Sawbones: A Marital Tour of Misguided Medicine - Sawbones: Blisters

Episode Date: June 23, 2026

We've probably all gotten a blister at some point, whether from walking too much or from shredding a guitar solo. Dr. Sydnee and Justin talk about what actually causes a blister, how they are treated,... and, most importantly, when is a good situation in which to pop them? Music: "Medicines" by The Taxpayers https://taxpayers.bandcamp.com/ Lambda Legal: https://lambdalegal.org/ Help support this show and unlock bonus content! Become a member at https://maximumfun.org/joinsawbones

Transcript
Discussion (0)
Starting point is 00:00:00 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 boil? We think you've earned it. Just sit back, relax, and enjoy a moment of distraction from that weird growth. You're worth it. Hello, everybody, welcome to Sawbones, a marital tour of Misguided Medicine. I'm me, girl host Justin Mackle.
Starting point is 00:01:09 And I'm Sydney McElroy. Just normal. Just like in the normal way. Sometimes Oprah's with me in my darkest moments. Oprah's there with me when I do the intro of Sawbones. And it always means a lot to me when she, I don't know how she gets in there, but her spirit wafts over me and it really means a lot to me. Oprah's with all of us.
Starting point is 00:01:26 Oprah, a little bit is with all of us. Especially if you grew up when we grew up, I think that Oprah's associated with a lot of comfort. A lot of simpler times. Well, I say Oprah's someone you can trust. But then didn't Oprah bring us Dr. Oprah did bring us Dr. Oz? Yeah. So I don't know.
Starting point is 00:01:45 Weren't they both? You take the good, you take the bad, I guess. But I mean, we can all agree that overall, force for good in the world. Oprah all. Force for good in the universe, Oprah. Thank you, Oprah. No shade to Oprah. It's just like.
Starting point is 00:01:59 No shade to Oprah. There is the Dr. Oz thing. Yeah. So that shade. So Sid, what are we talking about this week? Other than Oprah? We got a topic recommendation from Avis. Thank you, Avis.
Starting point is 00:02:11 And initially, I didn't know if there would be much to say about this. The question was blisters. Blisters. Blisters. A simple blister. The humble blister. Could there be much history behind the blister? And initially I thought, well, probably not, right?
Starting point is 00:02:28 Who invented this thing? That's my first question. Who invented a blister? Who invented this thing? What kind of hairbrain's idea is this? It's interesting, though. I'm going to go to your things we do. I'm going to get into, like, the things that we decide to really understand in research are not, I mean, some of it is obvious.
Starting point is 00:02:46 Like, we try to understand research the stuff that kills us, right? Right. Because 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? Old people who have a lot of money want to feel young again? That's part of it. That is part of it.
Starting point is 00:03:05 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, 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 it such a hot topic said? I'm going to talk about that. I want to talk just briefly.
Starting point is 00:03:47 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 hurt bubbles up through there, but it can't breathe or do anything else because it's all contained underneath the top level of epidermis. Okay.
Starting point is 00:04:18 That's, yeah. 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 corneum, granulosum. Spinosum, basal. You got your subdermis.
Starting point is 00:04:36 You get, yeah. I mean, yes. I mean, get down into the fat, like the subcutanis 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 the spinoosum. And what happens is in that separation of layers of skin, you get a collection of like, what we call like tissue fluid, basically, interstitial fluid. builds up in there. And now you've got fluid between skin layers. So there's been a much same way.
Starting point is 00:05:08 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 have begun to separate from the wall surface. And if you're 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.
Starting point is 00:05:48 There are all kinds of systemic illnesses, meaning like, whether it's a virus or inflammatory or autoimmune. You know, there's lots of reasons you can have blisters. Some guitar solos have been known too. Are blistering. There are 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.
Starting point is 00:06:07 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. Yeah. That's just cell fluid, interstitial fluid, just filling that space. So we're going to focus on that.
Starting point is 00:06:22 But it's not, it's important to know. It's not actually the friction of the external surface on your skin. So think about it for a moment. Have you ever had a callus? Look at me. Look at me, Sydney. Look at me. Was that leading?
