Hydrocolloid Dressings and Proper Care

Sawbones is a show about medical history And nothing the hosts say should be taken as medical advice or opinion It's for fun Can't you just have fun for an hour and not try to diagnose your mystery boyil We think you've earned it Just sit back, relax and enjoy a moment of distraction from weird growth. You're worth it. D with the since that as. Hello everybody, welcome to Saw Bones, Marital tour of Misguided Medicine.'m your co host Justin Mcl Roy. And I'm Sydney Mclrooy. Just normal. just O in a normal way. Sometimes Opra's with me in my darkest moments, Opra's there with me when I do the intro of Sawbones. and it always means a lot to me when her I don't know how she gets in there, but her spirit washes over me and it really means a lot to me. Opra's with all of us. Oprah a little bit is with all of us, especially if you grew up When we grew up, I think that ' associated with a lot of comfort a lot of simimpler times. O some Well, I say O for someone you can trust. But then didn't Opra bring us Dr. Oprah did bring us doctor Oz. Yeah. So I don't know.hil. You take they both? You take the good, you take the bad, I guess.. But I mean, I mean we can all agree that overall, good Force for good and the Oprah.all Force for good in the universe, Oprah. Thank you, Oprah. No No shade to Oprah. It's just like No shade to Oprah. There is the doctor Oz thing. Yeah So that shade So said what we talk about this week? U other than Oprah We got a topic recommendation from Avis. Thank you, Avis. And initially, I didn't know if there would be much to say about this. The question was blisters Blisters. Blisters. The simple blister. The humble blister. The humble blister Could there be much history behind the blister? And initially I thought probably not. R, Who invented this thing? my this is my first. Who invented a blister? Wh this thing? What kind of hebrains ide is this? It's interesting though the rier things as we do. I'm gonna get into like The things that we decide to really understand and research, are not, I mean, some of it is obvious. like we try to understand and research the stuff that kills us. right? Be We don't want to die. so that makes sense But then okay, there's a ton of research into joints and cartilage And like trying to regrow joints. and do you know why e who have a lot of money want to feel young again. That's part of it. That is part of it. The other part of it is that there's a ton of research into how to keep horses running longer. Which is actually the exact same clientele, which ironically, right? But it's when you find somewhere we're like, I mean, and this is a very this is very American what I'm saying, but maybe other countries have this too If you can find a way for it to be beneficial financially to do something like regrow hair or make people have erections then maybe you can find more research. Blisters are an area where there's a surprising amount of interest and research and historical record. What makes this such a hot topic s I'm going to talk about that. I want to talk just briefly What is a What is a blister You're asking me? Yes. Okay. so Sometimes When you get hurt It doesn't. You can get hurt and then it doesn't break the skin, but there's a hurt. That's beneath it. So it's sometimes like the layers beneath the top layer of skin are injured somehow and then the heart bubbles up through there, but it can't breathe or do anything else because it's all contained underneath the B epidermis Okay, that's yeah Basically So there's a separation between layers of skin. Sure. So if we think vaguely about like the epidermis, the outer layer and the dermis beneath it And then you can divide that further into layers of like corneium, granulosum, spinosum. dermis. You get you get Yeahah. I mean, yes, I mean, get down into the fat, like the subcutaneous fat. Anyway, the point is there are layers of skin. And a blister forms when there is some sort of separation between the granulosum and spinosum. And what happens is in that separation of layers of skin, you get a collection of like what we call like T tissue fluid, basically. interstitial fluid builds up in there And now you've got fluid between skin layers So it's been much the same way if you were to paint a wall and you maybe put on too much paint You might get a pace on the wall where the paint surface had begun to separate from the wall surface. And if you were to look behind that, you would actually see liquid paint rather than the dried paint on the outside. There you go And it's not When we talk there are a lot of different reasons why you might form a blister. I want to focus really on what we think of as friction blisters, which is not entirely accurate, but the blisters that you might get on your feet if you've walked a long time or on your hands, if you've been working with a tool without wearing a glove or something, those kinds of blisters. Obviously your skin can blister for other reasons, there are all kinds of systemic illnesses, meaning like whether it's a virus or inflammatory or autoimmune, or you know, there's lots of reasons you're gonna blisters. Some guitar solos have been known too are blistering. There's substances that are blistering, burns can blister. And these are all reasons why that same thing is going to happen. The layers are going to separate, fluid fills the space Right. If it's really deep blood fills the space, you get a blood blister. Most of the