Heat-related illness is common for those with chronic conditions. Learn from my mistakes.

I had a decision to make as I drove from North Carolina to Virginia on June 14: Do I go to the nearest emergency room or check myself into a hotel that made me uneasy?

The hotel was closer.

And at this point, I had been pulling over every mile since Durham to vomit, I was incredibly weak and I knew it wasn’t safe to keep driving.

I pulled into the hotel, unaware of how wrecked I looked (I’ll spare you the details) and told the front desk I desperately needed a room for the night.

I had the worst migraine of my life. And that’s saying a lot because more than one has landed me in the emergency department.

At this point I wasn’t sure if I had food poisoning, heat exhaustion or if it was POTS, a chronic illness I was diagnosed with in August 2011.

Ethan Hyman, an incredible News & Observer photographer, and I had spent the day in Selma and Wilson at the 301 Endless Yard Sale interviewing voters about their feelings on the state of the presidential election for an upcoming article.

I had warned Ethan, that morning, that heat has always been my kryptonite.

The U.S. Centers for Disease Control and Prevention warns that people like me with chronic health conditions are more at risk for heat-related illnesses. And while I know that, and typically monitor my symptoms fairly closely, this particular day caught me off guard. I hope I can prevent that from happening to someone else.

I can remember, even before being diagnosed with POTS, nearly passing out on middle school choir trips to warm nursing homes, feeling like my heart would explode during family hikes and having complete meltdowns as a child (sorry, Mom and Dad!) when I didn’t know how to explain that something was malfunctioning in my body.

After my diagnosis, I learned my personal signs of a POTS flare: dehydration, headaches, numbness in my limbs, dizziness, tunnel vision, loss of hearing and a sharp stabbing pain under my left lower rib cage, that doctors tell me quite literally is caused by my heart beating so fast it’s slamming into my chest wall.

I know when these symptoms come, what I need to do, how I need to take care of myself and the steps I should take to prevent myself from passing out.

And I know heat is one of my triggers.

So I was prepared for the yard sale. Probably more than I had ever been for an assignment. I had a cooler packed with water. I had 10 packets of LMNT, an electrolyte powder each containing 1,000 milligrams of salt. And I had extra medication in case I got sick.

Heat exhaustion

Under the blazing sun and in 90 degree heat, I felt fine.

It was the first day in a week I didn’t have a migraine — and one of the few since then.

I never felt like I was going to pass out.

I never felt any of my normal symptoms.

But we were hustling.

I kept drinking water, but I only once remember adding sodium. That was probably my biggest mistake. My doctor recommends, for me, more than 4,000 milligrams of salt and 3 liters of water per day to keep my blood pressure up.

Dr. Camille Frazier-Mills, an electrophysiologist at Duke University Hospital, who specializes in POTS and dysautonomia and oversaw my care while I lived in North Carolina, adds a caveat that while salt helps maintain hydration, it raises blood pressure. People who already have high blood pressure as a baseline need to be mindful of that when adding salt into their diet.

That Friday, my doctors and I were also in the middle of adjusting one of my medications.

My body only threw me one warning sign the entire day, and it was brief.

During our last interview, I had crouched down to talk with someone who was sitting in a chair at the Wilson County Fair Grounds. When I stood up I remember getting tunnel vision and being instantly hit with a headache, but it subsided almost immediately.

What is POTS?

POTS, also known as postural orthostatic tachycardia syndrome, is a form of dysautonomia, a disorder of the autonomic nervous system. That part of the nervous system controls everything your body does automatically— heart rate, blood pressure, body temperature regulation and digestion. The list goes on.

Its hallmark symptom, in adults, is when your heart rate increases at least 30 beats per minute within the first 10 minutes of standing.

POTS can cause low blood pressure, and if that becomes too low your heart tries to compensate by beating faster to ensure your blood gets back to your brain. If it doesn’t, your body forces itself into a horizontal position by fainting to get your blood where it needs to go.

And POTS causes a wide range of very annoying, often painful symptoms that leave many bedridden and with a quality of life similar to those on dialysis for kidney failure. I’m considered one of the lucky ones because I’m still high-functioning, but very much affected daily.

Chronic illnesses and heat

The Mayo Clinic says high heat and high humidity causes more blood flow to the skin, which in turn forces the heart to beat faster because it’s doing double its normal workload. Heat also causes blood vessels to widen, which lowers blood flow through the body, according to Manhattan Cardiology.

Both exacerbate POTS and can affect people with other chronic illnesses.

Frazier-Mills said a person with normal blood pressure and a normal heart rate have more breathing room or compensatory mechanisms in place to tolerate the extra heat. That’s not always the case for those on medications or those who have medical issues, and because of that they’re more apt to have heat exhaustion.

“It’s really kind of a reserve load issue, and so you have less reserves if your body is under chronic conditions or strains, or if you’re on medications, because obviously those medications may blunt some of the normal reactions that you should have in place and you’re not able to do it,” she said.

The CDC says that people who take diuretics, beta blockers, anticholinergics, antipsychotics and some antidepressants can also be affected by heat because those medications affect their ability to regulate body temperature.

The CDC also notes that people who use inhalers, insulin or EpiPens, and carry them, need to be careful because temperature can affect their medication’s effectiveness.

And then there’s the more physical aspect of heat and disabilities.

