Musular, Foot & Skin Issues
11th – 13th of Dhul Hijjah (Stoning at the Jamaraat)
If you have reached this stage of the Hajj, with little in the way of illness or ill health, give yourself a pat on the back. However the reality is, there are still more challenges to come.
The vast majority of pilgrims on the 10th day of Dhul Hijjah will be having their first shower, those dirty white sheets wrapped around the body will be discarded and life with a shower and shower gel, deodorants, perfume and normal clothing will resume. However the next three days will challenge you in different ways. The risks of heat related issues will not be gone, but now muscular problems and foot and skin issues become more prevalent. Like in my previous articles I will reinforce that anticipation and preparation is the key to avoiding injury and illness.
These next few days will involve plenty more walking, which will include the symbolic stoning of three pillars signifying the stoning of Satan. The crowds will still be there, as will the heat. However by now the body, its joints and your feet will have taken some serious punishment. For the men, walking in simple sandals without socks will have been the norm in the preceding few days, and with this comes the problems, which also affect women in equal measure.
Blisters & Cracked Heals
These are very common and the cause is predominantly walking in the heat with grit and sand collecting between the soles of the feet and the hard surface of sandals. This is the perfect environment for blisters to develop. Friction and constant pressure are the enemy and so this partnership needs to be separated. So my top tips are as follows.
- Do not try your new sandals on, for the first time on the first day of the Hajj. New sandals need to be worn in; to prevent friction related foot problems. Break in your new sandals at home by wearing them daily for a few hours for a few weeks prior to starting your Hajj pilgrimage tour.
- Debris, sand, uneven surfaces and so on are the norm, so do not get into the habit of walking bare foot.
- Whilst wearing your footwear the moment you feel grit collecting under the soles of your feet, stop, shake or blow away the debris and then recommence walking. Do not, just put up with it.
- Water attracts sand and debris. So dry your feet immediately after they are washed or if they get wet.
- Cracks in the skin need to be covered with a medical band aid type plaster to stop the entry of microorganisms likely to cause infections
However, even with the best of precautions, some pilgrims will develop blisters in varying locations of differing sizes and depths. The pain from these can be truly agonising. Like with most things, there is no one size fits all. However simple measures will help
- Wash and dry the affected foot and if possible stop walking on it, as time will be the best healer.
- For small, unbroken blisters apply a small piece of gauze/cotton wool and apply a firm plaster over the top.
- For small blisters that have burst, do the same. There are some commercially available blister packs sold in pharmacists that provide a soft gel type dressing. These dressings act as a soft gel, protecting the sore area from the elements and have a cooling as well as painkilling effect. If you have them, use them
- For larger yet to burst fluid filled blisters, my advice would be to seek a medical opinion, if you can get one. Invariably, large blisters will eventually burst so the question needs to be asked. Do you burst it now earlier and dress it, or do you allow it to burst itself? There are no hard and fast answers, so each case will need to be assessed on its own merits.
- Take some painkiller as blisters, especially those which have recently burst tend to be hyper sensitive and painful
Muscle & Back Problems
The days of Hajj will see many people walking distances that they have never undergone before. Muscles that have never been pushed will be feeling the pain of overuse and fatigue and this translates for many, into painful backs, aching lower legs and sore feet. The calves for some will feel the strain and the front of the legs will burn as they walk. So once again anticipation and prevention is the key. Here are some of my top tips.
- For 1-2 months before you go on the Hajj journey, begin to walk daily so that you able to easily walk for an hour with no difficulty.
- Reduce the amount you need to carry. Pack light and carry light. I am still surprised how, every year I witness people carrying rucksacks ready to burst with, I’m not sure what. If its not essential, don’t carry it.
- Take regular breaks for fluid replenishment. Remember muscle cramps can be a feature of dehydration.
- Take plenty of rest when you can
- Use painkillers and anti-inflammatory medication if needed, to alleviate pain, soreness and swelling.
- Do not undertake unnecessary unwarranted journeys.
- Seek help, if pain is persistent or is more than just an ache. It is not uncommon for people with on-going underlying muscular problems to have flare ups due to the excessive exertion
- If you can’t walk, don’t allow embarrassment stop you from using a wheelchair.
This is probably one of the most painful and embarrassing conditions suffered by many people in silence, yet it need not be that way. The skin between the inner thighs, coupled with heat, moisture, sweat and the constant friction of skin rubbing again skin can lead to extreme skin chaffing (breakdown). The victims are easily recognisable, walking with a wide based gait, rather like a gunfighter walking, legs wide apart, very slowly, going in for gun fight. Victims can be spotted a mile away! This hurts, but once again prevention is better than cure. So note the following.
- Avoid walking in the midday heat
- Anticipate this problem and apply a liberal amount of petroleum jelly between the upper thighs and groin. This may be messy but it’s protective.
- Carry a small tube of petroleum jelly with you at all times especially when anticipating long walks in the midday heat.
- Alternatively, use anti chaffing creams such as ‘Body Glide’ that have the same effect and are often used by elite sports persons to prevent these issues from developing.
Once again however, despite the best of intentions, this may still develop. In such cases take consolation that it will often improve rapidly but you may need to do the following to encourage healing.
- Apply lots of lubrication such as petroleum jelly
- Try to keep the thighs apart and let the air circulate freely
- Take lots of painkillers
- Avoid any unnecessary walking for the next 24 hours
Despite the above measures, if the area develops blistering, or the skin becomes red, hot, painful and swollen, seek medical help, as this may be a sign of spreading skin infection.
So in summary the last few days of the Hajj days will have their own challenges, but with the right careful foreword planning, hopefully these can be managed so as to cause minimal impact.
About the Author
Mr Imran Zia is a Consultant in Emergency Medicine at the Whipps Cross Hospital, Barts Health, London.
He has travelled accompanying pilgrims as a medical advisor and tour group doctor to the Hajj for the last 11 years. Over this time he has gained a valuable insight into the common medical themes that affect pilgrims and how they can be addressed in a practical manner, at times where local medical help may not easily available. These short articles are being written with a ‘prevention is better than cure’ mind set. The numbers of years experience based upon exposure, dealing with illness in a congested foreign healthcare structure has placed him in the unique position to be able to share
Articles by Dr Imran Zia:
- PRE HAJJ HEALTH PREPARATION
MR IMRAN ZIA
BSC MBBS MRCS FRCEM PGDIP (MED ED)
Guest Writer & Medical Adviser
CONSULTANT IN EMERGENCY MEDICINE
WHIPPS CROSS HOSPITAL
MR ZIA IS A PRACTICING EMERGENCY MEDICINE CONSULTANT AND HAS TRAVELLED ACCOMPANYING PILGRIMS AS A MEDICAL ADVISOR AND TOUR GROUP DOCTOR TO THE HAJJ FOR THE LAST 11 YEARS.
OVER THIS TIME HE HAS GAINED A VALUABLE INSIGHT INTO THE COMMON MEDICAL THEMES WHICH AFFECT PILGRIMS AND HOW THEY ARE ADDRESSED IN A PRACTICAL MANNER, AT TIMES WHERE MEDICAL HELP MAY NOT EASILY AVAILABLE.
HE IS A GUEST WRITER FOR CBHUK IN MATTERS PERTAINING TO HEALTH AT HAJJ.