time, they look kind of clear, right? Like a little bubble That's just cell fluid, interstial fluid, just filling that space So we're going to focus on that, but not it's important to know. it's not actually the friction of the external surface O your skin So think about it for a moment. Have you ever had a callus Look at me M Syne. Was that leading? No, I just mean on your foot or hand. It's a callus. It's a podcast for a living. al. So I no no, I have callalis is a yeah, mainly right here. The fingers. They're not as good as they used to be, because I' had guitar. I've had to stop playing for so long because but yeah, the cal is on my finger. And that's friction, right? Yeah. Okay, so it's not a blister. So when you think about a friction blister, you're talking about the shearing force between the layers of skin. It's not your skin on the shoe, your skin on the tool. It's the layers of skin shearing against each other, rubbing past each other, and creating that friction Does that make sense? Yeah, for sure. It's important. We didn't understand this for a very long time But in order to ch use the friction of the outside thing, Yes. Okay. But in order to Treat or more you know, uh Importly, prevent blisters. We have to understand why they form. So why are we interested in blisters? Why am I going to be able to tell you so much about the history of blisters There are two groups of people that really care about blisters. Okay. Let me guess the first one's got be sports people, right? Yeah, rununners. sports. Yeah, sports. So there's lots and I found a ton of history from like Running World magazine on Blister and like modern if you want to find historians there. If you want to know about bllisters or about what people are doing right now, which by the way ody' doing something different. And if you have always a good sign that nobody knows what they're doing. Yeah. If you find something where you have like Multiple different treatments for the same thing. That means we probably don't understand it. h's a good example. I think it comes as a classic. So runners are a great source of information about blisters than a now the military sure. Makes sense, right? So you have this is why we have research on this because you have this giant group of humans who are going to be walking, running, marching in extreme circumstances, perhaps maybe under intense stress in all kinds of different conditions for long periods of time And if their feet blisered and they cannot do it That is a big deal. So anything that involves the military, anything that the military butts up against in medical research, we always have so much more information historically. not just because of like the modern sort of, you think of like the I don't know, the profit machine or the idea of modern warfare. No, it's historical. I mean For a long time, people have been walking around fighting each other and getting blisters on their feet. Probably one of the most ancient Ancient things. even when they were adust in stone Stone sandals running around with a car powered by their own feet and running from, you know the Dino and all the gang. Like the Flintstein brrosur. I bet I bet Fint I bet Fred had lots of Wellisers probably got calles Calluses palises probably um, I will say just on a side note uh medically we did use to cause blisters. There was a pro blister mom. We've talked about it on the show Be before I thought it was healthy, a little band aid Nature's bandaid. If you could in some way apply some sort of like noxious substance, usually like Canthther Ridden from like the bllister beetle, you would put it on an area of skin. And it could just be like you have a fever or you're hysterical. This was a common cure for hysteria or gout or all kinds of different things. and you would put something corrosive on the skin. It was called vesication or vesicle, a blister, you cause a little fluid fill blister And then when you started draining it, you're letting out whatever humor you have too much of. And there is I will get to the end. There is a historical footnote here. We do still have use for blisters today But even going back to prehistoric times, we were mainly trying to prevent them The first evidence we have of people trying to prevent blisters, Do you remember Otzy the Ice manan And when they discovered it was two German tourists found in nineteen ninety one found a frozen body And this we've learned a lot about how ancient people lived from Ai I assume we named him that and like probably we didn't know. He probably didn't have 's license it was like written on the tag stitched his underwear. stitched his perfectly clean underwear. Otsy, you might get frozen in a block of eyes. And we gotta know who you are. Can uies. So one of the things we learned about Otsy were his shoes. So specifically OK nights. Crazy it became ice So his shoes Reonstructed by Peter Halavachk who is an academic interested in shoes throughout history. No shoes. I mean, like not just feet. You don't to make a sh like that. No, I mean like I don't mean in a bad way. L everybody's got to have an interest.. so he reconstructed them and the leather On the soul was from a bear There was deer hide on the upper part of the shoe And there's straw and moss inside And so' concerned about blisters. Yeah Well, because not only did Halavicek reconstruct the shoes, he then convinced a friend to try them and like go wear them in the Alps and walk around and see What'd you think