By Dr. Jim Ferguson
Every week I wait for a story to find me. Sometimes a story is obvious like Trump versus The Swamp. Sometimes a story line just strikes you on the toe.

When Becky and I built our retirement home we were sure to include a wood burning fireplace. There’s something about fire which is embedded deep in the psyche of human beings. In ancient Greek mythology, Prometheus was an Olympian god who gave fire to mankind. Though I discount this myth, somewhere in our distant past, the light and warmth of fire was discovered and became embedded in our genetic memory.

I was a conservationist and was recycling before it was cool. Years ago, I ran into a liberal friend at a recycling center. He was obviously puzzled to see me, and asked, “What are you doing here?” Obviously, my recycling challenged his bias and preconceived notions of conservatives. The word conservative derives from a Latin verb meaning to conserve.

Since our home is in the woods, we had to sacrifice some trees during the building process. We waste little on our Thistle Farm. Our table scraps feed chickens which produce eggs which we use and give to neighbors and friends. We’re still using pine boards, milled on our property during our barn raising five years ago, for pasture fencing, With the new home project we harvested a white and red oak and milled the wood for cabinets, fireplace mantles and door frames.

Winter’s cold is hard on an older internist, but a crackling fire warms my chilled bones and makes our home cozy. The only problem is that wood has to be split after it’s cut. Fortunately, my neighbor loans me his gas wood splitting machine. And I did wise up and installed a gas firestarter which works much like a gas grill. This is a decided improvement. I no longer have to split kindling to build a fire. This spares cold fingers the dangers of a hatchet.

Unfortunately, a log is sometimes missed when splitting and must be split the old fashioned way with a sledge hammer and steel wedges which I’ve done for forty years. And that’s where the problem began.

Podagra is a medical term referring to pain in the bunion joint of the toe. However, the implication is more than bunion pain often caused by stylish women’s shoes. Shoes with pointed toe pinch the forefoot, and together with high heels make women appear so fetching. Nonetheless, stylish shoes are hard on the forefoot and the bunion area of the foot.

Podagra connotes in a doctor’s mind not only pain but inflammation with associated swelling, redness, warmth and loss of function of the first metatarsal joint (bunion joint). The cause of podagra is often gout, although other similar conditions such as pseudogout can produce similar inflammation of the great toe.

You might find it curious that gout preferentially inflames the great toe. However, other arthritic conditions have predilections for certain joints. An example is osteoarthritis (aka degenerative arthritis) which preferentially involves the terminal joints of the fingers. On the other hand, rheumatoid arthritis preferentially affects the middle finger joints.

Uric acid is a waste product of metabolism which is absorbed into the bloodstream and is filtered by the kidney and finally eliminated. Higher levels of uric acid can precipitate an exquisitely painful attack of gout. There is a concept in medicine called the solubility product which describes the equilibrium of partially dissolved substances in the body’s water medium. If you increase the substances or decrease the volume of water, a point will be reached when the substances no longer stay in solution and crystallize. That’s not a healthy situation.

Consider the bunion joint which carries the entire weight of the body as you stride/walk. Uric acid and other dissolved salts accumulate in heavily used joints during daily activities. Then at rest, the extruded joint fluid is reabsorbed just as edema subsides with elevation of the legs. Because physiologic (semipermeable) membranes allow the movement of water faster than salts, the concentration of salts rise as fluid is absorbed favoring crystallization. That should be more than enough medical science for purists. Now let me tell you about another cause of podagra and the picture I’ve posted to the internet!

I found three logs I’d missed with the gasoline splitter, so I decided to get out my trusty sledge hammer and steel wedges to render these logs fireplace-ready. Normally, I cut and split wood in heavy coveralls and with boots, but not for three logs I told myself. This was a big a mistake. Though I’ve used these tools to split wood for decades, I’m not perfect. On the third log I missed the center of the wedge with the sledgehammer. It ricocheted off the wedge and mashed my big toe between the hammer and the frozen ground.

Curiously, when people hear this story they invariably ask me if I cursed. Perhaps they assumed that I would; I didn’t. Perhaps they imagined they would have done so in a similar situation.

People often consult me with injuries and whether they should seek immediate attention. A sign of significant injury is immediate swelling of the injured part, often indicative of internal bleeding. I find this a better sign than the degree of pain which is subjective.

From the picture you can tell that an eight pound sledgehammer slung from shoulder height onto your big toe, hurts. And from the immediate swelling I knew there was bleeding. I immediately iced my toe to reduce the bleeding, but the damage was done and by that evening the toe was, to use the vernacular, “athob’n.” Yes, the doctor confirmed the cause of my podagra was a fracture, but it’s telling when he saw my toe and said, “Oh, wow.” My toe was actually shattered like a plate dropped from shoulder height onto concrete.

The doctor gave me one of those strap on walking shoes which I referred to as my Christmas boot. It’s been five weeks now and I’m much better, but I won’t be kicking soccer balls anytime soon. I am back in normal shoes. And that’s a good thing because your toes get cold in winter in a “Christmas boot.”



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