Starting point is 00:06:40 No, I just mean on your, on your foot or hand, I've had a callus. I've podcast for a living. Callous. So I. No, no, no, I have callous as, yeah, mainly right here. The fingers, they're not as good as they used to be because I had to, I've had to stop playing for so long because my carpal tunnel. But yeah, the. The cows is on my finger.
Starting point is 00:07:01 And that's friction, right? Yeah. Okay, so it's not a blister. No. 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?
Starting point is 00:07:20 Yeah, for sure. It's important. We didn't understand this for a very long time. But in order to... You thought it was the friction of the outside thing. Yes. Okay. But in order to treat or more, you know, importantly, prevent blisters, we have to understand why they form.
Starting point is 00:07:37 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 of them's got to be sports people, right? Yeah, runners, sports, yeah, sports. So there's lots, and I found a ton of history from like running World magazine on blisters. And like modern, if you want to know.
Starting point is 00:08:01 The finest historians there. If you want to know about blisters or about what people are doing right now, which, by the way, everybody's doing something different. And if you have... It's 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. Hickups. It's a good example.
Starting point is 00:08:21 I think hiccups is a classic. So runners are a great source of information about blisters than and now. and the military. Oh, sure, yeah. 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
Starting point is 00:08:38 in extreme circumstances, perhaps, maybe under intense stress in all kinds of different conditions for long periods of time. And if their feet get blistered 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.
Starting point is 00:09:09 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 things. And even when they were just in 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 Flintstones. I bet. I bet Fred had lots of blisters. Fred probably got calluses.
Starting point is 00:09:39 Calices. Yeah. Yeah, calluses. Probably. I will say just on a side note, medically, we did used to cause blisters. that there was a pro blister moment. Yeah, we've talked about it on the show before. We thought it was healthy.
Starting point is 00:09:56 It was like a little band-aid, nature's band-a. If you could in some way apply some sort of like noxious substance, usually like cantheridin from like the blister 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 vesiccation or vesicle, a blister, you cause a,
Starting point is 00:10:20 a little fluid-filled 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. Ooh. But even going back to prehistoric times,
Starting point is 00:10:36 we were mainly trying to prevent them. The first evidence we have of people trying to prevent blisters, do you remember Otsey the Iceman? Yeah. Remember when they discovered it was two German tourists found in 1991, found a frozen body. Yeah. And this, we've learned a lot about how ancient people lived from Otsey.
Starting point is 00:10:58 I assume we named him that and like, we didn't know. He probably didn't have like a driver's license. Or it was like written on the tag of his underwear. Stitched his perfectly clean underwear. Atsy, you might get frozen in a block of ice. We got to know who you are. Clean undies. So one of the things.
Starting point is 00:11:18 we learned about Otzi were his shoes. So specifically... B.K. Knights. It's crazy. It's B.K. Knights. So his shoes reconstructed by Peter Halavichek, who was an academic interested in feet and shoes
Starting point is 00:11:36 throughout history. No shoes. I mean, like, not just feet. You don't have to make him show like that. No, I mean, like, I don't mean in a bad way. Everybody's got to have an interest. Sure. 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,
Starting point is 00:11:53 and there's straw and moss inside. And so... We're concerned about blisters. Yeah. Well, because not only did Halavichek reconstruct the shoes, he then convinced a friend to try them and, like, go wear them in the Alps
Starting point is 00:12:11 and walk around and see what you think. And... Well, they're super bad. No. It's like they're made out of a bunch of old, dusty, nothing. His finding said in these shoes, you can practically not obtain the blisters. Wow. That's interesting.
Starting point is 00:12:28 Yeah. So they were actually really effective at preventing blisters. However, like moss and straw have to be replaced a lot. So it's like high maintenance shoes. It's a cool shoe. But still. So Otsey was trying to prevent blisters. Right?
Starting point is 00:12:42 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
Starting point is 00:12:59 which was probably again for longer walking and to prevent wear and tear on the feet including blisters and again we have tried this in 2004 12 students marched across the Alps wearing these Ramshaw style boots
Starting point is 00:13:14 only five of them switch to modern hiking boots. The rest of them felt like yeah pretty good. Wow, that's fascinating. 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. Yeah, it'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 one the 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.
Starting point is 00:13:58 It just shows up in your mailbox. It's like, we just assume you want this. We move on to the 50s 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. Sure. If you 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.