And Well, they're super bad. No. It's like they're made out of a bunch of old dusty nothing. His findings said in these shoes you can pract practically not obtain the blisters It's interesting. Yeah. they were actually really effective at preventing blisters. However, like moss and straw have to be replaced a lot. H maintenance shoes you know. But still. so Osy was trying to prevent blisters Right? This far So I mean, you know, blisters have been around forever. We also know that Roman soldiers specifically at one point altered their sandal style As we kind of picture like Romans and sandals At one point they started wearing a boot The Ramshaw style boot Which was probably again for longer walking and two prevent wear and tear on the feet, including blisters. And again, we have tried this. in two thousand four, twelve students marched across the Alps wearing These Ramshaw style boots uh, Only five of them switched to modern hiers. The rest of them felt like yeah, pretty good You can read, okay, I couldn't actually find the study because it's not all uploaded online, but there is a journal of Roman equipment military studies. That is a journal The Journal of Roman Equipment military Studies. That is a specific interest. That's fascinating read too, I'm sure for a very specific sort of person But there is there is a journal that I think it's like once a year publishes people trying to recreate and then try out Roman military equipment. And if you're a middle school geometry teacher it just shows up at your house. It's crazy. It just shows up in your mailbox. like we just assume you want this Um We move on to the fifties and we start to not just understand blisters a little better, but you start to see researchers actually trying to replicate blisters first First you have to make blisters. If we can understand the blister, you must put yourself in the mind of the blister. Yes. And so the British army tried this first. and again, this is where we I mean, you really see like the military is who's interested in preventing blisters So the British Army decided with Dr. Paul Nayler, we're going to make blisters on our subjects. So you had to volunteer for this study and then get blisters put on you It really sounds like it would suck. Is it pay money? orr it just volunteer purely volunteer? You know, I don't know. I'm assuming that they were making Military recruits do it, right? Yeah. Probably I don't know. I don't know. I mean, I don't mean that in like a ne like movie gift certificates. we't know Part of the research was to see like how long it takes to make a blister so that we can understand how blisters form. So it was just like We're going to rub you with something someome sort of substance like the blister Beetle stuff, some sort of caustic agent. is like friction. A That' be very annoying. I'm going to rub you for it like Yeahah, I'm going to rub you for a long time and try to make a blister on you and see like Does it take different amounts of time for different people? Like are some of us a little more prone to? I think for me it wouldd be a very short time before I said, I'm quitting the study. I'd like to go home. Stop rubbing me now I'm leaving sucks. But they found a lot of factors were involved, like it was the amount of frictional force, the number of of Rubs the moisture, you could put other substances on there to try to like decrease the friction to see if that would You know, that's when we're starting to like we're getting into blister prevention technology. young doct. School is like, this is something I mean, this is where a lot of this stuff starts coming into play is like these studies in the military and then you've got somebody who's watching and is like, M, I might could probably I could probably fix that. I can make something to fix that. Um And in one study I liked in nineteen sixty eight, they found specifically because now they're trying to make blisters, they're trying to figure out why blisters form. The next step is Do we pop them Which I feel like this is like the key question when we get into modern blister management I have when I understand talking to you, a common person like myself shouldn't pop them unless I'm under the watchful gaze of a physician. Is that accurate? I mean, I don't want you to pop your blisters because I'm right here And I enjoy Oh, so wait a minute, it's just for you. You're just not No. So in this study and this this really And we'll get into it. It mainly holds true today. They took eighty three volunteers who had blisters And they were looking to see if either one, you should drain the blister likeike Stick a needle in, suck the fluid out Two, should you just what we would think of as like unroofing the blister, like take the whole top off see Yeah man. So like just yeah, I I get what you're saying. I was actually going to describe it more, but I don't actually think I need to. It hurts to think about it. I don't like it hurts. It hurts don't like I know. So they were they were trying to figure out like what was better. And what they found is We know we should not uroof them tearing that that ass skin off the top isologinks And Rve suck The ones I don't w want to say that anymore. The ones that they left alone and the ones that they like poked a little hole in and just sucked the fluid out didn't necessarily have that much of a difference really. I just feel like they both sk. we know that tearing that skin off is bad. Yeah, but's So we like it