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Extreme heat isn’t necessary for heatstroke, as this athlete’s harrowing story shows

Heatstroke can occur in less-than-scorching conditions. (Thomas Lammeyer/Getty Images/iStockphoto)

To Doug Wetzel, the chicken-or-egg question of what really happened to him during a triathlon last year is not of utmost concern. What matters is that he is alive and largely recovered, which was no sure thing when he was lying comatose at Maryland Shock Trauma Center, in desperate need of a new liver.

What Wetzel has been able to piece together sounds very much like an “anomaly,” as one doctor described it, but we can all benefit from heeding his takeaways from the awful experience: to “respect your body” — and to be careful when exercising in warm conditions.

Summer may be entering its final stages, but that hardly means that those exercising outdoors are mere weeks away from not worrying about taking the proper precautions. Wetzel, 32 and in terrific shape at the time, was running in temperatures in the mid-70s when he veered off course and collapsed on a nearby house’s front lawn, the victim of heatstroke.

Actually, he was the victim of several catastrophic ailments, including compartment syndrome in his right leg, which led to rhabdomyolysis, which he thinks led to his heatstroke (“this weird, perfect storm,” as he put it). But it all could have started when he fell off his bike during the cycling portion of the triathlon, and that incident is considered likely to have been influenced by some sort of heat-related impairment.

If this all sounds a bit hazy, well, it also does to Wetzel, who revealed that, even with a year to recover and a chance to revisit the triathlon course at Rock Hall, Md., his memories of the fateful May 2015 day are far from complete. He does recall drinking more water while cycling and running. However, he said, "I don't remember ever feeling, like, 'This is hot.' "

Understanding heatstroke

Assuming Wetzel was keeping properly hydrated during the triathlon, that might take off the table one of the causes for heat-related illnesses explained by Yvette Rooks. An assistant professor of family and community medicine at the University of Maryland School of Medicine, as well as the head team physician for the Terrapins, Rooks said that even an outcome as severe as heatstroke could occur in less-than-scorching conditions. The most severe heat-related illness (lesser forms include rashes, cramps and exhaustion), heatstroke occurs when the body loses its ability to cool down and internal temperatures rise above 103 degrees.

If athletes have “had an illness, if they’ve had a cold or something, their immune system would be [compromised],” she said in a phone interview, adding, “If you’re on a certain medication, like if you’re taking a diuretic for high blood pressure, that’s going to dehydrate you even more, so it’s multifactorial.”

Even being a particularly heavy sweater could be a risk factor, in addition to the usual suspects, such as heat and humidity, as well as alcohol and/or caffeine intake. Rooks and her team place a priority on having her Terps, especially the first-year members, make sure that they are not showing any of the signs of heat-related issues.

“One, that they are not breathing heavily,” she said. “Two, that they are sweating properly. That they don’t appear confused, that they’re not taking a knee after every play. That they are able to follow directions, and that they do not have cramping,” the latter being a major early indication.

Getting enough fluids as a matter of daily routine is also emphasized. “Just waking up that morning and saying, ‘I’m going to drink a gallon of water’ — no. You want to be doing your hydration days and weeks leading up to [an event].”

Sufferers of a heat-related illness should be moved, if possible, to “a cold, shaded place,” given fluids to drink and stripped of equipment and/or restrictive clothing. Bags or towels with ice, if not immersion in cool water, are also helpful in reducing body temperature.

Another first-aid tip Rooks offered was to raise the legs of victims as they lay flat on their backs. “Often if someone is dizzy or weak,” she said, “their blood pressure could be dropping, so you want to keep the blood flow to the core organs.”

As for what might have happened to Wetzel, Rooks noted that while his episode may have been anomolous, “we have to be aware of the early signs.”

A series of disasters, then some luck

What Wetzel does know, and shared at the Baltimore restaurant where he is the executive chef, is that he owes his discovery "behind some hibiscus bushes" to the barking of the homeowner's chihuahua. A friend of the homeowner who was a nurse advised that he call 911, then ice down Wetzel, whose internal temperature would measure at 107.

Wetzel was taken to a hospital before being airlifted to the Maryland Shock Trauma Center, where a team of about 200 doctors and staff worked to save him. The first order of business was to cut open his leg, which he nearly lost due to the compartment syndrome, a condition caused by excessive pressure within muscles in an enclosed area, and the rhabdomyolysis, in which muscle tissue breaks down and releases into the bloodstream.

“That was the first thing, and once they got that under control, it was like, ‘Oh, his liver is failing. He definitely needs a new liver,’ ” Wetzel said.

To his great fortune, the new liver arrived a couple days into his hospital stay; the anti-rejection medication he must take for the rest of his life is a small price to pay.

Marks on Wetzel’s legs, including “a really bad road rash,” led him and his doctors to guess that his compartment syndrome may have occurred in a bike crash. Rooks said Wetzel “quite possibly” could have been having a heat illness that caused him to fall and led to an “interwoven” series of calamities.

Back — cautiously — to exercising

After a lengthy rehabilitation, Wetzel is once again swimming and cycling, mostly doing the latter in the early morning when the day is at its coolest, and he said he stopped running after summer arrived. He is also not planning to compete in another triathlon after his experience at Rock Hall.

“Physically, I could, but I don’t think I want to put my friends and family through the idea of me going through a triathlon again,” he said. “Plus, mentally, I’m not close to doing that again.”

Wetzel eats more healthfully than before, saying,“I really want to take care of myself.” These days, he is likely to carry a thermometer with him when exercising, and he makes sure to “lather up on SPF 70 all the time,” as he has “a much higher risk of getting skin cancer now than ever before.” His damaged thermoregulation system has also left him “more susceptible” to another heatstroke, but he is determined to continue pushing himself physically.

“Everyone jokes, like, ‘Look what exercise did to you, it almost killed you,’ but the reason I’m still here is because I was in good-enough shape to survive that,” Wetzel said. “[If] I hadn’t been in good shape, I’d be gone.”