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Rangers Player Suffers From Energy Drink Ailment

Rangers Player Suffers From Energy Drink Ailment


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Vision problems from too many sports drinks force Josh Hamilton to quit the field for the week.

Josh Hamilton, an outfielder for the Texas Rangers, has been diagnosed with what some are calling one of the strangest sports injuries of all time: vision problems resulting from overconsumption of energy drinks. Hamilton, who left the game against the Angels on Tuesday, September 18th, had been complaining of dry eyes and impaired eye movement as early as last year. When his playing became seriously affected in the past week, he left his team on the road and returned home to Texas for a diagnoses: a condition called ocular keratitis.

Ocular keratitis, which causes a drying of the corneas, is said to be caused by excessive consumption of caffeine found in coffee and sports drinks, both of which Hamilton was drinking large amounts on a regular basis. The condition, also known as “Highway Hypnosis,” is a diagnosis usually reserved for long-term truck drivers who rely on caffeine to keep them alert on the road. Treatments include reduced caffeine intake and use of eye drops.

Last night, Hamilton returned to the field to face off against the Athletics. His new drink of choice? Water.


Uni student left in intensive care after four cans of energy drink a day

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May: We will look into an energy drinks ban for under 16's

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The 21-year-old man spent nearly two months in hospital as worried medics considered performing a heart transplant. He suffered the effects of downing two litres of energy drink each day for months, a case report in the British Medical Journal states.

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The man, who described his ordeal as 'traumatising', sought medical help after suffering from shortness of breath and weight loss for around four months.

He'd even experienced heart palpations, reports Manchester Evening News.

Blood tests, scans, and ECG readings revealed the student had both heart and kidney failure &ndash with the kidney failure linked to a long-standing and previously undiagnosed condition.

Doctors said that "energy drink-induced cardiotoxicity" was the most likely cause of his severe heart failure, with each can of energy drink the man was consuming containing around 160mg of caffeine.

The authors of the report noted that in the three months prior to his hospital admission he was unable to continue his university studies due to his lethargy and feelings of ill health.

Supermarkets sell a range of energy drinks (Image: PA)

In the report, the authors from Guy&rsquos and St Thomas&rsquo NHS Foundation Trust wrote: &ldquoWe report a case of severe biventricular heart failure potentially related to excessive energy drink consumption in a 21-year-old man."

The man had no medical history other than excessive intake of energy drinks, they said, adding that their conclusion "adds to the growing concern in the literature about the potential cardiotoxic effects of energy drinks".

The report stated that the man's heart function appears to have returned to normal with &ldquomildly impaired function" nine months later.

The recovered patient added his own thoughts to the article, describing his time in he intensive care unit as "extremely traumatising", and called for more warning labels on the drinks.

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The student wrote: &ldquoWhen I was drinking up to four energy drinks per day, I suffered from tremors and heart palpitations, which interfered with my ability to concentrate on daily tasks and my studies at university.

&ldquoI also suffered from severe migraine headaches which would often occur during the periods when I did not drink energy drink this also restricted my ability to perform day-to-day tasks and even leisurely activities such as going to the park or taking a walk.

&ldquoI think there should be more awareness about energy drinks and the effect of their contents.

&ldquoI believe they are very addictive and far too accessible to young children. I think warning labels, similar to smoking, should be made to illustrate the potential dangers of the ingredients in energy drink.&rdquo

It comes after a separate study, published in the journal Plos One, highlighted energy drink intake among teenagers.

Academics at Cardiff University analysed the responses of a health survey of more than 176,000 secondary school children in Wales aged 11 to 16.

The data, drawn from responses between 2013 and 2017, show that six per cent of pupils said they drank energy drinks on a &ldquodaily&rdquo basis &ndash a trend which didn&rsquot change over time.


What Happened at Pease River Wasn’t a Battle. It Was a Massacre.

How a Texas Ranger’s personal mythology came to be accepted as popular history.

Early accounts of the Battle of Pease River read like Hollywood film treatments from the fifties. A dashing young hero, Sul Ross, led a small force of Texas Rangers, U.S. cavalry troops, and militia volunteers into combat against a much larger group of Comanche warriors led by legendary chief Peta Nocona. It was 160 years ago, on December 19, 1860—a frigid, blustery day—and the Rangers’ coalition had the element of surprise on its side. “The attack was so sudden that a considerable number [of Comanche] were killed before they could prepare for defense,” Ross said years later, in a statement supplied to historian James T. DeShields.

According to narratives popular at the time, after they defeated the warriors, Ross and another Ranger, Tom Killiheir, pursued Nocona, a girl, and a woman holding a toddler as they fled on horseback. Ross killed the girl and injured Nocona, then ordered his Mexican servant to dispatch him with a shotgun. Killiheir, meanwhile, captured the other woman, whose name was Naduah, and her young daughter.

Naduah later told the Americans that she was born Cynthia Ann Parker. Twenty-four years earlier, as a child, Parker had been kidnapped during a bloody raid at her family’s compound in Limestone County, thirty miles east of Waco: she was the best-known white captive on the Texas frontier. But by 1860, then in her mid-thirties, she had become a Comanche. She was married to Nocona and was the mother of three children, including Quanah Parker, who later became a notable Comanche leader and reservation chief.

The attack, and especially the Rangers’ capture of the woman who had been Cynthia Ann Parker, was big news in Texas. The event made Ross, just 22 years old, famous. “So signal a victory had never before been gained over the fierce and war-like Comanches,” DeShields wrote in his 1886 book Cynthia Ann Parker: The Story of Her Capture. “The great Comanche confederacy was forever broken.”

Building on his Pease River exploits, Ross went on to serve as a Confederate general, a Texas state senator, a two-term governor, and the president of what is now Texas A&M University, the position he held when he died in 1898 (Sul Ross State University was also named after him). Ross was inducted into the Texas Ranger Hall of Fame for his “skill and courage.” But as the popular Pease River narrative has been reexamined in light of long-ignored accounts and other evidence, so has Ross’s heroism.

On a sunny morning this past fall, I left Wichita Falls and traveled northwest to the confluence of Mule Creek and the Pease River, in Foard County, to meet Ron Parker, the great-grandson of Quanah Parker and the great-great-grandson of Naduah and Peta Nocona.

I wanted to see firsthand the site of this Texas legend, but once I arrived, it did not appear especially monumental. The Pease was not unlike the rivers I grew up around on the plains two hundred miles to the north. The soil ranged from red clay to sand, and the tracks of coyotes, feral hogs, and cattle marked the river’s banks along its slow-flowing saline waters. Nearby, thickets of mesquite and invasive salt cedars hugged Mule Creek, a spring-fed stream.

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Parker and I followed the cattle trails near the creek and river. We stopped only once, when we flushed about twenty wild turkeys from the brush. As we walked on, Parker shared the version of the “battle” he’d been taught by the Comanche.

“Pease River was a Ranger-led massacre,” Parker told me. His great-great-grandfather Peta Nocona, he said, was nowhere near the action. “At the time, Nocona was with his teenage sons Quanah and Pecos and other warriors.” Nocona died several years later near the Antelope Hills in Oklahoma, Parker said. “He died of an infection.”

Parker, a Vietnam War vet, is also director of the Quanah Parker Society, headquartered in the nearby Hardeman County town of Quanah, named after his great-grandfather. His version of events definitively contradicts Ross’s story and accounts in history books. (The same account Ross provided DeShields also appears in John Wesley Wilbarger’s Indian Depredations in Texas, published in 1889, which the Texas State Library and Archives Commission deems “a valuable chronicle of the decades-long battle for control of Texas,” even though the book “harshly condemns the Indians and makes no attempt to consider their point of view.”)

