Water, Hyponatremia, MDMA & Heat Stroke: How Not to Die

 

By Terry Gotham

Now that the summer festival season is in full swing and we’ve all been dripping with sweat once at least once, it’s time to have a little chat. If you’re one of the people who hasn’t pissed clear at a festival since Dubya was president, this is 100% for you. If you’re the person in your circle that hounds everyone else to stay hydrated and eat salty snacks Wednesday morning on playa, this is also 100% for you. For this edition of Do No Harm, I spoke to Dr. Daniel E. Rusyniak, Professor of Emergency Medicine & Adjunct Professor of Pharmacology/Toxicology and Neurology at the IU School of Medicine. He dropped a pile of knowledge, so I’m going to be able to walk you through what happens to your body when you roll your face off. Down to the hormonal level, putting yourself at risk for heatstroke & hyponatremia. And of course, also illustrate how to NOT do that.

In your body, there’s this antidiuretic hormone called Vasopressin, also known as ADH. ADH’s job is to ensure your body retains water (hence it being known as an antidiuretic), and to constrict blood vessels. By increasing the water pemeability of the kidneys, it plays a key role in keeping your fool ass hydrated. When it’s heavily secreted, your kidneys get the signal to fast track water reabsorption & pissing yellow. This happens in a few complicated ways you can read about here. Guess what MDMA happens to affect?MDMA, along with many of the novel psychoactive substances taken at festivals, regional burns, and EDM shows can be grouped in the term “amphetamines and stimulants.” Which have the much desired effect of decreasing fatigue, especially fatigue you generate from exertion. You know, that thing you’re actively taking drugs to ignore?  Kind of like missing red flags on date 3 & 4, ignoring warning signs from your cardiovascular systems can have disastrous effects on your health.

Fatigue is crucial in preventing heat stroke. The reason this signal is being sent, is to keep your temperature from spiking too high. The thing that everyone forgets about amphetamine use is that it doesn’t actually give you super powers. The fact that you’re getting tired more quickly in hot environments is a warning/break point signal to your body/mind that you’re being fatigued.  When sober, mammals reach a point of exertional fatigue and maximum temperature, at which point you begin to tap out.  Guess what amphetamines & stimulants do?

By allowing you to push past your operational limits, stimulants turn you from a person who will collapse before overheating into a person with a non-trivial risk of doing the exact opposite of that. The perfect storm Dr. Rusyniak described could be used for most, if not all of the MDMA death at festivals in recent years, especially the ones at New York City’s Electric Zoo.

The summer outdoor dance party is therefore the perfect condition for exertional heat stroke to occur. Warm environment (decreasing heat dissipation), increased exertion (dancing), use of drugs that blunt normal protective responses to exertional heat stroke.
~Daniel E. Rusyniak, MD (Medical Director of the Indiana Poison Center)

The problem is exacerbated by the fact that most usual methods for rapidly cooling MDMA users may not be applicable. That person sweating their face off/rolling so hard you can see them chewing the inside of their mouth off from 15 feet away, is probably not giving up his spot in the crowd to get water. Even if he did, especially on day 2 or 3 of the festival, hyponatremia becomes a real risk. Exertion when you’ve not had zero calories, zero sleep and a cocktail of uppers and downers amplifies this risk . This is the reason why smart festivals hand out Gatorade & salty snacks after day 1. This stuff isn’t rocket science, but it does need to be planned ahead and there are plenty of ways to mess it up if you’re not careful.

There are two other wildcards to the MDMA experience. At higher doses (you know who you are), MDMA has been seen to cause cutaneous vasoconstriction. This vasoconstriction increases your blood pressure and can hamper heat release at the same time it raises your temperature. You’ll feel exceptionally hot, and then drink a ton of water, amplifying your risk for hyponatremia. It’s very hard to troubleshoot what’s going on in your cardiovascular system when you’re running a 101 degree temperature in the middle of the dance floor during a Steve Aoki set.

The idea that you can actually overheat is real, verified science, and we need to stop pretending is a myth. It can happen and when you go hard, it’s much more likely. Take breaks, don’t party in direct sunlight for 15 hours a day (you know who you are), and try to be as consistent as you can with water. On playa, Piss Clear is well known, but I think Piss Clear Regularly, should become as important. Drink water consistently, starting early in the day, before you start feeling faint. This way, you’re not fucked up thinking you have to drink a gallon of water when your anxiety spikes and you start telling your friends you feel like you’re dying.

