Blisters- Their care and feeding

[MChase]

At any one time in our club, I figure we have at least 300-400 blisters, calluses, or combos. One of our kids was hospitalized a couple of weeks ago on IV antibiotics due to an infected blister. Another went to the urgent care last night. Another had MRSA last season. I've never seen this type of infectious activity until the last year. I put some info on our Westerville Crew website about care of blisters. I am an ardent supporter of "unroofing" a blister, especially one that leaks any amount of fluid or is broken. I'm going to blog more extensively on it. We examined the hands of every kid on the team today and offered insight on which blisters/calluses needed their attention tonight. I believe that a more acute awareness of the etiology of cellulitis and its prevention is needed. If we as coaches don't educate the kids, then I fear by the time a kid has red streaks going up his/her arm, we risk complications. In talking with medical colleagues, one in the industrial environment noted, "It seems like all the cultures come back positive for MRSA". Scary.

On a hopeful note, the varsity members were particularly good at unroofing their blisters and trimming their thick calluses. The one who ignored one of his leaking blisters ended up with a swollen finger, redness, tenderness and stiffness. The physician in the urgent care blew it entirely and did not unroof the blister......so my rower did last night. Due to his action, the finger was much improved today.

(MRSA stands for methicillin resistant staph aureas. Staph aureus is a common skin pathogen. Staph aureus which is resistant to the common antibiotics, especially the old "standby class called methicillin, is labeled MRSA. MRSA can also be particularly aggressive.)

What's your experience?

[lw_rowing]

After my first year or so I have rarely if ever gotten blisters. The hands get a bit tender the first week back on the water but the blisters haven't reformed.

I wouldn't mind hearing more about shaving my calluses though.

[MChase]

One of the most common problems we find is a "blister under a callus". The problem is that if the blister breaks, bacteria can invade and the risk of infection increases. The only way to cleanse the blister of bacteria (using good old soap and water) is to remove the callus. What I prefer is that the kids trim their calluses to keep them from getting too thick in the first place. They way which I did it when competing was to use fingernail clippers. I just trimmed the top of the calluses to keep them from getting too thick. Otherwise, sometimes the thickness of the callus was enough to cause irritation.....sort of like putting a small pebble in your hand and rowing. Our Boy Scouts like to use knives (no surprise!) but fingernail clippers are used more often.

When I blog on it, I will include photos of good care and some of less than excellent care.

[matt b]

The following regimen has been very kind to my hands:

Lysol on the handles before and after rowing. Neosporin or another triple antibiotic on the blisters/calluses before and after rowing.

[caustic]

I was going to say that if you have a rather common occurrence of MRSA in your rowers, I'd look to the handles & tracks as the primary vectors. Clean the hell out of 'em, and about once a week soak the handles in a light bleach solution (if wooden). The absorption of the bleach water will help keep it mostly disinfected during the week, as moisture in rowers hands (or if they wet the handle), will be wicking out the chlorine that wicked into the wood during the soaking.


As for blister care, If it's not broken, I'll ignore it for about a day or two (so that a new layer of skin can form at the separation), and then open it, trim it, and if It's not fully healed I'll put some neosporin on it and wrap with athletic tape. Same thing with the callouses - try to keep them trimmed.

There's really only one trouble spot for me, and that's at the base of my left ring finger - my left hand holds the oar just a bit different, and while I've been working on that, I still get blisters at that spot very regularly.

[Norm]

We were taught to use an emery board on calluses to prevent them from getting too thick or having ridges on them and creating friction underneath. One sands down the callus until it is smooth on top but still has moderate thickness. It doesn't take too much, and removing the ridges prevents it from rolling onto itself and creating a hot spot and resulting blister.

I am all for disinfecting handles as well. With today's staph infections, I would also keep industrial-size dispensers of hand desanitizer around and make it a habit (if you don't have showers) that if they use it before leaving the facility. Or just have the rowers was their hands in the hose daily.

One thing rowers don't do so much any more is clean boats regularly. As the geezer here, I rowed in wooden boats and we had cleaning parties every Saturday after we rowed, and we sprayed the boats out daily. Not only did this clean crud out the boats, but it also cleaned our hands.

