if needed. 
  • Keep yourself well-hydrated by drinking enough water/cool beverages 
  • Wear loose clothes to protect sunburnt skin 
  • Do not pop blisters on a sunburn (let them heal on their own). 

Skin infections during summer season 

• Infections of skin and foot are more common during the summer season. Various types of germs can cause such infections (notably bacteria and fungi) leading to mild to severe symptoms. Sweating and humidity can further aggravate the problem. 
• Common skin infections seen during summer: 
  • Boils (painful infection in hair follicles and adjacent skin) 
  • Impetigo (red swollen skin area with some oozing and pain) 
  • Fungal skin infection (itchy, white/coloured lesions with often central clearing, more common in skinfold areas like groin, between adjacent fingers/toes, armpit, and below the breasts) 
  • Infected open wounds (including wounds due to cut injuries and thorn-prick injuries). 
• Prevention:  
  • Maintain good personal hygiene (with daily bathing and thorough scrubbing of skin, feet, toes etc.) 
  • Do not allow any dust, sweat, food material or other dirty material sticking onto your skin for long periods 
  • Avoid hot and humid environment. Keep your skin cool, clean and dry. Don’t keep your hands/feet wet or in continuous direct contact with water (such as while washing your car, working in kitchen etc.) 
  • Take adequate precautions to prevent any skin injury and get proper treatment in case an injury does happen 
  • If you are diabetic or have any other medical condition associated with decreased sensation to touch or pain, you must inspect your skin, hands and feet daily to screen for any injury or infection. 

• Treatment depends on the cause of the infection and its severity: 
  • Some types of viral skin infections may improve on their own within days or weeks 
  • Mild infections generally improve on their own due to our immunity 
  • Mild bacterial/fungal infections can be treated with topical antibiotic/antifungal skin creams to be applied directly on the infected area 
  • In case of no response or aggravation, consult your doctor or a skin specialist 

Heat exhaustion 

• Signs & symptoms: 
  • Heavy sweating 
  • Generalised weakness 
  • Dizziness 
  • Nausea 
  • Headache 
  • Muscle cramps 

• Management of heat exhaustion: 
  • Move to a cooler environment 
  • Take rest and avoid physical exertion 
  • Drink plenty of liquids and cool beverages 
  • Apply cold compresses to the body 
  • If symptoms worsen or do not improve: Seek medical attention without delay (take to nearby hospital or doctor) 
  • Some danger signs:  
    • Loss of consciousness 
    • Altered sensorium 
    • Fits 
    • Paralysis 
    • High-grade fever 
    • Persistent vomiting 
    • Inability to drink or eat 
    • Dark-coloured urine or not passing urine 

Heat stroke 

It is the most dangerous and life-threatening heat related illness, more common in infants and the elderly. Extreme heat stuns the body systems so that sweating stops and the body can no longer release heat from the body or cool itself. Victim’s body temperature rises rapidly to a very high value, typically in the range of 104°F to 111°F (sometimes even higher), and the brain and other vital organs begin to fail. 

• Clinical features: 
  • High body temperature 
  • Hot, red, dry skin 
  • Progressive loss of consciousness 
  • Rapid, weak pulse 
  • Low blood pressure 
  • Rapid, shallow breathing 
  • Neurological manifestations may include Mild confusion, agitation, imbalance, irritability, fits, and coma.  
  • In the absence of timely and proper care, the affected person may deteriorate rapidly leading to multiple organ failure, coma, and then death.  
  • It is crucial for doctors to make a correct diagnose of heat stroke and treat accordingly because such manifestations can also occur in certain other medical conditions (like malaria, septicaemia, side effects of certain drugs etc). 
• Initial management and first aid should be provided promptly: 
  • Move the person to a cool area and give him/her cool water to drink (if alert and can drink). 
  • Cool the body by all means (such as removing any tight clothing; applying cool, wet cloths to the skin; fanning with use of a hand-held fan, cardboard or similar other object; placing ice packs on the victim’s wrists and ankles, in armpits and on the neck; and keeping the area cool with use of an electric fan, cooler or AC) 
  • If the person vomits, stop giving liquids by mouth. Position him/her on one side and call for medical help 
  • Continue cooling the skin until medical help arrives (doctor, ambulance, or health facility/hospital) 
• Take the person to nearby hospital without any delay for further emergency medical care: 
  • If an ambulance is available (or can be called urgently), it is better to shift the person in an ambulance 
  • Continue the first aid and other supportive measures to cool down the person’s body temperature while transferring him/her to the hospital. 

Preventive measures against mosquito-borne diseases during the summer season 

• Summer season is associated with various mosquito-borne diseases also (such as dengue, chikungunya and malaria). 
• Preventive measures: 
  • Eliminate stagnant water sources where mosquitoes breed 
  • Use mosquito repellents 
  • Wear protective clothing (including full-sleeved shirts and pants) 
  • Sleep under mosquito nets 
  • Avoid going to places where mosquitoes may be present 

Precautions for people with various chronic health conditions/ comorbidities 

• People with chronic respiratory conditions (such as asthma and chronic bronchitis) should take extra precautions during the summer season: 
  • Avoid exposure to air pollution 
  • Stay indoors during high pollution days 
  • May use air purifiers at home (if available) 
  • Have their medications, inhalers etc. readily available 
  • Take their routine medicines regularly as prescribed by their treating doctors 
• People with other chronic conditions (such as diabetes, heart disease, chronic liver or kidney disease) should also follow similar precautions as they are more prone to become ill and their health can deteriorate faster.  
• All such people should take their routine medicines regularly so that their health parameters (including blood pressure, blood sugar etc.) remain under good control.  
• Vaccination of children and adults is helpful (especially adult vaccination for those with chronic health conditions) 
• In case of any symptom or health concern, they should seek medical assistance without any delay and follow the advice. 

Author: Dr Amit Kumar Gupta, MBBS, MD, DTCD, MBA, M Phil, PGHM, PGHFWM 

Medical Director, HCL Healthcare India (Email: amit_gupta@hcl.com)