The Big Hand Syndrome

Since my accident last year, my wife and I have been going for longer walks (since I could not run then). We enjoy the time together since it gives us a chance to share our thoughts, talk things out and simply hang out.

What we have noticed is that our hands are often swollen at the end of these hour long walks. It never happens when we go for a run, only after a walk.

Looking through some endurance related forum boards revealed that this is fairly common among ultra runners too. Ultra runners complain that their hands look like a "blown up rubber glove" or having fingers that feel "tight and hard to bend".

I've tried looking for research regarding the causes of hand swelling during walking/ moderate exercise, but not much can be found. It has been suggested by one published report that one out of four people will experience swollen fingers/ hand while walking. Women seem to be more commonly affected than men. 

There have also been suggestions that arm motion, heat-related issues or metabolic changes may play a part but nothing seems conclusive. 

One study (reference below) referred to the post-walking hand swelling as the "big hand syndrome".

It is suggested that hand swelling may be a result of the way our bodies and blood vessels respond to blood flow during exercise. Since exercise increases blood flow to our heart, lungs and our lower limb muscles (while walking) blood flow to our hands is reduced. This makes our hands cooler while the blood vessels react by opening wider, leading to swelling in the hands. 

As you contiune on your walk, your muscles try to dissipate the heat generated by pushing blood to the vessels closest to the surface of your body. This response makes you pespire and can also contribute to hand swelling.

In hot, sunny and extremly humid Singapore, skin blood flow and circulation may be compromised and regulation of body temperature will be more difficult, even during light exercise. Vasodilation (opening of blood vessels) occurs to cool our bodies by pespiring.

Depending on how much water we drink and our bodies' ability to cool itself, this may create a fluid imbalance, leading to excess fluid in the skin and underlying tissues.

Some papers also suggest fingers/ hand swelling can be a early sign of hyponatremia, but I don't think so. It would be very unlikely that one can get hyponatremia from walking for an hour or two. 

Trust me on this, I've had hyponatremia before and the more serious and obvious signs and symptoms include vomiting, cramps, giddiness, disorientation, diarrhoea and convulsions. I had most of those symptoms and that landed me in the hospital intensive care unit (ICU) for a few days after a ultra running race in Hong Kong back in 2000. Now you know what I mean when I say I'm a cat with 9 lives. I've definitely used up a few of those 9 lives. 

Unfortunately, there is no fool proof way to reduce or prevent exercise related hand swelling. What we found helped was opening and closing your fingers frequently when walking and/ or making exaggerated arm swings or circular actions with your elbow. 

Taking off your rings (like my wife in the picture above) and loosening your watch strap if you wear one will make it less uncomfortable.

All smart endurance athletes know it is important to pay attention to their bodies and it's natural to wonder if suasage-like fingers are symptoms of something sinister. Fortunately, hand swelling is just a slightly annoying, but not harmful, response to exercise. 

Reference

Ravaglia FF, Leite MG Leite, Bracellos TF et al (2011) Post Ambulatory Hand Swelling (Big Hand Syndrome): Prevalence, Demographics And Association With Dog Walking. ISRN Rheumatol. DOI: 10.5402/2011/65995

Thankful For Accidents

Talking to my boys at the hospital

I definitely had my fair share of accidents, actually 2 major ones I will never ever forget. I'm sure you know and remember yours. When you slipped and grazed your knees or broke a bone. Or that illness that took a long time to get better. It could also be a job or a gig that you failed to land.

Then there are the positive 'accidents' too, too many that we often forget to mention. A friendly smile or nod from a fellow runner or cyclist. A kind act from a stranger who happened to be passing by.

I am thankful to be born here. To be surrounded by family and friends and to be given opportunities that many others never even dreamed of. And from those opportunities given, the belief that we have in others and efforts that enabled results. 

To be able to read, to talk and to connect. To have others give us the benefit of the doubt. To be able to smile at times, and the chance to contribute towards our community.

With 2002 Commonwealth Games silver medalist, Patrick Lau

So many things to be thankful for. I am very thankful I met up with a old patient (pictured above) and friend yesterday. I am also thankful that many old friends and newer friends and patients who have reached out to me after my recent accident. Some of these friends met by chance or accident. 

Not many of us celebrate Thanksgiving in Singapore. I definitely have many things to be thankful for, my wife, family and friends for sure. Accidents included. 

11 Weeks After His Accident

His shirt says 'Rather be riding'

At almost 11 weeks post spinal fracture after a cycling accident, we find ourselves back in Prof Hee's clinic. Today we compared his MRI films from the day of his accident with the imaging done after 10 weeks of healing. It's 60% healed, which is great for his age and fitness level. 

But Gino being Gino, is raring to go and felt a little disappointed that he can only return to work gradually at the end of November. To maintain his fitness, he is allowed only intermittent running with brisk walking, light weight training and cycling on his stationary bike. I thought that was great news! 

But looking at his face a few hours after the appointment with his doc, I could see that he was trying to wrap his head around the fact that he wasn't closer to full healing. It is tough being a patient, waiting for our bodies to take the time it needs to heal fully. I guess that's why we're called patients when we seek treatment!

