Medical Leeches - What Works and What SUCKS

The Gold Country Medical Museum will open this summer in Auburn, California. One of the best attractions at any collection of medical memorabilia has to be live leeches. Our museum will have a ready supply to thrill the kids and scare the Moms. Leeches can live happily in little jars for months; feeding on an occasional meal of raw liver.

Leeches are disgusting little creatures that live on blood. They have been used for bogus "medical purposes" for centuries. George Washington was leeched and bled so often that it has been determined that this may have been the major cause of his death. For some reason, medical practitioners of centuries past felt that many of the body's illnesses were due to disorders of the blood. By removing a great deal of blood, either by special surgical knives/scalpels, or by our little friend, the leech; a miraculous cure would result. That theory does not make scientific sense...at all. This is pure baloney. Blood is needed to orchestrate the cure by transporting white blood cells, plasma, and immunoglobulins to the site of infections or injury. Remove too much blood; you die, by George.

Leeches do have modern uses, however, especially in plastic surgery. Accumulated blood under a wound lifts the tissue and prevents it from attaching. In most cases, we insert surgical drains to allow this old blood to come out. However, surgical drains, themselves, can leave unsightly scars.

Accumulated blood (hematoma) is also a reservoir for infection. By attaching these little creatures instead of a drain, the blood will be painlessly sucked out of the wound, reducing infection and improving the cosmetic outcome. Leeches have been successfully used by surgeons who have reattached amputated fingers or toes. ENTs have attached them to outer ears that have been traumatized, thus preventing a cauliflower ear deformity.

Today, I discovered that Demi Moore is using leeches in Austria to "cleanse and detoxify her blood". Since she said this on the David Letterman show, I expect that people are out there today looking for leeches to buy. Give me a break! Granted, Hollywood is famous for their "leeches" and bizarre behavior, but this takes the cake.

If Demi thinks leeches will somehow improve her health and appearance, she is sadly mistaken. Demi is a good looking woman. She does not need leeches hanging off her belly to make my A-list. They say there is a sucker born every day. Unfortunately, for her, that sucker is a leech.

Now, if someone discovers a lipo-leech that sucks fat out of overweight people, I will be first in line. And, I will even become a breeder; perhaps start my own leech-o-suction clinic.

There is so much quackery out there in the world, that I can't even believe it. One of my old physician colleagues once traveled to Czechoslovakia in the 70's to get injections of sheep embryos that were purported to promote longevity. Baaaaaa! Someone really pulled the wool over his eyes! One of my old patients read that bee stings cure arthritis, so rather than pay to get this unproven treatment; he just caught his own bees and tried to get them to sting him in the shoulder. The bees, of course, did not know that he had arthritis in his shoulder, so they stung him repeatedly in the hand.

If Demi wants to cavort with leeches, so be it, but please, Demi, keep it to yourself! Don't tell the vulnerable and naive world what you are doing. Most of the people will think you are absolutely crazy; some will go out and get leeches.

Hey...If it works for Demi, let's stick some on Grandma!

Related Topics:

• WebMD Video: Herbal First Aid
• Naturopathic Medicine

Technorati Tags: demi moore, leech, weird medicine, unproven, alternative

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Groin Shots

Photo Credit: Greg Younger

I was watching America's Funniest Videos the other day. I continue to be amazed how fascinated people are about watching others getting hit in the groin. There is not a man on this planet that cannot tell you the date and circumstances surrounding the worst time that he got hit in the boys. It's not that funny when you are the recipient.

My worst groin shot occurred in college. I was working in the hospital as a bed-pan technician. Another one of my friends working as a janitor - we will call him Hally since that was his real name - thought it would be a good idea to sneak up behind me and get me with a broom handle. I probably deserved it for something that I had done to him in the past.

Many groin victims see it coming and try and protect themselves. I did not anticipate this attack and got the full impact. I collapsed to the floor in agony. Hally ran away. Hearing my cries of pain, seeing me lying in a fetal position in the hospital hall, drew some obvious attention. Before I knew it, I was being wheeled into the emergency room. I couldn't talk. I was clutching my groin. They thought I was passing a kidney stone! As soon as I was able to speak, I only uttered one word: "Hally!" They removed the blood pressure cuff and monitor and let me limp back to work.

