Jul 16, 2020

Transcript

Interviewer: So your index finger is swollen. It's not a bee bite. It's not an insect bite. It's not anything that you're injured, and you're not really sure what it is. Is it normal?

We're in the studio with Dr. Kirtly Parker Jones, the expert in all things normal. That's how I always introduce her.

Dr. Jones: You usually introduce me as all things woman.

Interviewer: Oh, that's right.

Dr. Jones: But this is a good topic to think about.

Interviewer: Okay. Yes. So, Dr. Jones, my mother, because I think our audience by now thinks I'm just not normal, but my mother has this problem that's been recurring for over a month now that I don't think it's normal, but you be the judge on that and you help me decide. So her index finger . . .

Dr. Jones: Just on one hand?

Interviewer: One finger of one hand is swollen. And she thought it was maybe just an insect bite. She didn't injure it, but it's swollen. It's sometimes painful. Not all the time. It just varies. And we don't know what it is.

Dr. Jones: This is a great question because it's a paradigm for how we begin to think about a problem. This is not a girl's problem first of all. At least I don't think it is. It may be a problem that's more common in women, but this is not a girl's problem. So it's not my area of expertise. But what I am, having been trained as a physician, is an expert in thinking about how to solve problems. So, first, tell me more. It's been a month?

Interviewer: It's been about a month.

Dr. Jones: It's sometimes painful, but not all the time?

Interviewer: Yes. And so about a week ago . . .

Dr. Jones: Yeah.

Interviewer: . . . I asked her, I'm like, "Is it getting better? Have you tried icing it?" And she goes, "No." And so she ices it, and she noticed it just got so much worse . . .

Dr. Jones: Okay.

Interviewer: . . . to the point where she couldn't even bend it.

Dr. Jones: Right. So that's part of the questions. What makes it better and what makes it worse? So what makes this worse is icing it or making it cold. Does it have a color? Is it pale or is it red or is it the same color as the rest of her finger?

Interviewer: You know what, from how I can see, it looks normal. It just looks like, you know, when your skin is too stretched out because it's been swollen so it looks, I guess, shiny, right?

Dr. Jones: Okay. And the pain, is it sharp? Is it tingly? Is it achy? What is the kind of pain?

Interviewer: As she describes it to me, it's kind of tingly and it aches.

Dr. Jones: Aches, okay. So are you normal? And the answer is no. That normal is defined as something that happens to 95% of people, and this doesn't happen to 95% of people. Now, the other question is, and you can give me a range for your mother. Is she over 50 or under 50?

Interviewer: She's over 50.

Dr. Jones: Okay. Great. So this is an older person. Now, do I think this is an infectious problem? It's been happening for a month. It hasn't gotten a lot better, but it hasn't gotten a lot worse and there was no instigating cut or bite or anything. So we don't think it's infectious. Is it a contact thing? Meaning did she get her finger into something that causes a superficial contact, kind of like poison ivy or poison oak or something in the kitchen? Well, it's possible, but this is a month and it's continuing on. Now, what has she done? She went to see somebody?

Interviewer: She did. She finally went to see her family physician, surprisingly enough gave her painkillers. That's obviously not working.

Dr. Jones: Gave her what kind of painkillers?

Interviewer: I'm not too sure.

Dr. Jones: So something that's worthwhile trying are any of the prostaglandins inhibitors, and that would be aspirin, Motrin . . .

Interviewer: She has tried aspirin.

Dr. Jones: . . . Naprosyn, all in that kind of category of things that decrease inflammation. That's a good thing to try. Narcotics would not be indicated or useful on this.

So when someone has one finger that feels like this, you begin to think about, "Is this tendonitis?" In other words, does she have something in her tendon sheath that's inflamed that's hurting her finger? Because then it would be more or less irritated depending on how much she used it. And it could get swollen. So people who have tendonitis in their finger, sometimes their whole finger is swollen. And it could have been aggravated, and she is a woman who's used her hands a lot in the past. You've told me that she has been a chef. So tendonitis or inflammation of the tendon sheath of that finger can make the whole finger pretty swollen.

So is it life-threatening? Does she need to go to the ER today? This is the way doctors think. No, she doesn't need to go to the ER today because she's been doing this for a month. Is it going to be treated with painkillers? No, but anti-inflammatories would be helpful. And a three to four-day course of ibuprofen or Naprosyn, that she takes two to three times a day to see if that makes it better, would be useful.

If that doesn't get better, this is an important finger for her. So what kind of doctor would she see? Well, she's been to her primary care doctor. Now, the primary care doctor thought this might just go away. And so you think you've done a great job because they don't come back, and you don't know that actually you did a bad job and you don't know whether they're not any better. If she goes back to him, then he starts thinking, like I am, about a different set of things, like tendonitis or something like that.

So who deals with the hand? This doesn't sound like an orthopedic problem, but they know about stuff that affect joints and fingers. So an orthopedic doctor who does hands would be an expert to see.

The other kind of person who deals with finger and skin that gets swollen and joints that get hurt when you bend them are rheumatologists. They're specialists in joints and skin and fingers. Because sometimes people can get a weird result of a pinched nerve and the radial nerve feeds the thumb and the first digit and the middle finger and half of the ring finger. And so sometimes that could be a neurologic problem in the hand. But this could be a tendonitis of her tendon sheath that it just isn't getting better.

But you've got a swollen single finger and it's been going on for a month and it sometimes hurts a fair bit, but sometimes it doesn't hurt so much, but this is an important finger. So this is not normal. You need to probably go back to the doctor, and you may need to see a specialist for this particular problem.

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