Thursday, March 29, 2012

Medical Maggots

We have discussed extensively on this blog the devastating effects of diabetes on wound healing.  It can make sores that normally heal in days take months to heal.  The longer a wound stays unhealed and open, the greater chance of it getting infected and needing IV antibiotics at the hospital. 

Although the majority of wounds seen today are results of diseases like diabetes or venous insufficiency, that has not always been the case.  In past decades, the majority of wounds were related to war injuries.  In times of war, wounds were primarily results of bullets, explosions and shrapnel.  Back then, antibiotics has not been discovered and doctors were limited on how to clean wounds to prevent infection.  Most available treatments were harmful to both dead tissue and good tissue.  Many people lost limbs or even their lives from what would be considered today as minor wounds. 

Although there is documentation of maggots being used throughout history to help heal wounds, the first modern day use of them came during the American Civil War in the 1860s.  Doctors noticed that fly larvae seemed to leave good tissue alone and clean out only the bad.  Wounds treated with maggots seemed to heal faster and allow soldiers to keep their injured limbs.  Once antibiotics were discovered around the time of World War II, the combination of these two therapies proved to be a huge advancement in wound care.

In recent decades, maggot therapy has been used less and less as it seemed to be a very primitive form of treatment.  Obviously, the suggestion of using maggots to heal a wound has not been openly accepted by patients.   But when we remember that a diabetic’s immune system isn’t functioning properly, something has to be done to heal their wounds.  Maggots are now being used more and more to heal chronic wounds.  We’ll discuss how exactly maggots clean wounds in the next post.

Thursday, March 15, 2012

Antibiotics Revisited

Several months ago we discussed on this blog the proper use of antibiotics for infections in the foot and leg. I wanted to revisit that subject somewhat by talking about three important points your doctor considers when deciding to give or not to give an antibiotic to you.

1. Antibiotics have not been shown to be beneficial for non-infected wounds.

The signs of infection are pain, swelling, redness, and warmth. If no signs or only one sign is present, the wound is probably not infected. In this scenario, neither oral or topical antibiotics have not been shown to help heal the wound. It has been thought that it would be good to preemptively treat the wound with antibiotics to ward off infection. However, this increases the chance of antibiotic resistant bacteria infecting the wound.

2. Mis-using antibiotics will decrease their effectiveness and increase their price

When antibiotics are used when no infection is present, the bacteria are given the opportunity to develop resistance to that antibiotic. Over time, as more and more bacteria develop resistance, a previously effective antibiotic may become useless. This will decrease the number of available effective antibiotics, thus driving up their price. New antibiotics take years to develop and will be slow to replace the ineffective ones.

3. When given antibiotics, make sure to take the entire dosage even if the infection is gone.

Even when the infection looks to be resolved, it is important to finish off the entire course of antibiotics your doctor has given you. They are dosed in a fashion to kill all harmful bacteria. If you stop taking them once things to be getter better, it gives the bacteria a chance to reproduce and develop resistance.

If your doctor decides against giving you antibiotics, trust in his/her judgment. However, if all the signs of infection or pus presents later, be sure to let your podiatrist know so that appropriate action can be taken.

Monday, March 5, 2012

3 things to heal a Diabetic Ulcer

Diabetic ulcers are becoming one of the major causes of amputation of a toe or limb.  A small sore can turn into a large wound in a very small amount of time.  If you are diabetic, it is important to seek proper care and precautions need to be taken in order to prevent ulcers and to stop an existing ulcers from progressing into uncontrollable wounds.  These precautions can be summarized into offloading, decreasing bacterial load, and insuring adequate blood flow.

Offloading simply means to not put weight on the ulcer.  Offloading is accomplished by wearing special shoes that allow you to walk, but decrease pressure on the ulcer site.  Excess walking will put pressure and friction on the wound site.  These forces prevent the skin cells from healing the wound.  If a diabetic with a history of diabetic wounds goes barefoot just once, an ulcer can open up in a short amount of time.

Moist, dead skin is a perfect environment for bacteria to multiply and potentially infect a wound.  By seeing your podiatrist regularly, this dead skin can be “debrided” or removed from around the ulcer.  This decreases the amount of bacteria threatening the wound so as to decrease the chance of the ulcer becoming infected.

Blood is the substance that contains all the growth factors and oxygen needed for the body to heal itself.  You may be confused to why you leave your podiatrist with your wound bleeding.  Debriding the wound not only removes dead skin, but it removes any dead material actually inside the wound to insure the base of the ulcer is receiving blood to its surface.

When these three precautions are met, ulcers tend to heal without complication.  With proper vigilance, a diabetic can avoid ulcerations and amputations altogether.

Diabetes on the Skin

As we discussed last time, several skin conditions are associated with the development of diabetes. They occur because the walls of our arteries become too thick to allow oxygen to pass and nourish the skin. Over time, the skin will weaken, get thinner, or even begin to die. Let’s discuss two common skin manifestations of diabetes.

Necrobiosis Lipoidica Diabeticorum is a common skin condition that occurs with diabetes . It presents as very large reddish- brown patch of skin on one or both shins. With time, it will grow in size and become yellowish and shiny in the center. If left alone, this brown patch of skin can ulcerate and become infected. As mentioned before, this condition may show up before somebody knows that they are diabetic. Unfortunately, this patch of skin does not necessarily go away once diabetes treatment has begun. However, it may alarm a person to seek evaluation by a physician.

Another skin condition associated with diabetes is Xanthoma Diabeticorum. Xanthoma refers to fat that may deposit just under the surface of the skin. They appear as unexplained little yellow bumps. In the development of diabetes, there is a phase where there is too much fat in the blood (high triglycerides). Fortunately, these bumps will eventually go away after a couple weeks of controlling the amount of fat in the blood.

Lastly, Diabetic Dermopathy is a condition present on the feet and legs of diabetics. They look like discrete circular red bumps that may be flat or elevated. These lesions require no treatment , but will be present as long as a person is diabetic.

If you have similar changes happening on your skin, it would be wise to be evaluated by your primary care for diabetes. If diagnosed with diabetes, it is recommended to see a podiatrist every 2-3 months to avoid potentially limb threatening ulceration.