Busy, busy, busy.
Between work and getting ready to for the 100th Meeting of the Skeptics' Circle on Thursday as I mentioned on Monday, I'm afraid I don't have time for my usual sterling gems of skeptically insolent prose or an analysis of a scientific paper that a couple of my readers have sent me. If too many science or medical bloggers haven't totally deconstructed it by then, maybe I'll take it on either on Friday or Monday. Until then, if you haven't gotten me an entry to the Skeptics' Circle yet, you still have about 12 hours left until the deadline at 6 PM EST.
In the meantime, that doesn't mean I don't have time for a quickie blog entry or two today. For example, here's a truly sad story. Actually, it's a combination of sad and a candidate for a Darwin Award. Meet Russell Jenkins. Actually, you wouldn't want to meet him now because he's dead, and here's how he got that way:
A healing therapist died after a minor injury went gangrenous because his 'inner being' told him not to see a doctor, an inquest has heard.Russell Jenkins shunned conventional treatment for his foot injury after he trod on an electrical plug at home.
He instead tried the ancient remedy of putting honey on it but his toes later went black and began to stink.
Now, there's evidence that honey can aid wound healing, true enough, at least certain kinds of honey. But here's a hint: If you're a diabetic and your toes turn black and start to stink, seek real medical attention, not attention from a homeopath. Your foot ulcer has likely passed beyond what mere honey and wound care can do for it, and certainly homeopathy won't be able to do anything for it. To save your life, you need debridement and antibiotics, and if you're lucky, maybe--just, maybe--you might avoid a below-the-knee amputation (BKA). You probably won't avoid toe amputations, though. Black toes generally do one of two things. Either they turn into wet gangrene that spreads up the foot and leg to become limb- or even life-threataning, or they turn into dry gangrene, essentially mummifying, shriveling up, and fallling off. The latter outcome, of course, is far preferable to the former, but neither are particularly fun to have to deal with.
Here's the rest of the story:
Mr Jenkins, who ran the Quiet Mind Centre from his home in Southsea, Hampshire, injured his foot in December 2006 and developed an 2cm-long ulcer.
In April 2007, Mr Jenkins, a diabetic, sought alternative advice from homeopath Susan Finn, who suggested he treat it with Manuka honey.
When Ms Finn visited him the next day, she saw blood on the bed sheets and detected a foul smell.
His foot had become swollen and one of his toes was discoloured. Two days later, his toes turned black.
He died on April 17 from gangrene caused by a mixed bacterial infection.
This is indeed an example of a true believer. He died for his beliefs, in fact, just as much as any Jehovah's Witness refusing a life-saving blood transfusion or any fundamentalist Christian rejecting medicine for prayer. He believed in "alternative" medicine, although apparently even his homeopath didn't believe in homeopathy to treat his infected foot. Unfortunately, Manuka honey just doesn't cut it in the face of an infection like this.
I know of what I speak. My very first rotation as a general surgery intern, fresh out of medical school, was on the vascular surgery service at the VA hospital associated with the medical school where I did my residency. Once a week, we had clinic, and during clinic the intern's job was to man the "foot room." Yes, you guessed it: The foot room was where all the patients with diabetic foot ulcers, ulcers due to peripheral vascular disease resulting in poor blood flow to the lower extremities, and venous stasis ulcers came in to be seen. The intern's job was to examine them, debride the wounds sharply with a scalpel as needed, and to put new dressings on them. In the case of venous stasis ulcers, we would remove their Unna boots, debride any wounds as necessary, and then place fresh Unna boots on. Inevitably, we'd end up admitting at least two or three patients each week because their foot ulcers were too infected to treat as outpatients. Let me tell you, the smell of diabetic feet and infected ulcers permeated everything, and by the time I was done with a clinic day, I couldn't get the smell out of my nose or mouth, sickly sweet and not unlike an unholy mixture of sweat and rotting meat that, as much as I would like to, I can't forget. In fact, I smelled like it too, and it would usually take days for the last hints of that odor to dissipate--just in time for the next clinic. Indeed, having to deal with diabetic and vascular foot ulcers was one reason I didn't become a vascular surgeon--well, that, and the fact that I wasn't fond of spending 12 hours doing a bypass all the way down to a small blood vessel in the foot, only to have the bypass clot off when the patient is in the recovery room.
