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.
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."
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."
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[Homestead] Maggot cure for leg lesions,
Tvoivozhd, 11/08/2004