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DEAR DR. ROACH: I’m an 82-year-old man with osteoporosis, a pacemaker, and a vegetable garden, which I worked in yesterday for 5 hours in the extreme heat. I consumed a large bottle of ice water. When I came back into the cool house, I was unable to select or even pronounce the proper words. I felt like my brain’s gears were all in neutral. My wife had me drink a sports electrolyte drink, and I got back to normal in about 15 minutes. Did I damage myself in some way yesterday? -- Prof. G
ANSWER: The major concern in an elderly person with confusion after prolonged sun exposure is heatstroke, which is a medical emergency. I can’t make this diagnosis with certainty since you didn’t tell me (and may not even have taken) your temperature, which is usually over 40 degrees Celsius (104 degrees Fahrenheit) for heatsroke. The skin is hot and dry, as the person usually isn’t sweating.
Heatstroke is a very dangerous situation, and we treat patients very aggressively to cool them down quickly. Cold water immersion is one way of doing so; this takes lots of resources, and not all emergency rooms are equipped for this, especially when treating a large number of patients (as we would during a heat wave). Cold fluids can be given intravenously.
When I was a trainee during the deadly heat waves in Chicago, noncritical patients were cooled by being bathed in cool water (not ice-cold, which reduces blood flow to the skin) and with very large fans, which was an effective way of cooling many people at once.
I think the fact that you got better quickly is very good news. Getting the body temperature down from 40 degrees Celsius or more to a normal temperature usually takes several hours, so I suspect that yours wasn’t so high, thus putting you in less danger.
There are other possibilities. When people sweat, they lose water and sodium, and if you’re only drinking water, your sodium level in the body can get too low. This can certainly cause mental status problems. Most sports drinks don’t have enough sodium.
You might also have had transient low blood pressure. The initial treatment is to always get the person out of the heat and cool them off, often with fluids. (For heatstrokes, fluids should be given by medical personnel.)
To answer your question about any damage that you may have done yourself, I don’t think that damage is likely, but a visit to your doctor even now is prudent. Kidney damage and muscle breakdown are unusual but can be very serious complications of heatstroke and other dangerous heat-related illnesses. This can be checked through blood and urine tests.
Thyroid disease could also predispose you to temperature-related problems and might be worth checking. You have a pacemaker protecting you against too slow of a heart rate, so this should be routinely interrogated (where your doctor looks at the downloaded data from the device).
Finally, prevention is key. Staying out in the extreme heat for 5 hours isn’t a good idea for anyone, especially not a person in their 80s with a few medical issues. Garden in the morning when it tends to be coolest, and don’t stay out so long.
Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu. (c) 2026 North America Syndicate Inc.
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