After over thirty years of pediatrics and family practice, I have seen many groin victims. A popular high school boy was trying to impress his friends with his expert skateboard skills. In front of a hundred or so friends, he jumped on the metal hand rail of some steps and proceeded to slide down. Anticipating cheers and accolades, he did not intend for the board to slip, subjecting his testicles to the full impact of the metal rail. As blood streamed down his leg in full view of his classmates, he was rushed to our nearby clinic. I quickly determined that (a) his testicles were still there, and (b) he lacerated the scrotum. He would need a few stitches only. He returned to school the next day, only to get a standing ovation, not unlike Evel Knevel.

There are many stories on the Internet and on television about "Stupid Criminals". I can say there are many incidents of "Stupid Patients", too. There was the guy who decided it was a good idea to duct tape a chain saw (running a full speed) to a long pole so that he could cut the higher limbs of a tree. The vibration of the chain saw worked it out of this duct tape and the saw fell in his lap! Thinking the worst, he was afraid to even look. He came into the Urgent Care clinic with the chain saw (now turned off, of course) still wrapped in a wad of his clothing by his groin. We cut out off the clothes and chain saw only to find an impressive laceration on his upper thigh. I was pleased to inform him that the vital parts had been spared, assuming he was already circumcised.

Football and baseball players wear cups in their athletic supporters. Basketball and soccer players do not, since it is more difficult to run in those things. Years ago, I was at my son's Little League game. The boys were warming up, just throwing the ball from base to base. The first base player, perhaps distracted by any number of things, did not notice a baseball heading his way. In full view of the startled crowd, he was hit directly in the groin. A concerned mother rush to his aid, but he indicated he was fine. Several seconds later, he collapsed (fainted). Although several medical providers on the bleachers assured the coach that this was just a simple fainting episode, someone had called 911. The little boy was loaded onto the gurney and given oxygen! Hey, folks...wrong end! Twenty minutes later, another player on the same team got hit in the head running to second base. Now two players were down and only eight were on the field. The team had to forfeit and I got to go home early on that hot Saturday.

Fathers of toddlers really should wear a cup when romping with the kids. The average height of a two-year-old is about the height of the groin - another disaster just waiting to happen. Perhaps those groin shots by the kids are not unintentional. Maybe this is another one of nature's ways of trying to control the population?

I would love to hear your groin stories, now that I have the ball rolling (so to speak).

Related Topics:

• Groin Problems and Injuries
• Groin Pull

Technorati Tags: groin injuries, health and wellness

What's New in Middle Ear Infections

Most of the antibiotics prescribed for children in the U.S. are for the treatment of middle ear infections. In light of overwhelming evidence that antibiotics are not necessary in many (most) cases, old habits are difficult to change. Medical providers are continuing to prescribe stronger and stronger antimicrobial medications, and parents are still demanding them.

Americans are a "quick-fix", fast-food culture. Parents bring children to our clinic within hours of complaining about ear pain. New parents panic when they see their infants pulling on their ears. If ear-pulling alone was a definitive sign of a middle ear infection, then why aren't they bringing in children who pull their toes...or little boys who pull on their penises?

The less a person knows about a disease or condition, the more they tend to fear it. In the management of childhood ear infections, education is often much more powerful than medication. Since eardrums are "hidden" from the prying eyes of most parents, they do not want to take chances. When eyes become red in conjunctivitis (pink eye), parents know immediately. When eardrums become red - one of the signs of a middle ear infection - parents can't see it; unless, of course, they have a good home otoscope. All parents should have a home otoscope (about $30) and know how to use it.

