Signs & Cure for Skier's Toe

Downhill skiing is a ton of fun, but there are several common injuries that crop up with this sport. Perhaps the most common is the infamous skier's toe. Typically discovered at the end of the day, "skier's toe" shows up as a very painful BLACK TOENAIL- usually the great toe. The medical term is a subungual hematoma, which simply means below the nail bleeding.  This can occur from a single instance of trauma like dropping something on your toe, or from small, repetitive trauma like a too-small or too-big (so your foot slams back and forth) ski boot. As the tiny amount of blood builds up under the nail, the pressure escalates and the toe throbs.

The good news is that this can be quickly remedied in a clinic if you head in within hours or a day of noticing the black nail. If you wait several days trying to tough it out, we have less success treating the nail. The doctor typically burns a tiny hole in the nail, which allows the drop or two of blood to come out. (Sorry for the yucky description, but that's what we do.) Ski resort doctors usually have a cool handheld device that does the burning, while other doctors (and D-I-Y's, though I do NOT recommend this- partly because many people faint at the sight) use an unfolded paper clip with a heated end from holding it in a flame.

The BETTER news is that again, PREVENTION is key! Make sure your ski boots fit properly- don't cram your foot into a friend's boots- and be sure your socks are not bunched up. This painful injury does NOT occur if your shoes/boots fit correctly!

BOTTOM LINE: Make sure your ski boots and socks fit properly to avoid getting skier's toe, and if you DO get it, seek treatment as soon as possible!

PS And please, don't forget your HELMET when you SKI!

Snowboarding Can Be a Pain in the Rear...

Some time ago, I thought it would be great fun to learn how to snowboard. And it was...until the third day, when I was gathering speed linking my self-proclaimed awesome S turns (instead of my falling leaf) and I had to stop suddenly for a youngster that cut across my path and BOOM- I slammed right down on my rear. When the stars faded from my vision, the throbbing in the seat of my pants had my full, undivided attention- I had fractured my tailbone. For the next several months, my days were filled with apologies to our patients for appearing rude by not sitting as I listened to their concerns...but I could only sit on an inflatable "donut" that I was too vain to bring into each exam room.

Tailbone (coccyx) injuries are some of the most common snowboard injuries, although certainly they occur in other situations. Whether it is a bruise, dislocation or fracture, these injuries are caused by self-induced trauma such as falling hard on your rear end, a direct blow (your friend smashing in to you on their skis, or perhaps a contact sport like football), childbirth, or repetitive strain (such as bicycling). A bruise may or may not be visible, and the pain is typically worse when sitting or if you press on the affected area (either topically or via a bowel movement or intercourse.) X-rays can be tricky to interpret, often requiring both sitting and standing views for best accuracy.

Treatment is largely avoidance of pressure on the area, as obviously casting is not practical! Avoid prolonged sitting, and use an inflatable cushion if possible (the donut). Avoid constipation so you don't get additional pain from a hard bowel movement (so eat high fiber and drink lots of water!) Anti-inflammatory medications such as ibuprofen can help reduce pain, and using ice packs for 10-20 minutes several times per day the first few days will also help. If your pain is not controlled by these methods, it's time to head to see a doctor. They will not have a miracle cure, but can offer further diagnostics (to be sure you don't have a displaced fracture) and possibly stronger pain medications.

BOTTOM LINE: Protect YOUR "bottom line" by using padding if you are learning to snowboard and exercise caution by wearing "gripping" shoes on icy surfaces to avoid falling, and again, remember to protect your HEAD with a HELMET!

An Altitude Adjustment

Going skiing for winter break? Mountains are my favorite destination, but...please remember that the high altitude can come with a couple medical challenges. First of all, don't be fooled that cool weather means no sunburns! Check out this blog on sunscreen so you don't end up with a high altitude burn. Secondly, be aware of signs and symptoms of "mountain sickness" (aka. altitude sickness).

HOW HIGH do you have to be for altitude sickness?
There is not a set elevation for typical mountain vacations that affects everyone. Symptoms are uncommon at altitudes below 5000 feet above sea level, and fairly common above 8000 feet. If you fly to a higher elevation (such as above 8000 feet), wait a day to acclimate before you start hiking the high peaks nearby.

When does it start?

Symptoms usually within the first 24 hours, and often as early as the first few hours after arrival.

What are the common signs?

• Mild to moderate: HEADACHE, decreased appetite or nausea, insomnia, and lightheadedness
• Severe:  All of the above plus vomiting and shortness of breath

Treatment?

Ultimately, going to a lower elevation will relieve symptoms, but rest and hydration will alleviate most mild symptoms. For persistent or worsening symptoms, head to a clinic for possible oxygen and medications.

PREVENTION:

• Hydration and avoidance of diuretics like CAFFEINE and ALCOHOL, especially the first few days.
• SLOW ASCENT if possible (driving up to the mountains is lower risk than flying).
• If you have had altitude sickness previously, especially if it has occurred on multiple trips to the same elevation, see your doctor and consider prophylactic medications (acetazolamide or steroids).

BOTTOM LINE: Don't let the mountains literally take your breath away- plan ahead to prevent altitude sickness!

We Should All Be #FacingAIDS

Today (and every December 1st) is World AIDS Day. Do you know anyone living with HIV disease? Or anyone who has died of AIDS? With over a million Americans living with HIV disease, odds are good that someone in your life either has or will be affected by this infection. The scary part is that only 5 out of 6 infected individuals are aware of their HIV status...which means ONE in SIX people infected with HIV are completely UNAWARE they carry and can spread the disease.


This silent presence of HIV is the very reason that back in 2006, the CDC changed screening recommendations to state that EVERYONE aged 13-64 should be tested once for HIV, regardless of perceived risk factors. People at high risk should be re-screened annually, which certainly includes sex workers  and injection drug users, but ALSO includes both gay AND heterosexual people "who themselves or whose sex partners have had more than one sex partner since their most recent HIV test." Let me say it again- even if you have had only one new partner since you were last tested, it's time to get tested again this year. 

HIV is not tucked away back in some dark corner of our society with drug addicts and prostitutes. Heterosexual transmission is the primary source (84%) of new infections in American women, causing nearly 7000 new cases in 2010. 1 in 4 new HIV infections occurs in young people (ages 13-24). If you are sexually active, it is imperative to know YOUR HIV status, and that of any potential new partners.

I love the  #FacingAIDS campaign, because putting familiar faces on unfamiliar diseases is a terrific way to promote awareness and remove stigma. By the way, the #FacingAIDS pictures do not at all imply these people have HIV disease- simply that they realize that the "face" of HIV can look like ANYONE, and this picture is to encourage everyone to get tested and be certain they know their HIV status. HIV doesn't care how much money you make, where you live or how you dress...it is an equal opportunity virus.

On this World AIDS Day, please make a commitment to know your HIV status.

BOTTOM LINE: Every American aged 13-64 should be tested for HIV disease- if you have not been checked, get tested!