The more materials I gathered on the events at Pease River, the more credible Parker’s version seemed. In an interview in 1928, one of the Rangers who took part, Hiram B. Rogers, also described a massacre: “I was at the Pease river fight, but I’m not very proud of it. That was not a battle at all, but just a killing of [women].” I wondered how a massacre had been inflated into a great Ranger victory. I would soon learn that Ross himself was largely responsible.

Illustration by Christopher DeLorenzo

Twice Kidnapped

Naduah died in 1871, eleven years after being recaptured. “The dour Parker people to whom she was restored were utterly alien to her,” wrote J. Frank Dobie in 1926. “She belonged to the Comanches, to her children, and to nomadic life on the plains. She died of grief.

Born in 1838, Lawrence Sullivan “Sul” Ross grew up mostly in Waco, which was, at the time, on the Texas frontier. In 1858, Ross led a Native American auxiliary, comprising members of nations friendly with European Americans and hostile to the Comanche, which supported U.S. cavalry troops that fought the Comanche. Ross suffered serious arrow and bullet wounds in a battle near a village of the Wichita people. He reported that the Comanche who shot him was named Mohee—a name Ross would later use in an account of Pease River.

Ross completed a college degree in Alabama while he recovered from his injuries. Back in Texas in early 1860, he joined the Rangers just in time to captain a group from Waco in a notoriously inept campaign, led by Middleton Tate Johnson, to fight the Comanche. Poorly equipped and “mismanaged from the first,” in the words of historian Walter Prescott Webb, the expedition failed to defeat the warriors. Many of the Rangers drank heavily. Johnson even left his command for a while to get married in Galveston.

The Johnson campaign left a blot on Ross’s record—one he may have been anxious to remove. Later, in 1860, he got his chance when Governor Sam Houston appointed him to raise a Ranger company to pursue Comanche who had been raiding white settlements. He recruited forty men. About twenty U.S. cavalry troopers complemented the Rangers. They were also joined by around ninety local militiamen.

The subsistence farmers on the frontier of the 1850s feared the Comanche. Just a few decades earlier, the Comanche had ruled over most of what is now the Lone Star State, though you won’t see its empire represented among the “six flags over Texas” coats of arms at the Capitol. The Comanche were warlike and fiercely protective of their turf. They were also entrepreneurs who built a plains economy around their prowess in buffalo hunting and horse breeding. Skilled Comanche diplomats often bested the Spanish and French in negotiations, and their traders dominated fairs in New Mexico and Louisiana.

At the turn of the nineteenth century, some 40,000 tribal members inhabited Comanchería, which stretched across a broad swath of Central Texas and through Oklahoma and Kansas. But by the time Ross set out with his Rangers in 1860, the Comanche nation was in steep decline. Drought, starvation, and disease imported by floods of European Americans had reduced their population to about five thousand.

Beginning in the 1850s, the Comanche conducted vicious raids on the Texas frontier. As Ross and his troops made their way northwest toward the Red River, they found a Bible and other items that had been taken from farmsteads. Ross took this to mean he was on the trail of Comanche raiders. On December 19, he found Comanche encamped on Mule Creek, about a quarter- to a half-mile above its mouth on the Pease.

Charles Milton Bell/Bell Collection/Smithsonian Institution National Anthropological Archives

Collections of the Confederate Memorial Literary Society

Landscapes change over time, especially somewhere like the Pease River country. But when Parker and I followed a cow path to a flat area along Mule Creek, where there was room for horses to graze, and where banks rose on each side, providing protection from the wind, I was able to envision the scene.

By the time I visited the site, I’d researched enough to know the undisputed facts of what had happened there: the Rangers and cavalry attacked the militiamen’s horses were too “jaded,” or weary, so they did not participate. When it was over, Naduah, her young daughter, and a Comanche boy were taken captive.

The bodies of a few slain Comanche lay on the frozen ground. It was likely that a handful of Comanche—maybe six—escaped. Ross’s cohort suffered no casualties. The Rangers rounded up about thirty horses and mules. Four women were among the dead. Three males, likely still boys, also died. Everything took place in just a matter of minutes.

As he sought public office in the years after the Civil War, Ross embellished details of the event so that he would appear more heroic. Ranching legend Charles Goodnight, who inspired the character Woodrow Call in Lonesome Dove, once dubbed Ross “a lying four-flusher,” an old-fashioned term for someone who makes empty claims for personal gain.

To learn more about the four-flusher, I then drove two hundred miles to the house of retired attorney and former Hood County district judge Tom Crum, on the Brazos River southeast of Granbury. Crum has spent more than 25 years researching the 1860 massacre. He has located nine accounts Ross gave, all different. “He’d be the ideal person to have on the witness stand,” Crum said, “until he gets cross-examined.”

Crum and I spent two afternoons going over the collection of primary and secondary sources he and his friend Paul Carlson, an emeritus history professor at Texas Tech, used when cowriting a book about the day, Myth, Memory, and Massacre: The Pease River Capture of Cynthia Ann Parker. Eventually, Crum loaded my car down with stacks of material to take home. The most compelling resource was a fat three-ring binder containing hundreds of pages of single-spaced typed text, a firsthand record of nineteenth-century Texas events by a man named John Hamilton Baker.

Baker arrived in Texas in the 1850s intending to become a teacher. He opened a school in Palo Pinto, 56 miles west of Fort Worth, and then established the town’s first Methodist church before relocating to Granbury, almost 40 miles southeast. He also began keeping a diary and continued to do so for sixty years. Baker rode with the militia that supported Ross’s Rangers and cavalry troopers, and he recorded what happened on the river as a witness. After the shooting died down, Baker reported, the militiamen encountered Ross on the Pease. Ross shouted that he and his party had come across fifteen Comanche, killing twelve and taking three as captives. The militia members hurried up Mule Creek as fast as their worn-out horses could carry them.

Ross had become more creative in the years since the event. This time, he said a chief named Mohee was present, and professed that he fought him mano a mano, killing him.

“We found only four dead Indians, all [women],” Baker wrote. Baker also saw Naduah, her daughter, and a young Comanche boy, whom Ross would take home with him and name Pease Ross. But there was no sign of the eight other Comanche Ross claimed to have killed. Baker reported that about thirty Comanche horses and mules were seized, some of which the militiamen recognized as stock stolen from farmers. The next day, Baker wrote in his diary that the militiamen found three more dead Comanche, all male. Baker doesn’t specify their ages, but it is likely, based on Oxford professor Pekka Hämäläinen’s definitive The Comanche Empire, that two were boys—maybe as young as ten—who had the job of taking care of the horses in accordance with the traditional Comanche division of responsibilities. The third may have been an adult mistaken for a chief. Baker counted a total of seven dead, not the dozen Ross claimed. Baker also reported that as many as six Comanche escaped.

Just days after the event, Ross told a correspondent for the Dallas Herald that thirteen Comanche had been killed. Next, Ross filed his official report with Governor Houston. In it, Ross said the number of dead was twelve, and stated that the Comanche boy taken captive was the son of a chief. (Baker mentioned nothing about a chief in his diary.) Ross also said the number of animals captured was forty. In January 1861, a Pease River account appeared in the Galveston Civilian putting forth a claim that Ross had fought a Comanche chief hand-to-hand. Thereafter, various Pease River stories included a battle with a chief.

