When temperatures soar, especially combined with high humidity, people are at risk for heat-related illness including heat exhaustion and heat stroke.

While it’s best to avoid going outside in extreme heat, not everyone can stay inside. Whether you work outdoors or need to get in your exercise routine, there are ways to reduce your risk of developing heat illness.

Michael Redlener, MD

In this Q&A, Michael Redlener, MD, Medical Director of the Mount Sinai West Emergency Department, explains how heat can affect you and how to stay safe.

What are the risks of being active outdoors when it’s very hot?

If you are exercising or working outside, your body is working harder and your metabolism (internal process of converting food to energy) increases.  Normally, your body can regulate the internal temperature even as your metabolism increases. However, when it is hot outside, the high environmental temperature makes it harder for your body to regulate its internal temperature, putting you at a higher risk of increasing your body temperature to dangerous levels.

Who is most at risk?

People who are 65 or older, children, people who have disabilities, and people who are generally working outside or spending a lot of time outside have a higher tendency to get heat illness. People who are overweight, on certain medications, living with heart disease or mental illness, and people who drink alcohol, are all at risk. Having a sunburn also increases your risk because it reduces your ability to control your temperature through your skin’s normal mechanism.

Concerning medications, certain drugs can affect your body’s ability to process heat, so it’s important to consult your doctor if you plan on being out in the heat. The Centers for Disease Control and Prevention provides guidance on heat and medications.

What signs indicate I’m developing heat illness when being active in the heat?

There’s a range of conditions to watch for. Painful heat cramps caused by dehydration and too much sweating are usually the first sign of danger. If you experience heat cramps, stop any physical activity, move to a cooler place, drink water or a sports drink with electrolytes, and wait for the cramps to go away before you restart physical activity.

If cramps last longer than an hour, or if you are for some reason on a low sodium diet, or if you have heart problems and these symptoms continue, seek medical help. If it progresses, it becomes heat exhaustion. You will experience heavy sweating, and feel cold and clammy. You may have a fast and weak pulse, some nausea or vomiting, and muscle cramps. You will also experience general fatigue and tiredness, dizziness, possibly a headache, and you may even pass out.

If this happens to you or someone else, move to a cooler place and loosen your clothing. If possible, apply cool wet cloths to your body or get into a cool bath to reduce your body temperature. Sip water if you feel nauseous, and to make sure you’re staying hydrated. If you are vomiting and can’t stop, or if your symptoms are getting worse or lasting longer than an hour, seek medical help.

How does heat stroke differ?

The next stage after heat illness is heat stroke, the worst heat-related medical condition that can happen to you. During heat stroke, your body temperature is 103 degrees or greater. Not only will you experience a headache, dizziness, and nausea, you also become confused. You don’t know where you are, or possibly even who you are, and you can pass out. Heat stroke is an extremely dangerous condition that can lead to permanent brain injury, and even death. If you are exercising and become confused or can no longer function, or notice this happening to someone else, get to a cooler place quickly and call 911. If possible, apply cool cloths or take a cool bath to get that temperature down.

How can I change my exercise routine to reduce my risk?

Here are some things you can do to reduce your risk:

• Limit outdoor activity as much as possible, especially during the middle of the day, the hottest period. If you need to exercise outdoors, do so in the early morning (before 10 am) or evening (after 4 pm).
• Wear sunscreen—SPF 30 or higher.
• Start slow and pace your activity, and slowly pick up the pace as you can tolerate.
• Keep hydrated during and after your workout.
• Wear loose, lightweight, light-colored clothing, which absorb less heat.

How can I stay properly hydrated?

There are a number of ways to make sure you drink enough fluids.

• Bring a water bottle and drink more water than usual.
• Drink sports drinks with electrolytes to maintain a balance between water and salt in your body.
• Don’t wait until you’re thirsty to drink. Once you are thirsty, you’re already dehydrated.
• Avoid very cold drinks, which can cause stomach cramps due to the dramatic shift in body temperature during extreme heat.
• Avoid very sugary or alcoholic drinks, which increase dehydration.

Any other suggestions on what I can do if I work or do physical activity outdoors?

If you have to be outside during the hottest hours, have a plan about what you are going to do should you start feeling badly. If you are with someone, such as a friend or coworker, check on each other to stay hydrated and get help if medical attention is needed.

Weight loss drugs are frequently in the news these days. Some new medications are specifically approved by the Food and Drug Administration (FDA) for diabetes, and others are specifically approved by the FDA for weight loss. You may have seen them advertised on TV.