Lastly, I would invest in a lot of towels and be religious about their use. I bet there are bacteria in the towels. Ask parents to donate old towels and get some duffels and a laundry bin. Have one clean bunch of towels for use on boats, one dirty and one being washed w/bleach. (I am also amazed at how in so many clubs rowers are allowed to use dirty towels that have been dropped on the ground or boathouse floor or are covered with grime to wipe down shells. Over time, you might as well just rub sand and grease into the hull of your boat. Once on the ground, wash it)

[MChase]

if you have a rather common occurrence of MRSA in your rowers,

MRSA is common, not just among rowers. It is everywhere. There are school systems which will send all their kids home for the day and wipe down everything with bleach when one child is reported to have a MRSA infection requiring hospitalization. That is purely a public relations stunt. Nobody in public health would suggest that it will rid the school of MRSA.

Wiping down the handles will detract from the really important message- vigilance. Wipe down the handles and kids will think the threat is gone. Trouble is, they touched the same steering wheel on the way to crew practice as they did yesterday, the same door handle, the same keys, picked the same nose, scratched the same scalp, itched the same leg, and even, despite my pleading, wore the same unis. The point is, their entire environment will have to be thoroughly cleansed and that is impossible. Education and vigilance are needed. The damage is done. Not only did we feed antibiotics to our kids on every snotty nose occasion that we could, but also fed them to entire populations of pig, chicken, and cattle farms. Too late to close the barn door-- the swine are out and they carry MRSA.

[loblaw]

Yeah, not much you can do about MRSA obviously as it's just going to be part of your normal flora that you get colonized with walking around your community. I think there is an eradication process that can be undertaken but it involves clorhexidine baths, vancomycin etc. Scrubbing the oarhandles can prevent warts though.

The issue with blisters is infection and how to prevent it. I've always deroofed blisters and rinsed them out as they're going to burst anyway and then you can leave them open to dry out without the dead skin floating around. They shouldn't get infected if you're healthy and there is nowhere for anything to grow. Duct tape is about the only thing I ever found that would protect them from pain and stay on through a row though. I think I'd leave a deep bloody blister (subdermal) unless it popped. And don't pee on them!

[tenui]

My son had 4 or so confirmed MRSA infections in the span of 18 months or so. All 'boil/pimple' type on his thighs with 1 just below his glutes. He is now 5 and has been clear for 2-3 years. My daughter had a MRSA infection the first week she was home from the hospital at a hang nail on her finger. We've lived in our house for 7 or so years and my wife and I have never had an issue. We were both cultured (nasal swab) to see if we were carriers and came back negative. All of the infections were treated successfully topically with bactrum/bactroban (sp) because they were caught early. As far as we know neither had been working out at a gym or in any other close contact with the general population.

We consulted with infectious disease specialists at CHOP and they confirmed that it is virtually impossible to eliminate it from the environment. Wiping down individual items or pieces of equipment is practically a waste of time. They suggested routine hand washing with normal soap and water. They stressed ROUTINE vs obsessive hand washing which will lead to dry/cracked hands which will just be more susceptible to infection. Too much of a good thing, etc...

As for rowing equipment, while I agree you won't be able to 'rid' it of MRSA depending on the water you row on it may be a good practice nonetheless. Fecal coliform bacteria is a common 'farm' runoff bacteria found in many rivers/lakes especially after a heavy rain. You would be surprised at how much farm run off there is in the Schuylkill. This is the 'marker' bacteria used by the USGS to determine how safe water is for human contact. http://www.phillyrivercast.org is a good site for water quality in Philadelphia. You more than likely don't want this stuff in your open sores as well.

Personally, I believe the most effective prevention is:

1) to wash your hands before you change at the end of practice/erg/row after all of the equipment is away but before you leave the boathouse making sure to thoroughly clean inside of callouses/open blisters, finger nails, etc.

2) educate everyone in your club, program, students, coaches, parents, etc on WHAT a MRSA infection looks like and to have it treated early. High School kids get lots of pimples. If its on your arms, legs, hands or it becomes large or has an excessive amount of drainage you should have it cultured. Any redness/swelling around a blister/cut should always be watched.

It is practically guaranteed that someone in your boathouse/program will get a MRSA infection. The key is early treatment. If it becomes blood born the situation turns drastically different.

I guess I should add the disclaimer that this is not the advice of a medical professional but just the experience of personally dealing with MRSA for the past 5 years or so.