In any case, this is what we would call a "clean kill" by "alternative medicine." This homeopath was not medically trained, but even most lay people realize that gangrene is a Very Bad Thing, indeed, and life-threatening. Neither Mr. Russell nor Ms. Finn had clue one, and as a result Mr. Russell is dead, proving once again that "alternative medicine" that is not effective is not necessarily harmless.
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I blogged about this yesterday, but many thanks for adding the medical detail http://layscience.net/node/295.
Orac, do all diabetics have such problems? Is it very common?
One more addition to the long list of answers to "what's the harm?".
Gee, honey is full of bacteria, what a great idea. How very very sad. You would think once it started to smell he would have sought treatment. That smell is pretty bad. I hope a couple people got arrested for neglect or something.
Yeah, I imagine if your toe became sentient you have some serious issues...
If you're a diabetic and your toes turn black and start to think, seek real medical attention, not attention from a homeopath.
Wouldn't it count as murder to amputate a toe that had started to think? ;)
He should have considered maggot debridement. After all, it is natural and everyone knows you catch more flies with gangrenous foot ulcers than with honey.
"Gee, honey is full of bacteria"
http://www.science.ie/EN/index.cfm/section/news/news_key/579
Also the desiccant properties of highly concentrated sugars will hardly permit very much bacteria to survive. That is why pickling egyptians in salt worked so well.
"I hope a couple people got arrested for neglect or something."
Hey, idiocy is not punishable by law. And why, pray tell, should anybody else but the poor hapless - and luckily not further procreating idiot - be resposible for anything?
Your attitude explains a lot about the state of the states - be not responsible for your own stupid actions, blame and sue somebody else.
That is pure Darwinism. Any human being should be able to look at a gangrenous foot and say "Wow this is really, really, bad thing!" And I concur the smell is atrocious. I used to put a mask on and put tooth paste in the mask to decrease the offensive smell. Then tell the patient it was to decrease the risk of infecting the wound further.
@stavros...it is VERY common for diabetic persons to have problems with wound healing. One major problem is that diabetes, especially if not well-controlled, causes neuropathy (lack of feeling) in feet. This means you can have a wound in your foot and not feel it. Most diabetics get regular podiatric exams to prevent this very type of problem.
What a shame that Mr Russell died from a possibly treatable injury.
@Annie2 - actually, honey can be very good for treating wounds if nothing else is available. In historical medicine, honey was used quite a bit during WWI to treat wounds because it was good at helping them heal. It's hydroscopic (I think...) so it helps the wounds heal by killing off the environment the bacteria prefer. And it prevents bacteria from getting to the wound by acting as a barrior. Of course, now we have antibiotics which are better, but if you are in some rural area with no modern medicine available, it is a possible use. (Sorry...I'm at work so can't quite quote the context)
Dawn said: ...It's hydroscopic (I think...)
The word is hygroscopic. Hygros is Greek for wet, I believe.
According to page three of this pdf, honey is indeed hygroscopic enough to help keep cretain baked goods dry.
Thanks, Grep! I wasn't sure I had the right word. I appreciate the correction.
Boy does this bring back horrible memories.
My father died a year and a half ago of complications from something similar - although at least he wasn't stupid enough to try putting honey on it.
He'd had cancer about 15 years before, which was cured by a combination of surgery and
radiation. During the second cancer surgery, they needed to do a vascular graft, which
didn't go smoothly, because of the damage to the arteries from the radiation. They managed to get an artifical graft to take, but they never quite managed to restore proper
circulation to the leg.
15 years later, a blood clot formed, around the graft, broke loose, and ended blocking circulation to his toes, which turned black, as in the story above.
He was rushed to the hospital, where they amputated the toes, only to discover that the infection had spread, and taken up residence in the artificial arterial graft. They amputated his leg. Then he picked up MRSA, which wound up spreading to his spine,
and eventually, he developed pneumonia, which is what finally killed him.
The moral of the story, such as it is:
(1) Gangrene is nothing to laugh at. You don't treat it with bullshit woo - you get
your ass to a good hospital ASAP and get real medicine.
