Search for tag: "dehydration"

Interviewer: So during the summer months, temperatures are rising, people are getting out more, and you might be getting a little concerned about heat exposure and how it might be impacting your health.

We're here with emergency room physician, Dr. Troy Madsen. And Dr. Madsen, when it comes to heat exposure, what do people need to be concerned about?

Dr. Madsen: Well, the biggest thing with heat exposure is just your body overheating. That's where you really start to see issues not just with feeling uncomfortable, but potentially having even a life-threatening situation. Some people . . . you know, you may be familiar with just being out in the heat, you've been hiking or on your bike, or you know, whatever you might be doing, and you're probably familiar with that feeling of just feeling thirsty and tired and maybe a little bit nauseous and maybe a little bit of a headache. Well, at that point, you may be experiencing what we call heat exhaustion. But the big risk becomes when you move beyond that, and your body temperature continues to rise. And then you can experience what's called heatstroke. And that becomes a much more serious thing.

In those situations, your body temperature is often very high. You can have damage to the organs in your body, meaning damage to the kidneys, even potentially the heart, the brain. And in some of those situations, when you hear about these stories of people in places where there is just extreme heat and people are dying of the heat, it is often because of heat stroke that that's happening.

Interviewer: Yeah, we hear about these deadly heat waves and things on the news. And it's, you know, what does that even mean? We're talking like organ damage. Like the heat is getting so high that . . . are you talking brain? Are you talking heart? Who is at risk, and what is it actually doing to the body?

Dr. Madsen: It's exactly that. The body is getting so hot that it is leading to damage and breakdown of the tissues in the brain, the heart, the kidneys. Sometimes part of that is dehydration that's contributing to that as well where that's affecting your kidney function. But in terms of risk, there are a few groups who are really at risk of this. Number one is people who are experiencing homelessness, who may be out in the heat, aren't in a cool place. Other people who are out doing outdoor activities. And maybe you find yourself in a situation where you're out, you're exposed, you know, there's no way to really cool down, maybe you didn't bring enough water along on your hike or your bike ride.

But then there are also certain groups that are really at risk. And these are the very young and the very old. So young babies, infants, and then older people have a tougher time regulating their body temperature. So you might be out, and let's say you take your baby, you know, in a stroller, you're out on a walk, or you go to the zoo or something and you're feeling okay, or maybe you're feeling just a little bit of a headache or a little bit hot. Your baby could be experiencing very severe symptoms in that situation. So if you live with the very young or the very old, just be aware that if you're not feeling great, they're probably experiencing a whole lot more of the heat and much worse effects than you are.

Interviewer: So it sounds like heat exposure affects basically anyone and everyone if you don't, you know, take the right steps. What are some of the ways that a person can, say, prevent heat exhaustion and then later heat stroke?

Dr. Madsen: Well, the biggest thing, you know, is to try and be in a situation where you can cool down. If you're out on a hike or you're out somewhere in the outdoors, try to go in shaded areas, ideally areas that have a water source, something where you can cool down if you need to. Carry plenty of water, you want to make sure you have lots of water with you. The general rule of thumb is 16 ounces of water per hour. I tell people start with at least eight ounces if you're just doing moderate activities. Sixteen ounces can be a lot to carry if you're out on several hours, but try and do that if you can, or at least know where you can get some water.

The big thing I would suggest too is if you have elderly parents, relatives, friends, neighbors, check in on them. One of the sad things that sometimes happens is older people, especially right now, may not have checked their air conditioner, may not know if it's working, or it may work and then it stops working. And sometimes a very sad thing we see is people in this situation then are either embarrassed to reach out for help or don't know who to call for help. And the house temperature gets very hot, and they experience severe symptoms with heatstroke or even death. So check on those people. If you have babies as well, just be aware that they can experience these heat symptoms much more than you may be experiencing at that same time.

Interviewer: So heatstroke, something to keep in mind, something that could be very, very dangerous. ER-worthy if it gets bad enough?

Dr. Madsen: Absolutely, yep. If it's bad enough, if you have a family member or yourself who's just confused, not feeling well, absolutely, get to the ER. Try to get cooled down quickly. Call 911 if you need immediate help.

Interviewer: What should you do if somebody faints? We'll examine that next on The Scope.

Announcer: Health tips, medical news, research and more for a happier, healthier life, from University of Utah Health Sciences, this is The Scope.

Interviewer: All right. Here's the situation. You're in a social situation, maybe you're at home, maybe you're out and about, and somebody faints, like the traditional they're standing and the next minute they're down on the ground. What should you do? Dr. Troy Madsen is an emergency room physician at University of Utah Health. What should I do?

