Archive for the ‘Patient Studies’ Category

First Aid for the Practicing Herbalist-Finger Wound

Wednesday, February 12th, 2014

Before I go into some of the details here, I want to say that herbal first aid is much the same as all other first aid, the main difference is in some of the medicines dispensed. But the basics of sanitation, wound dressing and making the patient comfortable are similar. In this article the emphasis is on the pertinent parts of this first aid situation, there is a lot of background not covered.
(Please note; you can click on the photos to enlarge them)

Florida Earthskills Gathering

This first aid problem happened at the Florida Earthskills Gathering. X had cut her finger with a small foldable saw. These types of wounds often create deep gashes and heal slowly due to the serrations of the saw. And due to the slow mending process from the laceration, it is important to look for, prevent and kill any possible infection.

First day treating saw injury (4th day after it happened)

The cut happened before the first aid station was set up.  I first saw her 4 days after the wound was inflicted. This was a deep and jagged gash on her pointer finger. At the time of the initial wound there were no first aid personnel and the patient was given numerous suggestions by the people around her. Not knowing which was the best choice, she tried a number of them. One of the treatments was putting bee’s wax directly on the laceration to prevent infection. The patient did not have an infection when I saw her, but the bee’s wax seemed like a bad idea as it trapped in water and created a waterlogged swollen finger impeding healing of the local tissue.

The first thing we did was to remove the wax and clean up and inspect the finger. While the tissue looked pretty torn up, it did not look infected and so the goal was to help prevent infection and mend the tissue.

The first day we cleaned it up well, scrubbing the beeswax and other plant residue to get a good view of the wound. We then put propolis on it as a disinfectant and wrapped it in a non-adhesive gauze pad. Then we put on a finger splint as it was near a joint and moving it would continually open it. Each time she came for treatment, she was given a few different internal medicines in tincture form. We would put each of these in a cup with water so it would be easier to take. To prevent infection we gave Echinacea (Echinacea purpurea) and Oregon graperoot (Berberis sp). For pain and relaxing she took a few nervines such as Skullcap (Scutellaria lateriflora), Valerian (Valeriana officinalis), Jamaican dogwood (Piscidia piscipula) and Passionflower (Passiflora incarnata). And after each time she was wrapped up, we gave her a to-go bottle of the above tinctures.

Second day of saw injury (5th day after accident)

Day 2 we cleaned it up better (we had to stop the day before as the area was getting too sensitive to work on) and removed some dead tissue that was in the wound. Again we gave her dilute tincture of infection fighting and pain relieving herbs.  She had to shoot down of couple of these as debriding the tissue and cleaning it well is a painful process.

Third day treating saw injury (6th day after accident)

Third day of treating saw injury (day 6 after accident)

After removing the tissue the wound initially looked more intimidating but better to me, as the tissue was now red and suffuse with blood rather than the waterlogged tissue previously. Again propolis was put on as a disinfectant. And a cotton gauze pad was put on instead of a non-adhesive to help wick water from the local tissue.

Day 3 the wound looked better as the gauze had wicked away some of the water and the blood now coming into the area was helping the healing process. There were also less cracks around the wound. Less cleaning was necessary and we gave her the above medicines, wrapped it in gauze and splinted it up again.

Third day of treating saw injury

Day 4 the wound continued to heal and fill in. The main difference was to remove the splint as the wound was healed enough where it wouldn’t easily open and her finger was getting stiff. While it hurt to bend, I helped curl it (ouch) as she held it in bent position for a few seconds. Again, propolis was placed on and the same internal medicines given.

Fourth day of treating saw injury

Fourth day of saw injury (1 week after it happened)

Day 5 (the eighth after the incident happened) was the last day I saw the patient. It was looking much better though still painful. We got her to flex her finger a little more so it wouldn’t stiffen up to much, gave her some medicines and a wound kit to take with her. She had a good idea how to put the gauze and tape on as we showed her the process each day.

Fifth (and last) day of treating saw injury

Summary
Our basic goal was to prevent infection and help the wound to mend. To do this we observed and cleaned it about twice a day. Externally we put propolis on to prevent infection. Internally we gave medicines for pain, relaxation and to prevent infection. We used a splint the first few days to help the tissue mend.
I would like to thank Susan Marynowski for all the hard work of setting up, supplying and working at the first aid station at the Florida Earthskills Gathering. I would also like to thank Lorna Mauney-Brodek for her excellent clinical and people skills and for bringing her herb bus and equipment to the Gathering. For more information-Florida Earthskills Gathering (www.floridaearthskills.org) and Lorna’s Herb Bus (www.herbalista.org). I would also like to thank X the Patient for putting up with me taking photos.

Thank you for reading this and I hope it was helpful. ~7Song

An Herbalist’s View. Patient Study-Looking to reduce symptoms in progressive disorders.

