Травма от перегрева: как ударная жара навсегда меняет жизнь спортсменов

- Share via After an hour or two of running sprints and drills on the track with fellow high school volleyball hopefuls, Rebecca Ochoa realized she couldn’t see straight. It was a hot August day in Texas, and they’d had only limited water breaks. The coaches at Madisonville High School urged Ochoa to do one more lap. The 13-year-old stumbled forward and collapsed, her body overwhelmed by the heat. Ochoa had experienced heatstroke, the most dangerous form of heat illness, and it wreaked havoc on her body. She developed a severe related condition called rhabdomyolysis, in which muscles break down, and doctors were concerned about possible kidney damage. She was hospitalized for about two weeks. That was 11 years ago. “I am still not the same as before this happened, physically or mentally,” Ochoa said. “I constantly battle dehydration, fatigue, nosebleeds, and even passing out during the warmer months.” She never returned to volleyball. Madisonville High School referred questions to the Madisonville Consolidated Independent School District, which declined to comment. Extreme heat has been linked to half a million deaths worldwide each year. It’s one of the leading causes of weather-related deaths in the U.S. and contributes to more than 100,000 emergency department visits in the country annually. But many people still think of heatstroke as a short-term event: You overheat, then you cool off. It’s true that the damage depends on how quickly and thoroughly the person suffering can be cooled. But for those fortunate enough to survive, recovery can be far from straightforward. And as climate change increases exposure to dangerous heat, more people may encounter the grim truth Ochoa already knows: The effects aren’t always temporary or reversible. Heatstroke survivors told Bloomberg News of physical recoveries that stretched for weeks or months. “There are people that, unfortunately, barely survive heatstroke and then they’re paralyzed or disabled for the rest of their life,” said Rebecca Stearns, chief operating officer of the Korey Stringer Institute, a nonprofit named after a Minnesota Vikings player who died from exertional heatstroke in 2001. Proper cooling Heatstroke occurs when the body heats up and can’t cool itself down. A warming world is putting more people at risk. About 40% of children worldwide now experience an extra month of heat stress a year because of climate change, more than other age groups, according to a study published this week in Science Advances. Because their bodies are still developing, children may be especially vulnerable to long-term effects from heat exposure. Whether or not it’s from exertion, as Ochoa’s was, heatstroke can cause confusion, dizziness, headaches and loss of consciousness. People can recover well, experts say, so long as their body doesn’t remain at dangerous temperatures for too long and they receive proper cooling. When this doesn’t happen, “the membranes of the cells start to come apart and everything just starts to fail,” said Debra Hendrickson, a Nevada-based pediatrician who wrote a book about how climate change threatens kids’ health. “That’s why you start to see organ damage — the brain, the heart, the kidney, the liver.” Research has found that going without cooling really increases the chance of complications. Heat exposure has been linked to chronic kidney disease among young farmworkers. William Martinez, 34, once worked in the sugarcane fields in and around Chichigalpa, Nicaragua. “We saw how our families, fathers and uncles cut sugarcane, fell sick, and eventually died of chronic kidney disease,” he said through a translator. “Our thought pattern was, ‘We’re going to cut sugarcane, fall sick and die.’” He now works with the nonprofit La Isla Network to protect workers from heat illness. Ochoa doesn’t remember much about what happened between losing consciousness at school and waking up in the hospital, but others have filled her in. The volleyball coaching staff initially put ice packs on her body, including under her arms, to no effect. Then the school’s football coaching staff intervened and transferred her to an ice bath that had been prepared for the football players. Ochoa believes that move probably saved her life, but doctors worried she could develop kidney issues. She experienced muscle breakdown in the days that followed. The experience also led her to transfer high schools. The treadmill test No two cases of heatstroke are the same, and there’s no single path to recovery. Patients should spend the first two weeks resting and undergo bloodwork to track how key organs like the liver and kidneys are functioning and monitor for signs of potentially life-threatening muscle breakdown, Stearns said. If all is well, they can begin low-intensity activities in a cool environment, gradually working up to higher-intensity exercise in the heat. To determine whether patients are ready to ramp up, the Korey Stringer Institute administers a two-hour walking test. The pace is relatively slow, but the conditions are extreme: 104-degree heat and 40% humidity. Testers monitor whether participants’ heart rate and body temperature remain stable, including whether their temperature stays below about 101, according to Stearns. Months after her heatstroke, Ochoa tried a version of this test and couldn’t finish. KSI gave her guidance on how to improve her heat tolerance, but she never tried the test again. “I did all the tests and they were brutal,” she said. The experience showed her how much her body had changed. Access to structured recovery can vary dramatically. Members of the military and sports teams typically have the most resources, while people exposed to heat through jobs such as construction or farmwork may have far less support. Heatstroke patients aren’t always sent to occupational therapy because of an absence of standardized rehabilitation policies, a Japanese study published last year concluded. “More research is needed to understand the long-term course and to identify which patients are most likely to have lasting disability,” lead author Masayoshi Seki wrote in an email. Ryan Swoboda had access to some of the best recovery resources — and even for him, getting back to normal took months. In 2017, at 18, he collapsed in the heat at a football practice for freshmen on his third day at the University of Virginia. His temperature reached 109 in the ambulance. He was placed in a medically induced coma for three days and hospitalized for 19. It took about four months, he said, before he began to trust his body again. Swoboda still wanted to go back to football. Fortunately, he had the backing of the university’s athletic staff to help him. At first, he said, “all I would do was I’d walk on the treadmill for 10 minutes at a time.” Slowly, he worked his way up to running indoors and then outside. Before workouts that summer, he swallowed a pill containing a temperature sensor so staff could track his core temperature as he pushed closer to his limits. He also regularly visited KSI to see whether his heat tolerance was improving. He failed the institute’s treadmill test three times before passing on his fourth attempt. Only then was he cleared to put his shoulder pads back on — 13 months after collapsing. He went on to play five years of college football and two years professionally in the NFL. The incident didn’t just change Swoboda’s approach to heat — it also changed UVA’s. In the immediate aftermath, Swoboda recalled, the school expanded use of its core-temperature monitoring during football summer training. More significant, he says, it “empowered athletic trainers to pull players who showed signs of heat illness.” While the latter is still true today, the pills are no longer part of the program’s protocol after the company that made them went out of business, said Scott Fitzgerald, UVA’s director of athletic communications for football. But the program has evolved in other ways. “The size of the department’s nutrition staff has since increased, allowing for much more consistent hydration testing,” Fitzgerald said, adding that this is now the department’s primary way of preventing heat illness. Even people who appear to recover from heatstroke may face health complications later on. A 2018 study that tracked survivors of classic heatstroke found that 12 years later they had 3.5 times the rate of ischemic heart disease, the most common form, compared with people without a history of heat illness. Another study linked heatstroke to increased risks later on of heart attack, other heart problems and chronic kidney disease. Both Ochoa and Swoboda remain vigilant about the heat, taking steps to prepare for hot weather and paying close attention to how their bodies respond. Swoboda, who now lives in Florida, volunteers as a high school football coach. Whenever he notices a player struggling through a drill in the heat, he pulls them aside to take a break: “The biggest thing is not that you finish this drill,” he tells them. “It’s important and tomorrow I expect you to finish. But today we want to make sure you’re here tomorrow.” Court and Hirji write for Bloomberg.