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Heed the warning signs

The deaths of NFL star Korey Stringer and a UF player prove heat stroke can happen to anyone, experts caution.

By WES ALLISON

© St. Petersburg Times,
published August 2, 2001

Well before Korey Stringer died of heat stroke Wednesday, becoming the second football player felled by heat in a week, there were signs he could be in trouble.

The 335-pound lineman for the Minnesota Vikings missed part of practice Monday because of heat exhaustion, then hitched a ride off the field in a cart. During practice Tuesday, Stringer again felt faint, and he threw up three times before he eventually collapsed.

The deaths of Stringer, 27, and University of Florida fullback Eraste Autin, two exceptional athletes accustomed to playing hard in the heat, prove heat stroke can truly happen to anyone, illustrating how important it is for athletes and non-athletes alike to pay attention to early symptoms, experts say.

"I tell patients, read your body. In a warm climate, read the weather and anticipate," said Gary Wadler, an internist and sports medicine expert at New York University School of Medicine who served for 11 years as the lead physician for the U.S. Open tennis tournament.

"The biggest problem is that by the time they realize they're dehydrated -- and remember, heat stroke is the extreme of that -- it's a little bit late. It's a whole lot late."

Stringer, an All-Pro right tackle, collapsed on the practice field Tuesday, the second day of training camp. He never regained consciousness and died early Wednesday.

Autin died last Wednesday, six days after collapsing after a voluntary workout in Gainesville. He was 18, a 255-pounder from Lafayette, La.

Heat exhaustion is often treated in Florida emergency rooms, striking roofers or other outdoors workers as well as elderly residents who overdo it in the yard. Roughly 175 to 250 people die of heat-related illness each year in the United States, although that number can soar during a heat wave. During the heat wave of 1995, 465 people died in Chicago, the federal government reports.

Among high school and college football players, heat-related deaths peaked in 1970 at eight, then occurred sporadically until 1995, when five players died. Autin was the 13th player to die since, according to the University of North Carolina sports medicine department, which tracks such deaths.

Like many former football players, Barry Clements recalls when high school coaches often parsed out water as if it were gold. Nowadays, coaches seem to understand the importance of hydration, and water is as common as practice dummies on most practice fields, said Clements, the assistant director of athletics at the University of South Florida in Tampa, where he oversees sports medicine.

Most teams also weigh players before and after practice, to make sure they haven't lost too much water weight. USF encourages its athletes to drink 4 to 8 ounces of water every 15 to 20 minutes, he said.

But doctors who specialize in sports medicine stress that's not always enough: People don't generally go from feeling fine to fatal heat stroke. Cramps, dizziness or nausea usually come first, and coaches, teammates and trainers must watch out for those symptoms, as should anyone working outside in the heat.

In light of Stringer's death, NFL commissioner Paul Tagliabue said Wednesday that he has asked all 31 teams to review their training rules, the Associated Press reported.

By the time a person's body temperature tops 104, high enough to cause heat stroke, the chances of death or permanent damage are high.

"Think about what's going on. You've got athletes operating under extreme conditions, they're pushing themselves to the limit, and when it's summertime and it's hot and it's humid and maybe they've not shown up in training camp in maximal condition, you're sort of setting the stage," said Ferdinand Richards, an emergency room physician at Tampa General Hospital.

"Look at where athletics are going -- they're pushing it more and more to the edge, and to get there people are having to work hard and harder."

Just like a car engine, our body heats up when we run it. But once the outside temperature hits 90 degrees, it becomes much harder to exchange body heat with the air around us.

If it's humid, too, then our other main cooling system -- evaporation of sweat -- becomes compromised as well.

Heat kills by damaging tissues throughout the body, including the brain, heart and other organs, and by interrupting the chemical reactions that keep our bodies running.

"The cell functions quit, and the tissues don't work," said William O. Roberts, a Bear Lake, Minn., physician and fellow of the American College of Sports Medicine. "They'll burn up all their energy supply trying to cool off, trying to exchange fluids."

Drinking plenty of water is key because it keeps the body primed with sweat. Hydration also keeps the blood volume high and the circulation system working properly, allowing blood to transfer heat around the body.

Some are more susceptible to heat exhaustion than others, including the very young or old, the overweight, the sick and people who sweat a lot. Certain medications can cause someone to overheat or become dehydrated more quickly.

So can diuretics, which some athletes use to try to prevent performance-enhancing drugs from showing up in blood or urine tests, said Wadler, who also serves as medical adviser on drugs and sports to the White House Office of National Drug Control Policy.

Koco Eaton, the team physician for the Tampa Bay Devil Rays who also treats many local athletes, said he suspects over-the-counter, muscle-building supplements, like creatine, also help rob the body of water. These supplements are popular with many high school and college players.

"Basically, you've turned the temperature up of the engine, and that's why they work," he said. "But there's a down side as well."

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