If you were born after the mid-1930s, you were always living in a world that had access to antibiotics. Prior to that time, people were still getting ear infections, but perhaps not as frequently as today. So, what cured them? The answer is simple: our own immune systems. People at that time used warm oil in the ears; used heating pads, and of course, shelled out aspirin for the pain. Severe ear infections warranted a rare visit to the general practitioner. The standard of care for severe ear infections prior to 1935 was a surgical myringotomy - a small slit was made into the red, bulging eardrum to relieve painful pressure and allow the pus to drain. This was done without anesthesia. Did it work? Yes. We still use myringotomies today, but we insert a little tube so the hole will not close. This is the basis for using tubes in children.

Since the first antibiotic (sulfa), and the most popular one (penicillin) was developed, people considered them modern miracles. Antibiotics were being tried and used for everything. For most of young parents today who of children with ear infections, these were our grandparents. Our grandparents loved antibiotics, especially shots. I still see them today, accompanying their grandchildren, asking for a "shot". We now have over two dozen antibiotics that can be used in children with middle ear infections, but should we be using them? Some experts say "no". Others say "sometimes". I am in the "sometimes" camp.

Pathogens are changing. What caused ear infections in our parents when they were children, are not the same weak bugs any more. Our use and overuse of antibiotics over the last generation or two has contributed to the evolution of some nasty super-bugs. Now, it is a whole new ball game. Antibiotics do save lives and spare seriously-ill children from the ear infection complications of the past, such as mastoiditis or meningitis. Rather than abandon antibiotics, we need to use them more judiciously...and, not at all in many cases.

Parents are confused. Medical providers do not enjoy being antibiotic gatekeepers, but we have to take a stand sometimes. Medical providers are really just consultants for your child's health. It is really up to all of us to change old habits and approach middle ear infections a new way. Actually, it is time to rediscover some of those "old ways".

When your child has a suspected middle ear infection, it is NOT an emergency. No parent likes to see their child in pain or febrile, so why not try treating the pain at home first, before rushing off to the ER. I can almost guarantee that you will leave with an antibiotic when you visit an ER. Why? Parents expect an antibiotic; ER physicians are busy with life-threatening events in other rooms, so they do not have time to be confrontational with a sleep-deprived parent. It is much easier to shell out an antibiotic than it is to take to time to explain why an antibiotic is not needed. An ER-treated ear infection is unbelievably expensive, so a better course of action would be to wait. Treat the child's pain at home and try to wait a few days (yes, days!) to see if the child's immune system will save you the insurance co-pay. Parents need to trust the immune system. Our immune systems have protected us for millions of year before antibiotics made their debut.

Pain management is a huge issue. Ear infections hurt! If you have ever had a middle ear infection as an adult, you will know what I speak. The pain can be humbling to adults, so please be sympathetic to children in pain. Adults want codeine or Vicodin; we expect children to get by on a little acetaminophen. As a society, we often forget that the smallest people have the least coping skills. When kids are in pain, we have to treat it. If you have a child with recurrent, painful middle ear infection, you have to be prepared. Effective pain management will buy you time - time for the immune system to do its job.

Pain can be treated in two ways: topically, using analgesic eardrops, and orally, using pain medications. Most parents will give acetaminophen, but because middle ear infections are an inflammatory event, ibuprofen may work better (if you child is over age six months). Auralgan is a benzocaine topical ear drop that requires a prescription. All parents with children with recurrent ear infections should have this in their medicine cabinets, but they will need to ask their medical providers in advance. Auralgan, alone, can save you from those late-night ER visits. Since ear infections like to stick out their ugly heads at 3 AM, it needs to be available. Auralgan cannot be used if children have tubes or if there is a ruptured eardrum (blood and pus coming out of the ears).

Are antibiotics ever needed? You bet...sometimes. The number one reason for hospitalizing children prior to World War II was for ear infections. Antibiotics helped put a damper on those rare complications that could cause permanent deafness or even death. The vast majority of "uncomplicated" middle ear infections will go away...on their own...without the intervention (or interference) of your doctor. Babies under three to four months have inherently poor immune systems and must be treated. Children with prior histories of severe middle ear infections need to be treated. Children who appear toxic (very ill) or have evolving complications most likely need antibiotic intervention. This is why we have doctors and other medical professionals - to make these difficult treatment decisions.