as like a little protective layer there. Okay, that makes sense. Yeah. and that holds true because as a sneak peek. Your big worry. blisters is going to be infection because you've got the blister itself. And if we're talking about your standard like my shoes were too tight, it formed a blister kind of blister. I'm not talking about again, this is not about like Autoimmune diseases or noxious substances or burns. I'm talking about your standard Now on my foot I have a blister If you tear that skin off What's underneath is going to be much more prone to infection at this point because it's baby skin Baby skin. That epidermal layer on the top is protecting that So whether or not there's fluid in between that epidermis is important to protecting the skin as it regrows from infection. So your big worry is you don't want to make a hole in the foot Right. Yeah Um Our next big, so like we have this British military work being done And so now across, you know, across the Atlantic in the US, in the seventies, we have researchers who are like, we've got to get We got to catch up with the Brits The Brits are understanding feet way faster than we ever. Brits are looking at so many more feet than us. And Marion Salzberg, who's a dermatologist, father of dermatology Maryian Slzberger is like I am going to be the one at beat the great foot race No. Yeah race. I'm going to win the foot race. Yeah And so he's going to take us to the next step There's so many puns here. But first let's go to the billing department. Let's go Medices. The medices That escalt my God bar them outth. Hey, it's John Moe, I host Deppress Me and Sleeping with Celebrities, and I'm here with MaxFun member of the Mth, Kara Barnett. Hi, John. It's great to talk to you. We appreciate your support, Kara. How long have you been listening to the show? I've been listening to Deepressed Me since the first promo came out with Patt and Oswald. I've been listening since the very first episode. 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And the news is we're back withith an all new miniseries set in the Zix universe. The young old Durf chronicles. Yeah Well, Durf find his own killer before it's too late To find out how that question could possibly make sense, well, you just have to tune in.. And as always, it's ambitious and labor intensive to frankly, ab certain degree. Indeed. So if you are looking for a little break from your own galaxy, we would love for you to check it out. That's the Young old Derf Chronicles. seearch Mission toZ, ZIXX in your podcast app orr on maximumfun dot org d Keep it fresh All right, so let's get this off on the right foot No more puns. Now, here is what is fascinating. I started reading about Marion Salzberurger in nineteen seventy two, he was talking a lot about like We know it's not just the friction, we know it's the shearing forces. We're starting to understand this point with blister formation. And he's working a lot with like how can we help Our military Do like do better prevent blisters and he's got a lot of stats about like during the Second World War. I mean, the biggest problem that people were up against was typically not some sort of like battlefield injury. It was sickness or injury. Yeah, the just the circumstances Fors. Right. And so he was he was like, I am going to work on blisters, this is going to be what I want to do. And so he also u made his own version of a a rubbing machine T To form bl. the Rock Johnson is The rubbing machine Uh, he he also found that like It is not a burn. He did some research to look at like the temperature that was forming. like, is this a burn? It's not a burn. And then looking at like things you could do to prep the skin ahead of time. to decrease the likelihood of blisters and like really cemented kind of our common understanding of blister formation and blister prevention at this point in history. I do think he's the most interesting thing about him Um I mean, he's the he was quoted as being the father of dermatology, so clearly Not the most interesting, but in my mind is that The reason he pursued this so vigorously It was part of his push towards what he and I believe he coined this term, I think Iidiophylaxis Have you heard the term idiophlaxis Anophylaxis. I have not. I was trying to figure out why what that would Idio is like into your into one's under onesself like self perpetuating. rightight And then phax phyaxis fylactory like a vial. No. I mean, I think more like prophylaxis preventionaxesphylaxis ways to like inner armor Oh okay biological inner armor Okay Oh, so this is like your armor that your body already makes. So if you like or could we enhance? Could we secrete some sort of lube? that would limit blisters. Is there so you' saying some sort of l could secrete a ankle saving lube. Blisters are where he started, but it was part of a wider idea This is nineteen sixty two He went to the Army science confonference. that the United States military held. And he stood up and gave a lecture, I have a copy of the lecture I've been reading through. And this may be worth a whole other episode to get into idiophlaxis. I'm not sure yet But basically what he was saying is Over time, the military is continuing to enhance the various aspects of like Well, o, he broke it down into three pieces What what do we need on the battlefield? We need the man the human carrier or vehicle And the weapon gun. Yeah. Yeah Okay, so over time, technology has continued to enhance