Starting point is 00:14:30 So the British Army decided with Dr. Paul Naler, 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? Pay? Money? I just volunteer. Purely volunteer.
Starting point is 00:14:46 You know, I don't know. I'm assuming that they were making, like, military recruits do it, right? Probably. I don't know. I don't know. I mean, I don't mean that in, like, a nefarious way. You know? I don't know.
Starting point is 00:15:00 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. Some sort of substance like the blister beetle stuff, some sort of like caustic agent? Just like. Oh, just. It's like friction. Ah, that would be very annoying.
Starting point is 00:15:19 I'm going to rub you for it. Like, yeah, 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 would 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. This sucks.
Starting point is 00:15:39 But they found a lot of factors were involved. Like it was the amount of frictional force, the number of rubs, the moisture. You could put other substances on there to try to 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. Right. Young Dr. Scholl 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, well, I might.
Starting point is 00:16:13 I could probably fix that. I can make something to fix that. In one study I liked in 1968, 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.
Starting point is 00:16:47 Is that accurate? I mean, I don't want you to pop your blisters because I'm right here. And I enjoy popping. Oh, so wait a minute. It's just for you? No. No. So in this study, and this really, and we'll get into it, it mainly holds true today.
Starting point is 00:17:05 They took 83 volunteers who had blisters, and they were looking to see if either one, you should drain the blister. like stick a needle in, suck the fluid out. Or two, should you just, what we would think of as like unroofing the blister, like take the whole top off? Just the, oh, oh, stinks. Yeah, man, so like just, yeah, 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, doesn't it?
Starting point is 00:17:34 It hurts. I don't like it. I know. So they were trying to figure out, like, what was better. And what they found is we know we should not unroof them. tearing that skin off the top is bad. The phraseology stinks. Unroof sucks.
Starting point is 00:17:50 I don't 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. Like they both healed up. But we know that tearing that skin off is bad. Yeah. But it's done.
Starting point is 00:18:04 So we like it as like a little protective layer there. Yeah. Okay. That makes sense. Yeah. And that holds true because as a sneak peek. Your big worry with 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.
Starting point is 00:18:23 I'm not talking about, again, this is not about like autoimmune diseases or noxious substances or burns. I'm talking about your standard owl 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. Okay, because it's baby skin. Mm-hmm. Baby skin. That epidermal layer on the top is protecting that.
Starting point is 00:18:44 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. Our next big – so, like, we have this British military work being done. And so now across, you know, across the Atlantic in the U.S., in the 70s, we have researchers who are like, we've got to go. we got to catch up with the Brits. The Brits are understanding feet way faster than we are.
Starting point is 00:19:16 The Brits are looking at so many more feet than us. And Marion Salsberger, who's a dermatologist, father of dermatology, Marion Salsberger is like, I am going to be the one to beat the great foot race.
Starting point is 00:19:28 No. Well, yeah, that's good. Yeah, it's good. Yeah, I'm going to win the foot race. Win the foot race, yeah. And so he's going to take us to the next step. There's so many puns here.
Starting point is 00:19:38 But first, let's go to the billing department. Let's go. 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 Salzberger. In 1972, he was talking a lot about, like, we know it's not just the friction.
Starting point is 00:20:06 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 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, just the circumstances.
Starting point is 00:20:35 Complicating factors. 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 made his. own version of a rubbing machine to form blisters. Dwayne the Rock Johnson is the rubbing machine. He also found that like it is not a burn.
Starting point is 00:21:07 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. I mean, 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, idiophylaxis.
Starting point is 00:21:51 Have you heard the term idioflaxis? Idiophylaxis. I have not. I was trying to figure out what that would. Idiot is like into one's, under oneself, like self-perpetuating, right? And then phlaxis, phallaxis, like a phallactory, like a vial? No. I mean, I think more like prophylaxes, like prevention.
Starting point is 00:22:14 Oh, antiphylaxis, prophylaxies. 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?
Starting point is 00:22:26 Could we secrete some sort of lube that would limit blisters? Is there what you're saying, some sort of skin gland that could secrete a ankle-saving lube? Blisters are where he started, but it was part of a wider idea. This is 1962. He went to the Army Science Conference. 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.