Your medical provider is your partner in this battle. Work with them; not against them. Trust their medical judgment, or find one that you do trust. Educate yourself and learn to use the tools, like a home otoscope. Don't let fever cause you fear, and don't let pain go untreated. Trust the immune system and allow it time to work. Don't expect or demand antibiotics, but if they are prescribed, respect and use them appropriately.

Related Topics:

• WebMD Video: Treating Ear Infections
• Home Ear Examination

Technorati Tags: ear infections, antibiotics, childrens health

Managing Colds WITHOUT Medications

Photo Credit: Nabeel H

In October 2007, the Pediatric Advisory Committee and the Non-Prescriptive Advisory Committee recommended to the FDA that over-the-counter cough and cold medications not be given to children under the age of two; and strongly recommended that these same medications be withheld from children under the age of 6. In review of the medical literature, the committees felt that these medications were not safe or effective, citing several deaths in children, mostly due to improper dosing and other rare adverse effects. Now what are parents supposed to do?

THE COLD FACTS

• Children average 6-10 viral upper respiratory infections (colds) per year. Each cold can cause fevers, runny noses, congestion, and coughing for two weeks or more. Children in day-care and schools get exposed more often. Colds help build a stronger, overall immune system.


• Colds are more contagious a day BEFORE you are ill, and about two days AFTERWARDS.


• There are over 200 different viruses that can cause the common cold and there are no "cures". Antibiotics do NOT cure colds nor are they recommended to prevent secondary infections.

Fever and Body Aches: Fevers are a normal, beneficial, immune response to help fight off infections and should not be feared. Since children tend to have frequent viral infections as well as immature immune systems, fevers often occur. Fevers are harmless and do not need to be treated, but fevers can make a child feel miserable. It is okay to treat the various aches and pains associated with colds by using an appropriate dose of plain acetaminophen (Tylenol) or in children over the age of six months, with ibuprofen (Advil, Motrin). It is very important to maintain adequate hydration during the active stages of a cold. Water and juices should be encouraged.

Photo Credit: Olaf Gradin

Runny Nose/Nasal Congestion: The nose is supposed to be moist to help humidify the air we breathe. During a cold, the nose will become even more runny or congested due to inflammation in the nasal passage. This sticky mucous also traps dust, pollen, and other airborne particles common in allergies. If a little nose is watery, clear, or runny, just let it be and get a good supply of tissues. Older children should be taught how to blow their noses and safely dispose of used tissues.

If the mucous is thick, colored, or sticky, the body may need some help. SALINE NASAL SPRAYS can be used to help liquefy this thick mucous so it naturally drains.

In infants, mucous can be aspirated using a rubber bulb syringe. COOL MIST HUMIDIFIERS or VAPORIZERS using plain water help humidify the air we breathe and also helps liquefy thick, stagnant mucous. Warm liquids, like soups and herbal/non-caffeinated teas will help congestion. Contrary to popular belief, green or yellow mucous is NOT a definitive sign of a bacterial infection, like sinusitis. However, a persistent green mucoid discharge for over ten days certainly deserves a medical examination. Vicks Vapo-Rub and other mentholated remedies are typically safe to use.

Coughing: Perhaps the most annoying symptom of a cold is a persistent cough, especially a cough at night. Coughing is another beneficial symptom that helps keep mucous and excess saliva associated with teething out of the respiratory passages and lungs. COOL MIST HUMIDIFIERS and VAPORIZERS can help. Safely elevating an older child's head or angling the sleeping surface will also help. Prior to sleep, efforts should be made to clear the nasal passages of excess mucous. Recent studies have shown that a teaspoon of honey will help soothe an annoying cough just as well as over-the-counter cough suppressants. Honey should only be used in children over the age of two. Older children may benefit from glycerin-based, sugar-free cough drops. This is especially helpful at school.

Sore Throat: When noses are clogged, children will breathe through there mouths. This will dry the mucous membranes of the throat and make it sore; especially in the mornings. If a child is old enough to grasp the concept of gargling, using a mild saline solution (1/4 tsp of table salt in 8 oz of warm water) will be helpful. Acetaminophen and ibuprofen can be used, as well as throat lozenges for older children.