the carrier has continued to enhance the weapon Isn't it time technology enhance the man Hm. Honey This is like super soldier stuff. is what we're getting into. Now I'm excited. Idiophylaxis is, I have to imagine. I mean, we are in nineteen sixty two as this conversation is happening How much comic book stuff came from this idea? I mean, it is well known the history of comic books and science progress are very interwoven. The creator of Wonder Woman was also creator of the lie detector machine U So I guess it's possible. I mean, I was aw if Star Trek does that, right? Star Trek is inspired cell phone design and what have you for many years. So I guess it is possible that this guy is like What year sixty two. sixty two. I think that would be, some influence there. And now too the years. He was not the first one. No, sure But he was part of this sort of idea that we have all this like we are our technology is moving at such an advanced pace right now. but what's not moving at the same pace is like How do we provide notot just medical care for uniquely for people in the military, but how do we give them the best advantage we can any battlefield situation across the globe. By my countount If if forty is when Captain America actually went into to publication. So he would have been like If he had been born when Captain America like if this c was like seven, right? when Captain America came out. I can't I can't when I'd have to check the year of birth, but I think he's exactly the right age to be absolutely influenced by Captain America. They're definitely. well, I mean, I think that was the big question. you know, after World War two was this sort of, I mean, we're getting into the Cold War and the arms race and all that kind of stuff. And so then at the same time you're going to have a conversation on the military medical end How can we part of this is very practical. How can we better support our troops, especially as we were moving into an era where we did not know all the places on the globe where people might go and be stationed or engage in battle. Right. And so you have like an interest in vaccines. I mean, that's where I mean, like a very pragmatic thing here is this is why immediately affect us. There's some other world. We may be catapulted into to be. Yes. This is where you get like mandatory vaccination Amor. Yeah It's interesting because all of this stuff, it sounds like science, science fiction, kind of all, you know, colliding in one place. And it also sounds like super soldier stuff feels like where we might be right now, like you would think the U.S. military, like the people in charge would be like, oh yeah. like Yeah, like that. L became my like Yeah. Super so.. Right. But I do think it's interesting that vaccines are a big part of this theory and they're not for that because that would be the first place you start, right? Be you super soldier yourself to I it's a great way to be a super soldier is to get your vaccines and then you won't get those illnesses. You You have to be a pretty super soldier to not get pull out. You know think that's pretty so. But rolling back vaccine mandates in the military has led to flu outbreaks So we actually moved in the other direction. if you were worried about this, if you were worried about su soldiers. So don't worry about super soldiers We have up until the eighties, most people were just putting bandaids on there blisters, which is fine They're fine I like bandids. This is no shade on band aids. I use bandaids all the time. Bandaids are fine. But they don't necessarily, I mean, you're really just covering it at that point, right? You're just putting something over it because it hurts rightally just on something. It really just a band aid. And you've got that is the whole thing, right? That's they got the metaphorical wrap for that exact pie of Cyney. They're not doing much So he So Okay, so in nineteen eighty three, we've got a guy Lars back cell who is he works for a medical device company Coplast And he is also a runner Like I said, militaryian runners. and he used band aids on his blisters because that's all anybody had and they used bandids on their blisters. But this medical device company was using this new hydroclloid product and it was mainly for like wound care dressing after a surgery or something. It absorbed liquid and was also like sticky and it worked really well Come feel And he had kind of messed around with it for himself to like put on his heels and stuff while he was running to see if like this might be helpful. and he had had some success So he ends up on a train he is going from Stockholm to Gothtenberg And he is sitting next to a nurse who worked for the Swedish Army. And they start talking about blisters. and he's like, hey, you're a nurse, you work with soldiers, takeake this stuff And see if it helps. seeee if it's better than band aids Basically, this was kind of the if you look at a lot of the products that are out there now for blisters, There' these hydrocholloid products. This was the beginning of using this Cfel stuff and then all of the products. And if you Google this, you'll find there's tons of hydrocholoid is like the mainstay of blister care, blister prevention. and this is where it came from. tra. He actually he recollected The little hydrocolloid bandages after the After she did her trial, the nurse did the trial, and he took like the stinky box to his boss. to be like, here's the stinky shoe box of Bandid. I