In June 1875 the Galveston News published a letter from Ross detailing the “correct history” of what happened on Mule Creek. He misstated the date as December 18, which led to decades of mistakes in Pease River accounts by other writers. Ross had become more creative in the years since the event. This time, he said a chief named Mohee was present, and professed that he fought him mano a mano, killing him. Mohee—the name that Ross applied to the Comanche who shot him at the battle at the Wichita village, apparently slain there by one of Ross’s fellow Rangers—had come back to life, only to die once more on Mule Creek. In this account of Ross’s, the number of Comanche horses scattered or killed swelled to 350.

Eventually, Ross morphed Mohee into Peta Nocona and said he, Ross, had directed the Comanche’s death on Mule Creek. Crum and Parker are certain, however, that Nocona was not killed at Pease River. Quanah Parker said on several occasions that his father died in the mid-1860s. U.S. Army interpreter Horace. P. Jones, who worked at Camp Cooper, in Texas and at Fort Cobb, in Indian Territory, and who knew Nocona, said he spoke to Nocona at Fort Cobb more than a year after the Pease River massacre.

At the time Ross’s letter to the Galveston News was published, Reconstruction was winding down in the South. Former Confederates like Ross were making their way back into public life. Ross had become sheriff of McLennan County in 1873, but he had grander political ambitions: He resigned two years later and was elected as a delegate to the 1875 Texas Constitutional Convention. In 1880, he ran for state senate and won. By 1885, he was eyeing a race for governor. A contemporary of Ross’s said it was the “Pease River fight and the capture of Cynthia Ann Parker that made Sul Ross governor of Texas.”

Victor Rose, a journalist from Victoria who had served under Ross during the Civil War, played a role in helping his former commander publicize his slant on the Pease River incident. In correspondence, Ross thanked Rose for the way the journalist “dressed up” Ross’s stories. He directed Rose to get the Pease River accounts published in newspapers not as advertisements, but as news or editorials. Crum, in his book, suggests that Ross was concerned the public would detect the political motive in an advertorial. “I am satisfied the publication of this would swell my vote greatly, ” Ross wrote to Rose. I did not dig up any additional accounts from Ross in newspapers after 1875, but he found a more effective method to spread the story. DeShields’s popular book, Cynthia Ann Parker, appeared just in time for the governor’s election in 1886. The book contained Ross’s entire multipage statement about Pease River. According to the statement, it was a major battle and many warriors were killed Ross was responsible for the death of Peta Nocona, and Cynthia Ann Parker was heroically recovered. Ross handily won the election.

Moreover, DeShields’s account of Pease River came to be accepted as the standard. “Of such stuff,” author John Graves once wrote of the incident, “are true myths built, and among the myths we Texans have, the Parker story is one of the most potent of all.” Ross certainly understood the power of his own mythology.

This article originally appeared in the January 2021 issue of Texas Monthly with the headline “The Battle That Wasn’t.”


The Head Coach: Paul Highton, 41

The former Wales rugby prop was almost fatally floored by his addictions. Now, as welfare manager for the Salford Red Devils, he helps others avoid his mistakes

&ldquoWhen I retired from rugby in 2009, I had a list of people I didn&rsquot want to end up like. I&rsquod seen players with international careers who lost their family and their house and struggled to work. So I went to university, then set up a business.

&ldquoBut, about 18 months later, I started to question who I was. After an operation, I was prescribed tramadol. I was going through a divorce while trying to be a father, and every time I felt down, I used the drug to fix it. I went from taking six tablets a day to taking 30. My mental health went through the floor. At home, I was starting arguments as an excuse to leave, which I did. I got a cottage on Saddleworth Moor: it was supposed to be my safe haven, where I could get clean. But being alone made it all worse.

&ldquoOne night, I set everything up in the basement to kill myself, but I fell asleep after drinking a bottle of wine. That saved my life. In the morning, I realised what I&rsquod almost done. It was like a sledgehammer to the side of my head. For the first time, I admitted to myself that I had a problem. Still, I didn&rsquot know if it was a drug problem, a drink problem, or depression &ndash or which to tackle first. So I emailed the Sporting Chance clinic and
got a reply as soon as I started receiving therapy, drink and drugs fell away, and I found constructive ways to deal with my emotions. It helped me see who in my network were the people I could be open and honest with.

&ldquoPeople think breakdowns only ever happen to those in extreme situations. The truth is they can happen to anyone. We&rsquore all struggling. It&rsquos about being aware of your triggers, how you act when difficult situations arise, and how you can improve the next time.&rdquo


13 James Doohan - Missing Entire Finger

Speaking of severed fingers, actor James Doohan, best known for playing Montgomery "Scotty" Scott on Star Trek, had his right finger amputated after it was shot during World War II. The event is actually pretty nuts. One night, while going between command posts, one of his own men, a Canadian soldier, shot Doohan six times. Four of the bullets hit him in the leg, one hit him in the chest but was stopped by a metal cigarette case and the other went through his finger. He later had it amputated. If you go through and watch Star Trek, there are a few moments when you can see the missing finger, but he was excellent at hiding it. Not from shame but because what type of future would it really be if we can't replace fingers. Another actor, Walter Emanuel Jones, the original Black Ranger from Power Rangers, also is missing his middle finger. He lost it during an accident when he was four years old, but he never explained it any further.


10 of the best foods to eat to fight depression - from fish to fruit

When Professor Felice Jacka first began studying the effects of diet on mental health back in 2005, people thought she was, well, a bit mad.

“Suggesting what we eat might ­influence how we feel was, to many, the domain of hippie-trippy, non-evidence-based belief rather than real medicine,” says the Australian.

“Many seemed to have a disdain for the idea that diet might be of relevance to mental health.

“Back then there simply wasn’t much in the way of scientific evidence linking food and mood.”

Jacka, one of the world’s top researchers in nutritional ­psychiatry, became interested in her field due to personal ­experience.

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She developed an anxiety disorder as a child, then suffered panic attacks and bouts of depression as a teenager growing up in Melbourne.

But she focused on her exercise, diet and sleep – and by her late twenties had recovered.

Having previously attended art school, Jacka decided to return to university to study psychology, completing a PhD that made such significant findings it appeared on the cover of the American Journal of Psychiatry.

Its biggest revelation was that women who consume diets high in veg, fruit, unprocessed red meat, fish and wholegrain, were less likely to suffer with depression or anxiety disorders than their counterparts who ate more ­typically ‘western’ diets packed with processed food, such as meat pies, burgers, pizza, chips, white bread and soft drinks.

Perhaps more surprising, however, was it demonstrated those whose diets revolve around fish, tofu, beans, nuts, yoghurt and red wine also suffered MORE depression.

(This turned out to be due to a lack of red meat. Contrary to all her predictions, further research Professor Jacka carried out revealed that women who ate more red meat were 20-30 per cent less likely to have a history of depressive anxiety disorder).

Jacka, who is now director of the Food & Mood Centre at Deakin University in Australia, and founder and ­president of the ­International Society for ­Nutritional Psychiatry Research, said: “When I investigated, I saw a very clear relationship between red meat consumption and mental health – but not in the direction I expected.”

Her research clearly demonstrated that “compared to women consuming the ­recommended amount of red meat (65-100g three to four times a week), those eating either less or more than that were roughly twice as likely to have a clinical depression or anxiety disorder.”

Since that first research paper, Professor Jacka has gone on to publish more than 150 peer-reviewed scientific papers which have changed popular opinion on the causes of mental ill health.