[caustic]

if you have a rather common occurrence of MRSA in your rowers,

MRSA is common, not just among rowers. It is everywhere. There are school systems which will send all their kids home for the day and wipe down everything with bleach when one child is reported to have a MRSA infection requiring hospitalization. That is purely a public relations stunt. Nobody in public health would suggest that it will rid the school of MRSA.

Wiping down the handles will detract from the really important message- vigilance. Wipe down the handles and kids will think the threat is gone. Trouble is, they touched the same steering wheel on the way to crew practice as they did yesterday, the same door handle, the same keys, picked the same nose, scratched the same scalp, itched the same leg, and even, despite my pleading, wore the same unis. The point is, their entire environment will have to be thoroughly cleansed and that is impossible. Education and vigilance are needed. The damage is done. Not only did we feed antibiotics to our kids on every snotty nose occasion that we could, but also fed them to entire populations of pig, chicken, and cattle farms. Too late to close the barn door-- the swine are out and they carry MRSA.

That does it. We'll just have to nuke the planet from orbit - it's the only way to be sure.



But seriously, it sucks. I've been reading that Tuberculosis and Pneumonia are also on the rise again, because of the excessive overuse of antibiotics. Personally, I try to reduce my unnecessary use of antibiotics. Use alchohol wipes for wounds, try not to MAKE a mess, don't buy antibiotic soap, etc. Bleach & Ammonia may reek, but they sure as heck kill everything they touch.

[fatboy]

This stuff http://www.sudocrem.com/ is really good for treating burst blisters (before they get to the stage of requiring hospital treatment obviously). Not sure if available in the US

[tenui]

That does it. We'll just have to nuke the planet from orbit - it's the only way to be sure.

From Wikipedia...(pseudo-science)

...There are approximately ten times as many bacterial cells as human cells in the human body, with large numbers of bacteria on the skin and in the digestive tract... (There's more bacteria in you than you in you..!)

...There are typically 40 million bacterial cells in a gram of soil and a million bacterial cells in a millilitre of fresh water; in all, there are approximately five nonillion (5×10!30) bacteria on Earth,[3] forming much of the world's biomass.[4]...

Sounds like they would just survive the nuke attack and come out stronger. In reality, on a cellular level, we have nuked them over the past 80 years or so. Afterall, we used to be told to flush our unused medicine down the toilet. Healthier/smarter humans, however unlikely, is probably easier...

[1xsculler]

I'd guess they're considered to be very uncool; maybe they're not even legal but a very tight fitting pair of black Footjoy Raingrip golf gloves makes my sculling much, much more enjoyable. I still get calouses and the very rare blister but the damage to my hands is minimal. Your S.O. will really appreciate it too. I don't believe there is any downside to wearing gloves for sculling. Maybe they don't work for sweep rowing. If even one case of MRSA could be avoided by wearing gloves they should be manditory since MRSA can be fatal.

[tenui]

If even one case of MRSA could be avoided by wearing gloves they should be manditory since MRSA can be fatal.

40,000 people die annually in the US in car accidents alone. Should cars be illegal? People are going to die of MRSA. This can not be avoided. No amount of legislation, unless you are going to force people to live in latex suits, will solve the problem. As someone posted earlier, the horse is out of the barn. More than likely you have MRSA bacteria on your arms/legs right now. On a MRSA support group a woman reported getting an infection from cutting her legs shaving. Gloves are not the answer.

An infection does not have to be fatal if caught early and treated properly.

Mayo Clinic has a decent site on MRSA. Scroll down to the section on "What's the best defense against MRSA in the community?"

http://www.mayoclinic.com/health/mrsa/ID00049

I mentioned their are support groups and a ton of information on the web...but be warned. There are some people that have been battling blood borne MRSA and it will scare the hell out of you. There have been a few people that have died within just a few days of getting an infection. Notably a healthy UK soldier that died within a few days of scratching his leg while out on a run through brush. These cases generate a lot of hysteria and sell lots of papers, commercials (or I guess 'ad clicks' in the internet news age). 2,000 people die a year from food poisoning but for some reason its only the 7 that died from peanut butter that you hear about....

[MChase]

Wearing a latex suit would be catastrophic. Staph likes warm, moist areas like the groin, armpits and the nostrils. We all have staph on our bodies....you cannot eliminate that. Many of us grow staph in our noses.

I maintain that vigilance is most important. When you find a point of infection (a reddened, tender hair follicle on your legs), you unroof it and cleanse it. Same with a broken blister.