Rebecca Baum, a pediatrician specializing in developmental disabilities at UNC Health, said some people have a difficult time letting others know when they’re uncomfortable. Instead, they may show a change in behavior.

For others, they may have trouble moving to a cooler area if they become overheated.

“People with disabilities may depend on others for help, so caregivers need to be aware that overheating can occur and take appropriate measures,” Baum said.

She added that some disabilities, like autism spectrum disorder, affect a person’s ability to process sensory input.

“Their body may be very sensitive to signals that they are becoming overheated, or in other cases, not,” Baum said. “Their body may not register feelings of becoming overheated like we might expect.”

Heat-related illness in North Carolina

The North Carolina Department of Health and Human Services is tracking heat-related illness around the state on a weekly basis. High temperatures landed 226 people in the hospital between June 9 and June 15, while I was in the state.

Males between 20-24 were most affected, and emergency department doctors in Fayetteville treated the most patients, with heat exhaustion being the most prominent type of heat-related illnesses around the state.

DHHS noted that the temperatures in the Triangle never dropped below 70 degrees that week, and the maximum heat index ranged from 82.9 to 96.5 degrees.

The American Red Cross of North Carolina has been working to educate residents about the dangers of heat as temperatures continue to rise across the state.

Katie Sherk, the organization’s deputy regional disaster officer, said it’s important to pay attention to triggers that could result in dehydration and heat exhaustion and know that individuals with autoimmune diseases and neurological disabilities may not realize their body is overheating or overexerting.

She said during heat advisories people need to slow down, stay hydrated and stay indoors. Those without access to air conditioning should find cooling stations, like local libraries.

Sherk said heat impacts people differently. And like I experienced, sometimes heat exhaustion comes on with little to no warning.

“You can go from feeling pretty OK, and then the next minute you’re hit with a really bad headache, you have chills, maybe you have cramps and suddenly you’re pale. You’ve got clammy skin and you might feel very nauseous and weak,” Sherk said.

POTS and heat exhaustion

When Ethan and I got back to the newsroom, an hour after my last interview, my head began throbbing. I still wasn’t blaming the heat. I assumed the migraine was the same I had been experiencing all week. I had learned to power through most.

I had a five-hour drive ahead of me. I’m our D.C. correspondent, and I hadn’t bothered to book a hotel room in North Carolina that night. I was supposed to be at a family outing in the Virginia mountains the next morning.

I never imagined when I pulled out of The News & Observer how sick I was about to become.

Lying face down in a strange hotel room, able to hear everything happening in the next room, I regretted telling Ethan on our drive back to the newsroom how proud I was that my body never experienced any symptoms that day.

What I didn’t know — and actually only learned because I was assigned this article — was that had I checked my Fitbit I would have seen otherwise.

It registered that I did more than an hour of intense activity and a half hour of moderate activity that day. Ethan and I only walked 5,500 steps. That’s less than I regularly do at the Capitol. We never ran. We were largely in my car with air conditioning, or standing up interviewing people.

I checked my heart rate next. For more than an hour, I sustained over 140 beats per minute. Normal is 60-100 bpm. This was dangerous territory and why my fitness tracker believed I had been exercising.

Frazier-Mills explains that in high heat, the body’s blood vessels widen to allow the body to release heat. But that also caused blood pressure to fall, and that in turn forces the heart to beat faster.

She said people with POTS already have high heart rates when they stand. Typically, higher heart rates might cause palpitations or lightheadedness. Usually, I experience both.

So why did I feel fine?

She said it’s possible my body suddenly hit its tipping point.

“There becomes a point where the body’s like, ‘I’ve had enough of this’ and then you could have a secondary kind of vasovagal event,” Frazier-Mills said.

She said when the body gets fed up with the strain on its vessels, it relaxes and that either forces a person to lie down or pass out.

Frazier-Mills said she also finds that people with chronic conditions have a high tolerance to what their body goes through, so an average person might feel when something is off a lot stronger than someone who experiences differences on a daily basis.

For me, she said, I may not have noticed I was at my tipping point and needed to rest, so instead my body forced it.

Overcoming heat exhaustion

And boy, did it.

For nine hours in Orange County, I did everything I could to nurse myself back to health.

I knew what doctors would do if I went to the hospital — most likely an IV of saline solution and a migraine cocktail that would both numb the pain and put me to sleep.

Since I couldn’t keep fluids down, I started with the latter. I laid in my hotel room that was lacking in air conditioning.

At 1:30 a.m., the phone of the man staying next door began to vibrate and woke me up. The walls were that thin.

But that was a blessing in disguise.

For the first time, I realized I could drink. I tested that with water for a few minutes before moving back over to LMNT, to try to raise my blood pressure. Then I began adding in a combination of over-the-counter and prescription medications. (I’m excluding the types because everyone’s body is different and you should consult a doctor).

Less than five hours later, the fumes of my neighbor’s marijuana began drifting into my hotel room and I decided that was my cue to leave. I finally felt well enough to drive, my headache had subsided and I wanted to go home.

Since that fateful Friday, I’ve made it a point to stay in air conditioning as much as possible, drink copious amounts of water and maintain my salt intake.

I was born in Los Angeles and nothing makes me happier than a cold drink on a patio under a warm sun.

But the sun laughs at me.