Summers like the one we're having in central New York make me reminisce about the cool winter days in January, when all I complain about is how much snow we've gotten. Just like medical issues related to the extreme cold, extreme heat causes its own problems.

Heat related illnesses come in a spectrum from mild, to moderate, to severe and life threatening. Heat cramps are the first manifestation of heat illness and usually occur as brief pains or spasms in the larger muscles of the calves, thighs or shoulders. They are often related to exercise or working in a hot environment especially if you are not used to the work. The cramps occur because we lose not only water and become dehydrated, but also because we lose electrolytes (sodium, potassium) in our sweat.

The best way to deal with this problem is to make sure you are taking in plenty of cool fluids (sports drinks are very good for replacing salts as well). It is also important to take periodic breaks particularly during the hottest part of the day.

Heat exhaustion is the next stage of heat related illness. The body needs sweat to evaporate in order to cool down. When the humidity is high (70 percent and up) the normal cooling mechanism of sweating malfunctions and a person's body temperature can start to rise. This results in a mild form of shock. People often complain of headache, weakness, nausea and extreme thirst. They may feel faint or even pass out. A person with heat exhaustion may be extremely sweaty or may feel cool and clammy. Treatment involves resting in a cool area out of the sun. Replacing fluids is the most important aspect of treatment and once again replacing salt is essential. As noted above, salt can be in the form of a sports drink but can also be taken in from salty foods or snacks along with plain water. Anyone who has lost consciousness should be taken to a physician immediately. A physician should also evaluate anyone suffering heat exhaustion that cannot take in fluids.

Heat stroke is a medical emergency. At this point the body's cooling system is totally ineffectual and body temperature can rise more than 105 degrees causing brain damage or damage to internal organs. Classic heat stroke occurs in newborns and the elderly over the course of days where there is just not adequate fluid intake compared to losses due to sweating. Exertional heat stroke occurs in healthy individuals who are overexerting in a very hot environment. These people are often flushed with hot, dry skin. They are often confused, dizzy or even unconscious. The primary action physicians will take is lowering core body temperatures, often by immersing the person in an ice bath.

Certain medications will predispose a person to develop heat illness because of the way they affect the body's ability to cool off or by causing mild dehydration. These medications include many allergy medicines (antihistamines), blood pressure medications (beta-blockers, calcium channel blockers, water pills), laxatives, diet pills, medicine for bladder incontinence, sedatives and some older antidepressants (amitriptyline, nortriptyline). You should certainly not stop taking these medications just because it is hot outside, but you should inform your physician if you've been overexerting yourself in hot weather and are noticing any of the symptoms mentioned above.

The most important step to prevent heat-related illness is to stay in air conditioning whenever possible, particularly during the hottest part of the day.

Drink plenty of fluids throughout the day. And if you're fortunate enough, go for a swim. For now, we can just dream of my December article that will discuss frostbite.

Dr. Davidd Levy is a physician in Auburn. He can be reached at 282-0525