I thought that it would be useful to rethink this topic in the context of questions asked last time and also because the lovely Miss Maddy asked me to.
Most of you who have been on the forum for awhile know that I am a physiotherapist (though no longer working) and obviously an Em sufferer.I often like to have a laugh and chat with my friends here on the forum, but when it comes to advice I promise I am very serious and only do my best. That said I can only offer guidelines ,as I don’t know the specifics of anyone’s condition and there are so many coexisting issues that consulting your own doctor is recommended. What follows is how I use ice and my rationale.
WHY DOES MY DOCTOR TELL ME NOT TO USE ICE ?
- Well ice is dangerous and easy to misuse, so there is a real risk of litigation due to a cold injury . With heat ,for example a heat pack, it is easy to tell if it is too hot as it burns!!! With cold ,however it is uncomfortable initially then NUMB ,and thats when you risk a cold injury. This can be a cold burn or frostbite. With too frequent use little ulcers can appear and grow. BUT and it is a big BUT most EM patients need to use ice at some time in desperation,or in my case to get out of the house and do some normal things like eating out. So with this in mind I will offer some guidelines that I have set for myself.
HOW ICE WORKS(AND WHY IT IS BOTH FRIEND AND FOE)
- Ice has a profound affect on circulation ,which if you understand you will be less likely to misuse it .When ice is first applied to say a foot ,the circulation undergoes vasoconstriction, meaning the blood vessels narrow. This first response happens as this body tries to conserve heat by not allowing as much blood to flow to the cold area. This is the GREAT part for EM and how I love the relief it offers. However ,after about ten minutes the body cleverly senses that ,hey only my foot is cold and the rest of me is warm, lets not let that foot freeze - and the second response of vasodilation occurs . VASODILATION BRINGS MORE BLOOD TO THE FOOT AS THE BODY TRIES TO SAVE IT.This is already the level that cold injury begins to occur ,also the foot is a bit numb at this stage. It is also past the point were ice is useful for EM- take the ice off during this vasodilation part and guess what PAIN. Many people say ice causes rebound pain but,it is likely they have left it on too long . Putting ice back now,to numb the foot again is a very bad idea and well into a cycle that will end in a cold injury.
GUIDELINES I USE FOR ICE
I have normal arteries and veins,proven by an ultrasound ,that I am sure is a test most EM patients have had. In general people with vascular disease should NOT use ice. If anyone with decreased sensation wants to try ,please be aware there is additional risk and be even more conservative than the times suggested.
- the good news is that there is no need for long bouts of ice, vasoconstriction begins almost straight away! Personally, when I use an ice pack it is no longer than 10 minutes at a time and I often move my foot away and back again during this period. In general physios say not to reapply the ice until redness fades - well, that would be a fine thing indeed! I noticed that in normal patients it took 20 to 30 minutes for the redness to fade ,so I use this as the interval before I reapply the ice.
I have heard mention that some doctors say it is not good to apply ice to a red,swollen foot and that it will damage nerves. I am not sure about this as physios have been doing just that since there where physios. I can report that a bad sprain or haematoma are extremely red hot and swollen and if on a sports field a physio will come charging out with an ice pack. Acute gout or arthritis are also much relieved by it - so you can decide yourselves.
Please wrap an ice pack in a damp washer as direct contact can cause a burn.
I choose not to do more than three or four applications to the same spot in 24 hrs.
Do not put ice in a foot bath, it tends to cool beyond an ice pack and over too large an area. A cool foot bath three or four times a day for 20 minutes at a time are what I do if required . THE MAIN ISSUE HERE IS LOSS OF SKIN OIL (swimmers spend much longer than this training ),only if you plonk your feet in for silly amounts of time trouble arises. I keep it just cool and short and moisturise after. The same idea applies to a bath.
Some people like to pop their feet in plastic bags and then in water in order to keep them dry - something I WOULD USE AS AN EMERGENCY MEASURE IF THE POWER WAS OFF- so good to remember.
