DACTYLITIS IN WARRRIORS

What is dactylitis?

Dactylitis is a severe pain that affects the bones of the hands or feet and sometimes both. It is the first symptom, the first indicator of sickle cell disease, especially in babies. Dactylitis is caused by a blockage or restraint of blood circulation.

What are the symptoms of dactylitis?

The symptoms of dactylitis include:

 1. Extreme pain in the limbs

 2. Swollen hands and feet due to congestion and blocked circulation of blood.

Dactylitis is in itself a manifestation of vaso-occlusive crisis which is triggered by the following:

 1. Hypoxemia – Which is a result of low oxygen tension.

 2. Dehydration

 3. Acidosis

 4. Infections

 5. Weather extremes (extreme heat or extreme cold)

 6. Strenuous physical activity can also be a trigger for crisis, especially the vaso-occlusive crisis.

Understanding and knowing these triggers is key to effectively managing dactylitis because without triggers, there is no crisis and without crisis, there won’t be an episode of dactylitis. 

MANAGING DACTYLITIS

The first way to effectively manage dactylitis is to avoid the triggers and in the long run, prevent the crisis that occur as a result of the triggers.

How do you prevent crisis?

 1. Avoid dehydration : Stay hydrated at all times. Drink enough water and fresh fruit juice if you must drink any other fluid from water. Avoid carbonated drinks and soda at all costs. 

 2. Treat all infections as soon as the manifest. 

 3. Avoid hypoxia and acidosis

 4. In cases of extreme cold, stay warm by putting on a suitable piece of clothing. In cases of extreme heat, have regular cold baths, stay in a ventilated environment and stay away from heavy clothing materials. Wear something light that allows the free flow of air.

 5. Reduce strenuous activities as much as you can.

How do you avoid the pain?

There are natural ways to avoid and manage the pain rather than sticking with painkillers. Some of them include:

 1. Consumption of green fruits, berries and coconut water: These act as anti inflammatory agents and they also contain antioxidants. 

Coconut water is a very good natural antioxidant and anti inflammatory agent, the flesh is also good. The entire coconut is high in chlorophyll that enables red blood cells carry oxygen. Onions and garlics are also great antioxidants. Eating them raw might be offensive and cause bad breaths so it is advised that they are cooked than consumed raw.

 2. Consumption of foods rich in iron: These serve as blood builders. 

 3. Staying hydrated: Fruits such as watermelon, cucumber can help prevent dehydration. Freshly expressed juice from fruits can also help stay hydrated. However, nothing replaces adequate intake of water, drink up to five litres of water daily. Warriors are encouraged to stay well hydrated as dehydration is a trigger for crisis.

 4. Consumption of a healthy diet: The healthier your diet, the lesser the chances of triggers and crisis. Avoid processed foods and snacks. Eat whole grains and fresh fruits and vegetables. Fruits and vegetables should be a part of your meal as they contribute greatly towards boosting the immune system.

 5. Intake of supplements: Certain supplements are known to boost the immune system and raise the bar of the body’s immune system. The higher the immunity, the lower the chances of triggers of crisis especially dactylitis.

 6. Keeping appointments with your doctor: Sickle cell is a lifelong disease so keeping in touch with your doctor helps to notice and point out changes in your health and initiate quick treatment as soon as these changes occur. Heed your doctor’s advice, avoid self-medication and follow doctor’s prescriptions. 

QUESTION:

My daughter has dactylitis, initially the swelling of the foot was severe. Though it is reduced and only the ankle area is still swollen. 

She has difficulty in walking and moving around. 

My question is, what are the immediate treatment? What do I do?

ANSWER:

Like in all crisis, the first thing to do is to find your way to the hospital.

Look out for the possible triggers; are you in an environment too hot or too cold? Is there an untreated infection?

Administer painkillers and anti inflammatory agents like paracetamol and other anti inflammatory drugs. 

Ensure there is no dehydration, drunk lots of water and stay hydrated.

Administer malaria prophylaxis if you have not done that, as malaria is a major cause of triggers in this part of the world.

Usually, there is also management of acidosis which is by intravenous infusion of soduim bicarbonate.

While it is okay to contact other warriors during a crisis for moral support, it is better to go to a hospital for proper care and professional help and support.

QUESTION:

How long does an episode of dactylitis last?

ANSWER:

An episode can last for up to four weeks. As long as you religiously take your medications and follow all medical advice and regimen, the swelling will reduce.

Now sometimes, due to the memory of the previous pains, children often refuse to walk because somehow, they are in anticipation of the pain. That’s a psychological angle anyway. 

So in this scenario, what you need to do is reassure the child and give them the support and encouragement they need while they take their medications.

QUESTION:

Can massaging the swollen areas reduce the swelling?

ANSWER:

No it cannot.

The cause of the pain is more systemic than local. Now local means the cause of the swelling is from the hands and feet which medically, it is not. It is systemic because the blocked blood vessels in those parts of the body cannot be corrected by massage, your hand simply cannot reach far into those areas.

The swelling is caused by acidosis which is a high concentration of hydrogen ions in the blood which forces fluid into the tissues from the blood. 

With proper hydration and intake of painkillers, the fluid in those tissues will drain out when the body system is back on track.

QUESTION:

So massage does not really do any good?

ANSWER:

Not much apart from offering local soothing comfort.

I know some people want a magic button to press each time and just make everything go away but that’s not the case with sickle cell, it’s a process. Trust that as you’re doing the needful, your body is responding and correcting what needs to be corrected. 

Stay hydrated, take your drugs, keep regular appointments with your doctor, seek professional advice, avoid extreme weather conditions and maintain a healthy diet. 

Massaging has no effect whatsoever on the swelling.

Snippets of Dactylitis Lecture from Audrey Sickle Cell Foundation WhatsApp Platform.

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