It’s important to build good habits that don’t involve your limits, because when you’re on stimulants of whatever that shady dealer is peddling as the purest molly this week, you might just forget they exist. Additionally, you’re not a varsity or high performance athlete. While it’s been shown that marathon runners and athletes can be cooled from temperatures exceeding 107 degrees, let’s not pretend that any festival will ever have the capacity for you to consider that a way to justify being irresponsible. If you’re LeBron, you can expect a cold water bath and sodium testing on game day; you better expect an hour wait for water and impure drugs. If you’re not LeBron, please follow these simple tips:

  • If a festival or party allows Camelbaks, BPA-free reusable water bottles or any form of BYOW, take advantage of it.
  • Know where the free water stations are at any festival. If you’re at a festival or party that doesn’t have free water, berate them on social media until they have them. Don’t pay for parties that don’t have readily accessible water.
  • If you’re one of those people who use repetitive motions when rolling to de-stress, attempt to build a habit of reaching for your Camelbak nib and taking water as one. That’s way less damaging than finding people to date or smoking cigarettes in response to the jagged energy.
  • Salty snacks and food with savory tastes are your friend, especially after day 1 of events.
  • Alcohol + MDMA = Dehydration Bonanza. Pick one. Seriously, that’s the express train to FailVille, population you.
  • If you feel like a sweaty mess, believe yourself and go get some water. If you don’t feel like a sweaty mess and you’ve been on the dance floor for an hour in direct sunlight, GO GET SOME WATER.
  • If you’re drinking, try to have at least 8-12oz serving of water for every 2-3 drinks. If you’re drinking and dancing, make that ratio as close to 1:1 as you’re able to.
  • Don’t be embarrassed if you need to slow down, take breaks, ask for help or flag down emergency services. That’s what the staff & EMTs are there for. If you try to shrug off serious symptoms of heat stroke, you’ll still need to see EMTs…you’ll be out of commission for much much longer.
  • Taking breaks earlier on are much more rejuvenating. Giving yourself breaks every couple of hours at a multi-day event can make day 2 & 3 a lot easier than forced crashing for 4hrs because you can’t handle it anymore.

Don’t try to be a super hero y’all. The summer is long, and Dr. Rusyniak & I want to make sure every single one of you see Fall 2017 as well as your favorite DJs over the summer.

Party Like A Rockstar: Tips For Festivals & Burns Without The Ruin

By Terry Gotham

One year, in my camp, there was a fellow named Bad Andy. He had a penchant for yelling “Rock & Roll” at the top of his lungs while executing bad ideas, which is how he got his name. One such bad idea was drinking a bottle of Jameson & a 24 pack of Bud Light before going on a midnight art walk without a Camelbak. Some of you may have seen this episode before…

The next day, after Rangers delivered 3 IV bags of fluid & 4 32oz bottles of Gatorade into his system, he was back at our camp, suffering in a hammock while we poked him with sticks. His penalty was the same as it was for all Burners who get a little too confident. He lost a literal day to the hangover and had 10-15% less Burning Man than the rest of us (depending on how many days you’re usually there, of course). With festival season s about to kick off, I figured I’d create the spiritual successor to my New Year’s Eve article and get our faithful readers information they can actually use when going hard at weekend festivals, regional Burns, or even the Big Kahuna itself. Some advice will be more relevant to Burning Man, while other notes will apply more to regionals and retail festivals.

Basic Tips For Comfort

One thing that I learned the hard way my first year on Playa: Bring more than 2 pairs of sunglasses. There’s nothing worse than bringing a pair of sunglasses and having them break, or bringing 2 pairs, loaning one to your friend, and then smashing yours by accident. This may seem like a fashion faux pas, but wearing a cheap pair of plastic gas station sunglasses will get you way more Instagram likes than squinting in a 3-7 days worth of pictures.

For Burners, this goes double. Have 2 pairs of sunglasses & 2 pairs of goggles. Even a cheapo 2nd pair purchased as an afterthought can seriously decrease the amount you mutter “fuck fuck fuck” to yourself during a whiteout.

For anyone who hasn’t been to Mysteryland or PEX Summerfest or Burning Man, trust that the sound never stops. Ever. No matter what festival you’re going to, have a noise cancellation/hearing protection plan. This is more than just “bringing a pair of foam ear plugs,” because we both know you’re going to lose those on night one. At least 1 pack of foam ear plugs or those custom fitted/molded ones are must-haves if you’re planning on camping anywhere near amplified sound. If you bring extra, you can earn friends on the dance floor when you’re generous with the rest of the pack. This might be a good time to do some window shopping at gearhungry.com, camping survival gear and burns just go together, trust.

Additionally, if you’re bringing a child, know that protecting their hearing is paramount. Construction grade noise cancelling headphones are a must. If I see you with a baby on the dance floor, and that baby doesn’t have ear protection that makes him look like he works on a tarmac at an airport, I’m going to hate you to death with my mind.

One little suggestion to help you feel refreshed: Bring a toothbrush when you head out for the night. While this tip doesn’t really work in club land, giving yourself a fresh clean mouth and splashing some cold water on your face is as rejuvenating as a 20min nap.