WHY ICE IS NICE
- Simply because it is a useful tool for me to use in my EM battle. I rarely leave home without a couple of freezer bricks(wrapped of course) in my handbag. During coffee I try to elevate my feet on a spare chair, but when they begin to get red, and thats quick if I cant elevate, its shoes off under the table and ice for me. I make sure to follow my own rules though. Sadly a wet towel and fan don’t work for me I really need to constrict my blood vessels as they fail to do so on their own.
I have used these methods for about two years and have never had a problem, however it is a good idea for anyone with EM to inspect their feet regularly.
As mentioned this sadly cannot be specific advice ,unless you email me more details,or consult your own medical speialist or physio. It will undoubtedly be useful if you mention the guidelines so that they know that the plan is conservative!
CAN ALL THE REGULARS PROOF THIS ROUGH COPY PLEASE,WITH VIEW TO ADDING AS INFO FOR NEW MEMBERS - TA TIZZY XXX
Well, I am an observer as it is my dearest who is the sufferer. He needs to cool down his feet when they get hot and red and usually swollen... and in the 8 years since his condition made itself known he has not suffered from ice damage. However, if he does not cool his feet, he gets small areas of necrotic tissue due to lack of oxygen in the areas of micro circulation. These areas do not heal for months. Therefore ice is a blessing for him. As for going out... we do not go out, he DOES NOT leave the house, well perhaps for 5 min to see what is happening in MY garden, used to be our garden, now it is just mine.
The info above sounds good to me. I use ice most nights, I wrap a frozen gel pac in a towel and put it at the bottom of my bed. Then I can put my feet on it at will and the bottom of the bed stays cool. Some nights, just having my feet not covered is enough. At night I have two fans going. During the day if my feet are burning I put a cold wet towel on them. Some times I do soak in cold water. I have found the only way I can socialize is to bring my dishpan and water, so when my feet start to burn I have it there to cool them. At first I balked at doing this. Too embarrassed! But then I just decided to do it if I was to get out of the house at all. I belong to a senior group and I wasn't going because my feet would burn to much. One of the ladies suggested doing that.
I guess I have rattled on enough.
Have a cool day!!! It is raining here today.
Thank you for the great discussion Tizzy and thank you for all of the detailed information.
I know everyone has heard this many times before but am still not a doctor to date and the following is simply my opinion based on both experience and doctors recommendations I have heard.
Ice.....The general rule as tizzy has said is not to leave it on any longer than 10 minutes. It is a regular recommendation by doctors in treating injuries. My last doctors appointment my feet were so bad my nurse brought me a couple of ice packs they use to cool their meds to use on my feet. Key is as she said to is to not leave it on more than 10 minutes.
Now this is ok for some people and I am actually more like two people! My body has a mind of its own. I have days I continue to burn in a 63 degree room and other days this same temp causes Raynaud's and Pernio. At times I can't even get a yogurt or butter out of the fridge without instant numbness. Now if you have this problem too I shouldn't have to say it but Ice is a very bad idea for you in my opinion based on my personal experience. I, because of this problem don't use Ice at all because I can have severe instant negative effects on me. You might think..... if you are using it to cool your foot surely today Raynaud's / pernio isn't a problem for you today but no! I can flip flop on a dime as well as have cold numb patches in the middle of my burning areas! Crazy...I know.
I do know prolonged exposure to ice can cause serious damage. There may be a few people that get away with it but you never know if you will be the one regretting it or the one that got away with it.
Well there you have it... my personal opinion on ice.
8 years of ice blocks for me, too! No damage. Once had them turn blackish on soles (too long exposure) but standing and walking for less than two minutes they were bright red again and burning! Problem gone. I usually do the off/on with the ice.
I found ice water soaks can cause foot ulcers. I avoid this completely.
Bless you Tizzy for such an insightful, informative article :).
As we all know the issue of icing (cryotherapy) is highly controversial and can result in nerve damage, ulceration and necrosis.
BENS FRIENDS RECOMMEND THAT 'ICING' SHOULD ALWAYS BE UNDER MEDICAL SUPERVISION .