Dr. Madsen: Well, that's a great question, because fainting can be a really scary thing when you see it happen, and I'm speaking from personal experience here, not just as a physician. But, you know, it wasn't too long ago I was traveling with my wife. We were out eating lunch, and she looked over at me and my face just went blank. The next thing she knows my face falls down, I fall forward, knocked my water over. I'm lying on the table, and she's calling for help. She didn't know what had happened. This is me.

Interviewer: You were the fainter.

Dr. Madsen: I was the fainter.

Interviewer: Wow.

Dr. Madsen: Exactly.

Interviewer: Did you feel it coming on?

Dr. Madsen: I did. I felt it coming on, but then it just came on, and then after that I didn't remember anything. So she lifts me up off the table, and then she says my arm just went up like a bird and started shaking. She thought I was having a seizure. It was pretty dramatic. Finally, they got help there. They called 911, you know, all this drama that I really did not want to have happen. They ended up sending me to the ER, which I absolutely did not want to go to because I work in an ER. Everything checked out fine.

But it's one of these things where, when you see it happen, it's a pretty dramatic thing. I think the best thing you can do obviously is stay calm. It was great she wanted to lift me up, because she said my face was down in the water on the table. But the reason I started shaking like that is if you lift someone up when they've had, say they fainted, the blood is rushed out of their head, that decreases the blood flow to their head, and then they can have what looks like a seizure, which is what I did.

So the best thing you can really do is just help the person to lie down, get them comfortable. They're usually going to come to within about 30 seconds, and then they're not going to know exactly what happened. Typically, then it's going to take some time, maybe the next 30 minutes before they can really get up and start walking around, because they're typically pretty weak at that point. But it tends to be very dramatic like that was, but generally it's not a sign of anything really serious.

Interviewer: Really? That shocks me a little bit.

Dr. Madsen: Yeah. I know it's a little surprising, but you'd be surprised at how often we see people in the ER who have fainted. And if the person is a younger person who's otherwise healthy, typically we'll get an EKG just to make sure their heart is okay. Maybe blood work, but that's usually not necessary. In females, we always just make sure they're not pregnant. Certainly, if you're pregnant and you have issues with that, that could cause you to pass out. And 99.9% of the time everything is absolutely fine, and we just don't find anything wrong.

You can have what's called vasovagal syncope, syncope meaning passing out. Vasovagal just means that your blood vessels dilate. A lot of things can cause that to happen. If you stand up too quickly, decreases the blood flow to your brain. You pass out. It's your body's response to get you flat and get the blood flow back to your brain.

Interviewer: I'm going to push on this.

Dr. Madsen: Okay.

Interviewer: To me, as the average person, I'm like but something had to cause it that can't be right. Something had to have malfunctioned that should be working better than that.

Dr. Madsen: And that's what we think. I mean, you know, in my mind too there was the side of me that's just the emotional aspect like, "Wow, this was crazy. This really, really scares me." But then there's the rational aspect at that time when I passed out, I'm just saying to myself, "Hey, odds are nothing is wrong."

And I think back that day I hadn't been drinking fluids like I should. I'd been a lot of time on my feet. Actually, we were in Washington, D.C., at the Holocaust Museum, very emotional kind of response. So all of those sorts of things can then contribute to cause that response in the blood vessels where they dilate. That blood flow decreases to the brain, and then that's what causes you to pass out.

Interviewer: So it sounds like that we kind of know generally what causes it, but how that comes about we don't really know?

Dr. Madsen: Well, like I said, I mean it could be a combination of things. It's really a response often to, again, maybe there's a dehydration component, maybe there's an anxiety component.

Interviewer: You're saying a lot of maybes. It sounds like for any individual it could be a lot of different components.

Dr. Madsen: It could.

Interviewer: And we really don't have a lot of predictors?

Dr. Madsen: Yeah. That's true. We don't have a lot of predictors. Sometimes we see people in the ER who have multiple episodes, where they pass out lots of times, and they've had multiple tests done and they just can't figure out exactly what's causing this. So they're prescribed salt tablets, things like that to try and keep fluids in their vessels. You know, prescribing lots of fluid intake, things like that.

And I should qualify this too by saying that if you're someone who's older, who has other medical problems like heart failure, or if you had strokes, any kidney problems, things like that, then we probably need to do more testing. And those are the cases where I do get more concern, say someone who's 65 who's had heart problems, we're going to do a lot more tests. We're going to keep him in the ER, probably overnight in the hospital, do an ultrasound of their heart, looking for other possible causes.

