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91 responses total.

Precious bodily fluids?

All the cells suddenly absorbed a bunch of fluid?

(this item now linked to health conference)

Wounded cells send out an SOS and the help arrives in lymphatic fluids,
which pool in the wound's third space (extra-vascular and extra-cellular).
This fluid bath is rich in specialized components which promote blood
coagulation and cell-healing.  This excess fluid also helps serves as a
tamponade, minimizing capillary loss.  This all happens very quickly. 

Ice packs will minimize pain and swelling.  But applying cold does actually
fight the bodies natural healing process to some extent.  Which is why you
don't want to use cold for very long.  With something like an ankle sprain
it's advised you use ice, intermittently, for only the first 24 hours. 
Then apply gentle heat, at intervals.  Elevating the wounded area, above
heart level, is also helpful. 

An OSU trainer at one of their facilities once told me that after being
banged-up, one should wait for 48 hours prior to applying heat, which in that
case meant a nice hot-tub.  None of which persuaded me from not wanting to
jump into the hot-tub with said trainer....   (:   (Oh, don't worry, I wasn't
the injured party -- and there was a football game to be, uh, tied.)

The head is *very* well supplied with blood vessels - which may help
to explain why the bump rose so quickly.

What Mary said is right, sort of.  The cells send out a variety of
chemical signals constituting an SOS.  These signals cause the the
capillaries and local blood vessels to become very leaky.  As a result, a
variety of serum "stuff" spills out - proteins, antibodies, white cells,
etc.  The proper term for this is "inflammation", and it is the body's way
of dealing with injury.  Ice and anti-inflammatory agents attenuate this
response, and thus help with the swelling.  Part of the SOS signal
sensitizes local nerves, to make the area painful.  This is to let you
know that there is a problem, and that you should be careful with the
area in question.

I never could tolerate ice and such on an injury.  I just let my body do
its thing and all is well sooner or later.      ^like that

Re #7 - Your medical texts must be a tad out of date. The current, and
preferred term is "Mayday". I think it is part of the Geneva Convention, or
something when an international committee agreed on certain standards for
declaring a celluar emergency. I believe SOS went out (or down) with the
Titanic? STeve would know.

i would also guess that the head has less tissue to distribute the
fluids, so bumps appear larger and faster than on an arm or leg.

I can't quote texts for this, just speaking from experience...
basically, what was said is correct.  However, the speed of swelling is more
related to intensity of injury _and_ location, rather than location itself.
On the foot/ankle, the force of gravity can make an ankle swell up to a huge
size in no time at all!  Certainly, vascularity of the site, and it's relative
importance to the organism (head/brain vs toe/nail) will also be factors in
swelling.  (btw, this is interstitial edema...swelling of the spaces between
the cells.  there may also be some swollen cells, and fluid accumulations such
as hematoma, bursa, etc).

Regarding cold and heat.  It is my understanding that the "use ice 24 hrs,
then heat" routine went out over 15 years ago.  The current concept is to use
ice for "acute" injuries/inflammations and _moist heat_ for "chronic"
inflammations.  Chronic is usually defined as having existed for at least six
months, but that definition is in a grey area (depending on what kind of
injury was sustained, if any).

The idea of R.I.C.E. (_R_est, _I_ce, _C_ompression and _E_levation) for acute
injuries helps reduce initial swelling via vasoconstriction, compression and
elevation, but there is a rebound effect which actually _increases local blood
flow_.

If you use heat, on the other hand, you'll get vaso-dilation and a lot of
swelling very quickly.  but once you remove the heat the vessels go right back
to normal size and the edema can't get out.  The rebound effect of cooling
the tissues is to bring in more blood flow to warm up the cold cells, and
there is a prolonged vaso-dilation which ultimately allows for the edema to
subside more quickly, and at the same time, allows for greater infiltration
of the healing "inflammatory cells" and blood flow in general.

What Bret said is right too, sort of.  Lymphatic capillaries are
involved in the healing process, along with other local vessels.
Except, of course, if the injury is intra-cranial, where there
are no lymphatic components.   Or maybe that wasn't the "sort of" 
you meant?

#11 slipped in.

Have at 'em about the heat/cold, Bret.  I'm too tired at the moment.