you wanted them back 'cause it's like nothing comes for free. No. Listen, if you guys want only the first taste is free. But that is where we get the hydrochloroid. And even today, like, and I dove deep into this as I was reading all these like runner blogs about like what they do. And I mean, there's a ton of technology that has now gone into Obviously shoes and socks. There are various linings that you can get like multiple like wear two socks so that the shearing force is between the socks and not between your skin. Obviously there's these hydrocholoid things that you can put in your shoe not just like on your foot, but you can actually put in the shoe at certain spaces to reduce the most likely to blister. So there's tons of technology in the running world. All of this is also being applied in the military world because again, people who are on their feet a lot and it is necessary from a military perspective for the fighting force to not lose what they call man days, people days, you know, it's not just about They're gone. They're not out of the fighting force, but they're Losing human time. Y. personerson hour. Person hours. personerson hour. Yeah U But Here is what's interesting In terms of your regular civilian Blister care recommendations, the best grade of evidence I found to C and we grade like if we give you a medical recommendation, I can tell, I mean, and it makes sense. I can tell you if this is like a grade A recommendation. likeike this is the best evidence we have. We did the randomized control trials, They were double blind studies. We know this works. And there's stuff that we talk about on the show that I know works. I know vaccines work. I don't know if a lot of this blister advice is great ' two C means it's a pretty weak recommendation. It means e Probably whoo makes these recommendations? There consensus guidelines based on best evidence? And so consensus guidelines based on best evidence says, if you have a small blister, and again, these are friction blisters, so these are not from burns or other things. We're talking about Blisters on your hands and feet typically, palms and soules most of the time Fingers and toes from friction If it's small, it's minimal, it's bearable Leave it alone. Okay. Don't you If you want to put something over it like a hydrocoloroid dressing or a band aid, you certainly can But Leave it be If it's large and painful, derof it. intense. D. Do not der roof it. Do not derof it. Don't derof it. You that derofer down to puncture it. Now I recommend to my patients because I will tell you in my practice. I recommend your patients to let you do it Let me do it. nasty I recommend my patients let me do it because I take care of largely a population of people experiencing homelessness and they don't necessarily have a sterile environment in which to pop their blister. Is them?. So I want them to come into me and let me use sterile instruments and do it in sterile fashion Where you can enjoy the nastiness for yourself because they're on their feet This is the key If you are going to continue to be on your feet a ton, if like you can't just like prop your foot up and rest for a couple days, you probably and it's a big blister, you probably do need to pop it, right? Be it hurts. Yeah. So come to see. You want to use a sterile instrument to make the tiniest hole possible gently express the liquid within and then dress it so that you prevent infection. You hear the way she talks about it, right? passassion. ner voice. And you can use a hydrocholoid dressing with there's tons, there's generic ones. There's so many different options. I actually after doing all this research bought myself a roll of like hydrocholoid like tape so that I can just cut off pieces in the size and shape that I need Beause they sell the bandages in like all different sizes and dressings and all that stuff, but I can just get a bigole roll. It's just address blisters. I take care of so many blisters. and if you have to walk on it, you probably want something like that over it. The main thing is you want to keep that epidermis layer is gonna to keep it protected from infection. and that is good. So you don't want to peel that skin off If you must pop it, it needs to be sterile. I will say Heating up the safety pen, which is what everybody wants to do, right? Take a lighter, get a pin hot and then poke it in there. You are going to deposit some carbon in there, which is going to inhibit healing So it's better not to do it that way. It's better to have an actual sterile instrument. So like I have needles that are sterile in my clinic. Please come to me Not necessarily An reason why you should let dirty dog Syidney Sirl Macy All your funky blisters. The way that you can prevent them is with, I mean, the things that we know, like if you have an inducing action that is causing blisters, don't do it. Now if you must do it, like shoes and socks that are appropriately supportive, make sure that they're the right size. There are all kinds of like powders that you can use to help prevent blisters to reduce friction in the pads. If they get infected, please do seek medical attention. You can get some pretty severe infections that spread very quickly. So if you've got an infected blister, please go see somebody immediately. Obviously not every blister necessarily needs professional medical care, but if you think it's infected, go get it checked out. And there are a handful of reasons why we still