Interviewer: But otherwise, healthy individuals, 99.9% of the time it's not.

Dr. Madsen: That's exactly right.

Interviewer: No real reason to go to the ER?

Dr. Madsen: Yeah.

Interviewer: Okay.

Dr. Madsen: And if I had to say, you know, it's 99.9%, one of a thousand cases maybe I've seen someone comes in and then we find something on their EKG, or we see some sort of crazy heart rhythm that they go into, and it's like, "Wow, there's our answer." But the large majority of the time, these things happen and we don't find anything really wrong.

Interviewer: So all in all, fainting not as dramatic as one would think.

Dr. Madsen: That's right. It tends to be very dramatic, like I said, like my experience was a whole lot more drama than I had ever wanted on that trip, but usually things turn out fine.

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Interviewer: Kidney stones, could they happen to you? And what can you do to prevent them? We'll examine that next on the scope.

Announcer: Health tips, medical news, research and more, for a happier, healthier life. From University of Utah Health Sciences, this is the scope.

Interviewer: Dr. Gary Faerber is a urologist at the University of Utah Health Care. Dr. Ferber, do you get a lot of patients with kidney stones? I hear it's on the rise like 30% in the last 30 years.

Dr. Faerber: Yes, it is. Absolutely, there's no question about it. And people with kidney stones probably make up a good . . . almost half of my practice.

Interviewer: Wow, you deal with them a lot.

Dr. Faerber: Absolutely. And if you look at urologists across the country, about 20 to 30% of their practice is managing patients with kidney stones. So it's a big, big job for all of us.

Interviewer: So why the increase in the past 30 years? Thirty percent in 30 years, that's quite a bit.

Dr. Faerber: It is. And there probably . . . it's multi-factorial, to be honest with you. I think obviously, one of the reasons why is because Americans tend to be dehydrated. They don't drink enough water.

Interviewer: You're kidding me. You can't go outside without seeing somebody with a water bottle.

Dr. Faerber: I know, and it's crazy. About one in 10 patients are people that are in the United States drink the right amount of water.

Interviewer: Just one in 10?

Dr. Faerber: One in 10.

Interviewer: Okay.

Dr. Faerber: A full quarter percent or a 25% don't drink any water at all in the day.

Interviewer: They're just getting their water from sodas, and juices, and stuff like that?

Dr. Faerber: Right. Which is not a good thing, to honest with you.

Interviewer: So it's . . . dehydration is a big part of it. So just by drinking more water, it helps your system flush that stuff out and prevents it from kind of building up into those stones?

Dr. Faerber: That's absolutely right. If you can recall back to your grade school experiments where you would put the string in a bowl of sugar water and then you'd see the sugar precipitate out on the string. Well, the same thing sort of happens in a kidney. When the water or the urine isn't concentrated, then those crystals can't form. But when urine is concentrated, that's when you get the crystals forming, and then those crystals grow into stones.

Interviewer: Okay. So . . .

Dr. Faerber: Same thing happens.

Interviewer: If I want to prevent kidney stones, drink water. Be sure that I'm getting the right amount. What is the right amount, by the way? We were having a debate about this other day. Is it eight glasses a day?

Dr. Faerber: I tell people six to eight glasses of water a day.

Interviewer: And if that's just a normal person. If you're doing outside stuff sweating a lot, exercising a lot, even more?

Dr. Faerber: You obviously need to drink more. And I think probably a good rule of thumb is that if the urine looks yellow, you're probably not drinking enough. If it's nice and clear, then you're probably just fine.

Interviewer: All right. So what else could cause kidney stones? Like if I'm drinking the right amount of water, am I immune now?

Dr. Faerber: No.

Interviewer: Okay. I've got a better chance, but . . .

Dr. Faerber: You have a better chance. The other thing is that what diet you eat certainly affects your chances of forming kidney stones. The American diet is really conducive to forming kidney stones. We eat way too much salt. We have a lot of animal protein in our diet, and we have a relatively high amount of fats.

Of all those things, probably the most worrisome is the amount of salt that we ingest. The kidneys, when they see all that salt, excrete calcium in the urine, and that calcium in the urine forms kidney stones. Calcium oxalate are the most common kidney stones that we see in the US. So by limiting salt, we can certainly reduce the amount of calcium that you see in the urine.

Interviewer: If I have a relative that had kidney stones, am I my more likely?

