Diplomate, Board Certification of Emergency Medicine
Chairman, Department of Emergency Medicine Ma'ayenei Hayeshua
Hospital
I previously mentioned the issue of wild animals and, while
we have discussed this in the past, emphasis is important.
Dogs can be wonderful companions, but in Israel, many
abandoned dogs have become wild and circulate in packs. They
often enter cities and children must not play with them or
feed them. Recall that dogs instinctively chase a scared
running child. Ferrets are in the weasel family and are
popular as pets in the West, but are unpredictable and can
often maul a young child. They are also cute -- beware.
Skin infections take many forms, and one that is very common
in our country is Shoshana, or erysipelas. People with
varicose veins or other vascular disease, and those who are
overweight, have a tendency towards this disease. It is
caused by either strep or staph, but overuse of antibiotics
in Israel prevents the use of a single agent that can cover
these bacteria well, especially in legs with poor
circulation. One single antibiotic that can do the trick is
Augmentin, which in Israel is available in intravenous form
as well. It is now more convenient to take, as it can be
taken twice a day.
Sometimes these two bacteria can turn mean and start
producing toxins that cause the flesh to die and can spread
to the blood. It can not be predicted which infections will
turn bad -- be in close touch with your doctor.
Small infections in the foot such as cracks in the skin or
improperly cut toenails can doom a limb in a diabetic. They
have disease of the small vessel and can't fight them. Once
gangrene sets in, aggressive therapy must begin. Often there
are difficult and unusual bacteria involved.
In Israel, special doctors, called "shikumists" or rehab
medicine doctors, take care of these problems. I am aware of
people claiming that special creams can save these limbs.
However, I have seen many failures and await scientific
evidence. I am not saying it doesn't work; I am waiting for
more rigorous scientific scrutiny.
What is definite is that prevention of both diseases is
better. Diabetes, and erysipelas are diseases of the
overweight -- losing weight is imperative. Diabetics in good
control have fewer problems, and being aggressive with small
infections and having a podiatrist cut nails could save
problems.
Another infection is very common and that is fungi, which
particularly like warm wet places. Between the toes is an
ideal place for these organisms. Often called Athlete's Foot,
it responds to most antifungals, as well as to zinc
preparations. Drying feet after bathing, and avoiding public
showers can prevent this problem. Men, please do not take
this the wrong way. For hygienic purposes showers before
using the mikveh are required. I am only suggesting
that perhaps this should be done elsewhere, before going to
the mikveh. A good foot powder for those who sweat a
lot, and also wearing socks that breathe, will help.
That's the easy part. Fungi that invade the nails are more of
a problem. More on that next week. In the meantime, write me
in care of the Yated.
A message from Glaxo, sponsor of this column.
Augmentin can save trouble and time. See what we wrote
above.
