Common Sense to Battle Heat-Related Illness

Heat Pill: Body Temperature Monitoring

Heat exhaustion and heat stroke are a major concern for athletes around the world. Particularly for people living in hotter climatic regions, heat illness presents a dangerous situation. Prolonged exposure to heat and intense workouts can lead to quick dehydration and the lack of adequate rest and fluid intake can lead to complications of heat exhaustion and heat stroke. Even on a relatively cooler day, the high intense activity levels of sports persons could raise their body temperature above critical levels making them vulnerable to heat strokes that are life threatening. As per the data from the Annual Survey of Football Injury Research, since 1995, there have been a total of 34 deaths among football players at the high school, college and the professional level due to heat illness. The most important one being the tragic case of the late Korey Stringer, offensive lineman with the Minnesota Vikings who succumbed after a training session due to heat illness. [Jon Krawczynski] in May 2008, Chad Wiley, a Senior tackle with the North Carolina at&T State University also collapsed due to heat exhaustion. [Abigail Funk, 2008] School kids are more prone to heat illness. The recent death of Max Gilpin, a 15-year-old offensive lineman at the Kentucky high school, whose body temperature reached a shocking 107 degrees has sent wake up call to sports trainers. [Dan Peterson, 2009] Today, we have available a new and improved method of temperature monitoring that could prove to be life saving for athletes. The heat pill, as a body temperature-monitoring tool is gaining wide acceptance among trainers and athletes across the world. A brief overview of heat illness followed by a discussion on the use of the Heat pill and its effectiveness as a prophylactic screening utility will provide better insight into the subject.

Heat Illness

Heat illness is a broadbased term that represents a spectrum of heat related illness ranging from the mildest form called as dehydration to heat cramps to the more severe forms of heat exhaustion and the life threatening heat stroke. [UAB Health System] Without swift intervention, the symptoms of dehydration may quickly worsen to more severe heat stroke wherein the body temperature soars above 104 degrees. Heat stroke ranks third among the leading cause of death among American college athletes. [NASA, 2006] Typical symptoms of heat exhaustion are nausea, fatigue, Muscle cramps, weakness, vomiting, etc. Since these symptoms are also common with the more severe form of heat stroke, it is very difficult to differentiate between them and to find out if the person has reached the critical stage. The National Athletic Trainers Association has issued guidelines for athletic trainers prescribing a prophylactic approach involving frequent water breaks, gradual acclimatization to the heat and reduced activity when the mercury is soaring. Sweating along with increased blood flow to the skin are the two natural cooling mechanisms of our body. After a period of profuse sweating if adequate water is not replenished, the cooling mechanism is hindered resulting in an over heated body. In fact, fatigue is not so much due to muscle weakness but rather a symptom of an over heated brain. As Dr. Doug Casa, of the University of Connecticut and a heat stroke specialist says, “If you cool someone right away, on site, they don’t die — period. The key to surviving heat stroke is getting your temperature (down) to approximately 104 in about 20 minutes.” [Dan Peterson, 2009] Thus, it is obvious that frequent monitoring of the core body temperature during athletic events and active training sessions is very vital to identify hyperthermia before it sets in and develops into a life endangering heat stroke.

The Heat Pill

Advancements in technology have now brought forth a novel and effective method of monitoring body temperature. Tympanic and rectal temperature measurements used to be the traditional method of measuring the core body temperature. But these methods are unsuitable for realtime measurement of body temperature during intense athletic activities. The CorTemp Pill, a NASA originated telemetry technology that involves an ingestible sensor pill, is essentially a miniaturized transmitter that could accurately sense and transmit core body temperature as it passes through the human gastrointestinal tract. The John Hopkins physics laboratory in collaboration with NASA originally developed the technology in the late eighties using cutting edge space technologies such as telemetry and microminiaturized circuitry. The original purpose was to effectively monitor the changes in body temperatures of astronauts during space walks. By 1988, HQ, Inc., based in Florida licensed the technology for commercial use. [NASA] Since then the technology has found immense use in pharmaceutical research to measure core body temperature changes in response to drug interactions. For athletes and sports trainers, the ‘ingestible thermometer’ offers an effective method to monitor core body temperature on a realtime basis.