Dr. Faerber: Yes. You can't run away from your genes, unfortunately. So . . .

Interviewer: So that's just the way my body works is . . .

Dr. Faerber: It's . . . clearly, there's a significant familial component to the risk of forming kidney stones.

Interviewer: So if you have a family history, then it's really important to watch your diet, drink water.

Dr. Faerber: Yes, absolutely. There is no question about it.

Interviewer: And when you finally find out if you have them, there's no real lead up, is there? You don't . . . there aren't any symptoms that present till the excruciating pain comes along?

Dr. Faerber: Typically, what you describe is the most common thing is that people are perfectly fine, and then they suddenly develop this quite severe flank pain that is really debilitating. If you speak to women who've undergone childbirth and who have also had the unfortunate episode of having a kidney stone, they would say that having a child is much, much easier than trying to pass a kidney stone. So yeah, on a scale of one to 10, with 10 being the worst pain, most people say it's around a 12.

Interviewer: Wow. Other than the pain, and you have to go to the ER to have them removed, can there be long-term damage caused by kidney stones? Because there might be somebody that says, " You know, I really like my energy drinks. I can deal with every few years having a stone, even though they're excruciatingly painful."

Dr. Faerber: Fortunately, the chances of having a permanent injury secondary to the stone are relatively small. Most people, when they're in a significant amount of pain, would like to have the stone removed. Fortunately, most patients who have the typical kidney stone will pass the stone on their own.

It may take some help, but certainly, they can pass it on their own. Those who can't, we have very minimally invasive ways of taking care of those stones. If patients pass them on their own or they're treated effectively, the long-term damage to the kidney is really quite small, which is fortunate.

Interviewer: Is there evidence that supports the correlation with sugary drinks, salt, diet, that sort of thing? Do have like a number that if I have that kind of lifestyle, I've got three X or four X times more chance to get kidney stones?

Dr. Faerber: There are some . . . there are some numbers. The relative risks of those who drink sugary drinks, for example, their risk might be more than . . . more than double. It's really true of those who have a high salt rate intake. Their risk is three to four times that of someone who has a normal intake of sodium. So there are studies that have shown the significant risks of kidney stone formation in patients who eat too much sodium and drink too much soft drinks.

Interviewer: And the more of those things you do, it just keeps building upon that multiplying and multiplying

Dr. Faerber: Right.

Interviewer: So if you drink sugary stuff but, boy, I'm in the sodium and sugary stuff, that just means I have even more of a chance.

Dr. Faerber: That's exactly right. Which factor is the most important is unclear at this point, but certainly, if you have a family history, you're overweight, you drink sugary drinks, high sodium, you're at significant risk of forming a kidney stone.

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Interviewer: What should you do if you have a case of diarrhea? We're going to find out next on The Scope.

Announcer: This is From the Frontlines, with emergency room physician Dr. Troy Madsen on The Scope.

Interviewer: Dr. Troy Madsen is an emergency room physician at University of Utah Health. Let's talk about diarrhea and what should somebody do if they start having diarrhea? Should they be taking some medication? Should they be going to see their doctor? When should they start worrying?

Dr. Madsen: So diarrhea is obviously not the most pleasant topic. It's something probably all of us have dealt with at some point or another. But it's one of those things where you kind of have to give it time. And we do occasionally have people who come to the ER who have had diarrhea for say 12 hours or so. And they're very concerned. And they don't look particularly dehydrated, they've been able to drink plenty of fluids and stay hydrated. They don't have other medical issues that would make them more likely to get really dehydrated. So those are the kind of situations where you know, you really want to give it some time to see what happens.

Because most cases of diarrhea, assuming it's from some sort of a bug or maybe something you ate, are going to get better within 24 hours. Maybe they'll last two days, maybe up to three days, but even if someone comes to the ER and they said, "I've been having diarrhea for two or three days." And I look at them and it's not like their lips look really dry and their eyes look sunken or they look like they're just really dehydrated. And they're not the kind of person who has lots of medical issues that would make them more likely to get dehydrated. I say, well, not a lot of testing we really need to do here. We don't really need to test for really unusual infections. You're probably going to get better within a day and usually it does.

So if you're someone who has diarrhea I'd say, give it a couple of days. Keep drinking fluids. You can try drinking electrolyte drinks. Those might help and make a difference. You're not losing lots of electrolytes, which can be an issue. But if it's gone on for longer than that.