Know the route from where you’re partying back to your tent in daylight & the dark without relying on too many landmarks. One of the biggest issues newbie Burning Man attendees report is, the day after the Man burns, no one can find their way around because they were using “the man” as a guide post to locate themselves.

Even if you don’t plan on tanning during the event, don’t forget sunscreen! Not tanning oil, sunscreen, with at least SPF30.You’re going to be in the sun all day, so even if you’re not lily white, you might burn. I wouldn’t wish a sunburn on my worst enemy at Electric Daisy Carnival Las Vegas or Burning Man.

Lastly, have a plan to get there AND TO GET HOME. I’m amazed I need to say this, but apparently it’s a tough one for some of us. No one wants to be the guy who is hitching a ride away from the festival. And yes, if you’re hitching to get off playa on Sunday or Monday after the man burns, we all hate you.

How To Avoid The Penalty Box (Hangovers)

While some issues are largely surrounding being comfortable while partying, some will sideline you if you don’t handle them properly. That’s why the mistake Bad Andy made was so costly. He lost 24hrs of Burning Time, which is pretty expensive, given the cost to attend and how much he’d been looking forward to it all year.

On day 2 and 3, start mixing Gatorade & salty snacks into your water regimen. Pissing clear is important, but because you spend so much time sweating, unless you’re replacing those electrolytes, you’ll be at risk for an equally problematic situation. Here’s a pile of potential problems to look forward to if you’re not maintaining those levels.

Moreover, at Burning Man, unless you’ve got an RV, by the time it’s 10 am, it’s too hot to sleep in the tent you took to Rainbow Gathering & pitched in the shadows of a big ass tree. So, this is a big one. Get to bed early enough such that you’re solidly in deep sleep by the time the sun is up. While you may not be punished for this so severely at a forest-based festival, if you’re on a beach or on playa, messing this up will cost you a night of sleep. That may not be 100% disabling, especially for our younger readers, but do this 2 days in a row, and you’ll be a zombie, guaranteed.

An easy way to sneak snooze time is to schedule a nap during a DJ you hate. It feels like you can’t miss anything and you’ve gotta go hard, trust me, don’t give in to FOMO. You’ll have a better time if you’re well rested, and you won’t piss off the people you camp with. Even a nap that only lasts 90min is a full REM cycle if uninterrupted.

One oddly helpful suggestion I received on playa one year is to start collecting/packing out your garbage daily over the weekend. This sounds like a thing we all say we’re going to do, but never remember. I tried it once and can attest to how smoothly it made my departure. Bag stuff up and get it ready to process/bring back with you from Leave No Trace events, so when you’re hungover/tired the day after the burn, you’ve got one less thing to think about.

Reports of My Death Have Been Greatly Exaggerated

This last category will be a bit more serious. Certain mistakes will ruin your night and the following day, while others can ruin your life. For example, know where the crisis intervention/Ranger stations are before you have an emergency. This can literally make the difference between life & death. I cannot stress this point enough. Say hi to the Rangers, Ground Control (EDC) or Conscious Crew (Seattle/Tacoma region events) before you get fucked up. Make sure your sober spotter knows how to get the attention of emergency staff. I cannot stress this point enough. When you need help and everyone’s on Ketamine, reading a map’s gonna get real tough, real fast.

No matter what the amphetamines tell you, don’t dance for more than 4 hours at a time without stretching and taking a break to cool down. Seriously. The stimulants have gotten powerful over the years, but the cardiovascular system of your average dance floor participant hasn’t. Stretching isn’t just because it feels good while you’re fucked up, it’s to prevent soreness, stiffness and aches you might attempt to medicate with painkillers. Take a break, the party will still be there after you take 20min to relax in a cuddle puddle.

Secondly, calm it down with the frat row level drinking. No really, you can’t be conversationally drunk for more than 12 hours. Either exhaustion finally overtakes you, or you mis-time that 14th shot and you crash hard. I couldn’t be a bigger fan of margarita walks in the inner rings near center camp, but don’t plan on day-drinking all day and partying until sunrise that same night. Give yourself an early bedtime and a Camelbak or two of water, so you can actually hit up Utili-kilt Yoga the next day.

If you’re honestly attempting to take drugs to stay up longer than your body allows, skip the adderall and hit up the provigil. You’ll get a couple more hours of party but less of the amphetamine jitters & insanity. The old urban legend of being awake for 72hrs causing you to qualify as clinically insane is a total myth, but amphetamine psychosis most certainly is not. Don’t try and push it, because the drugs will knock you around.

Be kind to yourself. Don’t try and push so hard, there will always be another party. Slow your roll so you make it to Labor Day with epic memories that don’t involve ambulances or puking on the deep playa because you needed more calcium. If you find me on the dusty dance floor, I’ll have ear plugs for you.