In 2015, for example, she discovered that, in essence, junk food shrinks our brain – or at least the left hippocampus (which, in part, regulates emotion, memory and mental health). “We found getting not enough of the good stuff and too much of the bad stuff was problematic,” says Jacka.

But it was her SMILES study (Supporting the Modification of lifestyle in Lowered Emotional States) published in 2017, which could prove life changing for anyone with mental health issues.

For the trial, men and women with clinical depression were assigned either a dietary support group or social support.

“The diet was developed using everything we had learned to date on the links between diet, gut health and mental and brain health and was based on both a traditional ­Mediterranean diet and the Australian dietary guidelines,” says Jacka.

Read More
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“The team called it the ModiMed diet to signify it was a modified version of a ­traditional ­Mediterranean diet.

“It was ­specifically designed to be easy to make and follow – and inexpensive.”

The plan required eating more fruit, veg, whole grains, legumes, nuts, low-fat dairy, fish and lean meats while cutting back on processed junk food and alcohol. The results were astounding.

After three months a third of participants on the ModiMed diet had improved their mental wellbeing enough to say their ­depression had gone into remission, compared to just 8% in the second, social support group.

“Simply speaking, the more people improved their diets, the more their ­depression improved,” she says.

Professor Jacka has now distilled her ­findings from the last 15 years of research into a new book – Brain Changer: How Diet Can Save Your Mental Health, complete with meal plans and recipes for improved mental wellbeing.

Read More
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She believes we should consider our food as the basis of our mental and brain health throughout our lives.

“While we’ve been told for years that ultra-processed foods that are high in energy and damaging additives and low in fibre and nutrients will mean more illness and early death from chronic diseases, only recently have we understood the implications for our mental health and the health of our brains.”

More importantly, unlike many risk factors of mental illness – such as your genes, abuse, significant trauma or physical causes such as head injuries – diet is something we can address ourselves.

“What we put in our mouths really matters,” she says. “Don’t be seduced by fast, cheap, tasty food – the price you pay really will not be worth it.”

Professor Jacka&aposs Top Ten Food tips

1 Select fruit, vegetables and nuts as a snack. Eat 3 servings of fruit and 30g (1½ tablespoons) unsalted nuts every day.

2 Include vegetables with every meal. Eat leafy greens and tomatoes every day.

3 Select wholegrain breads and cereals. Base your serving sizes on your activity levels.

4 Eat legumes (lentils, peas, chickpeas, beans, soybeans and peanuts) three or four times a week.

5 Eat oily fish at least twice a week.

6 Eat lean red meat three or four times a week but limit your serving sizes to 65–100g.

7 Include two to three servings of dairy every day. Select reduced-fat products and plain yoghurt.

8 Use olive oil as your main added fat. Use 3 tablespoons of extra virgin olive oil every day.

9 Save sweets for special occasions.

10 Water is the best drink.

Food stories

ModiMed Sample Menu

At first glance this plan may seem quite restrictive, but the idea is merely to provide guidance. It isn’t intended to be rigorously adhered to with the measuring, weighing and recording of food.

Breakfast: 1 poached egg on 2 slices soya and linseed bread with avocado, tomato and spinach

Snack: 200g Greek yoghurt with 1 cup fresh or frozen berries

Lunch: 1–2 wholegrain flat breads with 95g tinned tuna and green salad Snack: 30g almonds and 30g dried fruit

Dinner: Grilled lamb steak with vegetables and brown rice

Snack: Smoothie (250 ml reduced-fat milk with a banana and 1–2 teaspoons honey)

Breakfast: ½ cup baked beans on 2 slices wholegrain toast with tomato, mushrooms, avocado and herbs

Lunch: 3 wholegrain crackers with salad and 20g reduced-fat cheese Snack: An apple

Dinner: Chicken pasta with vegetables and pesto

Breakfast: Omelette made with 1 egg, with red onion, tomato, herbs and 40g grated reduced-fat cheese on 2 slices wholegrain toast

Lunch: ½ cup tinned mixed beans with 1 cup salad vegetables and ½–1 cup couscous

Snack: An orange and 15g walnuts

Dinner: Beef stir-fry with sugarsnap peas, broccoli, carrot, asparagus spring onions, cashews and noodles


Mechanics

Accuracy is weighed against the target's evasion when determining if an attack hits or misses according to: Ώ] ΐ]



Chance to hit can not be lower than 5% but can hit 100%.

    , Worthy Foe, Vigilant Strike, and The Effigon The Effigon
    Gold Amulet Requires Level 57 (12-20)% increased Rarity of Items found +25 to Dexterity
    Adds 12 to 24 Fire Damage to Attacks
    +(100-150) to Accuracy Rating
    +(100-150) to Evasion Rating
    +(20-30)% to Fire Resistance
    Your Hits can't be Evaded by Blinded Enemies
    Damage Penetrates 10% Fire Resistance against Blinded Enemies By light we are shadowed,
    in darkness we are bound. will raise the chance to hit to 100%, ignoring all accuracy and evasion stats of the attacker and defender respectively. does the same, in reverse all attacks against the subject will hit regardless of accuracy.

Spells do not benefit from accuracy since evasion does not aid in avoiding them.


Billy Martin, Baseball's Brawling Genius, May Belong In Hall Of Fame

“Billy had to be dragged off [Clint] Courtney, flailing and thrashing like a madman,” writes Bill Pennington in Billy Martin: Baseball's Flawed Genius, his new biography of the fiery baseball player and manager (Houghton, Mifflin, Harcourt, 527 pages, $30). “It is how most of Billy’s fights or near-fights ended. From Clint Courtney to his dustup with Reggie Jackson in a Boston dugout twenty-five years later, the final scenes are always the same: Billy, wild-eyed and out of control, trying to get at someone to continue the fight.”

Almost all of his punching bags took a pounding. “Maybe Billy was just better at punching people than the rest of us,” said Tommy Lasorda, Martin’s friend and the longtime Dodgers’ manager. “Maybe that’s why everyone knew about it when it happened. He was laying guys out.” In 1979 Battling Billy punched a marshmallow salesman. Yes that was really his job. The man fell to the marble floor of the hotel “with a thud" a security man then took him to a hospital where doctors sewed 15 stitches to close the gashes in his face. During the previous year a young reporter caught Martin off guard and asked too many tough questions. He ended up in the hospital where he was treated for a cut lip, three chipped teeth, and a gash above his eyes. His medical bills, mostly for dental work, were $7500 ($27,000 adjusted for inflation today). Martin’s legal adviser and friend arranged to have a third party pick up the tab. During Martin’s playing days in 1960 he was at the center of a mauling of a pitcher, Jim Brewer, who required two surgeries to repair a fractured orbital bone near his eye. Brewer and the Chicago Cubs sued Martin for $2 million. Deadpanned Billy, “Ask Mr. Wrigley [the team owner] how he would like it, cash or check.” After a lengthy trial, Martin was ordered to pay Brewer $22,000 (almost $175,000 today) for his “suffering” and legal fees. The amount exceeded a year’s salary for Martin.

After reading Pennington’s thoroughly entertaining and brutally honest biography, its safe to say that as both a player and as a manager Billy Martin led one of the most violent and tumultuous lives of any baseball player in history. The chip on his shoulder was superhuman. Mickey Mantle, Martin’s close friend and teammate, said that “Billy is the only guy in the world who can hear someone give him the finger.”

