7 Tips for Avoiding Heat Exhaustion on Vacation

It's the first day of summer. And while most of you are preparing for the season's fun and sun, I want to give you a head's up about the very real dangers of heat exhaustion.

In Tiananmen Square before the fall

When it comes to this topic, I am quite the expert. I have ended up in the hospital for heat exhaustion and dehydration four times (after the first time you are felled by heat exhaustion, you are a more likely candidate for encore performances)  Details here. The most recent incident happened in Beijing. It occurred on Day 3 in China. Day 1 included a fourteen-hour flight from the US of A. Day 2 included a climb up the Great Wall. All resulting in Day 3, which included a visit to the pavement-laden Forbidden City in the smog and 90 degree heat, followed by a trip to the ER for an IV.


Even if you are not traveling to exotic climes, the fact is, summer is the time when heat exhaustion is most likely to strike. If you fly to your vacation destination, you are starting off your trip dehydrated. Add in the fact that you are likely out in the sun day after day, for hours at a time. It's the perfect recipe for a heat attack. Heat exhaustion can hit anyone of any age and any level of fitness (see LeBron James). It can hit at the beach, on the pitch, or on city streets. Here is some advice (vetted by doctors) on avoiding heat exhaustion.

1. HYDRATE, HYDRATE, HYDRATE. You can never have too much water before you go out in the heat and while out in the sun.  As you hydrate, it's smart to alternate between water and beverages loaded with electrolytes.

2. Take it easy within 24 hours of landing after a long-distance flight.

3. Carry electrolytes with you if are prone to heat exhaustion.  I recommend REI electrolyte tablets, which are among the few without artificial ingredients.

4. Along with your water bottle, carry energy bars, dried fruit or something similar.

5. Wear a hat and sunscreen.

6. Get out of the heat and rest. Once you start feeling the effects of heat exhaustion, you may be too far gone...and an IV may be your only solution, so to speak. But if you feel on the cusp, immediately stop activity, head toward shade and try to cool your body off with ice or cold water.

7. What do you drink once heat exhaustion kicks in? Interestingly, the Chinese doctor who treated me said drinking water straight is one of the worst things you can do. He suggested that once heat exhaustion sets in, water intake further dilutes salt and potassium levels. This condition is called hypontremia. If this is your issue, there is a need to drink liquids containing electrolytes instead of straight water. At the same time, avoid carbonated beverages or anything with caffeine.

7 More Tips About Heat Exhaustion

For those of you who saw me on NewsChannel 8 today, my previous post covers most of the points I addressed on TV. However, for those who are looking to do a bit more research into the phenomenon, here are links to a few articles which provide professional insight on the topic.

While you may think of heat exhaustion as a condition most affecting hard-core athletes, it can impact the Regular Joe as well. So, there's a lot to be learned from how professional athletic trainers deal with it. Here's some input from the National Athletic Trainers' Association.

Certainly, the staff of Grand Canyon River Guides has to know the inside scoop on heat-related illnesses. Multi-day trips in the Grand Canyon in the middle of summer are adventures just waiting for a heat incident. Here's the company's chief of emergency services take: http://www.gcrg.org/bqr/14-1/hypo.html

A Food Network nutritionist discusses how much water to drink.

Several companies produce electrolyte beverages and powders. Nuun makes self-dissolving electrolyte tabs that are designed for athletes, but can be used by all. I can't vouch for the product, not having tried it, but the FAQs on Nuun's website seem solid.


Meantime, two other notes gleaned from experience and research:

1. Heat exhaustion isn't always caused by heat, per se, although it is usually a major factor.
2. Other factors that can contribute to the condition are dehyration, altitude, air quality, humidity, and surface temperature (a tennis court or pavement will be hotter than a field of flowers, for example).

7 Things to Know about Heat Exhaustion

Looking perky before the fall

After a long day of summer sightseeing, have you ever felt headache-y, queasy or nauseous? Have you experienced the shakes or has your face gone pale? You may have had heat exhaustion without even knowing it. And it's important to know it, because once you have an episode of heat exhaustion, you are more susceptible to it in the future.

Now, I am not a doctor, nor do I play one on TV. But believe you me, I know from heat exhaustion. I've ended up in the hospital with it four times. The first was after a three-hour singles match in the mid-day California sun. The second was after I had flown to California non-stop and played tennis (doubles, this time) later in the afternoon. That incident was clearly caused by the triple whammy of dehydration from the plane, the sun, and exercise. Incident #3 was after my first and only attempt at Bikram Yoga (I highly DO NOT recommend this form of yoga--it's actually the antithesis of yoga, IMHO). And finally, there was the infamous incident in China, which took place, not after a round of exercise, but in the middle of a day of sightseeing in Beijing. That's another one that resulted in an IV in the ER. I highly DO NOT recommend the ER in China.