A FEW WORDS ABOUT VITAMINS, HERBALS, ETC
In an effort to "do something", many parents are turning to alternative treatments using herbs, vitamins, and homeopathics. Please keep in mind that there are no controlled, scientific studies on their safety in children or any that prove they are beneficial. Before taking treatment suggestions from the non-medically-trained person at the health food store, discuss it with the pediatrician.

OTHER THINGS TO DO
Children should remain well-hydrated - encourage them to drink plenty of liquids. Everyone should wash the hands often to avoid the spread of germs and avoid touching your own eyes or nose (entry points for viruses). Children who are febrile in the contagious, early stages of a cold should not attend school or day-care. Make sure children get adequate rest.

WHEN TO SEE YOUR MEDICAL PROVIDER
Colds last a week or two if you aggressively treat them, or a week or two if you just leave them alone. However, colds may set the stage for secondary bacterial infections, such as middle ear infections, sinusitis, or pneumonia.

• Infants less than three to four months of age who are having fevers, coughing, or lethargy should be promptly examined.


• Any child who is getting progressively sicker each day, more lethargic, or having a persistent, recurrent fever lasting longer than 4 days should be examined.


• Complaints of ear pain, pulling on the ears, persistent fever, irritability, fussiness, may be a sign of an ear infection - especially in children who have a history of them.


• Children who are not well immunized against normal childhood diseases or do not receive the annual influenza vaccine are more likely to get secondary infections.


• Children with chronic respiratory diseases, such as asthma may be more prone to secondary infections.

Related Topics:

• WebMD Video: Surviving Kids' Germs
• WebMD Video: When to Call the Pediatrician

Technorati Tags: children, toddlers, babies, colds, cough, sore throat, fever, medicine, health and wellness

Treating Spring Fever

Staff Photo

Rheumatic fever; scarlet fever; typhoid fever...you name a disease and medical science is likely to have a fever for it. I deal with fevers every day in my clinic, but the worst of all fevers, in my opinion, is Spring Fever and I've got it. Spring fever can only be cured by going outside to play in the dirt. Spring fever does not respond to Tylenol.

I know that many parts of the U.S. (and Canada) are still buried in snow, but in Northern California we are starting to see some definite signs of spring. Flowers and trees are blooming, frogs are calling for mates, grass is growing, mosquitoes are buzzing, and of course, the weather is much warmer. I am itching to get outside and do something...anything. I am definitely a warm weather person.

Every year, I get tricked by a "false spring". I will go out and buy some vegetable plants, trying to get an early start in the garden, only to have them covered by one last snow storm and die. This year, I am not going to do it, but it is very tempting to take a chance.

There is nothing like working 12-hour clinic shifts when the weather is so great outside. All winter long, medical offices are crowded by sick people, and of course, medical providers get sick, too. Sometimes I am glad that I cannot look out of the windows in my office (too high on the wall), otherwise, I think I would be more depressed.

Today, I fertilized and weeded the lawn and restarted the automatic sprinklers. I picked up the remaining dead limbs that fell off of the trees during a recent storm (rain and wind, not snow!), and carried off a few hundred pounds of leaves to the compost pile. My compost from last year has been spread on the plants and fruit trees. We have lots of lemons and kumquats.

All of the daffodils are blooming - thousands of them. When we planted the bulbs, we did go a bit overboard. I have a few rogue flowers popping up in the lawn that I will have to dig up now that they have been located. Camellias are also blooming and the hummingbirds have returned.

Yesterday, four large deer - three bucks with impressive racks and one lucky doe - were happily eating grass in the lawn. I love watching deer, but I saw them looking at my blooming fruit trees. I suspect that as long as the grass is green and growing, they may leave the trees alone. Most of our trees are deer-fenced; the new bare root trees are not fenced (yet).

The only thing growing in the winter raised-bed garden are onions and weeds. The weeds are more impressive. I may till up the soil next week and lay down a load of chicken manure (second best to turkey manure), in preparation for planting the veggies. Again, I am going to hold off until the end of April this year before taking a chance. Last year, it snowed on April Fools Day - proving, once again, that I was a fool to plant so early.