In many cases, these drugs are part of an overall weight loss plan that may also include diet, exercise, and lifestyle changes, and they may often be a last resort for those who have tried other alternatives.

In this Q&A, Sophie A. Chrisomalis-Culver, MD, a specialist in internal medicine, explains who can benefit from these drugs and the experiences of her patients. She sees patients ranging in age from their 20s to those in their 80s for weight loss through Mount Sinai Virtual Primary Care.

Who is eligible for treatment with weight loss drugs such as Ozempic® and Wegovy®?

A lot of my patients have been trying to lose weight the good old-fashioned way with diet and exercise, but just can’t. To be a candidate for these drugs, you must have a Body Mass Index (BMI) over 27, along with other health issues such as hypertension, high cholesterol, diabetes, pre-diabetes, or you must have a BMI of 30 and above. You also must have tried a calorie-restricted diet, meaning under 1,200 calories per a day, and exercise 150 minutes of cardio per week for at least three to six months without success. We see many patients for consults about weight loss who have not yet reached this point, and others who have been at this point for most of their adult lives. We also consider patients who have an increased body fat percentage which their BMI may not reflect, but does impact their cardiovascular disease risk. Therefore, the BMI is simply a guide to determining eligibility for these medications and is ultimately patient dependent.

Sophie A. Chrisomalis-Culver, MD

Most of my patients are in their 30s or 40s. But I do have some in their 20s, and many over 50. Many of my patients are women who are post menopause and have trouble losing weight after they turned 50. And there are many women who have not been able lose weight they gained in pregnancy, though before they became pregnant their weight was normal.

Are the medications the primary therapy?

In addition to the medications, diet, exercise, and lifestyle are the foundational components of healthy living. We refer all our patients to a nutritionist and work towards more active lifestyles, but the medications are the key factor in how they are losing the weight. Most of the patients I see have tried everything to lose weight without success—but with these drugs, they are seeing success.

What are the different medications available, and how do they work?

The medications are a bit different. Ozempic and Wegovy are brand names for the generic drug, semaglutide. Ozempic is an FDA-approved injectable drug for diabetes, while Wegovy is approved for weight loss in patients who are not diabetic. These are called GLP-1 drugs because they mimic the action of a hormone called GLP-1 that controls blood sugar levels while decreasing appetite and slowing the digestive process.

Mounjaro® and Zepbound® are brand names for tirzepatide, which is a GLP-2 drug which means that it works on two receptors that stimulate two separate hormones that control blood sugar levels and curb appetite. Zepbound is FDA-approved for weight loss, while Mounjaro is approved for diabetes.

All of these brand names come in different formulations and strengths, which is why one brand name may be used for diabetes and another for weight loss. Ozempic is the drug that is most often in the news because it was the first to be used for weight loss. While it’s not FDA-approved for weight loss, physicians can prescribe it if a doctor determines it’s the best course of action for you. Most of our patients are taking Zepbound now due to shortages of the other formulations.

Are there risks to these weight loss medications?

With any medication, there are some risks. While taking into account each patients individual history, we also follow a specific set of clinical guidelines developed in collaboration with  Mount Sinai’s Division of Endocrinology, Diabetes and Bone Disease to make sure that there are no contraindications for individual patients. The biggest ones are a personal or family history of pancreatitis, thyroid cancer, multiple endocrine neoplasia (MEN) syndromes, or endocrine cancers. If you are pregnant, planning on becoming pregnant, or breastfeeding, we would either pause or not prescribe these medications at that time.

In terms of side effects, the most common are gastrointestinal (such as nausea, vomiting, diarrhea constipation). We start patients off at the lowest effective dose and follow them closely throughout their weight loss journey.  Side effects are usually tolerated at the lower dosages. Several of these medications work by slowing the digestive system so you feel full longer, and constipation can go along with that. Some patients may experience a change in bowel movement from a baseline of going every day to going four times a week instead. We encourage hydration, a high fiber diet, fiber supplements such as Metamucil®, and exercise to keep the gut moving. If patients are not having at least three bowel movements a week, we stop the medication or lower the dosage. Otherwise, a patient could be at risk for  problems with their colon.

How often do you see patients for follow-up?

