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Remember Hydrotherapy

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Some years ago a patient came into my office with an unusual complaint: He said he had a capillini condition. For those less familiar, capillini is a very thin, rod-shaped spaghetti enjoyed by many pasta lovers. He held out his hand to show me the problem. He had an infection around his thumb nail, an acute paronychia. He had been washing dishes a few days earlier and could not dislodge a piece of capellini adhered to the bottom of a pot. Scrub as he might, it would not come loose, so he used his thumbnail to get under the pasta to try to dislodge it. Up it came, but unfortunately, it wedged between his nail and his nail bed and snapped off, a small splinter under the nail with no part of the splinter protruding.

There is very little space between the nail and the nail bed, and the pressure and pain were mounting. The throbbing and discomfort were such that in the middle of the night, he went to the emergency department. Generally speaking, a splinter under a nail can be removed carefully if a bit is sticking out, by clipping the nail around the splinter and employing a good pair of tweezers. But this was deeper in and an infection had started to brew, with tenderness in the area beginning to spread to the rest of the finger. He came home from the ER without removal of the splinter or resolution for the finger.

As a naturopathic doctor, I thought about the best ways to treat him. I knew he did not want to go back to the emergency department where they would need to cut a deep V in the nail reaching to where the hard pasta was embedded. Due to the infection, he would likely be prescribed oral antibiotics. I know that infections of the fingertips and nails must be treated carefully to prevent the infection from spreading and that treatments must be individualized to the patient. I suggested the use of botanical and nutritional antibiotic substances alongside aggressive hydrotherapy.

Some might think of hydrotherapy as a quaint approach used in times gone by, but it is commonly used in both occupational and physical therapy. Harkening back to naturopathic medicine roots, hydrotherapy is a treatment many naturopathic doctors also embrace. It refers to a wide array of treatments that make use of the mechanical and thermal influences of water when applied to particular areas of the body. Depending on the patient's complaint, the goal is to stimulate, calm or balance the nervous, immune, cardiovascular and digestive systems or to offer pain relief.

Hydrotherapeutic actions rely on the temperature of the water and the length of immersion or application. Cold water makes superficial blood vessels constrict, which pushes blood toward internal organs. In contrast, hot water encourages blood vessels to dilate, which aids in waste removal from tissues. Cold water is stimulating and invigorating; hot water is relaxing and soothing. Alternating hot and cold water decreases inflammation, improves elimination, and stimulates circulation. Moving water impacts touch receptors at the skin, which helps relax tight muscles and supports the circulatory system. Total submersion minimizes pressure on joints and internal organs. We also now know that hydrotherapy impacts nerve impulses, which play a role in the creation and release of stress hormones, hence why the hot bath or hot tub is so relaxing. Like all medical and healing approaches, hydrotherapy must be applied appropriately for the right conditions. The CDC maintains a lengthy and updated set of guidelines for Environmental Infection Control in Health Care Facilities-Hydrotherapy Tanks and Pools and other organizations such as The American Cancer Society also maintain a webpage on hydrotherapy.

In practice, I use particular hydrotherapy treatments directly on an area in question, like soaking for a local infection, described below; other times water is applied remotely to have a more derivative impact, for instance, employing a hot foot bath to relieve the pressure of sinus congestion.

For my capillini patient, I recommended alternating hot and cold soaks to the finger. I told him the greater the contrast in temperature, the more effective. The hot water should be as hot as he could tolerate without burning himself, and the cold water should be ice cold. I suggested he immerse his whole thumb and to do three-minute immersions in the hot and 10 seconds in the ice water, back and forth for 10 minutes, repeat every 2-3 hours while awake. I had him put Hydrastis canadensis tincture, a dropperful or so, in the hot water. This herb, commonly known as goldenseal, has antibiotic, anti-inflammatory and astringent qualities.

I also recommended extra vitamin C, zinc, garlic pills, and a multi-strain probiotic, to be taken by mouth, all things to help to fight infection. I asked him to refrain from alcohol and refined sugar, to be sure to drink plenty of water and to rest as much as he could.

By the next day, the splinter had come out and though the area was still pink, the swelling had gone down and it was less tender to touch. I felt comfortable continuing this approach; he carried on with the plan and by the following day, the swelling and inflammation had resolved. His finger was back to normal without the need for the deep V cut to the nail or oral antibiotics. He was happy he was able fight off the infection and glad to have side-stepped antibiotics, which had historically been difficult on his digestive system. He loved using the hydrotherapy, felt like it supported better circulation to and away from his finger and helped get the infection moving out of his system. He has vowed to let pots with food debris caked on soak overnight from here on out!

References:

Rockwell, Pamela DO. Acute and Chronic Paronychia. Am Fam Physician. 2001 Mar 15;63(6):1113-1117.

Dwayne Clark CDR, MC, USN. Am Fam Physician. 2003 Dec 1;68(11):2167-76.
Centers for Disease Control, Other Uses and Types of Water, Retrieved on September 1, 2012 from http://www.cdc.gov/healthywater/other/medical/hydrotherapy.html .

American Cancer Society, Hydrotherapy, Retrieved on September 6, 2012 from http://www.cancer.org/Treatment/TreatmentsandSideEffects/ComplementaryandAlternativeMedicine/ManualHealingandPhysicalTouch/hydrotherapy.

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