If you're getting beyond three days and maybe into four or five days and maybe you've been camping recently. Or you've been swimming in mountain streams or lakes or drinking from mountain streams. Or you have a new pet. Or you have a pet turtle you found out while you were traveling and you pulled it out of a stream. These unusual things that would set you up for something more serious like giardia or salmonella. Things where we start to think about unusual infections. Those would be cases to come to the ER or see your doctor and get tested for that.

Interviewer: So generally, up until about two days, if somebody came into the ER you wouldn't run many tests if they looked healthy and they weren't at high risk of something else, you just have them wait and see?

Dr. Madsen: Most likely. I mean the reality of the ER there is the dynamics of the ER where the fact that someone comes in the door they often just get testing done. But it's typically not really necessary.

Interviewer: So if it was a family member you would say just wait it out for another day or so?

Dr. Madsen: I would. If a family member called me and said I've had diarrhea for a day or two I'd say wait it out. I would ask them has it been bloody diarrhea? That raises concern for me. But most of these cases people are just having kind of normal diarrhea. Just frequent bowel movements. Watery, they're not describing blood in their bowel movements. If you're seeing those sorts of things, that's going to change things a bit. But, typical diarrhea. Give it a couple of days.

Interviewer: Would you recommend taking any sort of antidiarrheal?

Dr. Madsen: If we're worried about an infection like salmonella. So those unusual cases where let's say you've had recent foreign travel or you have had recent exposure to mountain streams and you're drinking from mountain streams or swimming in lakes. There we're hesitant to say use something like Imodium. Just because people that have those infections can then become chronic carriers of the disease or it can make things worse. But in the average case of diarrhea where those are not a concern, I think Imodium is perfectly fine. I don't think there's a problem at all. If it can help you get through the day, get through work, whatever you have to do. No issues with that.

Again we're talking here about the average person who doesn't have a lot of medical issues. Times where you would be more concerned about diarrhea. Even after a day or two would be . . . If you do have some medical problems that make you more prone to dehydration. Maybe you take a water pill. Something for heart failure or for kidney issues that takes water off. And then you're losing fluids because of diarrhea. Maybe you then start to feel light headed. Or you're dizzy. These would all be things where I would say where I would say yeah, you need to come to the ER. You may need some IV fluids. We may need to rehydrate you.

Also, very young children. If they are really just not taking fluids well. When they cry, they're not making tears. Their eyes look sunken. You look at their mouth, their lips look dry. Again, reasons to go to the ER even after maybe even 12 to 24 hours of diarrhea.

Interviewer: Sounds like in the common cases it's dehydration you're most worried about?

Dr. Madsen: Exactly, dehydration and then along with that electrolyte abnormalities where you can lose electrolytes with the diarrhea.

Interviewer: All right, so watch out for those things. Think about, have I done anything strange or unusual recently that might be the cause of this that could be a little bit more insidious. Otherwise just wait it out.

Dr. Madsen: Exactly, give it some time. It'll run its course. You'll probably get better within a day or two.

Announcer: Have a question about a medical procedure? Want to learn more about a health condition? With over 2,000 interviews with our physicians and specialists, there’s a pretty good chance you’ll find what you want to know. Check it out at TheScopeRadio.com.

updated: May 30, 2018
originally published: September 6, 2016

Interviewer: Coming up next we're going to talk about a common hiking hazard and how to make sure it doesn't happen to you. That's next on The Scope.

I want you to think about it. When you go hiking, what problems do you normally run into? Maybe sore feet, tired legs, blisters. Pretty common problems, but today Dr. Emily Harold, a sports medicine specialist at University of Utah Orthopedic Clinic, is here to tell us about one of the more common hiking problems that isn't something that a lot of people really think about, and that's dehydration. And when I heard about this I'm like, "Really? Dehydration? Don't we all drink enough water? It seems like everybody's got a bottle of water."

Dr. Harold: Well, I think we all drink some water. I think that we don't all drink enough water. I mean, I think that we are blessed to live in a great state that has an amazing climate, and it's a very low humidity climate. And because it's a low humidity climate, when you're outside and it's hot outside and the sun's beating down, a lot of times your sweat dries quicker and you don't really realize how much you're sweating. And it can almost be pleasant when it's 80 degrees outside in this environment versus 80 degrees in Houston, Texas, in which case everybody knows they're sweating.

And so a lot of times people are sweating more than they realize and they're losing more water than they realize and they don't replenish enough, and that can lead to headaches, and tiredness, and in extreme forms can even lead to things like heat exhaustion, heatstroke, which can cause a lot of damage over time.

Interviewer: So if I was just going out for like an hour or two hike, do I really need to take water? Is that enough time to start getting symptoms of dehydration?