Initially, we see patients every four weeks, or sooner if they experience any side effects. We start at the lowest effective dose and then titrate up every four weeks until they reach a dose where they’re losing as much as one to two pounds a week. Some patients are able to lose weight on the lowest dose. Some patients plateau after two or three months, and we increase the dose. Others don’t lose any weight at all until they hit the higher dosages. Once we feel good about their treatment program, we may have a follow up visit every three months. But we need to follow up with everybody to make sure they are not losing too much weight or losing it too fast.

How do patients take these weight loss medications?

Most of these medications are a self injection. It’s a pen with a tiny needle, and all you feel is a pin-prick. Usually, you inject it in your belly or the lateral side of your upper leg, wherever you have more fat. The medication comes with an instruction manual with pictures, and it’s pretty self-explanatory. But we do have clinical pharmacists who offer video visits to walk patients through how to do it if they need assistance.

What results have you seen?

I’ve seen tremendous success with my patients. Not only from a physical standpoint, but also from an emotional and mental health perspective. It’s been life-changing for patients. Some of my patients were immobile, burdened with arthritis, and very uncomfortable in their day-to-day life. Many had sleep problems and were at high risk of cardiovascular disease due to conditions that come with obesity, such as high blood pressure, high cholesterol, or pre-diabetes.

Many had other issues with their health related to their obesity. It’s a slow process because the goal is one to two pounds a week, so it takes years to get the necessary weight off for some patients. Overall, it’s been amazing to watch their progress and see the transformation in so many facets of their lives. We are so grateful to finally have a tool that works to help treat obesity in the primary care setting, as much of preventative health is founded upon healthy habits, including maintaining a healthy weight or BMI.

Fibroids are the most common type of non-cancerous tumors found in women of reproductive age, according to the U.S. Centers for Disease Control and Prevention.

Located in the uterus, they can vary in size and in number. By the age of 50, a majority of women will have one or more fibroids. The cause of fibroids is not fully understood, but hormones and genes are believed to play a role.

In this Q&A, Tamara N. Kolev, MD, an obstetrics and gynecology specialist at Mount Sinai Health System, answers frequently asked questions about fibroids and explains minimally invasive procedures for treatment. Dr. Kolev specializes in gynecological treatments using minimally invasive procedures and is involved in research on gynecological topics.

What are fibroids?

Fibroids are benign growths in the female uterus that are comprised of muscular tissue. They are present in about 70 percent to 80 percent of women. However, not all fibroids cause symptoms, so often women will not even know that they have fibroids.

What are the common symptoms of fibroids?

Some of the common symptoms for fibroids include abnormal uterine bleeding, pelvic pain, pain with intercourse, and back pain. Some women may experience problems with urination or bowel movements.

When do fibroids need to be treated?

Not all fibroids have to be treated, especially in women who do not have symptoms. However, when a woman experiences frequent heavy vaginal bleeding, treatment often is recommended. One minimally invasive approach is transcervical fibroid ablation.

What is transcervical fibroid ablation?

Transcervical fibroid ablation is an incisionless approach to treating fibroids. We use an ultrasound probe that is inserted through the vagina and through the cervix to identify the targeted fibroid. Then we use radiofrequency to ablate, or remove, the fibroid. This is usually performed in an outpatient surgical center, and the patient is able to go home the same day.

When do women see results?

Typically, patients will see results within three months of the procedure, with a majority of patients reporting a significant reduction in menstrual bleeding, along with a marked improvement in quality of life and symptoms. Over time, the previously heated fibroid tissue is broken down by the body, leading to a shrinkage of the fibroids.

Are there any side effects?

After the procedure, some patients may experience some irregular bleeding or cramping, which is completely normal. Patients will begin to see significant benefits of the procedure in approximately three months.

Who is a good candidate for the procedure?

Candidates for the procedure are women who suffer from heavy vaginal bleeding from fibroids. We can treat more than one fibroid during the procedure, as well as remove fibroids that vary in size and that are located in different areas of the uterus. The great thing about the procedures is that we can target more than one fibroid at the same time.

Are there other minimally invasive treatment options?

Uterine fibroid embolization is a nonsurgical procedure that typically takes place in the radiology suite. A radiologist blocks the blood supply to the uterus, which helps to shrink the fibroids.

 Are there other ways to treat fibroids?

There are multiple ways to manage fibroids. In addition to minimally invasive procedures, there is medical management, including hormonal treatment. Finally, there are surgical options, such as myomectomy, which is removal of the fibroids, or a hysterectomy, which removes the uterus.

Call to Action: Learn more about the Mount Sinai Fibroid Center of New York: https://www.mountsinai.org/care/obgyn/services/fibroid-care