I’m sorry Carol Finke. Black feet ? That sounds horrible. It only goes to show the dangers involved but I am glad they got better if you can call burning up with EM again better that is but I’m glad you don’t seem to have any further or lasting damage. You got lucky
Carol Finke said:
I found ice water soaks can cause foot ulcers. I avoid this completely.
Tizzy, this article is invaluable. Controversy sparks debate ;). Icing is a reality for many EM'ers, no getting away from it. Its a subject that truly necessitates discussion. Cant turn a blind eye to the fact it happens with ,or without , medical supervision. I am a firm advocate for raising awareness on the pros/cons of 'icing' .
Moderator team love your article and think 'icing' is a great topic for a future 'Spotlight On' feature. Would it be ok if we incorporated your article into the feature?. Spotlights are then stored top of page , which makes accessing EM-related information much easier.
My personal opinion on ice- like everything EM - is whatever works for you!. I dont ice ,as I get no relief from it , but I do take freezing cold baths(immersion therapy). Whether icing or cold water immersion , cryotherapy is a massive topic that needs to be better understood. Thank you for being concerned and taking the time to raise this issue.
Three years ago I ordered those socks with pockets for foot shaped inserts that you put in the freezer from the major online retailer. By putting a sock on and then the sock with the icey inserts my burning feet are protected from danger. Since the freezer inserts are very thin the exposure time is less. I liked them so much I ordered a second pair. They were around $20. I don't use them very often now because my doc found the right med combo, but they were a major relief and well worth the money when I needed them. I don't know if we're allowed to share the brand names of products but if it's okay to private message me to share the product name I'll reply. I don't sell the product or have any connection with the manufacturer.
Veerla, you say you feel responsible like it’s a bad thing! If it was indeed your comment then thank you! It is a much needed conversation. I know some that ice may seem to be offended with thoughts like…ya right but surely they don’t have my. Kind of pain but no offense is ever meant nor anyone’s pain is meant to be minimized by any means!
I don’t think any or at least many of us are ANTI ICING ( darn phones auto correct won’t acknowledge icing as a word and keeps changing it!) Oops back to subject on hand… it’s not about ANTI ICING as much as it is about education on how to use ice safely if you are one that can safely do so not so much ice is a terrible thing.
I have tried all kinds of lotions from those promising cooling to anti itch when the burning gets so bad it itched like crazy and so far nothing I have tried has scratched the surface of the pain. I even tried gold bond medicated COOLING powder with no results. Expensive too! It says cooling right there in the name! I would love to know if anyone has found something that’s helps them. Oh…yes I get dry feet but only when I am flaring then is quickly returns to normal. This happens all over my body wherever I burn . I can go from normal to looking like my hands are a ninety year old woman’s in seconds from drieness. If left flaring too long or too often which I rarely happens anymore now that I know what must do to control it. I will get tiny cuts all over my skin from drieness. They will wrinkle up and split.
I don't remember you saying anything that could have offended. And it's so natural for us to over do the ice, that it's been a really good thing that we've been able to talk about it.
Tizzy, I really appreciate your post. I feel that personally I have received a lot of benefit by using cold gel packs, and I have kept stacks of them in the freezer for years. I don’t leave home without mine, either. But it is true that in the last year, I have experienced what I would call rebound.
I did not have a rebound for the first 20 or so years, but I also did not have red skin and my skin was not hot to the touch. My only symptoms or intensely burning skin, and sometimes a deeper aching throbbing feeling. This is possibly why I went undiagnosed for so long.
Last year, I started having the red skin in my feet, and then up to my knees. This was the same time that I first experienced what I would call rebound burning. It actually got more intense the longer I stayed on cold packs. Reading your explanation of vasodilation explains why this happened to me.
I hope others who read your post will use it reasonably and obtain what ever benefit they can with cold, all the while bearing in mind the dangers of it. If EMers are careful and balanced, they should get a lot of help from your post.
