In early July 2023, I had a walk-in visitor to my pharmacy.
"Doc, have you got anything for painful sores on my feet?"
This was a 50-year-old male, First Nations, Height about 6 feet, weight about 230 lb. He is self-employed as a chicken-vaccinator; His full day of work consists of standing inside industrial chicken coops and vaccinating all the chickens against salmonella. It is difficult work in a dirty environment.
He complained that he had developed large sores on one of his feet-- And also a deep sore on his abdomen, near his navel, which he attributed to an accidental needle stick, courtesy of a chicken that had gotten out of control.
He was most concerned with his feet. The pain from the sores was making it difficult to stand up, and he had to stand up in order to keep vaccinating chickens.
I was able to examine the sores. The most troubling one was a tunnel about 5 mm in diameter going into the right second toe about 3 to 4 mm deep. It appeared clean and had no discharge, but the wound had to be getting near the bone.
The abdominal wound was slightly larger, perhaps 7 to 8 cm in diameter and 5 to 7 mm deep.
"How long have you had these sores?" I asked.
"About a week, or maybe 10 days," he replied. "I'm a slow healer."
"Have you ever been evaluated for diabetes?" I asked.
It turned out that he had not been evaluated for diabetes. He and his mother traveled through rural British Columbia, vaccinating chickens. It was how they made their living. He was several hundred kilometres from home, and his family physician had retired. Effectively he had no health care provider.
Ad Hoc Diabetes Testing
I had a demonstrator blood glucose meter and strips in the pharmacy. With the patient's permission, I walked him through a finger-stick blood glucose test. The result came back at 10.7, several hours after his lunch in the late afternoon, and an hour before dinner.
I asked his mother to take a picture of his glucose result to document the date and time, and advised him to go to hospital. I explained that wounds like these in uncontrolled diabetes can result in the loss of a foot or even part of a leg, and that it can happen rapidly. I was not initially able to convince him to go to hospital. I set him up with a telephone doctor appointment and advised him to call 8-1-1, the BC Nursing Consult line, hoping that they would also advise him to seek medical treatment.
Something must have worked, because he returned two weeks later to report that he had been diagnosed with diabetes in hospital.
"I called my Dad to let him know," he related, "and Dad said, 'Welcome to the Family! Your uncle and your grandfather both got diabetes right around when they turned 50.'"
"Er, Thanks Dad, for letting me know."
"No problem, Son."
I set him up with a meter, strips, lancettes and alcohol swabs, the usual equipment. For some reason the hospitalist did not prescribe metformin or any other medication. He was told that they wanted him to monitor his blood glucose for two weeks. Coincidentally, this would be about the time he was due back home--Where he still had no family doctor.
He was eager to show me the state of his sores--
In the absence of other medication, he had searched the internet for advice on how to self-treat diabetic foot wounds. He went to a health-food store and purchased the following products:
Natural Antibiotic Gel. 32 PPM Silver in a tea tree oil hydrogel. Canadian DIN# 80090443
Colloidal Silver Drops 50 mcg/ml Silver Canadian NPN# 80105973
Complete Collagen Powder Canadian DIN# 80073874
Twice daily after washing, he put several drops of Natural Antibiotic Gel into his foot and abdominal wounds, and then sprinkled Complete Collagen Powder on them until the wounds filled up.
The wounds scabbed over in a couple of days. He continued to apply these two products twice a day, and also drank 1 ml of Colloidal Silver Drops daily in a glass of water.
After a week, the scabs came off. On examination, the wound in his foot appeared to be full of scar tissue. The abdominal wound appeared smaller but it was difficult to tell as there was a layer of pasty-looking product over the site that the patient identified as the collagen product.
I advised the patient to seek medical help and evaluation again. He told me that he would do that when he returned home.
Comment:
Despite the nearly complete failure of the BC Healthcare System to meet this patient's needs, he has had a good outcome, at least so far.
The concentration of Silver sulfadiazine in Flamazine cream is 1%
Since the Silver content of Silver Sulfadiazine is about 30% by weight (107.87g/mol / 357.14 g/mol), there is about 300 mg Silver in each 100 grams of Flamazine Creme, or 3 mg Silver in each 1 gm of creme.
Silver sulfadiazine has 3000 mcg/ml Silver, compared to 50 mcg/ml in the oral drops, or 0.0032 mg/ml in the Natural Antibiotic Gel, so we can't be confident that the silver in these preps was very helpful. Possibly the collagen powder in the wound, non-sterile as it was, provided a matrix for the development of scar tissue.
There is some information that tea-tree oil has antiseptic properties and also prompts immune activity. In this one case, I can report a successful outcome, although the reasons for it elude me. Perhaps someone will want to test tea-tree-oil gel and collagen as a wound treatment.
**Disclaimer**
This is a case report which means, 'something interesting happened that is worth mentioning.' It is not treatment advice. It might not work again for someone else. The fact that you are probably reading this off the internet should give you pause for thought that this treatment, which was undertaken without any medical professional input, is very risky at best.
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