(2) Pick your doctors and your hospital with care. What really killed my father was
incompetence: the doctors didn't really understand what they were dealing with, and
were constantly working in reactive mode - instead of considering what problems they
should expect/watch out for, they just waited to see what happened, and then reacted.
There were a half a dozen different times when a competent doc could have predicted
the next disaster, and prevented it.
Honey is a key ingredient to wilderness survival. Of course, once you get to town you're supposed to go to the frickin Doctor. This was nothing but pure Darwinism.
Gangrene is nothing to laugh at.
I'll second that. My great-uncle had an above-the-knee amputation after insisting on treating an ingrown toenail by himself despite diabetic neuropathy. After that, he spent his last few years at an assisted care facility.
This blows my mind. I would like to know what happened to the incompetent Miss Finn.
Melissa -
I'm assuming that your great uncle was "of a generation" (as I like to refer to people who were born before the great depression). It is really hard for people of that era to accept that something as "silly" as an ingrown nail can cause them to lose body parts.
I have a close friend who's diabetic and he went to the hospital when a small cut on his foot didn't heal after a couple days. I honestly thought he was being damned silly about it, until he explained that had he waited too much longer, he would have lost the foot. His doctor found that was probably just a few days away from gangrene setting in - under the surface that small cut had caused an infection that was several inches. From the outside it was just a little red and puffu.
My husband is a diabetic and ever so fond of "natural" treatments. He's also pretty active, so he gets foot and lower leg injuries.
I'm perfectly willing to let him treat them with his favorite - tea tree oil - since he excruciatingly cleans such wounds before applying the oil. But, I make sure I examine the wound at least once a day. If I see any sign of infection, he's going to the doctor and he knows it.
I also give him a pedicure once a week. We take good care of his feet... for lay-persons. I simply cannot imagine waiting until a wound smells bad to get treatment.
I wouldn't worry too much about the tea tree oil, it's a proper antiseptic. As long as it's just a first-aid treatment, and not a substitute for real medical care.
To be fair, it isn't established that Ms. Finn didn't try to get him to see a doctor. See this report (my emphasis):
This suggests that proper medical attention was mentioned, but Mr. Jenkins refused it.
Sad story.
I would've preferred comparing it to jelly, jam, and preserves, and candied fruit. Large quantities of sugar (any sugar) have long been known for their preservative qualities. Bacteria generally cannot survive in them.
Generally. An interesting exception is Clostridium botulinum. Its hardy spores are often found in honey, and this has made honey a leading cause of infant botulism. The child consumes contaminated honey, the spores germinate in the anaerobic environment of the gut, there aren't enough fecal floral already present to outcompete it, and the child rapidly becomes critically ill. The organisms produce botulin, one of the most potent poisons in the natural world.
I don't see how this guy was killed by alternative medicine, sorry. First off he said a voice in his head told him not to go to the doctor. Then he noticed his own foot rotting and refused to go to the doctor. It sounds more like he had mental health issues, which is a lot more common among diabetics than you'd think. My own mother struggles with both, and the more her sugar's out of control, the less in touch with reality she is. I've had similar issues although I'm not diabetic yet and am not nearly as far gone as she is--if I lay off the carbs my moods are more even and I cope better.
I think two things went on here--his mental illness, and his friend's criminal negligence. Alternative medicine does work for some people--whether it's the placebo effect or something else at work--but there are good alternative practitioners who know when to try to handle the situation themselves and when to call in the big guns. Sort of like a good GP knowing when to treat something himself and when to refer his patient to a specialist.
And you know something? Lots of GPs make bad judgment calls. They kill lots of people that way, too. But I don't see MDs starting up websites about stupid incompetent so-called "doctors" who do stupid things to their patients to make more money or to avoid lawsuits. In fact, the medical community pretends that malpractice is a rare animal indeed, and places 99 percent of the blame for increasing medical care costs on the ingrate former patients who go around suing everybody. Can't imagine why they would do that, y'know. Killing someone through malpractice is totally a crime and you can always have the doc arrested instead.
I'd be tempted to say that anti-quack websites are set up to distract people from the much more prevalent problem of abuses of patients by MDs, but of course you wouldn't do a thing like that, would you?