In answer to your inquiry about the cooling socks I use:
They are called NatraCold/Hot Therapy Socks. I purchased them from Amazon and they are about $20. Being able to put a regular sock between them and my skin makes me feel safe using the gel inserts that I keep stored in my freezer. Again, I don’t sell them or have any financial interests in the product. Just hope to be of some help to fellow sufferers.
I'm brand new here. Thank you for this article. I'm newly diagnosed. I was told by my doctor that I can't use ice anymore. Even the cool air sometimes causes Raynauds on me and ulcers. I wanted to cry in his office. The article is very informative. I'm so happy that some can use ice. I may still sneak around and do ice for 5 mintues, hehe. Too much pain sometimes not to try it.
On the subject of heat and cold. My change of profile picture is to show what happened at the Science Museum yesterday when we found a thermal imager. The creature with a bright red blob for a nose is me of course and the brilliant purple hands caused general amusement as everyone else had nice warm, white on the imager, hands. The photo doesn’t show my feet which showed white except for deep red toes. I had been wearing gloves all day and because of the burn had been walking barefoot in the museum where we had been for a couple of hours. Clearly my body doesn’t know if it is coming or going:(
By the time we left the museum my hands were in flare and my feet remained flaring for the rest of the day.
Nel, presently wearing very little except gloves.
I’m not sure what “How we live” is! I did a search on that title from my homepage, but I didn’t come up with anything. I also searched it from the discussions page, but still a blank. There must be quite a bit yet to this website that I need to discover.
I should probably mention that from the very start, I sewed fabric sleeves for my cold gel packs. I did that so I could easily wash them and keep my packs in good shape, but that probably also protected my skin quite a bit. Now I rarely use them in the house; I have fans set up in various places. But the backs of my thighs burn most of the time, and they still haven’t started turning red yet, so I am still able to sit on cold packs when I am working at the computer or sitting in the car or in a public place.
When I first switched from cold packs to a fan on my feet, I despaired because the fan seemed to provide so little relief. But I kept spritzing my feet with water, and after a few days the intensity of the pain subsided somewhat.
As I read the profiles and postings other members, I know I am incredibly fortunate that I have had this 25+ years, and it has not progressed any further than it has. My heart goes out to so many others who have such severe and disabling EM!
Hi, Tizzy, When I first started having flaring issues in my feet I didn't know it at the time, but the near constant flares for some time caused some major edema problems, since I had chronic venous insufficiency and had stopped wearing the compression stockings. That caused more problems - the beginning of lymph blisters in one of my ankles! But I knew none of that for a few months and focused my efforts on cooling my feet. In Jan of'13, I would go out onto our back patio, and stand on 3' sq section of blocks, moving every 15 seconds or so because the blocks would begin to feel "warm" beneath my feet. The first week the temps were 10-15 degrees F (-12 to-9.4C), then they moved back up to the 30s (0C +). I would stay out for 10 minutes at a time and then would go back inside to endure the heat of the house. If it had snowed I would just stand in the snow... I ended up with some skin problems after those excursions on the ice, and my feet are finally looking nearly normal - other than the wrinkling from being swollen to a few times their normal size.But that was all before discovering Chillows. I purchased a half dozen Chillows in the spring of that year, and now don't think I could survive without them. (There are different qualities, believe it or not - the ones sold on TV are made with a less durable material.) They are not ice packs, but since I refrigerate them, they do get cold, colder than the use they are intended for. But covered with several layers of material a Chillow can cool down the heat build up in my legs that will send my feet into a flare, or ease the intensity of the burning in my legs when one is going on when combined with fans. And as it seems to lose its coolness, I can just remove one or more layer of material until the coolness is all gone. There have been times, however, when even a Chillow hasn't been enough. Then I have used a flexible neck freezer pack wrapped in cloth and bound around my ankle and foot. I leave it on for about 15 min though, because I'm trying to get it through my surgical support stockings, too, which seem to be very thick right through there! Anyway, it helps some, but never enough, and for some reason I haven't been able to convince my hubby to swap legs with me for awhile to give me a break! ;-)