Starting point is 00:22:54 And this may be worth a whole other episode to get into idioflaxis. 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, okay, he broke it down into three pieces. What do we need on the battlefield?
Starting point is 00:23:14 We need the man, the human. the 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.
Starting point is 00:23:30 Mm-hmm. Isn't it time? Technology enhanced the man. Hmm. Honey, this is like super soldier stuff is what we're getting into. Now I'm excited. Idiotphylaxis is, I have to imagine. I mean, we are in 1962 as this.
Starting point is 00:23:46 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. Very interwoven. The creator of Wonder Woman was also creator of the lie detector
Starting point is 00:24:02 machine. So I guess it's possible. I mean, I was also a Star Trek does that, right? Star Trek has inspired cell phone design and what have you for many years. So I guess it is possible that this guy is like, what year? 62.
Starting point is 00:24:17 62. I think that would be, yeah, some influence there. And now, he was not the first one. No, sure. But he was part of this sort of idea
Starting point is 00:24:27 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 not just medical care
Starting point is 00:24:40 for, uniquely for people in the military, but how do we give them the best advantage we can in any battlefield situation across the globe. So by my count, if 40 is when Captain America actually
Starting point is 00:25:00 went into publication. So he would have been like, if he had been born when Captain America, like, if this count was like seven, right, when Captain America came out, I can't, I can't, when we, I'd have to check the year of birth, but I think he's exactly the right. I 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
Starting point is 00:25:24 War II 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, and 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
Starting point is 00:25:48 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 there. It doesn't immediately affect us. There's some other world we may be catapulted into wherever be.
Starting point is 00:26:01 Yes. This is where you get like mandatory vaccination. Yeah. It's interesting because all of this stuff, it sounds like science, science fiction, and 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.
Starting point is 00:26:23 Like, yeah, like that. They'd be coming like, yeah, Super Soldiers! Let's get Robocop. 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? Because you could super soldier yourself. I mean, it's a great way to be a super soldier is to get your vaccines and then you won't get those illnesses.
Starting point is 00:26:45 You have to be a pretty super soldier to not get polio, you know? I think that's pretty soon. But rolling back vaccine mandates in the military has led to flu outbreaks. It's too bad. So. Yeah. Yeah. So we actually moved in the other direction if you were worried about this, if you were worried about super soldiers.
Starting point is 00:27:02 So. I'm not worried about super soldiers. We have a, up until the 80s, most people were just putting band-aids. on their blisters, which is fine. Like, they're fine. I like Band-Aids. This is no, no shade on Band-Aids. I use Band-Aids all the time.
Starting point is 00:27:16 Band-Aids 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 when it grabs on something. It's really just a Band-Aid. And you've got... I mean, that is the whole thing, right? That's the, they got the metaphorical wrap for that exact piece of Sydney.
Starting point is 00:27:36 They're not doing much. So, he... So, okay, so in 1983, we've got a guy, Barr's backsell, who is, he works for a medical device company coloplast, and he is also a runner, like I said, military and runners. And he used band-aids on his blisters because that's all anybody had, and they used band-aids on their blisters. But this medical device company was using this new hydrocalloid product, and it was mainly for, like, wound care dressing after a surgery or something. And it absorbed liquid and was also, like, sticky, and it worked really well. It's called Comfield.
Starting point is 00:28:14 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 Gothenburg. 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.
Starting point is 00:28:37 Take this stuff and see if it helps. See if it's better than Band-Aids. And basically, this was kind of the, if you look at a lot of the products that are out there now for blisters, there are these hydrocoloid products. This was the beginning of using this comfeel stuff and then all of the products. And if you Google this, you'll find there's tons of hydrocoloid is like the mainstay of blister care, blister prevention. And this is where it came from. It starts with a conversation on a train. It's wild.
Starting point is 00:29:06 He actually, he recollected the little hydrocoloid bandages after the, after, after, you know, She did her trial, the nurse did the trial. And he took, like, the stinky box to his boss to be like, here's this stinky shoe box of band-aids. I just figured you wanted them back because it's like nothing comes for free. No. Listen, if you guys wanted it, only the first taste is free. But that is where we get the hydrocholid. And even today, like, and I dove deep into this as I was reading all these, like, runner blogs about, like, what they do.
