DEAR DR. DONOHUE: As a teen, I went camping with my dad and my uncle in the winter. I had a great time, but I got frostbitten and lost the tip of my little finger. That hasn’t stopped me from winter camping. I go every year. This year I am taking my son. I would like some information on frostbite – prevention and treatment. – S.B.

ANSWER:
The hands, fingers, toes, feet, nose and ears are the places most often frostbitten. Prevention means keeping them warm. A face mask and earmuffs ought to take care of the nose and ears. Two pairs of gloves keep the hands and fingers warm. Mittens are probably better, because heat is transferred from adjacent fingers. Two pairs of socks are needed for the feet. The first pair should be made of acrylic fiber, because it wicks moisture away from the feet better than other materials.

The first stage of frostbite is heralded by pale skin and pain. Ice crystals form in the tissues and draw water from nearby cells. The crystals grow larger and can compress the cells. Rapid rewarming at this stage pretty well assures no permanent tissue damage. Rewarming is done by putting the frostbitten part in a bath of warm water whose temperature is 99 F to 102 F (37 C to 39 C). Don’t begin rewarming unless the person can be kept warm from that point on. Refreezing does much tissue damage. Don’t rewarm frostbitten feet if the affected person has to leave the area under his or her own locomotion. Rewarmed feet are too painful to walk on.

The second stage is marked by numbness, and the third stage by lack of sensation. Treatment is the same – rapid rewarming. Permanent tissue damage is a likely consequence, but prompt treatment minimizes loss. Don’t rub frostbitten skin. There’s a wonderful book that describes cold injuries and their treatments. It’s “Hypothermia, Frostbite and Other Cold Injuries,” by Mountaineers Books. The authors are Gordon Giesbrecht and James Wilkerson. As an avid winter camper, you should consult it.

DEAR DR. DONOHUE: My husband teaches judo, which, like wrestling, is a close-contact sport. During classes he will have wrestled with about 10 to 12 different men. Is there a risk that he can pick up AIDS from this? We have thought about suggesting everyone get tested but are afraid of lawsuits. – M.H.

ANSWER:
AIDS has been a concern for more than 25 years. During that time, only a few cases – less than a handful – have had even a remotely possible link to athletic transference of the AIDS virus. The virus is in blood, and there is a theoretical risk of transmission if an HIV-positive person bled into an open cut of a non-infected person. The actual risk is all but nonexistent. Mentioning to prospective clients that an HIV-positive individual ought not to participate in the sport if he or she has a bleeding cut is all the prevention I would take.

DEAR DR. DONOHUE: I am a grandfather who is concerned about my 15-year-old grandson. He runs the 3,200 meters (approximately 2 miles) and the 1,600 meters (approximately 1 mile). I believe these two events are too much for a 15-year-old. I would appreciate your response. – H.R.

ANSWER:
So long as the boy isn’t complaining of any pain, has no sore joints and is not wiped out all the time, I don’t think these events are too much for him.

DEAR DR. DONOHUE: I started a running program. I gave it up one week later. My soles were so sore that all the pain wasn’t worth the supposed benefits of running. The soreness has gone, but I’m scared to try it again. What do you think went wrong? – B.B.

ANSWER:
It takes time for a neophyte’s feet to adjust to the forces that running imposes on them. Do you land on your heel and the fleshy part of the front of the foot almost simultaneously when your foot hits the ground? Do so. The other possible place of trouble is your shoes. Are they new and well-cushioned? You can give it another try without fear.

DEAR DR. DONOHUE: My daughter plays high school basketball. In her last game (I was in the stands), she was tripped, then fell to the floor and hit her head. She got up immediately and continued to play. She told me she had a slight headache. Since then, she’s been fine. She saw the family doctor for an acne check, and she told him what happened. He called me and told me she shouldn’t play any more this year. He said another head injury could kill her. What’s this all about? She’s heartbroken that she can’t play. – M.C.

ANSWER: The doctor is worried about second impact syndrome. If a person has had a concussion, resumes playing before the brain has made a complete recovery, and has another head injury, pressure in the brain can rise to such heights that it can be fatal. The second injury need not be a major injury.

A concussion is a temporary loss of brain function. Loss of consciousness is not necessary for a head injury to be considered a concussion. It does, however, add to the seriousness of such an injury. Signs of a concussion include a loss of memory of the things that happened just before and just after the injury, a headache that doesn’t go away, difficulty concentrating, being in a mental fog, blurred vision, ringing in the ears and a change in sleep patterns.

Your daughter had none of those signs. Apparently she’s been quite well since the incident happened. I don’t think she had a concussion. Unless she told the doctor things she hasn’t told you, I wouldn’t stop her from playing for the rest of the season. Talk to the doctor. If he remains adamant about his recommendation without giving you good reasons for it, have the girl see a neurologist for a second opinion.

Dr. Donohue regrets that he is unable to answer individual letters, but he will incorporate them in his column whenever possible. Readers may write him or request an order form of available health newsletters at P.O. Box 536475, Orlando, FL 32853-6475. Readers may also order health newsletters from www.rbmamall.com


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