Recounting each brawl on the field and in barrooms in vivid detail, Pennington paints a portrait of an outlaw from the Wild West with a hair-trigger temper who punched first and asked questions later, if at all. I recently enjoyed a two-hour conversation with Pennington, an award-winning sports writer for The New York Times, at Foley’s NY Pub & Restaurant across the street from the Empire State Building, where the author appeared for a book-signing. Pennington said that “Martin is mostly remembered for fighting and getting fired, a drinking, kicking, lunatic— a multifaceted guy lost to history. There’s so much more to this guy than this caricature. How do you compile a winning percentage of .553, which is better than 13 managers in the Hall of Fame? He took over teams that stunk and turned them into winners.”

Of all the aspects of his genius, his truest may have been to ability to motivate men to believe in themselves. Loyal teammates and players spoke of him having their backs, either by waging war against owners or umpires. “He wanted others to know he was fighting for them,” Pennington writes. While most fans can recall his clashes with Reggie Jackson, the mercurial Rickey Henderson adored Martin as a father figure and played hard for him. In Martin’s era the press sometimes depicted Latino players, even Roberto Clemente, as hot-tempered, sullen, or moody rather than probe the financial and cultural barriers they had to overcome. Coming from a broken home himself, Martin was able to identify with them. Five of Martin’s Latino players named their sons after him. Martin was also exceedingly generous, never turning down an invitation to an umpire's charity event.

Pennington includes a version of Casey Stengel’s famous quote that the secret to managing is keep the five guys who hate you from the four guys who haven’t made up their minds. After tough losses Martin flipped over many a post-game buffet table, sending deli meats and mustard flying across players’ shoes and lockers. Martin publicly browbeated players whom he thought were dogging it or skipped the brow part and simply beat them. He clobbered a Twins pitcher named Dave Boswell, a much taller and heavier man. “Dave’s face was all black and blue and he looked like he had been hit with Jake LaMotta or something,” said teammate Jim Kaat. During a fight at a hotel bar, Ed Lee Whitson, an underperforming pitcher with the Yankees, kicked Martin in the groin. “Billy was doubled over in pain,” Pennington writes. “But then he stood up straight and took a deep breath, like something a character in an action movie would do. And, then, in a firm, defiant voice he said to Whitson, ‘Now, I’m going to have to kill you.” You’ll have to buy the book to learn the four-round fight’s outcome. Suffice to say, it gets even better than that.

As a young Times reporter covering Martin from 1980 through 1989, Pennington was an eyewitness to many of the events in his book including Martin v. Whitson. But this is no memoir. Pennington is the Robert Caro of baseball biographers. His bibliography of books, magazine articles, and newspaper archives runs eight pages long. Pennington, a reporter’s reporter, conducted 225 interviews not just of players and coaches, but bartenders, subway workers, and hotel managers— virtually anyone who ever crossed paths with Martin.

Pennington, an elegant writer in the tradition of Times legends Red Smith, Dave Anderson, and George Vecsey, brings to life his Shakespearean tragic hero, a King Lear in pinstripes raging against the baseball storms. “It was always Billy against the world,” Jim Kaat said. “It’s almost as if needs adversaries in his life.”

The narrative arc of Billy Martin: Flawed Genius resembles a sine wave. Martin is hired with great fanfare because he is the people’s choice. His team, usually lousy, vastly exceeds expectations and wins their division, the pennant, or, in the Yankees’ case, a World Series. Martin can’t stay away from bars and gets into fights like a real gunslinger. (“Guys would line up to be the one to knock him out,” Pennington told me. “He didn’t draw. He just hit.”) Martin’s brazen defiance of authority costs him his job. A fierce public backlash against ownership ensues. The front office switchboard lights up and either the owner hides out, fearing for his life, or is hung in effigy. It happened in Minnesota, Detroit, Texas, Oakland, and in New York. Martin lost nine managerial jobs in all, including Yankees owner George Steinbrenner’s serial hiring and firing.

Besides winning wherever he landed. Pennington attributes Martin’s deep appeal to his blue-collar everyman ethic: “He told his bosses to shove it. “Often.” How many of us wish we would have done the same, particularly working for a boss as tyrannical as Steinbrenner who once fired a secretary for ordering him the wrong sandwich. In Minnesota Calvin Griffith, the Twins’ owner insisted that Martin meet with him two or three times a week to discuss strategy at any time, except when he took a nap, from 5:00 to 5:30. Martin knocked on his door one day at 5:00 and at 5:15 on another, explaining those were the only times he could meet. Griffith gave up and canceled the meetings. In Texas, Martin, ordered the public address announcer to play John Denver’s “Thank God, I’m a Country Boy” during the 7 th inning stretch instead of “Take Me Out to the Ballgame,” which the owner demanded. Martin was terminated. Echoing Kaat, Martin’s son Billy Joe said. “Sometimes it was almost as if he manufactured excuses to get out of a situation."

At Foley’s, Pennington laughed repeating Yankees manager and executive Lou Pinella’s line that whenever Steinbrenner said Martin “looked tan and rested” the owner signaled his intention to rehire him. “As soon as he took over it was like watching the picture of Dorian Gray,” Pennington said. If you ever needed proof that you should leave your work place troubles back at the office, look how much Martin aged in the photos of this book.

Much of Martin’s volatility and empathy probably stemmed from his Dickensian childhood in West Berkeley, the city’s poor section at the bottom of the hills. His mother, Jenny Martin, worked at a speakeasy and whorehouse and put a knife to his paternal father’s neck, threatening to kill him if didn’t leave or ever returned. Billy had to fight his way to school against kids who mocked him as Horn and Pinocchio because of his big nose, which he had multiple surgeries to correct. “Don’t take shit from anybody,” his mother taught him. Pennington presents numerous memorable scenes with Jenny. One of Martin’s three wives tried to learn the secrets to his mother’s Italian cooking to keep her husband happy, but Jenny sabotaged her by rushing through steps in the recipes when she was in the bathroom, apparently because Jenny wanted her son to come home for momma’s meals. While managing Oakland an elderly woman in the stands asked a cameraman to summon “the little cocksucker" for her. Of course she turned out to be his mom, visiting from her nearby neighborhood.

For much of his life off the field or away from a bar, Martin was a fish out water. Pennington touches on the “insidious disease” of alcoholism. “Why didn’t someone talk to him about his drinking?” the Rangers’ Tom Grieve asked. ”But that’s not what people did 40 years ago. I admit I think about it now, even forty years later. It was sad because I loved playing for him.” Pennington speculates that had Martin been born in 1948 rather than 1928, he would have received help in a more enlightened age. My WebMD impression is that his bouts with the bottle may have been the tip of his problem. He almost appears manic depressive or to have had a bipolar disorder. Whatever the case, he was certainly hell-bent on his own self-destruction long before medications like Prozac could have blunted some of his personality’s sharper edges. Maybe today he would see a psychiatrist, something Pennington reveals that he never did. A close baseball friend of mine told me that Martin reminds him of another “charming sociopath,” Hal Chase the sinister Yankees first baseman a century ago.

For those of old enough to remember, Martin’s death in a car crash in 1989 at age 61 somehow seemed shocking and inevitable at the same time. On Christmas Night, no less, he and a drinking buddy were heading home on icy roads from one of the few open bars in town and he wasn’t wearing a seatbelt that probably could have stopped his head from smashing a windshield. Only a miracle could have saved him this time.