How the CorTemp â„¢ Works

The Core temp sensor pill contains a micro silver oxide battery, a quartz crystal and a circuit board on a ceramic substrate. Once ingested, the quartz crystal inside the pill vibrates with a specific frequency that is relative to the internal temperature of the body. This vibration creates a magnetic flux and the sensor transmits a low frequency signal across the body, which can be effectively monitored by a data recorder that displays and stores the data. The software supplied with the CorTemp â„¢ kit will facilitate transfer of data between the recorder and a PC or other portable device. The software could also be used for preprogramming the device to sound alerts once the core body temperature crosses a preset limit. The data recorder can handle as many as 99 athlete ID’s. For long-range use, the company also provides a RF-based monitoring system that could operate at a distance of 300 feet from the recorder. Using this wireless telemetry feature, athletes wearing the Recorder/RF remote set can be remotely monitored by an ATC. [HQ Inc.]

Advantages of the Temperature Pill

There are several advantages of using the CorTemp â„¢ ‘temperature pill’ technology. Firstly, unlike the traditional methods, the CorTemp â„¢ technology allows for easy and real time monitoring of core body temperature in a non-laboratory environment. This is highly suitable for team based outdoor sporting events where temperature changes can be rapid within a short period of time. The telemetry-based system offers an ideal method for recording thermal changes during high intensive training sessions as the non-tethered technology does not affect the on field performance. Further it totally eliminates the embarrassment and the inconvenience associated with wearing a rectal probe. The disposable nature of the sensor pill eliminates any hygiene concerns that are normally associated with reusable tools. [HQ Inc.] Already many NFL teams such as the Vikings, Jacksonville Jaguars and Philadelphia Eagles are using the heat pill on a test basis. As Mike Ryan, the chief trainer of the ‘Jacksonville Jaguars’ says, “If it works and it’s doing it’s job, no one will get to the stage where there’s a problem. That’s what we like. it’s a form of preventative medicine.” [Associated Press, 2005]

Reliability

Scientific research has indicated that Core Temp pill is very reliable with an accuracy of (Â± 0.1 ” C). A recent study by Casa et.al (2007) documented temperature measurements at different sites such as oral, forehead, auxiliary, gastrointestinal, Aural etc. during a session of 180 minutes of physical exercise and compared them with the recommended standard of rectal temperature (RCT). The subjects were 15 male and 10 female athletes with age of (26.5% Â± 5.3 years) and weight (72.73Â± 15.95 kg). The subjects were measured before the exercise session and every 60 minutes during the 180-minute exercise session and every 20 minutes during the 60 minutes post exercise session to document the change in temperatures. As an accepted standard parameter, all temperature measurement devices were considered invalid if they exceeded the acceptable bias of Â±0.27Â°C. [Casa et.al, 2007] (the average difference between the rectal and the particular device temperature). The results from the study indicated that the ingestible thermistors (Core Temp pill) are the most reliable among the other devices. When compared with the standard rectal temperature, only gastrointestinal temperature (using Core Temp pill) with a mean bias of (-0.19Â° C) and forehead temperature (-0.14Â° C) were found to be the most accurate and reliable measurements. Also, due to the fact that forehead temperatures were dependent on the settings and showed great fluctuation, the researchers concluded that gastrointestinal measurement of core body temperature was the one closest to rectal temperature measurement and hence the most reliable form of core body temperature measurement. Therefore, for sportspersons who are involved in intense physical activity in the outdoors, all other forms of core body temperature measurements besides the rectal and gastrointestinal measurements are considered invalid and not recommendable. [Casa et.al, 2007]

