What Lies Beneath: The Goodness of Grubs : Emergency Medicine News – LWW Journals

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Johnston, Michelle MBBS
This month’s piece, in a peculiar confluence of previous columns, explores the power of nomenclature, old remedies made good again, the philosophical issue of managing chronic disease so it doesn’t clog the ED, and the general purview of weirdness.
It’s about maggots. Hear me out.
Many years ago, a patient with platinum-status frequent flyer miles would present regularly to our ED. He had a grisly amputation stump, a filthy wheelchair, an even filthier vocabulary, and no roof to call his own, but he was rather endearing in his own unique way. Where his lower leg was formerly situated was a wound of various combinations and cycles of breakdown and infection, the surgical site a jungle of raw exposed tissue and bacterial dominion.
But our man had constant companions. Maggots. Not infrequently he would be subjected to a gentle hose-down in the ambulance bay before he was permitted to come inside, but in no time at all, the wound would be reinfested with maggots. It was as if they would collectively sigh, crawl back out of the drains and the pipes, and wend their way back to him to carry on their good work. Because good work they did. (We named them his homing maggots.)
When the maggots were permitted to stay on, industrious and committed, his wound was pristine. No slough, no infection, no surrounding cellulitis.
Maggots have a bad rap. Even the word makes my skin crawl. Sure, they are slimy little larvae, hatched from blowfly eggs that have been laid in something dead or decomposing or just plain squalid. But if we look beyond that, at what they are capable of, they seem considerably less repulsive. They are, in fact, fiendishly clever and extraordinarily useful.
Their simple wriggly little bodies have a soup of biologically active enzymes, unparalleled in the natural world. They bury their heads in wounds and vomit out a cocktail that permits debridement, disinfection, microbial biofilm destruction and inhibition as well as stimulating remarkable degrees of tissue growth. If any remaining bacteria are slurped into their tiny guts, the microbes are promptly killed. It is multifaceted biotherapy.
And there’s more. The maggots stick their backsides upward and breathe through their anuses (ani?), meaning nonstop feeding! No coming up for air! Amazing.
Of course, Aboriginal Australians have long utilized maggots to heal wounds, as have other ancient civilizations with perhaps less squeamish sensibilities than ours.
Chronic wounds are a huge burden on the health system. The cost in Australia is estimated at several billion dollars. The U.S. FDA approved medicinal maggots for use in 2004. Cost is one thing, the burden of presentations to our crowded EDs another.
Could the humble maggot be one of the less obvious solutions to helping keep patients with chronic wounds out of hospitals and EDs? I would certainly think twice about a hose-down now if only our patient were still with us.
I think maggots need a corporate rebranding. Like Facebook to Meta, a fetching name can hide a multitude of unpleasantness. I’m not sure. Wellness Worms? Goodness Grubs? Medicated Wigglers? Perhaps we could put it up for debate.
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Dr. Johnstonis a board-certified emergency physician, thus the same as you but with a weird accent. She works in a trauma center situated down the unfashionable end of Perth, Western Australia. She is the author of the novel Dustfall, available on her website, http://michellejohnston.com.au/. She also contributes regularly to the blog Life in the Fast Lane athttps://lifeinthefastlane.com. Follow her on Twitter@Eleytheriusand read her past columns athttp://bit.ly/EMN-WhatLiesBeneath.
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