Starting point is 00:29:38 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 hydrochaloid 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.
Starting point is 00:30:18 They're not out of the fighting force, but they're losing human time. Yes. Person hours. Person hours. Person hours. Yeah. But here is what's interesting in terms of your regular civilian blister care recommendations. The best grade of evidence I found is 2C.
Starting point is 00:30:38 And we grade, like if we give you a medical recommendation, I can tell, I mean, it makes sense. I can tell you if this is like a grade A recommendation. Like, 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.
Starting point is 00:30:57 I don't know if a lot of this blister advice is great because 2C means it's a pretty weak recommendation. It means, eh, probably. Who makes these recommendations? They're consensus guidelines based on best evidence. 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. But we're talking about blisters on your hands and feet, typically, palms and souls most of the time, fingers and toes, from friction. If it's small, it's minimal, it's bearable, leave it alone. Okay.
Starting point is 00:31:32 Don't you can, if you want to put something over it like a hydrocholoid dressing or a band-aid, you certainly can. But leave it be. Okay. If it's large and painful and tense, de-roof it. Do not de-roof it. Do not de-roof it. Put that de-roof it down. Don't de-roof it.
Starting point is 00:31:49 You can opt to puncture it. Now, I recommend to my patients, because I will tell you in my practice. You recommend your patients to let you do it. Let me do it. You're nasty. I recommend to 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 that what you tell them or yourself?
Starting point is 00:32:12 Yes. No. So I want them to come into me and let me use sterile instruments and do it in sterile fashion. Well, you can enjoy the nastiness for yourself. Because they're on their feet. And that's the, 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?
Starting point is 00:32:32 Because it hurts. Yeah. So 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? Passion. Dinner voice. And you can use a hydrocholoid dressing with tons.
Starting point is 00:32:48 There's generic ones. There's so many different options. I actually, after doing all this research, bought myself a roll of, like, hydrocoloid, like, tape so that I can just cut off pieces in the size and shape that I need. Because they sell the bandages in, like, all different sizes and dressings and all that stuff, but I can just get a big whole roll in tape. You sound like a serial killer.
Starting point is 00:33:06 It's just addressed 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 going 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 pin, which is what everybody wants to do, right? Take a lighter, get a pen 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
Starting point is 00:33:36 have an actual sterile instrument. So like I have needles that are sterile. in my clinic, please come to me. I mean, not necessarily you listener. Just another reason why you should let Dirty Dog, Sydney, Smirrall-McRoy pop 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.
Starting point is 00:34:03 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 induce blisters.
Starting point is 00:34:31 Sometimes we do it to help separate a section of skin that we might need to graft. So if we're going to harvest a tiny bit of your skin to put somewhere. else on your body. We might use a blistering technique to separate the epidermis from the underlying layers so that we can then get that piece of skin off. You can do that sometimes when you're administering like an anesthetic. You can form a little blister or vesicle. They've done that for research purposes. If they're trying to see if you're responding well to something, they'll induce a little blister and then suck the fluid out of it and test it looking for various substances to look for immune responses and things like that. So there are still reasons. We don't use cantheriodin.
Starting point is 00:35:08 We don't use a blister beetle And it's not to remove a humor It's bud But but we still might induce blisters So Thank you so much for listening to our podcast We hope you enjoyed yourself Thanks to the taxpayers
Starting point is 00:35:23 For use of their song, Medicines As the introduction and outintroduction Of our program You got one more weekend to come see Matilda Hey yeah Right Can head on over to the Ritter Park Ampheater This Friday, Saturday, Sunday
Starting point is 00:35:36 The show starts at 830 the gates open at 7. It's an outdoor amphitheater, so bring chairs, blankets, umbrella, just in case, just in case. And feel free to bring food and beverage. There is some stuff for sale there, but you can bring your whole picnic basket. Yeah. Pickingnicknick basket. It would be fun.
Starting point is 00:35:55 Thank you so much for listening to our podcast. Until the next time, my name is Justin McRoy. I'm Sidney McRoy. As always, don't drill a hole in your hand. Maximum Fun. A Worker Own Network of Artist-owned shows. supported directly by you.

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