Too darn hot!

It's not just the heat of a sultry summer day; hot kitchens, hot baths, and the heat of a fever can magnify problems with fatigue, gait, muscle strength and other symptoms.

"These difficulties are real. It's not your imagination," explained Dr. Stephen Waxman, chairman of Neurology at Yale University School of Medicine and director of the Center of Neuroscience and Regeneration Research. "Heat-sensitive people with MS need to structure their environments prudently," he said.

Some people unaffected

"But some people with MS are not affected by temperature in the slightest,"said his colleague Dr. Jeffrey Kocsis, professor of Neurology at Yale.

"Even in scorching weather, the core temperature of the central nervous system is not going to change that much," he said. And it is the core temperature, the heat deep in the body, that makes the difference in nerve conduction.

"Years ago, the 'Hot Bath' test was used to diagnose MS," Dr. Kocsis continued. "A person was immersed in

104[degrees]F water for ten to fifteen minutes. If the person's neurologic signs or symptoms worsened, it was taken as evidence of MS. Not only was the test poor because it increased some people's symptoms, it was also unreliable! Inadvertently, it showed the wide range of responses that people with MS may have to heat."

Power in the shower

Dr. Robert F. Goldberger, who looks at MS both as a physician and as a person who has the disorder himself, learned how dramatically his own body responds to heat when he had a sore throat and slight fever. His strength was so affected he could hardly move. His doctor suggested Tylenol and a cold shower.

"I followed the first part of the advice--and found that my strength gradually returned as my fever receded," he said. "Later, when I was feeling better, I followed the second suggestion--a long, cool shower--and I was amazed to find that I became still stronger. Just one-and-a-half degrees of elevation in body temperature had been enough to lay me flat," he said.

This experience started Dr. Goldberger's practice of taking a cold shower every morning. He has experimented with varying both water temperature and the length of time, and he now knows how to decrease his body temperature between one-half and a full degree.

Water works better than air

"It is far easier to cool oneself by showering or swimming than by sitting in an air conditioned room," Dr. Goldberger said. "Air is a poor conductor of heat. Water, on the other hand, conducts heat very well."

Dr. Goldberger found that swimming in 78[degrees]F water for thirty minutes lowers his body temperature by as much as two-and-a-half degrees. He enjoys swimming more than showers and he also points out that the vigorous exercise is important for weight control and cardiovascular health. In contrast, vigorous exercises performed out of the water often caused him to have an elevation of body temperature and increased weakness.

he believes that people with heat-sensitive MS should establish a regular cooling routine. His own includes regular swimming in water many people would find unpleasantly cold.

Temperatures in the low to mid-80s are generally perceived as more tolerable. Water in the 90s is not recommended.

"If you inquire about swimming at a community facility, ask about water temperature," Dr. Goldberger suggests. "Some pools used for people with arthritis may be dangerously warm for you."

Community swim

Low-cost swimming classes for exercise, socializing--and for cooling--are offered by a number of chapters of the National MS Society. The program sponsored by the Georgia Chapter in Atlanta is an excellent example. Classes are held in several locations and have proved extremely popular. The instructors go through a special training program to learn about MS and the best exercises and equipment to use. The Georgia groups swim in water that is ranges between 80[degrees] and 84[degrees]F.

Swimming gives people "social support that is different from support groups," according to Connie Divine, the chapter service director, who developed the Georgia programs. Some participants have also noticed improvements in their flexibility and their gait. "And the people in our swimming programs just generally seem to feel better about themselves," she said.