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The Burning, Itching, And Swelling Of Stinging Nettles: Removing Them From The Skin

Stinging nettle plants, courtesy of Dezidor (CC BY 3.0)

Stinging nettle plants, courtesy of Dezidor (CC BY 3.0)

Hikers often brush up against injurious plants, such as poison oak or thorny shrubs. One particularly vexing plant is the “ubiquitous weed, Urtica dioica,” commonly known as stinging nettles. As described in an article entitled “Mechanism of Action of Stinging Nettles” (Wilderness & Environmental Medicine:22,136-139,2011) by Alexander Cummings and Michael Olsen, direct contact exposure to the weed causes immediate stinging and burning sensation on the skin. The authors exposed mouse skin to the plants and looked at this skin using an electron microscope. They found smooth nettle spicules that had pierced the skin surface, a few of which retained their bases, which appeared empty of liquid contents. The authors concluded that the mechanism of action of stinging nettles skin reaction was both biochemical and mechanical, likely caused by impalement of spicules into the skin.

The spicules are present as small “hairs” that are found on the stem and undersides of the leaves of the plant. Even light touch against the plant can cause a reaction, which is often characterized as Read more »

This post, The Burning, Itching, And Swelling Of Stinging Nettles: Removing Them From The Skin, was originally published on by Paul Auerbach, M.D..

Superfocus Glasses May Improve Vision In The E.R.

A man wearing superfocus glasses.

As I write this post, I’m wearing my new Superfocus glasses. I was given the glasses by the company to demonstrate, and they are nothing less than remarkable. I’ve used them mostly in two very common settings for me—indoors and outdoors. In both situations, they performed very well.

Superfocus lenses work by mimicking a young, healthy human eye. Each lens is actually a set of two lenses (flexible and firm). The flexible, inner lens has a transparent membrane attached to a rigid surface, sandwiching a small amount of clear fluid. The bridge (across the nose) connecting the lenses allows you to adjust the shape of the flexible lens. Slide the tab along the bridge to find the exact correction for the particular user. The intent is to achieve clear, undistorted vision within any lighting or distance.

You can learn a great deal from the Superfocus website about the benefits of adjustable lenses, how to obtain the glasses, and so forth. I won’t reiterate information from the website, but rather discuss how I have used these glasses and discuss their performance based on my own experience.

First, I used them during my work in the E.R. as a physician. Read more »

This post, Superfocus Glasses May Improve Vision In The E.R., was originally published on by Paul Auerbach, M.D..

Book Review: Heading Outdoors Eventually Leads Within

Heading Outdoors Eventually Leads Within” is a small book written by Kathy and Craig Copeland and published through their company, Here’s a summary from the website:

Everyone walks. What distinguishes hikers is that walking does more than transport us, it transforms us. But nowhere is the thoughtful undercurrent of hiking celebrated. The wisdom we glean from the wilds is a match lit in the rain. That’s why we created this book: to cup our hands around the flame. These journal entries are the mental waypoints we recorded while hiking 30,000 miles / 48,280 km (more than the circumference of the Earth) through wildlands worldwide. Accompanying them are photos of the places (primarily the Canadian Rockies, Utah canyon country, and New Zealand) where we conceived and noted the initial ideas. We hope our words and images compel you to recognize, voice, own and honour the thoughts arising from within while heading outdoors. Doing so will deepen your fulfillment. A truly adventurous life is contemplative as well as vigourous.

It is important for me to state at the outset that my opinions, like those expressed in most book reviews, are highly personal. What I write about “Heading Outdoors Eventually Leads Within” are my impressions, and you may not agree with them. I am beginning with this comment because I truly had mixed feelings about the book. There were parts that seemed right on target, for me personally, and parts that seemed to miss the mark. I am certain that the authors have great pride in their work, and they are to be congratulated for their efforts. Read more »

This post, Book Review: Heading Outdoors Eventually Leads Within, was originally published on by Paul Auerbach, M.D..

Blood Under The Nail – What To Do

The following is a message that I received from a reader:

“Professor Auerbach – I am an avid reader of your blog ‘Medicine for the Outdoors.’ Your two posts about foot blisters are really interesting. In my hiking experience there is another foot related issue, that is the subungual hematoma in the toenail. I think it could be an interesting subject in one of your blog posts. Thank you very much for the attention.”

Well, it just so happens that I have been a sufferer myself, so I’m happy to write a bit about this. Subungual hematoma refers to blood under a toenail or fingernail. In the fingers, this usually occurs from a blow or pinch, such as catching a finger in a door or striking it with a hammer. In the foot, it is commonly caused by repetitive blows in a confined space, such as hiking in a boot with a toe-box that is too small and/or too stiff. The photo above is my foot after a 10 mile hike over rocky terrain in hiking shoes that didn’t fit quite right. They were broken in, but they weren’t sufficiently flexible for that type of hike. A couple of hours in, I knew I was in trouble because of the pain, but there was no turning back. No surprise, when I took off my sock, I saw the blue color and knew that eventually that particular toenail was a goner.

What can be done about this condition? When it first happens, applying an ice pack might relieve the pain. Certainly, you should trade out the poorly fitted shoes for ones that provide greater room and comfort. If possible, curtail hiking activities for a day or two, and let the situation settle, or the blood collection might increase.

When a fingertip is smashed between two objects, there is frequently a rapid blue discoloration of the fingernail, which is caused by a collection of blood underneath the nail. Pain from the pressure may be quite severe. If the pain is intolerable, it is necessary to create a small hole in the nail directly over the collection of blood, to allow the blood to drain and thus relieve the pressure. This can be done during the first 24 to 48 hours following the injury by heating a paper clip or similar-diameter metal wire to red-hot temperature in a flame (taking care not to burn your fingers while holding the other end of the wire; use a needle-nose pliers, if available) and quickly pressing it through the nail. Another technique is to drill a small hole in the nail by twirling a scalpel blade, sharp knife, or needle. As soon as the nail is penetrated, blood will spurt out, and the pain will be considerably lessened. Before and after the procedure, the finger should be washed carefully. If the procedure was not performed under sterile conditions, administer an antibiotic (such as dicloxacillin, erythromycin or cephalexin) for 3 days.

In the case of my toe (above), the pain subsided with a day’s rest from hiking, so there was no benefit to be obtained by draining the blood. A new nail grew in underneath the one shown in the picture, with the entire process taking a full nine months from injury to nail replacement.

This post, Blood Under The Nail – What To Do, was originally published on by Paul Auerbach, M.D..

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Latest Book Reviews

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The Spirit Of The Place: Samuel Shem’s New Book May Depress You

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Eat To Save Your Life: Another Half-True Diet Book

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