Dr. Harold: It's enough time. We would recommend at least a quart an hour. So if you're going to go out for a two-hour hike, one, we recommend probably drinking a liter before you go. And then while you're out, at least a quart an hour while you're out. More if you are running, trail running, doing activities that are more than just walking.

Interviewer: You've covered more endurance-based events like marathons and whatnot, and you say that it can really be common in those events. Explain that a little bit.

Dr. Harold: It's a common problem. A lot of times in marathons, people are out on the course for four, five, six hours. On a hot day, they don't drink enough fluid when they're out running and a lot of times when they come in after they cross the finish line, they can have some dangerously high body temperatures, 103, 104, 105. And so we really kind of institute a rapid cooling part and we try to give IV fluids for hydration, but it's very important that you drink enough water, especially when the temperature gets up above 70.

Interviewer: And when that sun's out, is it even worse?

Dr. Harold: Yeah, because the sun dries the sweat off a little quicker, and so you don't get the same cooling effect as you get when it's a little cloudier.

Interviewer: So drinking water, very easily preventable of dehydration. What about extra salt in those situations?

Dr. Harold: It is recommended that if you're out for more than an hour that you do ingest some salt.

Interviewer: Really? And above and beyond what I would normally get in my diet?

Dr. Harold: I think that's why trail mix became so popular. Because people realized if they went walking for a long time, that salt that comes from peanuts and that kind of thing can actually help to retain some of that water that you're drinking, and that helps to replenish their water stores a little easier.

Interviewer: Gotcha. And then also we're talking about kids. If you go out hiking for a couple hours with kids, that has a different effect on a kid than it might an adult.

Dr. Harold: Exactly, and if you're like my kids, you like to run ahead and you're constantly exploring. So you're not drinking water and no matter how much you tell them to drink water, by they time they're to start drinking when they're thirsty, they've already gotten a little bit dehydrated. So it gets really important just to watch your kids' water bottles. I usually recommend bringing a water bottle for each kid and having them drink from it, so you can monitor how much they're consuming.

And if you get somewhere and you realize they haven't really drunk very much water at all, then you can push their fluids a little bit just to keep them from getting dehydrated.

Interviewer: How often does heat exhaustion and heatstroke really lead to things? I mean is that not too common, more common than I might think?

Dr. Harold: I think both. I think we'll see a lot of hyperthermia or high temperatures sometimes in the emergency room. Usually if you catch them early and you cool people quickly, it doesn't lead to bad outcomes. Now if you have someone who is in Canyonlands or Moab and gets lost and wanders, that's something that can lead to heatstroke and it can lead to some, exactly, brain injury.

Interviewer: Just kind of wrap up, then, for myself or for my kids, what would I look for for symptoms to indicate they need to be drinking more water? Or is it just monitor water drinking?

Dr. Harold: I think it's easy enough to monitor water drinking. A lot of the symptoms are kind of difficult. Things like fatigue, they get that when they hike anyway. Headache is a common one. So if your child or you notice that you are starting to get a headache when you're walking, a lot of times that's because you're dehydrated. So that's the earliest one.

Interviewer: So in that instance drink water, get out of the sun for a little bit, rest for how long?

Dr. Harold: Exactly. Find a shady spot.

Interviewer: How long would you want to rest for?

Dr. Harold: Some people find a shady spot, drink some water, you want to rest for probably a good 10, 15 minutes until you start to feel better.

Interviewer: Yeah, and that will start to go away. And then you're fine to go back out again?

Dr. Harold: Absolutely.

Interviewer: I mean, this seems just like one of those topics that I don't think a lot of people think about and a lot of people don't think is really all that serious in their life.

Dr. Harold: Yeah, I think that's my final thought. It's something that I know I could do better at and most of us can do a better job of hydrating, but it is something that can lead to problems and it does make for a much more comfortable walk if you're properly hydrated.

updated: June 16, 2021
originally published: August 24, 2016

Dr. Gellner: Old wives' tales about food and drinks, we've heard them all. I'll clear up which ones are true and which ones are not on today's Scope. I'm Dr. Cindy Gellner.

Announcer: Keep your kids healthy and happy. You are now entering The Healthy Kids Zone with Dr. Cindy Gellner on the Scope.

Dr. Gellner: Number one, feed a cold and starve a fever. False. Both high fever and colds can cause fluid loss, and drinking plenty of fluids can help prevent dehydration. And with both fevers and colds it's fine for your child to eat whenever they want and whatever they want. But don't be surprised if your kid doesn't want to eat at all. As a parent, you don't eat either when you're sick. They'll eat when they're ready. Hydration is more important.