From the vantage point of 25 years later, all he psychodrama swirling around Martin obscures his keen baseball mind. “Risk didn’t worry Billy,” the awe-struck Hall of Fame manager Tony LaRussa said. “His genius is really not properly understood.” In the game’s vast continuum, Martin learned from his manager, the crafty Casey Stengel in the 1950s, who learned from his scrappy manager, John McGraw, in the early 1900s. Like a master chess player The Brat, his less affectionate nickname, was usually thinking three plays ahead of his opponent. He was also adept at stealing signs. But the main goal of the much-vaunted Billy Ball, which earned him a Time magazine cover story, was “pressuring offensive tactics.” To manufacture runs, he had his players execute squeeze plays. Rod Carew stole home seven times in 1969. Martin even orchestrated successful triple steals with the bases loaded infielders were at a loss trying to decide where to throw the ball. “He had a standing rule with the Tigers,” Pennington writes. “Any player who got hit with a pitch with the bases loaded would get $150 in cash and the right to pick his next day off.”

His trick plays were so old-school that they would have made McGraw proud. There was the hidden ball ploy whereby an infielder would pretend to throw the ball back to the pitcher and tag out a napping runner. With men on first and third, the trail runner would stumble off first to get in a rundown and the lead runner would break for home. He usually scored. For the perfect spitball, Martin had a pitcher rub the inside of a pant leg with soap. As the game wore on, the oozing sweat created a slimy mess in a location no umpire dared check.

I couldn’t help but wonder what a wonderful jolt a tactician like Bill Martin would give today’s somewhat sluggish game. How often do you see a steal of home, let alone a suicide squeeze? “It’s a lost era we will never see again,” Pennington told me. “Managing by the book is safer. He’s a guy who managed totally by his gut and didn’t care what people thought. He lived by his own rules. It had to be his own rules.”


Opinion: Being coeliac isn’t a choice – here’s why more awareness is needed

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Having been forced into eating gluten free since 2016, food and drink writer Rebecca Shearer discusses why we should all be taking some time to reflect on our choices this Coeliac Awareness Week.

As much of the hospitality industry has started to reopen its doors, people are able to go out and eat in restaurants, cafes and bars for the first time in a long time.

But not everyone is able to rejoice in the fact that we can have a meal out with friends again, namely those who are sufferers of coeliac disease.

Coeliac disease is an auto-immune condition in which the body fails to digest gluten. Sufferers can experience a whole range of symptoms, including bloatedness, nausea, tiredness, mouth ulcers or anaemia, if they eat gluten, which is mostly found in wheat, barley, rye and some oats.

Own experience

From my own experience, I know well that following a gluten-free diet sounds so much easier than it is. I’ve been unable to eat gluten since August 2016 following a horrible stomach virus that has caused me to develop an intolerance to it, though I am yet to be tested for coeliac disease itself.

Often, people mistake a gluten-free diet to be a “fad” or lifestyle choice, in the same way as veganism and vegetarianism are, without actually realising that there is an allergy involved. It’s often a source of frustration when people assume that not eating gluten means you’re trying to be “healthy”.

Coeliac disease and gluten intolerances aren’t a choice, nor are they a lifestyle. As society isn’t as gluten-free as it perhaps could be, having to eat a gluten-free diet means constant planning, constant reading of labels and constant groans of frustration when something that’s made from potato, rice or corn seems to have been turned into something glutinous by being baked, fried or battered in flour.

Next time

The next time you’re in the supermarket, take a quick look at what goes into a product that you would usually have the glutinous version of – I bet that the gluten-free version will have so many more additives and additional ingredients than you may have realised.

We’re not trying to be healthy, we’re just trying to not make ourselves sick.

The next time the country goes into panic-buying mode and you’re desperate to make spaghetti Bolognese but your local supermarket is out of pasta, I urge you not to reach for the gluten-free version just because “it’s all they had”.

March 2020

In March 2020, when this was reality, myself and many people suffering from a gluten intolerance or coeliac disease around the country found that we couldn’t purchase the basics, including pasta and bread and in some cases even gluten-free flour, because others were sweeping them off the shelves when all the glutinous food was gone.

It wasn’t fair and it’s this kind of ignorance towards the impact it has on other people that those who can’t eat gluten face on a daily basis.

Restaurants and cafes aren’t immune to this. Some do try to offer a limited version of their menu that is gluten free, while others offer no such thing and instead shift their focus to vegan food.

Veganism isn’t an allergy and if a vegan meal was to come into contact with an animal product, the consumer wouldn’t necessarily know about it as they wouldn’t react.

Reaction

If gluten-free food was to come into contact with even the slightest bit of gluten, even if it’s being made on the same counter as a glutinous product before it, someone who is gluten intolerant will know about it within 24 hours of eating it.

Home cooking was a big feature during the first lockdown of the pandemic, but for many who suffer from a gluten allergy or intolerance, it’s been our only option since we were diagnosed as there still isn’t enough awareness out there about it.

So, as Coeliac Awareness Week takes place this May 10-16, take some time to consider how you can help us in your day-to-day life.

Choices

When you’re reaching for the gluten-free sandwich at Marks & Spencer because you fancy “being healthier”, why not consider whether there’s an alternative instead? The next time you’re in a restaurant and want to have a burger with a gluten-free bun because you want to be “healthier”, take a moment to think about whether that will stop someone with a gluten intolerance from being able to enjoy their meal further down the line.

And for all the restaurant, cafe, bar and supermarket owners reading this, we need you to help us bring more awareness into the public conscience, take us just as seriously as you take diets that are a choice and lead the way in making our society a much easier place to be a foodie when your diet is gluten-free.


Avoiding heat illness

She didn’t say “Hi” or even acknowledge our presence as she jogged past us on the trail that hot August day in Lassen Volcanic National Park in northern California. Even at an elevation of 6,000 feet, it was an unseasonably warm 80 degrees and this young runner, no older than 18 years old, wore skimpy jogging clothes that exposed her skin to the searing sun, while carrying no drinking water. Sweating profusely and with skin bright red, she ran up the trail and out of sight, miles from any trailhead.

A half-mile or so up the trail, we again met up with her. Now sitting on a rock crying, she told us her story. She had been jogging with friends when she became separated. She was lost and had been going up and down trails for hours frantically trying to find her way back. Dehydrated and near heat exhaustion, she was so embarrassed and scared that she didn’t ask for help when she passed us the first time. We gave her water and sat her in the shade as her friends caught up with her and brought her back.

We think of heat illnesses, such as heat exhaustion, heat stroke, or dehydration, as something that affects firefighters wearing heavy protective clothing in hot conditions or something that our soldiers face fighting in the desert. Heat illnesses affect many of us in our daily lives, however. Every year we hear of high school football players that die from heat stroke during summer practice. In athletes, heat stroke is the second leading cause of death. Elderly die in the cities during heat waves. Hikers die, as do those stranded when their cars break down.

In a normal year, an average of 175 Americans die of heat illnesses. During the heat wave of 1980, 1,250 Americans died. The sad thing is that heat illnesses are largely preventable through planning and common sense.

The body and heat

The body produces heat from food and from muscles during exercise. Normal metabolism generates 2,000 to 5,000 kilocalories per day and would raise the temperature of your body 1.5 degrees every hour if it were not for the body’s cooling mechanisms. When you exercise heavily or carry a backpack in hot temperatures, heat production by the body increases five to tenfold. Add to that hot and humid environmental conditions and it is easy to overheat, a process called hyperthermia.