I do appreciate our modern medical technology. What I do not appreciate is seeing it misused, or being talked to like a child on the rare occasion I can't deal with something anymore and go seek medical attention, or reading tale after tale about how MDs support giving a patient SSRIs instead of referring them to therapy or support giving them dangerous diet drugs when there's no evidence to indicate that non-diabetic obesity increases mortality risk, or how OBs bully women into getting c-sections they don't actually need. Yanno.
I *will*, however, say that the friend deserved to go to prison for criminal negligence, only I don't know what the laws are in the UK about that (which is where this occurred).
That's the worst part--that he was in the UK and was on the NHS and could have gotten mental health care a long time ago. Of course I don't know how good their care is, either.
But the friend? Should have been arrested. Yep.
somebody invokes Doggerel #14 AND #139 at once!
I think Bronze Dog's entry "Mistakes" is appropriate for this:
"Many of you have probably been hearing about the airplane crash in Lexington, Kentucky. For those of you who haven't, here's the gist of it: The pilot took off on the wrong runway. It was half the length needed for the plane he was flying.
Of course, there were warning signs: There were signs pointing to his correct runway. The runway he was taking off on wasn't lit. It was cracked, and the one he was supposed to go to was resurfaced a week ago.
Additionally, there are protocols to be observed: The pilot has to ask the control tower for permission to take off, which gives them a chance to point out any pilot errors before giving permission.
It also seems likely to me that even more problems will be unearthed before this is over.
Of course, as we all know, human beings are quite fallible. People can and do make mistakes, but by keeping aware of that, we can design systems to minimize the effects of human error. Many of those systems are quite successful. Despite bad examples like this crash, flying is still safe enough for countless flights to take place: Right now, there are probably several planes landing safely after an uneventful trip, save for a kid running up and down an aisle annoying people.
Now, imagine this: Someone proposes that we ditch the entire system, claiming that this crash, along with others, was evidence that the conventional theory of flight is wrong, and that we need to switch to a system where planes are constructed from junkyard parts, never tested, and pilots are free to go willy-nilly on the runways and in the air.
Now you know what I think when an altie whines about malpractice during a discussion about the efficacy of a treatment."
Or to put it another way....
...somebody, if some doctors do nasty things, does that mean that homeopaths/naturopaths/etc should be allowed to also? Of course not. Orac does not blog about "doctors are saints; ignore their misdeeds while we malign alternative health pratcitioners". If you read this blog enough, you'll see that his main point is that there shouldn't be a distinction between alternative medicine and regular medicine at all. They should all be subject to the same high standards, so that when practitioners screw up egregiously, there is a way to call them to task for it. He applies his Respectful Insolence to anyone acting unscientifically, whether they are MDs or homeopaths or even laypeople.
Right now, if an obstetrician performs an unnecessary c-section and the woman and/or baby are injured, he or she can face a malpractice lawsuit, which should help to discourage the practice. We, the public, have that protection because of a defined standard of care which is violated by unnecessary c-sections*. We do not have the same protection against, say, naturopaths. If a naturopath instructs you to take an herbal remedy which you turn out to be allergic to, can you sue them? Possibly, but it probably won't be a malpractice case, and in most states there is no requirement that they carry malpractice insurance (unlike doctors).
Woo kills. In a previous life I rented a building to a natural foods co-op that gradually became a giant repository of pills and herbal potions. I watched the well meaning ladies that ran the operation kill at least two people by treating lymphoma with wheat grass tea.
The stupid.... Indeed it does burn.
'some kinds of honey'?
There's a difference? Sioux Bee, Sioux Bee, Sioux Bee do? Or don't?
A bit late, but the judgment in a challenge to the coroner's decision can be found here: http://www.bailii.org/ew/cases/EWHC/Admin/2009/3229.html
@Mojo
Man, reading that, I kept thinking is was some fictional story. As I kept telling myself, "No, this actually happened," I was horrified. I simply cannot fathom anyone of sound mind seeing the effects of gangrene and thinking, "I'll be fine. I just need to attend to my spirit. No doctors." And I have to wonder if the Coroner and the justice were wrong not to consider Mr. Jenkins, and to some extent Ms. Cameron, delusional, and therefore unable to make sound decisions regarding his care.