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Month: March 2018

Research Round Up 3: Puffy hand syndrome

Research Round Up 3: Puffy hand syndrome

Reviews of medical research relating to and/or informed by harm reduction

This week we have a fascinating little piece of research from the medical journal Joint Bone Spine about what is medically labeled as “Puffy hand syndrome”. Puffy hand syndrome is a condition in which long term IV drug users may develop chronically, non-painful, hand swelling. I’ve seen plenty of people with this condition, but it certainly doesn’t happen to everyone- so I was curious about this research. Why does puffy hand syndrome develop? What can be done if you have puffy hand syndrome? What can be done to prevent puffy hand syndrome?

According to the research in this journal (Chouk et al, 2017), the exact cause of puffy hand syndrome is unknown, but it is a complication of IV drug use and of injecting into one’s extremities (injecting in to the hands or feet may result in puffy hand or puffy feet, respectively). The researchers speculate that repeated injections into the extremities might lead to the break down of the lymphatic system in that area, causing lymphatic fluid to back up and lead to the puffy appearance. The destruction of the lymphatic networks in the hands and feet are exacerbated by missing shots, but infection and inflammation may also contributes to damage to the lymphatic system (another research study seems to show a correlation between staph infections and puffy hand syndrome (Amode et al, 2013)).

The article by Chouk et al (2017) describes some strategies to help avoid developing puffy hand syndrome. These include using a tourniquet, not injecting in to the hands (or feet), and not missing shots (easier said than done). Of course, with infection contributing to the risk of developing puffy hand syndrome, let’s add good injection hygiene as a preventative measure as well- so scrub your infection site with alcohol before injecting, use a tourniquet, use a cotton only once, and always use a new needle if possible.

Also worth noting, women tend to develop puffy hand syndrome more than men.

If you have puffy hand syndrome and want to treat it there have been several documented treatments involving long-term compression therapy (this is the same basic treatment track as used by women who have had lymphatic damage resulting from breast cancer and associated treatments). The article presents a case study of one man who had no longer injected in to his hands and who used compression therapy (in this case compression gloves, also sometimes known as arthritis gloves- often available at drug stores) every day for three months. At the end of the trial he had noticeable shrinking of his hands’ puffiness.

 

Chouk, M., Vidon, C., Deveza, E., Verhoeven, F., Pelletier, F., Prati, C., & Wendling, D. (2017). Puffy hand syndrome. Joint Bone Spine, 84(1), 83-85. doi:10.1016/j.jbspin.2016.05.001
Amode, R., Bilan, P., Sin, C., Marchal, A., Sigal, M.-L., & Mahé, E. (2013). Puffy Hand Syndrome Revealed by a Severe Staphylococcal Skin Infection. Case Reports in Dermatological Medicine, 2013, 376060. http://doi.org/10.1155/2013/376060
Research Round Up 2: Femoral Injection

Research Round Up 2: Femoral Injection

Reviews of medical research relating to and/or informed by harm reduction

When I was getting my bachelor’s degree I was surprised with how much of academic research is focused on stating things in dry, scientific, objective, language about things that seem like common knowledge. A recent article out of England, published in the journal Drug and Alcohol Dependence, attempts to figure out why people inject in to their femoral vein. The authors of the article are concerned about people injecting into their femoral veins, as the risks associated with femoral vein injection are much higher than with injecting into peripheral veins on the arms.

The authors did a pretty big survey of injection drug users and their two big results might seem pretty obvious: one, older users inject in their femoral vein because they have run out of other useful veins in which to inject, and two, younger users inject there because it is a discreet site which won’t leave noticeable track marks on them.

There were some long-term users in Pittsburgh who always got long needles because they’d been going in their femoral site for years, but that was in Pittsburgh where the heroin is a little kinder on one’s veins. Anyway, the article noted that the femoral vein is a pretty stable, it’s a big vein and once one figures out how to find it it’s a pretty reliable place in which to inject. The problem with the femoral vein (like with injecting into muscles) is that if things go wrong, it tends to take awhile to present itself and usually by that point it’s pretty bad.

So what are the risks of using the femoral vein as an injection site? In their study there’s a much greater risk for developing sepsis- so as opposed to injecting some nasty shit into your arm and having your body wall it off and try to contain it (which is a way to describe the forming of an abscess), the infection hits a big vein which rapidly goes straight to your heart and from there back out to everywhere else. They also noted a much higher incidence of deep vein thrombosis (DVT), that is a large traveling clot that can lead to respiratory failure. So those are the big risks. Other potential serious problems to look out for are abscess formation, circulation problems (like if your leg suddenly swells), and the potential to hit the femoral artery as well as nerve bundles (as they are right next door to the vein!). Because this area is on a mainline to one’s heart, because it moves large volumes of blood, because it services your whole leg, and because the consequence are so serious- if you are injecting into your groin and have any problems- first stop injecting into that area, and second seek medical help at a clinic or a hospital right away. I couldn’t find a link to this one, but an abstract is here.

Going into the groin: Injection into the femoral vein among people who inject drugs in three urban areas of England. V. D. Hope, J. Scott, K. J. Cullen, J. V. Parry, F. Ncube, M. Hickman. Drug Alcohol Depend. 2015 Jul 1; 152: 239–245. Published online 2015 Apr 9. doi: 10.1016/j.drugalcdep.2015.03.029