Normally, the body reduces heat by sending more blood to the skin where blood vessels dilate to bring the blood closer to the surface where it can be cooled by the lower air temperature. This only works when the air temperature is lower than the body temperature. Normal core body temperature is 98.6 degrees. When air temperatures exceed 95 degrees, the blood is not cooled in this manner.

Sweating is another way the body uses to lower the temperature of the blood. As the sweat evaporates, it cools the body down. Each quart of sweat that is evaporated on the skin removes about 580 kilocalories of body heat. At this rate, body temperature can normally be regulated.

It is necessary to drink 2 to 3 quarts of water per day to maintain normal metabolism. With sweating caused by physical exercise or in hot temperatures, this can easily increase to 4 to 6 quarts per day (1 to 1.5 gallons), or in extreme conditions over 8 quarts per day. It is possible to sweat away 1 to 2 quarts of water per hour in extreme conditions. The U.S. Army warns that soldiers in hot environments can lose 15 quarts (almost 4 gallons) of water per day.

Humidity also leads to overheating. When the humidity level is over 80%, sweat does not evaporate and the body’s ability to cool is dramatically decreased. Sweat produced drips from the skin and only leads to dehydration without providing cooling.

If enough water is not consumed to replace the lost water, blood vessels in the skin constrict since there is not enough volume of blood to keep them open and sweating ceases in order to conserve water for the body. This leads to the body overheating. When heat-control mechanisms of the body are overloaded, the increased body heat rapidly causes tissue damage to the vital organs such as the brain, heart, kidneys, and muscles, and disrupts the chemical processes of the body.

Four environmental conditions determine the risk of heat illness: The absolute air temperature (ambient temperature) is the air temperature as measured with a thermometer in the shade and is the least important cause. Solar load is the amount of direct sun on the skin and can be an important contributor to heat illness. Full sun on bare skin in severe conditions can add up to 150 kilocalories per hour of heat load to an individual. As mentioned, humidity determines the rate that sweat can evaporate and cause cooling. The drier the air, the greater the evaporation and amount of cooling. Humidity is more important than temperature in determining the risk of overheating. Finally, wind speed is an important factor in assisting evaporation. Cool winds reduce heat stress, while hot winds increase it.

Prevention of heat illnesses

Avoid dehydration: The human body is 75% water and needs a constant new supply since we have no method of storing it in our body. Dehydration, drinking less water than the body needs, is the major cause of all heat-related illnesses. Unfortunately, the body is already two to five percent dehydrated before we begin to feel thirsty and losing only one quart more can produce severe dehydration.

The body conserves water by not producing as much urine when it is dehydrated and urine becomes concentrated and dark yellow in color. Urinating plentiful amounts of light-colored urine shows that you are not dehydrated.

Water loss needs to be replaced, requiring a conscious, continual effort to stay properly hydrated to avoid dehydration. Drink fluids even if you are not thirsty. While consuming 2 to 3 quarts of water a day is pretty easy, it gets harder to comply when water needs increase. Plan your daily water consumption, drinking early and often. If you expect to lose 4 to 5 quarts in a day, drink one quart of water when you wake up, one quart with each of three meals, and small amounts frequently throughout the day. The U.S. Army Research Institute of Environmental Medicine estimates that the maximum amount of water that can be absorbed per hour is 1.3 quarts and recommends drinking about two cups every 30 minutes during intense periods of work. For hikers and backpackers, a good rule is to drink every time you take a break or stop briefly. During physical activity, it is easier for your body to handle small amounts of water spread out during the day rather than a large amount all at once.

People avoid drinking enough for many reasons, but it is often because their water bottle is difficult to get out of their pack. Water carrier systems, such as the Platypus or CamelBak hydration systems, are very convenient. They consist of collapsible plastic water containers that are placed in your pack or in a separate water backpack. Using a plastic tube from the water container, you can sip on water as you hike without having to reach for a bottle.

Water needs to be drinkable. Water left in the sun on a 105-degree day will be too hot to drink. Plain, cool water at 60 to 70 degrees is more likely to be consumed, and flavorings, such as Kool Aid, Gatorade, lemonade, and others, may help encourage drinking.

Prolonged sweating from heat or exercise can also cause loss of body salts, called electrolytes. Electrolytes are minerals, such as sodium, potassium, and chloride, in the body fluids. They are essential to maintain fluid balance and function of the nerves and muscles.

Sodium chloride (salt) is lost in large enough amounts during heavy sweating to cause medical problems. When an individual replaces lost fluid with normal water, it further dilutes the concentration of sodium in the body. This salt deficit, called hyponatremia, is essentially water intoxication and symptoms may mimic heat exhaustion or gastroenteritis, making a diagnosis difficult. Recently, it has been recognized that many marathon runners develop hyponatremia during races, and rangers at the Grand Canyon National Park have also seen this problem in hikers.

As with dehydration, the good news is that prevention is fairly easy. Experts recommend eating salty snack foods such as Saltine crackers, Pringles potato chips, Cheez-Its, salted nuts, or drinking sports drinks. Single serving bags of Cheez-Its contain 340 mg of sodium and 20 ounces of Gatorade has 114 mg of sodium, enough to prevent hyponatremia. Salt pills, which irritate the lining of the stomach, are no longer recommended on a routine basis.

Acclimatize: The body takes time to acclimatize to temperature. Firefighters who are brought from the cool coastal areas to inland fires where air temperatures are over 100 degrees suffer a high rate of heat-related illness. It takes several days to as long as a week to acclimatize to hot weather. During this time the body will sweat more and lose more salt, which can lead to electrolyte imbalance. With acclimatization, sweating becomes less and the sweat glands secrete less salt.

When first in a hot environment, allow yourself plenty of time to get used to the temperatures before exercising or working for prolonged amounts of time in the heat. To fully acclimatize can take 7 to 10 days, during which time you should exercise about two hours per day. While doing this at home works, most of us don’t have this amount of time to acclimatize when we travel to a new area, such as on vacation. In such cases, minimize the amount of work you do and maximize water intake.

Watch very young and very old individuals carefully in hot weather, as their bodies do not regulate temperature well and they can rapidly become overheated. Age does affect the severity of heat illness. Heat cramps in an 18-year-old may be heat exhaustion in a 40-year-old and heat stroke in someone age 60. Individuals with weight or alcohol problems are especially prone to the heat.

Conserve body water: Minimize or avoid sweat-producing activities in work and travel. This is especially important in survival situations. Stay cool, stay in the shade, and do not lie on hot ground, which can be 30 to 45 degrees hotter than the air. Often, cooler ground can be found by digging just a few inches below the surface. Breathe through your nose to reduce water loss and do not smoke. Eat at a minimum, as water is needed for digestion, and avoid eating fatty foods since they require more water to digest.

Hike or work in the early morning or late afternoon when the sun is low and the heat is less intense, causing less water loss from sweating. Walk at an easy pace and wear lightweight, light-colored, loose-fitting clothes. These allow more ventilation and reflect the heat better than dark colors. Don’t expose your skin to the hot sun and wear a broad-brimmed hat to keep the sun off your face.

Other precautions

Get plenty of rest. The U. S. Army Research Institute of Environmental Medicine has found that fatigue and lack of sleep reduces the body’s ability to regulate heat, causing overheating.