The face of heat exhaustion

One month later, I am still sorting out dozens of receipts written in Chinese, trying to decipher what's what in order to send my claim to the Travel Guard insurance company. So that you can avoid similar travails--both heat stroke on your travels and the accompanying paperwork, a bit of advice is in order. Again, I am not a doctor, but I've learned some excellent tips from the four who have treated me for the condition.

1. HYDRATE, HYDRATE, HYDRATE. You can never have too much water before you go out in the heat and while you are out. Better yet, as you hydrate, alternate between water and sports drinks loaded with electrolytes.

2. Take it easy within 24 hours of landing after a long-distance flight. Aside from the above-mentioned combo of coast-to-coast flying and tennis, I believe the incident in Beijing may have developed from the following set of activities:
    Day 1: 14-hour flight to Beijing
    Day 2: Climbing to the top of the Great Wall in heat and humidity
    Day 3: Four hours at the (shaded) Summer Palace, followed by an afternoon of sightseeing in Tiannamen
              Square and the Forbidden City. Temperature was in the high 80s, not taking into account the heat    
              from the pavement and the air quality.
While I had taken care to get plenty of sleep and what I thought was plenty of water (although probably rationing unconsciously due to the yen to avoid using squat toilets still so prevalent in China), BOOM! Down I went in the Forbidden City.

3. Carry electrolytes with you if are prone to heat exhaustion. I had Emergen-C packed in my suitcase, but it wasn't with me in the Forbidden City. A friend had salt pills packed, but again, she didn't have them in her purse. Both would have been perfect for dissolving in a bottle of water.

4. Carry energy bars, dried fruit or something similar.

5. Wear a hat and sunscreen.

6. Get out of the heat and rest. Once you start feeling the effects of heat exhaustion, you may be too far gone...and an IV will be your only solution, so to speak. But if you feel on the cusp, immediately stop your activity and stay cool. This is what I tried to do in the Bikram class 30 minutes in....but the instructor wouldn't let me leave the room, the heat index of which was probably upwards of 130. After 30 more minutes in this extreme sauna, I forced my way out (as the instructor chased after me calling me a coward--nice).  Had I left the  room when I initially felt ill, I would have been okay with liquid, rest, and shade. But the extra heat did me in, even though I was laying on my mat during that time. On to the ER.

7. What do you drink once heat exhaustion kicks in? Interestingly, the Chinese doctor who treated me said drinking water straight is one of the worst things you can do. He suggested that once heat exhaustion  sets in, water intake further dilutes salt levels. This condition is called hypontremia. If this is your issue, there is a need to drink liquids containing electrolytes instead of straight water. No other ER doctor had  ever mentioned that to me.  Interestingly, though, in checking a number of legitimate medical websites, 100% recommend water, although agreeing that electrolyte-spiked liquid is better yet. These same sites put a total kibosh on drinking carbonated beverages or anything with caffeine.

Best bet--before leaving on a hot trip, ask your doctor for his/her advice and get travel insurance, just in case. As for me, I'm staying out of the heat.

7 Things to Remember When Traveling to China

It's been 27 years since I was last in China, and boy oh boy, have things changed.

The airport is new and shiny, with Western style toilets (hooray).
The city outskirts and innards are now lined with high-rises and highways.
Cars have replaced bicycles as the main form of transportation.
And I am sure more will be discovered during my next three days here.

But for now, let me provide 7 pieces of advice to first-time travelers to China.

1. Just because you feel overwhelmed upon arriving, remember that the basic rules of international airports still apply. Do not get money at the currency exchange located near baggage claim. Instead, wait until you are in the main terminal and use a bank ATM. You'll get a better rate. Also, don't fall prey to gypsy cab drivers, who are lurking in the arrivals terminal. The one who tried to tackle me first offered a ride to the Kempinski for 400 RNB. Noticing the scorn on my face, he reduced it to 200. In fact, the ride in the LEGAL cab cost 80 RNB.

2. Don't expect cab drivers will know English. Always print up the address of your destination in Chinese so that your driver takes you to the right place.

3. Unlike in the USA and many other Western countries, smoking is still common in China. Always request a non-smoking room. The regular rooms have an ingrained stench, even at nice hotels.

4. Sorry, no Facebook. You'll have to wait to share your posts and pix until you get beyond the Chinese borders.

5. Similarly, GMail is iffy at best. While you can do searches on Google's main page, access to Gmail and other Google apps (Blogger, Maps) is often blocked by the Chinese government. I have tried to get into GMail scores of times since arriving. I made it through twice, once through the backdoor of google.co.uk. If GMail is your main email account, prepare to forward those messages to another service before leaving home. HotMail, for example, is working fine here.

6. Even if you are traveling first-class, it's still BYOTP in many tourist toilets. What's more, said toilets may not be the, ahem, comfortable thrones to which Westerners are accustomed.

7. Avoid ending up in a Chinese hospital. More on that in the next post.

BTW, this post was uploaded in Mongolia (see #4)