Fly Well: Clip well, clean well

Stick and rudder, fingers and toes

April 1, 2013

Sackier

What’s the difference between comedy and tragedy? Comedy—you get eaten by a lion. Tragedy—I get a thorn in my finger. And tragedy it is, because a thorn can be hideously painful, possibly precipitating infectious complications. What other ailments might afflict our rudder-controlling toes and flap-lowering fingers, making flight painful or impossible?

If our eyes are the mirror of the soul, our nails are a window into disease, and numerous conditions can be diagnosed by checking them out. A malfunctioning alternator causes a flaky battery; a malfunctioning thyroid can cause flaky nails. Clubbing occurs when the angle between nail and nail bed disappears, and can indicate lung, gut, or heart disease or a lurking cancer. Spoon-shaped nails (koilonychia) might imply either iron deficiency or hemochromatosis, where there is too much iron in the body; pitting occurs in psoriasis; yellowed nails might be tuberculosis or swelling from lymphedema. Transverse depressions are known as Beau’s lines; opaque, pale nails with a dark band, Terry’s nails, which could signify diabetes or other chronic diseases. Onycholysis sounds like a vampire-novel villain but actually means a nail splitting away from its bed, often caused by infections, certain medications, or fingernail adhesives. Magnificent-sounding but unattractive onychogryphosis, “ram’s horn nails,” occurs in the elderly, from poor nail care or chronic pressure—perhaps from ill-fitting shoes. Corns and calluses resulting from shoe pressure are very uncomfortable.

Other nail conditions are less subtle; a hammer blow to your thumb or a wrench dropped on your foot—ouch. The resulting black bruise under a nail, subungual hematoma (medispeak for “a black bruise under a nail”), is frightfully painful but responds well to elevation, ice, and painkillers. If pain does not abate, a doctor can pop a heated needle through the nail to drain the blood and release the pain. It rapidly relieves pain, but I advise you to take along a clothespin to cover your nose; the odor of a singed nail is nasty!

Infections around the nail, paronychia, cause intense throbbing—as does an ingrown toenail or fingernail, usually resulting from poor nail-clipping practices.

Fungal infections affecting fingers and toes, onychomycosis, are really troublesome, can be highly resistant to treatment, and afflict one in two adults. Initially causing few symptoms, this contagious disease takes root and spreads from toe to toe, most commonly afflicting the big and little toes. Other than the eventual chronic pain, there tends to be an unpleasant aroma; nails becoming thick, discolored, splitting, or breaking; and dust from fragmenting nails building up in socks. Avoidance is easier than a cure and involves good hygiene, well-fitting shoes, good nail care, and taking immediate care of minor digit injuries. Treatment can be attempted at home with hydrogen peroxide or vinegar baths; local or oral antifungal medications; or, recently, laser or similar light-based therapies.

While on the topic of charming infections, a word about warts. While purportedly a sign of the devil and treatable by witches in days of old (the 1960s, I think), these pesky things are really uncomfortable on fingers or the soles of ones’ feet. Spread at places where moisture and hot air abound—such as athletic clubs, swimming pools, and pilots’ favorite watering holes—they are very common. It is important to isolate the wart to prevent spreading, and over-the-counter therapies work well if they’re caught early. Usually this involves applying a salicylic acid solution (similar to aspirin), then covering the wart, and a day later rubbing off a layer of coated skin with a pumice stone. Repeated applications often does the trick. Alternatively, one can freeze off the wart with a home applicator. If you have a larger wart, several growths, diabetes, poor circulation, or are unsure that the offending critter is indeed a wart, see your doctor—other therapies are available to obliterate this unwelcome invader.

Black marks under a nail or elsewhere on the hands or feet—especially if pain-free, expanding, and occurring in the absence of any remembered trauma—may indicate melanoma, a particularly vicious skin cancer. This merits an immediate trip to your physician.

Why do elephants paint their toenails red? To hide in cherry trees. Ever seen an elephant in a cherry tree? No? See—it works! So look after your fingers and toes to ensure the only odd mark on your hands is a smear of oil; and on your feet, the imprint of rudder pedals. Clip well, clean well, and fly well. That way, you can hide in the sky to your heart’s content.

Dr. Jonathan Sackier is an expert in aviation medical concerns and helps members with their needs through the AOPA Pilot Protection Services plan. Email the author at jonathan.sackier@aopa.org.

Jonathan Sackier