I know that he's grateful to be well and have the chance to return to work soon, but it takes time to accept that his body doesn't heal as quickly as he wants or needs to. He has done the best that he possibly could be done in terms of healing, now the hard part .. to wait.

Aized

Ultrasound Or Ultra Bullshit?

When I was doing postgraduate studies in Adelaide back in 2003, I was fortunate to have David Butler as one of our tutors teaching Pain Sciences. He also introduced us to the term 'ultra bullshit' when it came to what he thought about the effectiveness of using ultrasound to treat patients. Especially those patients with chronic pain.

For those of you using therapeutic ultrasound, please do not be offended. I'm not suggesting that you cannot, should not or better not be using it, I'm just saying that we almost never use ultrasound in our clinics to treat patients.

However, I've been receiving therapeutic ultrasound almost daily since my T4 spine fracture last month. Why the sudden change? There have been studies showing that pulsed ultrasound can accelerate bone union by up to a week. I'm up for anything that helps my fracture heal better and faster!

Therapeutic ultrasound appears to effectively heat tissues (muscles, connective tissues etc) but research has not established the ideal temperatures for tissue benefit or tissue damage. Current research also suggests that therapeutic ultrasound will not help pain reduction, delayed onset of muscle soreness (DOMS) or iontophoresis (deliver medicine under the skin), BUT it does appear to facilitate fracture healing. That previous sentence you read was 'a sight for my sore eyes'!

So my beloved wife has been helping daily with my ultrasound regime, although she does delegate the tasks occasionally to my boys as she says it's terribly boring holding on to the ultrasound device.

Looking forward to my next MRI to see how my fracture has healed.

Reference

Eberman L, Schumacher H, Niemann AJ et al (2013). Research Evidence For Therapeutic Ultrasound Effectiveness. Int J Ath Trg. 18(4): 20-22. DOI: 10.1123/ijatt.18.4.20. * Thanks to Byron who got me the article.

Gino Was In A Cycling Accident.. Again!

ECG in progress

This was yesterday. Gino needed an echocardiogram done after his accident. Let's rewind to the start of 4th September 2021.

Gino went for his usual Saturday bike ride with the CycleWorx group. They had completed about 60km when they were cycling along Nicholl Highway towards the city. The roads were empty and they were cycling on the left most lane. So it came as a shock when a motorcyclist rear ended him. Gino recalls that it all happened so quickly. He flew backwards and landed on his back. He got up to see his bicycle on top of the motorcycle and the motorcycle on top of the motorcyclist. His friends called for the ambulance and police.

I received a call from Gino at about 8am. It was words I'm not fond of hearing, "I've been in an accident." I've since learnt from his last cycling accident in 2013 that Gino has a high pain threshold and always says he's ok. When I asked him where it hurt and he said his upper back, I thought, "Oh man! Not his spine again!" He had sustained a fracture in his skull and lower back in 2013.

My dad drove me to the scene of the accident and I was relieved that the ambulance was still there. Gino was on his right side, strapped onto the gurney. He was inhaling painkillers and complaining of upper back pain. He also asked for his muesli bar that was squashed from the impact of the accident in the pocket of his jersey, which was ripped to shreds by the accident. We had to be transported to Tan Tock Seng Hospital. 

It was not a good experience there. Most of the nurses were great but the doctor who received us at Accident & Emergency was less than impressive. To cut a long story short, even after we repeatedly told her that Gino's pain was between thoracic spinal levels 3 to 6, the X-rays were done for the lower thoracic and lumbar spine. We were elated when the doctor reported that there were no fractures, and took her word for it. In hindsight, I'm questioning myself why I did not check the films! We were discharged from A&E and told we could go home. Gino was feeling less pain as he had been given meds.

I am grateful that our friend who I had called after the accident, who's a spine surgeon, called us as we were waiting for our Grab ride home. He was appalled that we had been discharged so quickly after a road traffic accident. He asked to see the X-rays again and only then did we realize that the upper thoracic spine levels had not been captured. We changed our destination to Mount Elizabeth Medical Centre.

As the effects of the meds started wearing off and after the thorough assessment done by Prof Hee, Gino stood up and exclaimed," Oh no! This feels like the same pain I had when I fractured my low back." I know Gino knows his body really well so we proceeded to get him admitted to be assessed more thoroughly with MRI and to be monitored. 

His MRI films showed a wedge compression fracture at thoracic spine level 4. Since it was at that level,  he had to have his heart assessed with an ECG and blood tests plus a CT scan to ensure that all his organs and vessels were not injured and also check that his ribs are intact.

Arrow shows the location of the fracture

CT scans of his thorax turned out to be clear. Phew! There were some abnormalities with his ECG readings so we have to follow up with a cardiologist. We are hoping that it was just the stress from the accident and that it will settle, but we will get his heart checked. 

The fracture in his spine will be treated conservatively, meaning no surgery as that particular thoracic level is well supported by his ribs and connective tissue. We will let the body heal itself. Gino cannot work and cycle for a few months. His surgeon advised him to maybe to stick to the park connectors or the gym when he can start cycling again. I don't know about that!

Aized

His ripped jersey

Happy after being told he can go home