Next, wait an hour after eating before going swimming. No. According to the American Red Cross, it's not necessary for anyone to wait an hour after eating before going in the water. However, if your child had a big fatty meal and they're on a swim team and have a meet, it might be a good idea to let their food digest some. No one wants puke in the middle of the pool. The Red Cross also advises against chewing gum or eating while in the water. Your child could choke.

Next, coffee stunts your growth. That's false. In that coffee won't affect your child's growth, but too much caffeine doesn't belong in a child's diet anyways. Not to mention the acid in coffee and what it does to their sensitive stomachs. Coffee and caffeine can prevent the absorption of calcium and vitamins as well. So don't just give it to them.

Fish is brain food. This one is true. Fish is a good source of Omega 3 fatty acids and it's been found to be very important in brain function. Certain fish like tuna however, have significant levels of mercury, which isn't good for kids either. So keep those fish down to once a week.

One we've all heard, chocolate causes acne. Thank goodness this one's false. Although eating too many sugary high fat foods is not a good idea for anyone, studies show that no specific food has been proven to cause acne.

Spicy food can cause ulcers. Yes and no. Spicy foods may aggravate ulcer symptoms in some people but in kids they're more likely to cause indigestion.

While these are old wives' tales, remember, eating a healthy diet is never old advice.

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Interviewer: A lot of us when we go hiking or camping take a first aid kit, but what are the three most important things that you should have with you at all times, like if you were on a desert island of hiking and space was a consideration? We'll find out next on The Scope.

Announcer: Medical news and research from University of Utah physicians and specialists you can use for a happier and healthier life. You're listening to The Scope.

Interviewer: Dr. Troy Madsen is emergency room medicine at University of Utah Healthcare. Let's talk about the three things that you would absolutely want to have with you if you were out in a wilderness situation?

Dr. Madsen: Three things I'd want to have with me, and I've thought about this because you always think about this whole desert island scenario. Who knows if any of us will ever be on a deserted island, but for whatever reason we always like to think of these scenarios. I've thought, knowing what I know and doing what I do, what are the three most useful things I would like to have? There are three things.
Number one is an antibiotic. This antibiotic would be one that typically is going to treat skin infections or pneumonia or even a urinary tract infection, just the common things. If I had to name one I'd probably name levofloxacin. That's a common antibiotic we use for pneumonia. It can also help with skin infections if I were to get a skin infection there and also with urinary tract infections, so kind of some of the more common things. That's one of those things if you're out on your own and you've got access to no medical resources that can make a huge difference and potentially could save your life if we're talking a very severe infection where you can't get medical help for an extended period of time, for days or weeks. That would probably be the first thing.
The next thing would be a nausea medication. There's one called Zofran. The generic name is Ondansetron. This is one that used to be used a lot for chemotherapy patients, but has become much cheaper. It's essentially very cheap now just in pill form. It requires a prescription, but it's one of those things where if you had vomiting and were very sick, this could make a huge difference. Just being able to take one of these pills, you're going to prevent yourself from severe dehydration and a lot of the complications that come from that.
The last thing would be something for lacerations or injuries that come up. In my mind, I'd kind of think maybe some sutures where I could stitch myself up. But the thing that's super easy to use for lacerations that aren't huge but are still pretty big is something called Dermabond. That's the brand name, but quite honestly, Dermabond is nothing more than super glue.

Interviewer: Really?

Dr. Madsen: It's just super glue. They just changed it a little bit so it doesn't sting as much, but it's the same stuff. I would just take a tube of super glue. You can use that on a wound, or personally I would carry Dermabond just because I've used it. If you have a wound, even if it's a gaping wound, you can just wash it out really well, hold the edges together, put a line of this stuff over it and it dries within 30 seconds. Put another line to kind of hold things together, and you could make a big difference for a laceration, potentially preventing complications and infection just by having this available.

Interviewer: Wow, it sounds like when you're out the three big concerns, I think this is telling in another way, are dehydration because of some sort of a stomach issue, infections and infections again.

Dr. Madsen: And injuries and lacerations. Yes, exactly. I figure a lot of the other stuff. You think, "Okay. What if I broke my arm?" Well, you've got sticks out there. You could make a splint.

Interviewer: You could make a splint.