Re #9:  I believe "Mayday" is the preferred distress call for voice, and
SOS is used for CW (Morse code) transmissions, because it's short and has
a distinctive rhythm.  "Mayday" is a corruption of the French for "help
me," which I can't spell. ;)

   "m'aidez," perhaps? ;)

Voila'

I was told to apply cold (icepack) to an acute injury for no longer
than about 10 minutes, though I do not recall the reason - something
about longer application at any one time being detrimental to the
healing process. I've used this regimen with some satisfaction.

Gull. You mean we have millions of tiny little key-sets inside? Neat. No
wonder I hear rapid clicking sometimes. I stand corrected.

   Every time I've done something to myself, like falling down, etc.
I've been told to put ice on it.  I've tried several times, but it
just felt wrong, and drove me back to the hot water source.  Heat
has always seemed to work, for me.  I wonder if others have noticed
that too?  Maybe this is something of an individual thing?

Ice usually seems to help, at least for me.  It's a little uncomfortable with
the cold, but it does tend to numb the pain and reduce later problems.  I've
had some recurring knee pain from when I used to try to jog on a regular
basis, and ice definitely helped when I used it.

I find that ice, mixed with just the right quantity of vodka, has certain
comendable properties at times.

I'll second that motioin, but I'll thave my ice with some bourbon, please.

Both vodka and bourbon mixed with ice can produce temperatures lower
than freezing. Useful to know when your swizzle stick gets too limp.

Is there OOCQ material in #23?

Anyway...

        Some say the world will end in fire,
        Some say in ice.
        From what I've tasted of desire
        I hold with those who favor fire.
        But if it had to perish twice,
        I think I know enough of hate
        To say that for destruction ice
        Is also great
        And would suffice.

                        - Robert Frost

Sorry for the digression folks, but the heat/cold discussion
reminded me of this great Frost thing. Now back to your regularly
scheduled bonk on the head.

In _Going to Extremes_, a book about Alaskans, the author talks some about
cold.  Not "with wind-chill it's 20 below" cold, but real, serious cold. 
The kind of cold you need to think about at all times like it was an enemy
waiting for you to make a mistake. 

An old-time Barrow resident tells the story of another long-time
inhabitant who was out trapping on the ice shelf, a flask of vodka in his
coat pocket.  He was in no danger until he reached for the flask and took
a gulp of the liquid only to have his throat tissues freeze on contact. 
He died within minutes of asphyxiation.  For a few moments he had stopped
thinking about the enemy.  Good book, by the way. 

You'll find lots of different calls on applying ice to inflamed areas.
But the standard (or middle ground) seems to be to apply cold for
20 minute intervals, when awake, for 24 hours.  The 20 minutes means
20 minutes of sensed cold.  So if you have this huge knee dressing,
and you apply cold packs, start counting 20 minutes from the time the
cold is actually *felt*, then when the ice is removed allow the area to
again feel body temperature before adding more cold.  Cold works
by causing vaso-constriction.  But if cold is left on for a prolonged
period it will actually cause vaso-dilation.  It also works to dampen
the sensation of pain.  Intermittent cold works far better than constant
cold in minimizing pain too.

Now, cold isn't advised for all wounds.  You never want to use cold
on a burn, except for maybe the first few minutes afterward to halt
the burn's extension.  For non-traumatic injuries where there is pain
you'd not want to add cold.  And the list goes on.  If in doubt
as your doctor for advice.  That's what you're paying her for. 

I used my hand as a hammer once, and induced a hematoma on my palm. These
have usually taken some time to go away, but the last time I applied
ice, much along the regimen described by Mary. It was amazingly effective,
and the hematoma disappeared within hours.

   (That is a great book, I'll second that.)

Why is applying cold to a burn bad?  I prefer burn medecine or aloe applied
regularly, but failing that, I've found dowsing the burned area with ice
water every couple minutes keeps the pain down.  I don't know why it makes
a difference, as I just get the burn slightly cold, not numbingly cold.

