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The Heat Stroke Death of Korey Stringer

Korey Stringer was born in 1974. He was 6' 4" tall, weighed 335 pounds and was an All American tackle at Ohio State University. He went on to become an All Pro lineman for the Minnesota Vikings.

On Tuesday morning, July 31, 2001, the temperature index reached 110 degrees. The Vikings wore full pads and helmets for morning practice, which was a bad decision because extra clothing and padding prevent the body from getting rid of heat.

Stringer found it very difficult to keep up with the other players, even though he was a great athlete and was in his own words “in the best shape of my life.” Stringer vomited three times during practice and complained of weakness and dizziness, collapsed during a drill, and breathed heavily when he walked to an air-conditioned tent. The trainer in the tent observed Stringer’s condition and offered him water. Stringer remained in the tent on an examining table for forty-five minutes, until the trainer called for a cart to take Stringer back to practice. When Stringer rose to meet the cart, he suddenly laid down on the ground and became unresponsive. At this point, the trainer summoned additional help and applied ice towels to Stringer’s body (Sports Law Journal, Villanova University, 2005, vol12, issue 1). He was taken by ambulance to the hospital and when he arrived, his temperature was 108.8 degrees. That evening he bled into his skin and everywhere else. He died the next morning in kidney failure.

Just Heat Stroke?
Heat stroke means that the body temperature rises so high that it cooks the brain so your body stops functioning and you can die. Now, more than twelve years after Stringer’s death, nobody has changed his diagnosis of heat stroke. I have no new information on his death, but I do know that certain drugs markedly increase a person’s risk for heat stroke.

During the lawsuit that followed his death, the attorneys for the Minnesota Vikings claimed that he frequently used a supplement called Ripped Fuel, which contains ephedra. His training camp roommate said that Stringer had used Ripped Fuel the morning of the day he collapsed. No traces of ephedra were found in Stringer’s body, but the Vikings claimed that toxicology reports did not test for ephedra. Reports state that his body was tested only for a diuretic called hydrochlorothiazide (Sports Illustrated, February 25, 2003). Athletes use this diuretic to hide illegal anabolic steroids used to make them stronger.

Some athletes take ephedra to lose weight or to be more aggressive. Ephedra is a stimulant and all stimulants, including amphetamines and cocaine, can cause a sudden uncontrolled rise in body temperature. A single nasal spray of cocaine blocks blood flow to the skin and sweating, to prevent a person from cooling his own body (Annals of Internal Medicine, 2002;136(1):785-791). Ephedra increases risk for heatstroke by:

increasing heat production by making your heart beat faster and stronger, and
preventing heat loss by constricting blood vessels near your skin and decreasing sweating.
The International Olympic Committee, the National Football League, the National Collegiate Athletic Association, minor league baseball, and the U.S. Armed Forces have all banned the use of ephedra.

I’m Not So Smart Either
Almost all cases of heat stroke occur when you suddenly increase the intensity of your exercise, as in the finishing sprint of a long distance running or cycling race, or an intense run down the field in soccer or football. In 1965, I almost died from heat stroke in an unimportant local race near Four-Mile Run in Arlington, Virginia. I am still embarrassed by the stupidity that I, as a doctor, showed when I ignored all the warning signs as my temperature continued to climb. First your muscles are affected, then your circulation and then your brain.

Muscles: As your temperature starts to rise, your muscles feel like a hot poker is pressing against them. It is normal for intense exercise to make your muscles burn, but hard exercise does not cause painful burning that feels like fire. Furthermore, the burning of hard exercise is relieved by slowing down. The muscle burning of impending heat stroke does not go away when you slow down.

Circulation: As your temperature rises further, the air that you breathe feels like it’s coming from a furnace and no matter how rapidly and deeply you try to breathe, you can’t take in enough air. When you exercise intensely, you can become very short of breath, but the air you breathe will not burn your lungs. Burning in your lungs, not relieved by slowing down, signals impending heat stroke.

When you feel that the air is so hot that it burns your lungs, stop exercising. This sign means that your heart cannot pump enough blood from your exercising muscles to your skin so heat is accumulating rapidly and your temperature is rising rapidly. Your temperature is now over 104. Continuing to exercise will raise your body temperature even further and it will start to cook your brain.

Brain: Your head will start to hurt, you may hear a ringing in your ears, you may feel dizzy, you may see spots in front of your eyes or have difficulty seeing and then you can end up unconscious. Your temperature is now over 106 and your brain is being cooked just like the colorless portion of an egg that turns white when it hits the griddle.

Treatment of Heat Stroke
When a person passes out from heat stroke, get medical help immediately. Any delay in cooling can kill him. (Caution: a heart attack can also cause a person to pass out and you do not want to cool a person suffering from a heart attack). A person who is suffering from a heat stroke will have skin that feels incredibly hot. Carry the victim rapidly into the shade and place him on his back with his head down and feet up so blood can circulate to his brain. Cool him by pouring on any liquids you can find or spray him with a hose. It doesn’t make any difference what you use: milk, Coca Cola, beer, or anything else. Evaporation of any liquid cools. As you cool him, he will then wake up and talk to you and act like nothing has happened. While he’s sitting or lying there, his temperature can rise again and he can go into convulsions or pass out again, so he must be watched for at least an hour.

Take it Easy When You Exercise in Hot Weather
During exercise, almost 80 percent of the energy used to drive your muscles is lost as heat, so you heart has to pump extra blood from your hot muscles to your skin where you sweat, sweat evaporates, and cools your skin to dissipate the heat. The harder you exercise, the more heat your muscles produce. Everyone who exercises, particularly in hot weather, has to sweat to keep his body temperature from rising too high. Cocaine and amphetamines can kill exercisers by blocking sweating and blood flow to the skin.

June 16th, 2013
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About the Author: Gabe Mirkin, MD

Sports medicine doctor, fitness guru and long-time radio host Gabe Mirkin, M.D., brings you news and tips for your healthful lifestyle. A practicing physician for more than 50 years and a radio talk show host for 25 years, Dr. Mirkin is a graduate of Harvard University and Baylor University College of Medicine. He is board-certified in four specialties: Sports Medicine, Allergy and Immunology, Pediatrics and Pediatric Immunology. The Dr. Mirkin Show, his call-in show on fitness and health, was syndicated in more than 120 cities. Read More
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