Contraindications

As with any other drug or diagnostic tools, there are some contraindications for the ‘Heat Pill’ as well. The existence of gastrointestinal disorders, inflammatory bowel syndrome or a previous history of gastrointestinal surgery are cases where the use of the heat pill is not recommended. The Core temp Pill is also contraindicated in case of those who have implanted cardiac pacemakers or any other electro medical device in their body. Also, if the subject is going to have a MRI taken during the day then the Core Temp Pill should not be ingested, as it would interfere with the MRI results. Also in some extremely obese individuals, the patient’s girth may effectively exceed the radial range of the sensor, which is approximately 24 inches. [HQ Inc.]

Cost of the Heat Pill

As good it is as a preventive screening tool, the heat pill is quite an expensive option and may not be affordable for all athletic departments. With the monitoring device costing around $2,500 and an added $35 for every ingestible pill, this device may not be appealing for everyone. As Eric Coris, the director of Sports medicine program at the University of South Florida (USF) says cost would be a crucial factor in the widespread acceptance of this technology, “Monitoring players’ heat and fatigue levels likely will become the norm as the technology increases and the price to participate decreases, Ultimately, it may get into the performance realm,” [J.L Webb]

Conclusion

The ‘Heat Pill’ has made possible calculating core body temperature in a non-laboratory environment on a realtime basis. For assessing hyperthermia on the field, the ‘heat pill’ offers the best technological means and the most useful life saving screening method for the Trainers. While there is little doubt that the Core Temp is a reliable, easy to use and potentially life saving screening tool it is not affordable for everyone. In the near future when the price drops as with all emerging technologies, the ‘Heat Pill’ would be more widely used and could possibly eliminate heat stroke, which is currently the third most important cause of death among athletes in America. There is no question of doubt that the ‘Heat Pill’ will serve as a life saving technological advancement for athletes around the world.

Bibliography

1) Jon Krawczynski, (2005),’ NFL Teams to use Pill to Monitor Body Temperature’, Accessed Feb 21st 2010, Updated 8/15/2005, available at, http://www.usatoday.com/sports/football/nfl/2005-08-15-pill-heat-nfl_x.htm

2) Abigail Funk, (2008), ‘Heat Illness Study Roundup’, Accessed Feb 21st 2010, Available at, http://www.training-conditioning.com/2008/08/study_roundup_heat_illness_1.html

3) Dan Peterson, (2009),’ Heat Stroke Deaths in Football ‘All Preventable’, Accessed Feb 21st 2010, Available at, http://www.livescience.com/health/090202-sports-heat-stroke.html

4) NASA, (2006), ‘Ingestible Thermometer Pill aids Athletes in Beating the Heat’, Accessed Feb 21st 2010, Available at, http://ipp.gsfc.nasa.gov/TOP-SS-Ing-Thermom.html

5) Douglas J. Casa PhD, Shannon M. Becker MA & Matthew S. Ganio, MS et.al (2007), ‘ Validity of Devices that Assess Body Temperature During Outdoor Exercise in the Heat’, Journal of Athletic Training 42(3) 333-342

6) HQ Inc., ‘CorTemp: Ingestible Core Body temperature Sensor. Intended Use / Contraindications’,

7) HQ Inc., ‘Core Temperature Monitoring via Telemetry: Research Applications’,

8) J.L Webb, ‘Team Physicians Use Cutting-Edge Technology,

Common Sense to Battle Heat-Related Illness’, Accessed Feb 21st

2010, Available at, http://orlando.medicalnewsinc.com/news.php?viewStoryPrinter=711

9) Associated Press (Aug 2005), ‘Pill Monitors Athletes’ Body Heat’, Accessed Feb 21st 2010, available at, http://www.wired.com/medtech/health/news/2005/08/68522

10) UAB Health System, ‘Heat Related Illness’, Accessed Feb 21st 2010, available at, http://www.uabhealth.org/14224/

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