To understand something of pain control it is helpful to understand some
of how the sensation of pain is conveyed.  In lay terms, there are two
types of pain pathways, those through large bundle fibers and small
bundle fibers.  These routes are responsible for carrying different
"styles" of pain.  Sharp, piercing, acute pain is carried through the
small bundle fibers.  Most sudden onset, acute pain, is carried through
this route and is carried very quickly.  Dull, throbbing pain, with is
communicated more slowly, utilizes the large bundle route. 

Now, although small bundle impulses are felt faster, the stimulation can
be "overruled" by stimulating associated large bundle fibers. An easily
understood example:  When you stub your toe you know immediately you've
done so, from the sharp pain you experience But you know that in another
moment or two the real deep, dull, throbbing pain will start.  Two
different types of pain being conducted by two different pathways at
different speeds.  And, in that golden moment before the second wave
arrives, you'll probably reach down and start massaging your toe, in
anticipation of that second wave of dull pain, because you've learned,
without knowing exactly why, that massage will stimulate the large bundle
fibers, compete for large bundle receptor sites, and to some degree
override the small bundle impulses as well. You will feel pressure from
the massage and less intense "stub" pain.  Every kid who has ever asked
his mom or dad to "rub it, it hurts" knows this works. 

Applying cold causes vasoconstriction, which in turn lessens swelling, and
cold stimulates large bundle fibers which in turn "deadens" the sensation
of pain. 

With a third degree burn you won't feel much pain, the nerves are gone. 
With less sever burns, where tissue is exposed, pain can be controlled by
providing a barrier between the tissue and the air. Doing this won't
compromise healing circulation, will be more effective in minimizing pain,
and won't increase the chance of wound contamination.  Cold doesn't really
help much with long-term intense pain, anyhow.  For that you need narcotics. 

For those little finger tip burns, where the skin remains intact,
feel free to apply ice for comfort.  That's not a real wound, that's
a boo-boo.

  Ok, but it's sure a painful boo-boo, relative to its size!  :-)
Thanks for the info, I didn't know much of that, and it's quite
interesting.

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Mary is hitting the nail right on the head.  I hope it was book learning
and not the wisdom of (personal) experience :-)  I like the 20 minutes on,
20 minutes off for ice, used for 24-48 hours after the initial injury. 
Ice has a tendency to stiffen you up, so I tend to switch to heat (warm
compress, hot shower, heating pad, etc) after a few days.  Actually, that
is for strain/sprains, where being loosened up is important.  For a knock
on the head, I'd just do the ice thing for a bit and take an
antiinflammatory if it hurt a lot.  By the way, anti-inflammatories work
"peripherally", that is, on the inflammation itself (and therefore the
nerves).  Narcotics work "centrally", that is, on your brain, and do
nothing for the underlying injury.

This thread has just recently, unfortunately, become too relevant. On
Friday my wife Alice turned her ankle skating, and has been immobilized
since, while it has swollen, turned blue, and hurt like hell. It was
X-rayed soon afterward, but a professional reading wasn't available 
until today - the fibula is broken. We have been applying cold much in
accord with the regimens described above. This does not obviously reduce
the swelling (but we have no "control" for comparison), but it makes
it feel a lot better. Also, Motrin and Tylenol-3 are being applied as
needed. She will get a cast on Wednesday, which will probably remain on
for eight weeks. This is a lot more serious than a "lump on the head":
are there other considerations for breaks, ripped tendons, etc, which
are different than for a "lump on the head" (besides, getting medical
attention quickly)?

Sorry to hear about Alice.  Bummer.

The area should be immobilized.  The splint should include both
the joint proximal and distal to the break.  If all she has on'
the area right now is an ace bandange it will shift some and
there will be more pain than necessary.

And I know this sounds silly, but roses help a whole lot.

This response has been erased.

  Well, interesting though it would be, I'm glad there are no additional
broken ankles on Alice to serve as a "control!"  Best e-wishes for a
speedy recovery!

Get well soon, Alice. Sounds like you have a good caregiver in that
rcurl guy. 

Thank you all for your wishes. The fracture did not separate the fibula,
but a cast is likely (tomorrow). The doctor did not suggest a splint -
just the bandage. One interesting development is that practically
everyone she has told about her accident has either had a broken ankle
themselves, or know someone who has. I didn't realize it was epidemic.

- Backtalk version 1.3.30 - Copyright 1996-2006, Jan Wolter and Steve Weiss