Dealing with fall yard work and winter’s snow and ice are included in the daily routine for people who live in the northern tier of the country. Raking leaves, pulling garden plants, cleaning gutters and shoveling snow are standard assignments when summer turns to autumn and autumn turns to winter.
Those activities can actually provide a bit of exercise and help keep you in shape. But, if things go wrong, handling a rake or a shovel can be deadly.
“Fall yard work, if you do it in moderation and keep hydrated, is very good for you,” said Shenjing Li, M.D., an interventional cardiology physician at Sanford Health in Bemidji, Minnesota. “But if you push yourself too hard, especially on extremely hot days, it can be harmful.”
Heat and cold, when combined with exertion, can overload the heart, so paying attention to what the body is saying is crucial.
“When mowing the lawn, using a riding mower is better than a push mower, especially for people who already know that they have coronary disease,” Dr. Li said. “People who have a history of heart failure and are on Lasix or other medications to lower the blood pressure should watch for signs of dehydration. Sometimes people will feel dizzy when they stand because of orthostatic hypotension. If you feel woozy when standing quickly after doing yard work, take a break.”
Unsafe yard work
Yard work precautions shouldn’t stop when the weather turns cold.
“Winter is tough on our cardiac patients,” Dr. Li said. “From my personal experience, on one shift on Thanksgiving Day in 2016, while I was a cardiac fellow in Sioux Falls (South Dakota), I had five major heart attack patients come to the emergency room. They all had the same scenario: They went outside to shovel snow and suffered heart attacks.”
Among that day’s patients was a 70-year-old man who was known to have coronary disease. Soon after he began to shovel he suffered his heart attack. And he couldn’t be saved.
Another man who was in his 70s suffered a similar attack. Fortunately, after a helicopter ride to the emergency room, the medical personnel were able to save him.
Another lucky patient was a man in his 30s who also was in a battle for his life following his heart attack. Once again, the talents of Dr. Li and his associates created a happy ending.
“Shoveling snow is very unsafe. For high risk patients — people in their 50s who have high blood pressure and maybe even diabetes — shoveling snow can be deadly. But even if you are young and healthy, that doesn’t mean that you are safe,” Dr. Li said. He cited a study conducted in Canada reporting that about 100 Canadians die every winter while shoveling snow.
Cold air’s effect
The exertion of lifting and pushing snow can be enough to trigger a heart attack. Adding cold weather to the equation, however, makes the task even more deadly.
“When you inhale extremely cold air, and when your skin feels the cold air, the blood vessels constrict,” Dr. Li said. “When that happens the heart has to pump harder to overcome the resistance. Shoveling also increases the need for blood flow and that increases the heart rate and the blood pressure.
“There is more oxygen demand for the heart and when this happens, especially to people already with coronary disease, there can come a point where the heart won’t tolerate (the added demand).”
The body will usually indicate when the heart is stressed, but some people may not correctly interpret the signs.
“When people do the heavy shoveling, they can think that the discomfort they feel is because of the act of shoveling when, actually, it can be from the heart,” Dr. Li said. “From a coronary standpoint, working with snow is not a benign activity. It holds risks. Shoveling snow and cold weather are a dangerous combination.”
Unfortunately, every winter people will have to deal with snow. Hiring a plow driver to push it probably is the best option, but if you are going to remove it on your own, Dr. Li suggests purchasing a snow blower.
“If you have to work with snow, use a blower and take breaks,” he said. “You should also watch for signs (of a heart attack) and, if you don’t feel good, don’t deal with the snow at all. It also is better to have someone work with you to share the workload and to be there if something goes wrong.”
Falls are common
Autumn and winter also are very busy seasons for emergency department professionals as people climb ladders to clean gutters, shovel snow off roofs and slip on icy sidewalks and steps.
“The No. 1 cause of trauma activations, where people are severely injured and we have to mobilize our trauma team at the Bemidji Medical Center emergency department is falls,” said Joe Corser, M.D., chief of service at the emergency department. “Falls cause more activations than even motor vehicle accidents. We see 25-year-olds who fall off ladders and we see elderly patients who fall while standing on slippery sidewalks.”
A victim of a fall can sustain myriad injuries, and many of them can be serious.
“We see a wide spectrum,” Dr. Corser said. “I had a patient who fell off the roof and sustained multiple injuries to the spine and multiple rib fractures. Fall victims also often have sprains, fractures and dislocations of the ankle. And head injuries, including concussions and bleeding on the brain, (also can result from a fall).”
Quality footwear and the right ladder for the job can lessen the chances of falling doing yard work, but being careful is the best way to avoid a trip to the emergency department.
“I think telling people to not go up a ladder is unrealistic, but if you have to do it, use a ladder which has a much wider bottom than top,” Dr. Corser said. “And to make the ladder less likely to tip, you have to have somebody standing on the bottom. Using a ladder is a two-person procedure.”
Caution is also important when dealing with ice and snow.
“We see many falls of the elderly (during winter) and I would definitely suggest that they use their walkers when outside,” Dr. Corser said. “Good footwear, keeping the sidewalk shoveled and using de-icer (can reduce the chances of falling).”
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