Clown Hands and Sausage Toes

March 23, 2015

The night before last I was feeling great. I had been reading articles about climbing mountains online at SummitPost.org, and simultaneously reading out of High Altitude Medicine and Physiology, 5th Edition, a great textbook about what happens to humans at high altitude. I had no sooner put the book down, when I had my own fist had experience of what happens to human bodies at high altitude.

No sooner had I turned out the lights than my feet started to really hurt, specifically the first and second toes of the right foot, and then the second toe of the left foot. Like excruciating pain. I’ve never had gout, but I imagine this is what gouty arthritis felt like. Except I had it in 3 toes! I also had mild pain in the 2nd MCP joint (that’s the first joint on the pointer finger) and the 3rd PIP joint (that’s the second joint on the middle finger). I tried taking ibuprofen, without any improvement in symptoms. I had to reach for the hydrocodone with acetaminophen, which was finally able to control my pain to the point where I could get some sleep.

I have never felt such pain before!

When I woke yesterday morning, my feet were not nearly as painful, but still quite swollen, but the middle finger on my right hand was so bad that I could not straighten it, and my fingers, especially on my right hand, were quite swollen. My knees ached, and I was generally not feeling well. It is as if I had aged decades overnight.

Yesterday I was on the day shift, and we were steady with 7 patients. I felt like my right hand was a withered, crippled, claw. Everytime I had to shake a customer’s hand it was excruciating.

After the day was through, I pulled down Auerbach’s Wilderness Medicine, 5th Edition (the copy at the HRA post has actually been signed by Paul Auerbach and Ken Zafren, who is one of the medical advisor’s for the HRA), not an easy task in itself! After flipping through Acute Mountain Sickness, High Altitude Pulmonary Edema, and High Altitude Cerebral Edema, I got to a small one-paragraph section on Peripheral Edema at High Altitude. According to this authoritative text, peripheral edema will occur in 18% of people over 4200 meters, and suggests the use of a diuretic medication for symptom relief. Ah, Acetazolamide (Diamox), you always seem to be near at hand in high altitude. I never needed it for Acute Mountain Sickness, it’s most common use at altitude, but here I am relying on its diuretic properties to let me pee away my peripheral edema.

My hands on the night of March 22.  The knuckle on my right pointer finger is obviously swollen, and I can't straighten my right middle finger much past where it is without significant pain.

My hands on the night of March 22. The knuckle on my right pointer finger is obviously swollen, and I can’t straighten my right middle finger much past where it is without significant pain.

My feet on March 22.  Look how swollen each of the toes look!

My feet on March 22. Look how swollen each of the toes look!

I took 125mg last night, and had two good pees overnight. In the morning, my left hand and toes had greatly improved. My right hand is still being a bit problematic, but acetazolamide and I keep waging our battle against excess fluid. 250mg during the day, and I’ll take another 125mg tonight. I am mostly back to normal, but still can’t quite straighten my right middle finger!

My hands on March 23.  The knuckle on the right 2nd finger is still somewhat swollen, and while I can straighten my right middle finger a lot more than yesterday, I still cannot straighten it completely.

My hands on March 23. The knuckle on the right 2nd finger is still somewhat swollen, and while I can straighten my right middle finger a lot more than yesterday, I still cannot straighten it completely.  My left hand looks pretty much normal.

While my toes look much more splotchy than they did yesterday, they are not swollen and feel much better.  I have a blister on the left 2nd toe from the trip to Ama Dablam, and my right 2nd toe has a bruise on it where a nearly blind guy stepped on my toe today (casualties of wearing flip flops in the HRA clinic!)

While my toes look much more splotchy than they did yesterday, they are not swollen and feel much better. I have a blister on the left 2nd toe from the trip to Ama Dablam, and my right 2nd toe has a bruise on it where a nearly blind guy stepped on my toe today (casualties of wearing flip flops in the HRA clinic!)

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