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From: B. Harris)
Subject: Re: Rest, Ice, Compression, Elevation
Date: 19 Jun 1997

In <> Leonard Evens <>

>Lisetta Hagens wrote:
>> Help! I am a lowly pharmacist and and well acquainted with the
>> acronymn RICE for rest, ice, compression, and elevation in the
>> case of strains, sprains, etc.  The question is ...How long?
>> I realize that ice will releive pain at any time, but is there
>> a point where you may want to switch to a heating pad?
>> Say, after 48 or 72 or 96 hrs?  Is there a point in time after
>> which elevation will not really do much good? And the compression
>> (ace bandage or whatever)... shouldn't that be continued until
>> the injury is pretty much healed?
>> And last but not least, after the ice and elevation are no longer
>> needed, has anyone tried topical capsaicin cream to strains/sprains?
>> If you did, was it of any help?
>> Any input would be helpful, as I am still "RICE"ing my ankle.
>> Lisetta Hagens, RPh
>I have always found that ice was best and heat was useless. It sometimes
>makes you feel better temporarily but does not do anything to reduce
>inflammation, and in some cases can make it worse. Supposedly it
>encourages circulation and healing, but you can do a much better job of
>that by finding some alternate means of getting exercise which does not
>stress the injured part.
>The reason ice is useful is that it is practically impossible, short of a
>cast, to immobilize the injured structure. Hence, you are always
>reinjuring it while healing progresses, and the ice keeps the
>inflammation down.
>I have also found that judicious use of Nsaids (asprin, ibuprofen,
>naproxen) is helpful. But since dose is very important and there can be
>adverse side effects, it is important to do this under the supervision of
>a physician.

   The atheletic folks generally recommend RICE for 24 hours before you
go to heat.  I've never been able to figure out why cold isn't
beneficial for as long as inflammatory signs are present.  So long as
there's no skin break, and you're not needing the inflammatory response
to help you control infection, why not suppress it?  You might slow
healing a bit, but you gain great deal in pain control.

                                               Steve Harris, M.D.

From: B. Harris)
Subject: Re: Cold compress absent refrigeration ??
Date: 25 Aug 1998 19:51:15 GMT

In <6rujnv$48n$> writes:

>[Note: cross-posted to]
>The question of installing refrigeration on a cruising sailboat is
>usually argued on the basis of cold beer, ice for drinks, cold beer, and
>.. oh, yes, keeping leftovers until the next day. It occurs to me (as my
>left thumb is soaking in icewater) that there is a significant medical
>reason to want refrigeration on a cruising sailboat. Cold is one of the
>best immediate treatments for bangs, burns, and sprains, of which sailors
>suffer many. Note that it doesn't do nearly as much good to cool the
>injury after it has swollen, i.e., after your partner has radioed a
>larger boat begging a little ice, and ferried it back to your boat.

   You must have been in the Gulf of Mexico or something.  Water up and
down both coasts of the US is PLENTY cool enough for an injured thumb.
Use a bucket <g>.

> But applied immediately, it can mean the difference between a
>black thumb a few hours hence, and not even being able to tell it was
>This raises two questions for those who do without refrigeration.
>(1) Is there any first-aid remedy that replaces cooling the injury,
>that works almost as well?

  No.  Cooling does a LOT of heavy magic insofar as damping down the
inflamatory response (which is not good for you unless you're infected,
and with antibiotics, may not be so great even then). And guess what?
The single best thing now known for brain injury due to lack of blood
flow (drowning, cardiac arrest) is cooling the brain by 5 C or so in
the 12-24 hours AFTER the injury.  Just like your thumb.

>  (2) Does anyone have any experience with
>creating a cold compress or soak absent refrigeration?  I am wondering
>about something analogous to the heatpacks that start an exothermic
>reaction when clicked.

    They make those for cold, too, and in large sizes.   Last one I saw
was large enough to be applied to a neck, and contained a super-
saturated solution of ammonium acetate.  You clicked a little disk to
provide a seed crystal, and the crystalization of the salt absorbed the
heat and did the rest (the magic of entropy-- here an endothermic
reaction allows spontaneous crystalization).  To reverse, you heat it
up in the microwave until all salt is gone, and let cool very slowly.

                                               Steve Harris, M.D.

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