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[Tvoivozhd <tvoivozd AT infionline.net>]

Yup, back to the future when antibiotics don't work---as the patient 
herein says, maggots scavenging dead flesh from a leg lesion that 
refuses to heal, is a hell  of a lot better than sawing the leg 
off---another of the few instances where pragmatism and common sense 
prevails over ideology.

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 Dawn of the Dead-Flesh Eaters 

By Randy Dotinga 
<http://www.wired.com/news/feedback/mail/1,2330,0-607-65117,00.html>

*Story location:* http://www.wired.com/news/medtech/0,1286,65117,00.html

/02:00 AM Sep. 29, 2004 PT/

SAN DIEGO -- Donna Nordquist, a sturdy retired office manager, knew just 
what to say to the dozens of maggots inserted into a slow-healing wound 
on her ankle: "Go for it!"

Call her an exception to the rule. Few patients are as accepting as 
Nordquist was during two days of "maggot therapy" last week. Many refuse 
outright to let the little worms anywhere near them, like the 
92-year-old Beverly Hills woman who shrieked when plastic surgeon Dr. 
Barry Handler brought up the idea. "She probably never had to deal with 
a maggot in her life, and she didn't want to start now," he recalled.

Even so, hundreds of U.S. doctors have jumped on the low-tech 
maggot-therapy bandwagon, and the nation's leading producer of medical 
maggots has had to double production less than a year after the Food and 
Drug Administration approved the animals as bona fide medical devices. 
It seems that maggots, long neglected by medicine, have come back from 
the dead.

Their resurrection began in the early 1980s when Dr. Ronald Sherman, a 
researcher at the University of California at Irvine, began exploring 
their potential benefits for patients with wounds, especially on their 
legs and feet.

Despite their reputation as disgusting and repulsive animals, maggots -- 
blowfly larvae -- are largely harmless. Their life cycle 
<http://inverts.cmnh.org/ForEnt/lifecycle.htm> is simple: The flies lay 
eggs when they find decaying flesh. The maggots hatch, enjoy several 
meals at the nearest dead-animal buffet, develop cocoons known as pupae 
and turn into flies. Then everything begins again.

Without blowflies and maggots, decomposition would occur a lot more 
slowly, if at all, and forensic entomologists would have a lot harder 
time using bugs to figure out times of death in murder cases.

For centuries, according to Sherman, military doctors have noticed that 
maggots do a good job of eating dead flesh on a live person. "Soldiers 
injured on the battlefield whose wounds became infested with maggots did 
better and their wounds did better than soldiers who weren't infested," 
he said.

In the late 1920s, a former World War I surgeon began trying maggots on 
patients at Johns Hopkins University, and the treatment soon became 
common. Herb Nordquist, Donna's husband, remembers being treated with 
maggots 60 years ago when he had an infected foot. "It didn't bother 
me," he recalled as nurses removed his wife's maggots in a doctor's 
office nearby. "I had no idea what was going on."

Antibiotics soon entered the picture, however, and maggots fell out of 
favor as doctors turned to penicillin and its sister drugs. But 
Sherman's research 
<http://www.ucihs.uci.edu/com/pathology/sherman/home_pg.htm#Natural%20History%20of%20Blow%20Flies> 
resurrected the critters, and 15 years ago he created a "medical maggot" 
nursery, using rancid liver as food.

He and his wife now send shipments of 250 to 500 disinfected maggots -- 
$70 plus shipping -- to as many as 35 doctors a week. (Since maggots are 
tiny before they begin feasting on flesh, doctors can put dozens of them 
into a single wound.) Just six weeks ago, the number of weekly shipments 
rarely topped 20, said Sherman, who's been dubbed "Dr. Maggot" by the 
press.

Why maggots? The problem is that technology and drugs aren't enough to 
help some patients with wounds that don't heal properly. Dead flesh is 
often difficult and painful to remove, and doctors sometimes can't help 
but take away healthy skin -- including scar tissue -- in the process. 
Leaving the flesh there isn't a good option, either. "The problem is 
that it slows sound healing," said Handler, who is treating Nordquist. 
"Your body expends energy to separate and eject the dead tissue which 
could be put toward building new scar tissue and healing the wound."

Enter the maggots, which are happy to gorge themselves, usually without 
doing much damage unless they slip into healthy tissue. They also kill 
bacteria, which can be a bonus in patients infected with bacteria that 
are resistant to antibiotics, such as those with a potentially deadly 
infection with methicillin-resistant Staphylococcus aureus, Handler 
said. The condition <http://www.cdc.gov/ncidod/hip/Aresist/mrsafaq.htm> 
is common in drug addicts, and outbreaks have struck American gay men 
over the past few years.

It helps that maggots are easy to work with, unlike leeches, those other 
animals you're likely to find at the doctor's office. While they're 
primarily known as bloodsuckers, leeches 
<http://www.leechesusa.com/leechesusa/> are useful in medicine because 
they inject blood thinner into patients, Handler said. That helps 
prevent the body from rejecting a reattached piece of skin or even a 
finger.

While they're not short-timers like leeches, which must be removed every 
4 to 6 hours, maggots don't stay in patients for long. In Nordquist's 
case, nurses at Scripps Memorial Hospital La Jolla put them in on a 
Tuesday, covering them with a special bandage to keep them from 
escaping, and removed them, much fatter, on a Thursday.

The maggots went to that great road-kill carcass in the sky, and 
Nordquist hurried home to Baja California, hoping the maggots had helped 
heal her ankle, injured last spring in a fall off her porch.

When it comes to the "ick factor," the 63-year-old Nordquist is 
definitely a trooper. "If you know the difference between them being on 
a wound and coming out of a garbage can, it makes it a lot easier," she 
said. And while she felt the maggots in her leg, she didn't mind. "I 
knew they would wiggle and squiggle and move around. Let me tell you, 
you can go through a hell of a lot of pain if you can keep your leg."

And she figures other patients will accept maggots, too. "They just 
haven't hurt long enough. When they have, they'll jump at it."

End of story


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