The sun is now setting and I can see the snow-capped Sierras outside my window. I still hear birds singing; dogs barking (my own); and the sky is blue and clear. It really does appear that spring has sprung. We will see.

Related Topics:

• Get Fit by Gardening
• WebMD Video: Tips to Prevent Gardening Injuries

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Rears and Ears

Although I run the ENT board for WebMD, my practice is primary care. During my clinic day, I see everything that walks, crawls, or is carried through the door. I see about 120-140 patients a week. I estimate that 40-50 of them have problems related to their ears. Last week was a unique week, since I had a disproportionate number of problems related to rears, lots of lacerations, and other injuries. So, it was a week of Rears and Ears.

If you have young children, especially children in preschool or day-care, you know that these winter months are ear infection months. Since most middle ear infections in children are related to colds, the cold and flu season is really ear infection season.

The week started out with a little boy who tried to cut his own hair with a pair of very sharp, sewing scissors. As he trimmed the sides, he also cut off a nice piece of ear. Fortunately, it was able to be successfully repaired.

We only had two patients who inserted foreign bodies in their ears and noses. The pencil eraser in the ear was easily retrieved, but another one (a bead in the nose) was a real clinical challenge. The three year old became so upset and agitated over our repeated attempts to get this bead out of her nose, she lunged out at her mother who was gently blowing in her mouth (a technique that may help dislodge the nasal foreign body) and bit the mother's lower lip. We ended up sending the little girl to the ER where she could be sedated; but I had to put a dozen sutures in Mom's lip.

About half of the children coming in with potential middle ear infections did not have a problem. Yes, they may have felt something in their ears, but it wasn't an infection. There can be many causes of ear pain that have nothing to do with the ear. For instance, a bad tooth (particularly the molars) can cause pain to be referred to the ears. Tonsil infections, lymph node enlargement, sinus infections, salivary gland disorders, etc, all can cause the ears to hurt. Sometimes, babies are just observed pulling on their ears and parents think that have an ear infection.

In the midst of all of these ear-related problems, there was one issue further south. Most of the rear-end issues in pediatrics involve diaper rashes. Unlike the old days when diaper rashes were either yeast or primary irritants, now we are seeing more and more cases of MRSA - an antibiotic resistant Staph infection. So far, I have found a half-dozen of these in the last month.

In the last seven years, I have devoted my practice to pediatrics which encompasses children from age five minutes to age 21. I can have a four-pound preemie in one room; and a 250 pound adolescent linebacker in another room. It was the big linebacker that had the butt issue.

Hemorrhoids are really common problems, but not typically in children. This young man came in wearing a very painful, blue, golf-ball-sized, thrombosed hemorrhoid. The proctologist (colon-rectal surgeon) refused to see him because he was a "child". He was 5 weeks short of his 18th birthday, if you can believe it. The general surgeons did not want to see him, either. So, here was a young man in acute distress with a huge hemorrhoid. He needed some immediate help. I put away my otoscope and prepared to do the relatively-minor rectal surgery myself.

We got him prepared (medically and emotionally) and put him on the procedure table with his butt prominently "in the air". No sooner that we had him exposed to the elements, than other staff started barging in the procedure room. You would think that a closed door would somehow trigger someone to at least knock, but no....

The first intrusion was another doc in the office who wanted to show me his new digital camera. The thought he would take a few pictures of me sewing up a laceration. When he walked in with the camera, the teenager was stunned. Naturally, he did not snap any photos for our bulletin board. Since supplies are also kept in this area, at least two medical assistants barged in looking for various things. One of them actually thought I was talking to someone -- a butt-head, apparently. I was able to finish the surgical procedure with just these three interruptions. Incidentally, the grateful patient is doing well and is back on the football field; running a bit faster than last week.

Another life saved...so to speak.

Related Topics:

• Preventing Ear Infections in Children
• Getting Guys to the Doctor

Technorati Tags: primary care, ear infections, cold, flu, hemorrhoids