Thursday, July 7, 2016

What Does This Patient Really Need? or Sticking My Neck Out Again--Updated

[Update: I looked it up; this topic lingered on my mind. In Afghanistan, where Sadri lives, a common skin infection is spread by a specific local parasite, and responds to a specific treatment. For those who want to look up the details, it's called leishmaniasis. The vector species isn't found in the United States but Americans who were in Afghanistan have picked up the infection. So there was a valid reason for choosing Sadri as a poster patient for an appeal for funding medical treatment in Afghanistan. My reaction was therefore all wrong...I think it's worth leaving up just by way of explanation of how photos can fail to communicate what needed to be said in words.]

Someone out there may feel moved to sign the petition linked at the end of this post. I don't, because I can't understand what is going on. Oh, it's plain enough to see, if you click on the link--a young, nice-looking woman, a mother, known to cyberspace as Sadri, has a horrible-looking skin disease. But it doesn't look like Hansen's Disease, which really does require extensive and expensive medical treatment. It looks like one of those messes I've seen on several people in my part of the world--including myself; I had it on the backs of both legs for about five months, a few years ago. Grandma Bonnie Peters had it on one ankle, more than ten years ago, and that ankle is still thinner than the other ankle is today. A family friend had it on one arm in 1970 and had scarring, and occasional recurrences, in 1986.

As a child I remember being terrified of nice, well-meaning adults who happened to have it, afraid it might be contagious (which is rare). If you go to a doctor they'll call it eczema unless, and until, it develops into ringworm or impetigo. It's what the Bible writers had in mind when they applied the term translated as "leprosy" to things that begin with one or more small whitish blisters, may go on and get worse, and may heal completely in a few days. What it is is an infection in which a skin wound, typically a minor wound, becomes infected by a combination of fungi and bacteria. Depending on the strains of infectious agents involved the infection can be trivial or horrific. If strep bacteria are involved you can smell the wound several yards away; if Pfiesteria are involved, the patient may lose a limb. In nasty cases the skin bubbles up in blisters, then swells to grotesque and painful size, then collapses as the flesh is literally eaten out by the infection, if the infection gets that far. If it gets as far as it appears to have got into young Sadri's face, healing takes a long time. But expensive medical treatment is not required and may even, in at least one case I observed firsthand, do more harm than good. Doctors can prescribe antibiotics; if the bacteria involved are resistant to the antibiotics involved, while the fungi actually feed on the antibiotics, God help the patient who can afford the antibiotics.

Meanwhile, for most people plain old soap and water, applied every three hours, dabbed on and dried off with clean cloths each time, and as much sunshine and dry air as possible, are the cure. Sweat feeds the infection; extra baths cure it. The reasons why it's seldom serious, in my part of the world, are (1) that we get a lot more fungi, staph, and strep than Pfiesteria, and (2) that most of us now take a complete bath every day. Over-the-counter antibiotics and antifungals (I used Lamisil and Neosporin, myself, and a good splash of bleach in the bathtub) can help speed things up. Direct applications of herbs like garlic, goldenseal, neem, etc., may help depending on the infectious agents involved; baking soda applications can help if the infectious agents include Cladosporium mold, which thrives on acidity. A diet low in complex carbs and high in fresh fruit and vegetables is good for the immune system generally. Customs of keeping some sort of clothing over the infected area at all times, even during or immediately after bathing, encourage fungus infection, slow down recovery, and allow the infection to spread into more vulnerable places.

Maybe this is something the medical profession could profitably study...I've known a lot of people who had "eczema, unknown origin," which, if not cleaned up with frequent applications of soap and water, progressed into nasty "psoriasis" or "impetigo" or "skin fungus." It's more infectious than contagious; people get it after touching or handling some innocent-looking object outdoors, or swimming or wading in polluted water. I've not known anyone who got any more benefit from expensive additional treatment than they got from soap and water and, at most, a dab of something out of the home first aid kit. I know GBP will testify, vigorously, that a compression treatment with a heavy-duty topical antibiotic did her ankle more harm than good. She believes the antibiotic was what enabled the infection to eat through the flesh and into the bone for months after she tore off the compresses and washed off the prescription medication...and that terminating the prescription treatment, against medical advice, was what stopped the infection spreading upward and allowed her to keep the full use of the leg.

I'll concede that there may be a need for more subsidies for more doctors in rural Afghanistan. I'll even concede the possibility that what Sadri has may be something more exotic, more likely to respond to medical intervention, than this familiar, poorly understood, home-curable condition her picture and her friend's words suggest to me. But from here it looks as if these doctors have chosen the worst possible poster girl to plead for funding, and as if Sadri needs to focus on self-healing, without wasting any more time on prescription antibiotics.