Saturday, January 19th, 2013

This patient study looks at how herbs can help improve symptoms when there is little to do to change the primary problem. This is common situation with a number of chronic disorders. A note on confidentiality, I would only ask a patient whom I felt wouldn’t mind having their case discussed on an open forum such as this.  While it is obvious that I wouldn’t say their name, this sort of write-up would be obvious to the patient who is being discussed. Not only do I ask permission, but I want to make sure they would appreciate the idea, as he did here and was glad to share his situation. This case is from the Ithaca Free Clinic so all services and medicines are free. (The clinic also knows that I post on Facebook).

This patient is 57 years old. He had polio when he was three years old, and wonders if some of his current problems are due to post-polio syndrome (this occurs in some polio survivors and can include progressive muscle weakness, fatigue and muscular atrophy).

He developed brain cancer (astrocytoma) at 17 years old. This was in 1972, and the amount of radiation he received (and survived!) is causing many of his major health issues. He has a number of neurological problems from the radiation poisoning which is causing cerebral atrophy (brain shrinking). He sees a neurologist and gets brain scans regularly. I surely don’t understand all the aspects of this situation, but we started working on some of his more problematic symptoms.

The patient eats well (lots of home grown veggies and meat that he hunts) and is in general good health. He has a pretty good attitude about life. Many of his symptoms are progressive and he is appreciative for the reasonably good health he has now. He feels that he might have contracted Lyme a few years ago and took antibiotics for it. The reason I mention this is that it is hard to tell what is causing some of his symptoms, whether they are from post-polio syndrome, Lyme, effects from the radiation, or none or all of the above.

His initial symptoms were; very painful and stiff right arm and shoulder, difficulty sleeping, headaches, and difficulty mentally focusing. He needs about 12 hours a night of sleep to function well.

Our initial treatment strategy was to help him sleep better, increase mental clarity, and reduce some of his muscle pain. We kept the medicines and dosaging simple since it can be hard for him to remember a lot of details at one time. Valeriana officinalis tincture was given for sleep. We first tested it in the office by giving him a few drops to make sure it did not have an antagonizing affect (agitation), which it did not. The Valeriana dosage was 1-2 (1 oz) dropperfuls (about 1.5 to 2.5 ml) before sleep. He was given a 2 oz. tincture for mental clarity with Centella (3 pt), Salix (1 pt) and Acorus (30 drops). Dosage is one 2oz dropperful (approx 2 ml) 3 times daily.

His next visit was a little over a month later. He felt like the herbs were helping and wanted to continue with them. The Valerian was helping with sleep, but sleeping was still difficult. The arm and shoulder pain was about the same as was his difficulty with focusing.
We continued with the Valerian and told him to increase his dosage. We changed the tincture to Centella (2 pt), and 1 pt each of Acorus, Ocimum tenuiflorum and Passiflora. Tincture dosage was 1.5 ml 3 times daily. We also added a powder of Eleuthero (1.75 pt), Crataegus (1 pt) and Passiflora (.75 pt). One teaspoon mixed into water 2 times daily.

The next visit he had lost 7 pounds, mostly muscle. His arm pain was worse, but his headaches were better and he was sleeping better.

The medicines we gave him after this visit were Harpagophytum procumbens capsules for the muscle and joint pain (2 capsules twice daily). We changed the powder to 2 parts Yucca and Glycyrrhiza (his blood pressure is around 112/85) and one part each of Urtica, Eleuthero, Curcuma and Withania (same dosage as previously). We changed the tincture to Centella (1 pt), Gingko (1 pt) and Acorus (.4 pt). (Note, I wanted to use Gingko earlier, but ran out of the tincture, so we had to make some more). Tincture dosage 2 ml twice daily.

A note on a few of the specific herbs we have given him. The Centella, Ginkgo and Acorus are for mental clarity. The Harpagophytum and Yucca are helpful for arthritic-type pain. The Glycyrrhiza, Salix and Curcuma are antiinflammatory. The Urtica, Eleuthero, Glycyrrhiza and Withania are tonics for overall strength. The Passiflora, Ocimum tenuiflorum and Crataegus are nervine tonics.

He came in recently (January 2013), and seems to be in a better state overall. One of the things that also helped was cutting out coffee. The Valerian continues to help him with sleep, and we made up the previous medicines again except for the Harpagophytum capsules.

As you can see, we are not performing any miracles here. The effects of radiation poisoning are progressive, but instead of throwing up our hands to a difficult problem (though not a difficult patient, he readily takes his herbs) our goal is to back down his symptoms. While some of his problems have not gotten better, they have also not worsened, which is a reasonable result with a situation like this. He feels good taking the herbs and coming in for regular consultations. One of his main problems was fatigue due to a lack of sleep, and that has improved, which has the downstream affect of improving overall quality of life, a major goal.