Rapid Changes Don’t Work

Right around the time I got my new indoor spinning bike, my toes started to get red, swollen, and itchy. My reaction was to put ice on them because they were getting too hot and needed to be cooled down. Little did I know that I was self-inducing 50 days of pain to myself physically and mentally. This is the story of how I figured out what was wrong and what I learned from the negative experience.

When my toes first started to get swollen and itchy, I thought it was an allergy, or my toes rubbing against the shoes of the new bike shoes. When the toes continued to be inflamed even after icing them and buying bigger and different bike shoes, I thought perhaps I had “covid toes” so I got a covid test. It came back negative, but that wasn’t conclusive for me either, since some “covid toes” symptoms were known to occur after someone has the virus and was no longer carrying covid.

I did a virtual care appointment with my primary care provider, who is based in California (at the moment, I have relocated to Washington State.) He thought that I was exhibiting symptoms of cholinergic urticaria, also known colloquially as “heat bumps”, caused by sweat and heat. This was entirely plausible to me since I did get really hot and sweaty after biking. He didn’t think it was chilblains because it doesn’t snow where I live now and I’m not spending time outside hiking in the cold, wet rain. In addition, I grew up in Boston and lived there for 20 years. Compared to freezing Boston, the mild winters of Seattle are not cold, which is why I also wrote off “being cold” as a cause. Therefore, I proceeded to try to do everything to keep my feet and toes cold because cold was the opposite of inflamed and hot, from icing them, to not wearing socks and going barefoot while I was indoors, to keeping my feet outside of the bed covers while sleeping so they would remain cold, to getting onto the spinning bike when my feet were really cold so that they “wouldn’t get too hot”. However, the swelling continued, the toes got itchier and the angry redness kept moving down my toes, towards my feet. I was taking twice the dosage of over the counter antihistamines (at the guidance of my doctor) and nothing was improving. I was afraid I would lose my toes and woke up in the middle of the night and grabbed my flashlight to examine my toes and make sure they were okay. I would also wake up in the middle of the night to put on more steroid cream because they were so itchy. It was difficult for me to think about work or anything else other than “What is wrong with my toes?” At some point, I thought I had arthritis, diabetes, covid toes, eczema, fungal infections, inflammation reaction to food, or heat-induced inflammation. I was starting to get desperate for a solution.

About a month into the swollen toes, I started noticing that my right pinky finger was also getting swollen and itchy. “On no! It’s spreading,” I thought. I didn’t know what “it” was, and was trying everything from steroid creams to reduce the swelling from the outside, turmeric pills and antihistamines to reduce the inflammation from the inside, and avoided all meats and dairy to try to reduce inflammation. I even stopped cycling and stopped running or walking outside for fear of irritating the skin on my toes, since the few times I did do that, I ended up itchier and in more pain. I was dumbfounded as to what was happening when my fingers started to exhibit the same painful characteristics as my toes. So I went in for a dermatology appointment with Ame Phitwong at Puget Sound Dermatology. I was willing to see anyone who had an open slot, even though I went in with low hopes given their 2.5 stars review and because I wasn’t able to see an MD on such short notice, and had to see a DNP/ARNP instead. A few important things I learned from that visit:

  1. Just because someone doesn’t have the fancy academic credentials (e.g. an MD), doesn’t mean they aren’t good at their jobs. Ame was incredibly attentive and noticed immediately that my fingers and toes were really cold. She followed up with a phone call after checking the photos with others in the department and told me she thinks that I have chilblains, but wanted to wait until the lab results came back before prescribing me anything.
  2. The one key thing I had not described to any of my doctors or doctor friends in the past month of my misery was that my fingers and toes were cold to the touch. I didn’t know to tell them that. I just knew that my fingers and toes were inflamed and felt itchy, as if they were on fire. Sometimes, you literally need a “human touch” or an in-person interaction for someone to properly understand where you are coming from. You can’t get that from a video call.

Sure enough, after Ame said I had chilblains, I started to treat my symptoms as if they were chilblains, and not an internal allergic inflammation or topic dermatitis. Instead of freezing my fingers and toes to alleviate the itchiness, I kept them consistently warm (in socks and in gloves.) This was difficult at first because putting ice on them made them feel better in the short term (but they would always go back to throbbing and itchy after the ice came off.) However, within 24 hours, I started to notice that if I kept my fingers consistently warm and then did a pilates workout that would get my blood moving, my fingers and toes wouldn’t get crazily itchy like they did when I was cold and then did a light workout. This was the most progress I had made in over a month, so I kept at it. Within 5 days of the diagnosis and the change in behavior to keep my fingers and toes consistently warm before working out, the wrinkles on my toes and fingers had returned and the swelling and itchiness had subsided.

So what illness did I have?

Well it turns out that chilblains occur when your blood vessels rapidly expand, or rather, when you warm up too quickly. The convenience of having an exercise bike at home exacerbated this issue by causing the blood vessels in my toes to rapidly expand when I hopped onto the bike. Compared to when I would go to the gym to workout after work, I had a 3-foot commute to my exercise bike (it’s literally right next to my desk). At least when you are going to the gym, you are walking or moving to the gym, getting your blood moving and “warming up.” Of course a proper warm-up is still necessary, but of all the times that I didn’t properly warm up and just started to run or cycle at a gym, I had never had this issue. The difference now was that I was consistently going from being sedentary at my desk directly to the bike, because it was too convenient to do so. As for my fingers, well my left hand never exhibited any inflammation or swelling. I’m a righty, so I was using my right hand to place the ice on my toes. My right hand was getting frozen and then warming up too quickly as well! The blood vessels in my right fingers were also rapidly expanding and leaking fluid out of them, causing the inflammation.

The heat was not the problem,
nor was the cold.

The rapid change
from cold to hot was the culprit.

As with our physical bodies, I’ve learned that our minds can accept very different ideas, but the only way to be successful at convincing yourself or someone else of that drastically different idea, is to do so gradually. We mentally cannot process a rapid change, just like our blood vessels physically cannot process such a rapid change in temperature without rupturing. When I was younger and more naive, I wanted change in the workplace and change from others rapidly. I wanted others to adopt different ideas, my ideas, immediately. Not only did I get a biology lesson from this experience, but I also drew inspiration from this for my workplace and for how I plan to interact with my friends and family in this new year.

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