Be aware of the environmental conditions that you may face. Know the anticipated temperature, humidity, wind, and solar load predicted for the day and plan your activity and water intake accordingly. The National Weather Service heat index is a way to help determine the risk of developing heat illnesses. It is a chart that combines the air temperature and relative humidity to derive the “apparent air temperature,” essentially how hot it really feels when humidity is added to the air temperature. For example, an air temperature of 95 degrees with 60 percent humidity has the same effect on your body (apparent air temperature) as 114 degrees. These are for temperatures taken in shady conditions. In full sun, they can be up to 15 degrees higher. At an apparent air temperature above 90 degrees, risk of heat illness is high and activity should be adjusted accordingly.

Certain drugs and medications taken in hot weather conditions can promote heat illness. Avoid taking drugs such as atropine and anti-motion sickness drugs which hinder sweating, beta-blockers which decrease cardiac output, diuretics which promote dehydration, antihistamines and antidepressants which alter normal physiology, and drugs such as hallucinogens and cocaine which increase muscle activity and therefore body heat. Some of these should not be stopped on your own, so talk to your doctor if you anticipate this being a problem.

Management of heat illnesses

Dehydration: Thirst, irritability, nausea, and weakness occur with 5% loss of body water, only 2.5 quarts for a 150-pound person. A 10% loss will cause headache, dizziness, inability to walk, and tingling sensations of the arms and legs. At 15% loss, the tongue becomes swollen, vision can dim, numb sensations occur on the skin, and urination may be painful. Any greater water loss can cause death.

Treatment is to replace lost fluids by drinking water, juice, lemonade, Gatorade or similar sports drinks, soup, or decaffeinated coffee. Drinking alcoholic and caffeinated beverages is discouraged since they increase urination and promote dehydration. Drink until you begin urinating pale yellow urine, remembering that it can take 6 to 8 hours for the fluids in the body to become balanced before urine production will begin.

If the person is not alert or is having prolonged vomiting or diarrhea, they should be evacuated immediately to medical care so that intravenous fluids can be given.

Heat Edema: Heat edema (swelling) is common, especially in the elderly, during the first few days in a hot environment. The hands, ankles, and feet become puffy or swollen and rings may become tight or difficult to remove. Remove rings or constrictive jewelry and minimize walking. When resting, keep the feet elevated. The swelling should resolve on its own within a few days. If leg swelling is associated with shortness of breath or the individual is otherwise ill, swelling may be due to other causes and a physician should be seen.

Miliaria Rubra (Prickly Heat): Prickly heat is an itchy, red, bumpy rash caused by plugged sweat glands on areas of the skin that are kept wet by sweating such as the armpits and groin. Treatment involves cooling and drying the affected skin while trying to avoid further sweating. Itching may be relieved by taking antihistamines, such as Benadryl 25 to 50 mg every 6 hours.

Heat Syncope: Syncope (fainting) is caused by insufficient blood to the brain. In the heat, blood vessels on the skin dilate, taking blood from the brain and heart, and standing for long periods of time causes blood to stay in the legs. Both of these things, along with lower blood volume from dehydration, can cause lack of blood to the brain resulting in a person becoming light-headed, dizzy, or fainting.

Have the person lie down with their legs elevated until the symptoms have resolved. Give them cool fluids to drink while cooling the skin with water or by placing ice packs or cool cloths next to the neck, armpits, and groin.

Heat Cramps: Painful muscle spasms can occur in overheated muscles that are exercised heavily. Often they occur in individuals who are salt deficient. Cramps often begin when the individual is resting after exercise and present as severe pain and spasms of the calf, thigh, abdomen, or hand muscles.

Treatment is to have the individual rest in a cool environment while drinking plenty of fluids. Apply steady, gentle massaging-type pressure to the cramped muscle. Salt drinks or snacks are helpful with heat cramps.

Heat Exhaustion: The most common form of heat-related illness is heat exhaustion. If not treated, it can continue on to become heat stroke, a life-threatening emergency. Heat exhaustion is overheating of the body temperature that does not cause permanent damage, while heat stroke can permanently disable or kill the victim.

Heat exhaustion occurs when the heart and cardiovascular system cannot meet the needs of the skin (temperature regulation), muscles, and internal organs. It usually involves both dehydration and salt depletion. Heat exhaustion is frequently seen as part of other conditions such as illnesses that cause fever, loss of electrolytes, or gastrointestinal illnesses.

Symptoms may include thirst, fatigue, nausea, weakness, loss of appetite, vomiting, headache, dizziness on standing from a seated position, and muscle cramps. Sweating is almost always present however, it may be absent and the skin may feel cool to the touch. Mental status is usually normal, although there may be minor confusion or agitation. The pulse is weak and rapid.

Treatment involves taking the stress off of the cardiovascular system and heart. The individual should stop all physical activity, rest in a cool, shaded environment, and remove any heavy or restrictive clothing. Have them drink plenty of fluids containing small amounts of salt, as you would for dehydration.

While heat exhausted individuals may be able to cool off enough on their own, it is best to use external cooling methods to help them. Cool water can be splashed on the skin while fanning the individual. Better yet, ice or cold packs can be placed along the side of the neck, armpits, and groin areas where large blood vessels are relatively close to the skin. This promotes rapid cooling of the blood. Be careful not to put ice packs directly on the skin for long periods of time. Wrap them in a light towel or cloth.

Individuals with heat exhaustion appear to recover very quickly with the above care. However, it takes the body 24 hours of rest and re-hydration to fully recover.

Heat Stroke: As heat exhaustion progresses, the body’s cooling system completely breaks down and the blood and organs overheat. Known as heat stroke, this is a true medical emergency that has an 80 percent chance of death if not treated.

The difference between heat exhaustion and heat stroke is technically the presence of tissue injury, something that is difficult at best to tell in pre-hospital situation. For practical purposes, anyone who has symptoms of heat exhaustion and abnormal changes in their mental state, such as extreme confusion, disorientation, anxiety, agitation, or inability to walk in a straight line, should be considered to have heat stroke. They may also develop seizures or coma.

Body temperature is hot, usually over 105 degrees. Blood pressure is usually low (check for a weak pulse in the wrist), pulse high (greater than 100 beats per minute), and breathing rapid (over 20 breaths per minute). The skin may be red and hot, although this does not occur with everyone. Sweating may have stopped or may be present.

Heat stroke is a medical emergency that requires rapid hospitalization. Seek help immediately. Above 106 degrees, the body can lose the ability to control its own temperature and temperatures can rise uncontrollably causing severe damage to the kidneys, liver, brain, heart, muscles, and coagulation systems. Intensive medical care is required.

While waiting for help, immediately cool the victim as quickly as possible using the techniques described under heat exhaustion. If available, the individual can be carefully immersed in cool water. Do not immerse in ice water, which can cause severe constriction of the skin blood vessels and limit the ability to lose heat. It can also cause shivering, which is the body’s way to generate more heat—not something you need at this time. Treat for shock by lying the person down with legs elevated.

Do not give the individual anything to drink because of the risk of vomiting and aspirating stomach contents into the lungs. Medicines for fever, such as Tylenol or aspirin, are of no help and should not be given.

Most heat illnesses are entirely preventable through proper planning and hydration. Remember to know the environmental conditions you are facing, stay properly hydrated, and avoid over-exposure to the sun and heat. Doing so will let you enjoy the outdoors without becoming the next victim of the heat.


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Comments:

  1. Arlan

    Silence has begun :)

  2. Jore

    It is removed (has tangled section)

  3. Farrs

    It is a pity that I cannot speak now - I have to leave. But I will return - I will definitely write what I think.

  4. Gulmaran

    What an incomparable topic

  5. Maujin

    And what will we stand on?

  6. Zayne

    Oooh ... I'm lying under the chair !!!!



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