Dr. Madsen: You could do that. That's the sort of thing you could deal with. It's always hard to say. There are other things that would be nice to have, like maybe an ace bandage or some Band-Aids and that, but I can make do with that. These are the three things I've thought it would be great to have these things if I ever needed them and were ever in a situation out in the middle of nowhere and needed them. These can make a huge difference.

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Interviewer: You're out camping, hiking, or something like that, and that water in that stream looks so refreshing, but you hear that you shouldn't be drinking it. Well, should you? We're going to explore that next on The Scope.

Man: Medical news and research from the University of Utah physicians and specialists you can use for a happier and healthier life. You're listening to The Scope.

Interviewer: Is it okay to drink stream water if you're out camping or something like that? We're with Dr. Troy Madsen, Emergency Medicine at the University of Utah Hospital. We hear that it's bad. You should always take your own water. But is it? Do you see a lot of people visit in the ER for something like that?

Dr. Troy Madsen: I've rarely seen it. It's one of those things I've heard the same thing, and I certainly take the precaution where I don't stream water. Maybe that's why we don't see people because they're not drinking stream water. We don't see a lot of people. I've rarely seen anyone in the ER. I have heard of a few cases of people who drank some stream water or lake water and then came to the emergency department with profuse diarrhea, which is often what you get a week or two later.

Interviewer: That's the big thing?

Dr. Troy Madsen: Yep. That's the big thing you get. But, again, I don't see it a lot, and it's probably because I think the risk is not really high, but the risk is there. It certainly is there, and the big thing we're worrying about is Giardia.

Interviewer: okay.

Dr. Troy Madsen: That's something you can pick up from stream water or lake water. That's often the issue, and that's why we hear that, "Don't drink stream water or lake water."

Interviewer: All right. So we're not encouraging that you do it, but at this point, in your opinion, if worse came to worse and you needed to have water, is it probably okay?

Dr. Troy Madsen: Yeah. If I were out somewhere and I needed water and I just felt like the thirst was going to affect my ability to get out of an area or hike out, I would drink the water. We're talking either about the immediate danger of severe dehydration versus the risk of an infection that's not going to hit you for one to two weeks, and that can typically be treated with antibiotics. So if I had to weigh the risks, I would err on the side of that infection.

Interviewer: That's interesting. Is there anything else to consider? I feel like this conversation is almost done.

Dr. Troy Madsen: Well, it's a great conversation to have, you know. If you ever are out hiking or backpacking, the best to have is just carry some iodine tablets. I like to do some trail running, and just in the little handheld water bottle I carry, I've got a little packet with a couple of iodine tablets because I figure if I'm out somewhere in the mountains and there's a water source there, but I'm too far away to really refill my bottle and I need some water, that's some option.
It's easy to do. That's going to take care of most things. So it's very simple. You can also carry water filters, which are very simple. They're very small to fit in your backpack. Those are nice because you just drop something in the water, you pump it, and it brings out water right into your bottle. And that stuff is great. You can drink that stuff, and that's going to filter pretty much everything out that you would be concerned about.

Interviewer: So as I'm weighing the risks versus maybe the need to drink water, are there other risks that are out there than Giardia?

Dr. Troy Madsen: There's one called Cryptosporidium as well. That's a risk there. We think of that probably a little bit more with people who may have some immune system issues, certainly someone who might have HIV or are on chemotherapy. Anything that's going to affect your immune system there, you have to take extra precautions.
But Giardia is typically the big one. That's often what we think about with really kind of the classic case of someone who drank some stream water, comes to the ER, sees their doctor a week later just saying that they're just having profuse, watery diarrhea. That's usually the big risk.

Interviewer: Is that caused by dead animals in the water?

Dr. Troy Madsen: Usually. That's often what we think about. Maybe animal feces or a dead animal, some sort of source. And obviously, when you're in the mountains, you might see this crystal, clear spring and think, "This is just fine." But who knows what's upstream from that.

Interviewer: Just ten feet away.

Dr. Troy Madsen: Who knows, right? Who knows what's right around the corner or in, you know, the small mountain lake that's then the source of that? You know, you never know what could be in there that could be a source of infection. So you can't trust it just based on how it looks.

Interviewer: And iodine is enough to take care of it?

Dr. Troy Madsen: Yes.

Interviewer: Take care of most problems that we would run into here in the United States?

Dr. Troy Madsen: It is. Yeah. If you've got iodine tablets with you, you should be safe. Again, if you've got immune problems, reconsider. But for most of us, iodine tablets are going to make things just fine.

Man: We're your daily dose of science, conversation, medicine. This is The Scope, the University of Utah Health Sciences Radio.