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Hookworms, hookworms everywhere!

Cutaneous larva migrans is the second most common helminthic infection and the most common tropically acquired skin complaint. If you get it, it's rather a nuisance but no reason for major concern. It can strike all around the world, especially if you're barefoot. Depending on where you are, you'll get a different causative critter though.

As the name suggests, this is an annoying skinrash usually caused by a hookworm that has accidentally chosen you lucky thing to be its host. After entering your skin through a follicle or a cut in your skin with the help of a protein desolving enzyme, it sheds its cuticle and starts migrating around the upper layer of your epidermis, causing intense itching and the characteristic linear or gyrated raised skinrash that tracks the hookworms passage through your tissue. As you are not the intended host, the worm is not able to penetrate the basal cell layer of your skin and hence does not make it to your lungs, where it really wants to be. The most common causative agents and its playgrounds are:

  • Ancylostoma braziliense (hookworm of wild and domestic dogs and cats): Southern United States, Central America, South America, and the Caribbean
  • Ancylostoma caninum (dog hookworm): Australia
  • Uncinaria stenocephala (dog hookworm): Europe
  • Bunostomum phlebotomum (cattle hookworm)
  • As you are not the worm's intended host, it will soon wither away and die, but if you're unlucky, that might take up to a year. Prevention is the key here, so if you're somewhere with warm, hot, sandy soil, wear something on your feet. As the itch can be quite annoying, treatment might be necessary: albendazole, metronidazole and ivermectin might be used (depending on where you are). Try not to scratch it, as it might become infected with some nosocomial bacteriae, and things usually get worse from then on.

    References:
    Roble, DT et al. (2020): Cutaneous Larva Migrans. Medscape, https://emedicine.medscape.com/article/1108784-overview accessed 23.3.21
    Ngan, V. (2003): Cutaneous Larva Migrans. Dermnet NZ, https://dermnetnz.org/topics/cutaneous-larva-migrans accessed 23.3.21

    I was talking to Heisenberg yesterday. A brit doc. Cool.

    I like the NPR article about hookworms, here. Dr. H expressed skepticism. He points out that the evidence is not fully in.

    Well, yeah, but I take a rather fluid approach to evidence. Yes, I pay attention to evidence based medicine, but when it totally fails, I am HAPPY to try other shit. Also some of medicine is wrong all the time. I tell patients that I think that 25% of mainstream allopathic medicine is probably wrong most of the time. That's why the damn guidelines change, right?

    If I had horrible asthma and was on all the meds and it was not working, I would try the hookworms. No worries.

    I don't have allergies or asthma, they checked after the last fucking round of fucking PANDAS.

    When we were waiting for the Women's Health Initiative, I had gone to a course in Hawaii about women over 50. I could talk non stop for an hour about all the hormone replacement evidence. BUT, I told patients, that is this year. When the Women's Health Initiative comes out, I may tell you something different. And gosh, wasn't that true? Not one of my patients complained about the hormone replacement. They all said, "Well, you said it might change."

    Yeah, baby. Same with Fen-Phen. I was very conservative about putting people on it for weight loss. They had to start an exercise program first. I told them about the few cases of ... what was it, heart failure? Something. I told them they could be on it for 3 months, off for one, then another 3 months, then NEVER AGAIN. So they could use it to assist in starting exercise and a better diet, but not indefinitely. Again, I got no complaints when Fen-Phen was shut down.

    And opioids. I thought the "give them all they need to stop hurting" instructions in the early 1990s was massively stupid. Hello, fuckers, it's addicting. Like, duh. I still don't really understand why US physicians fell for that shit. Well, I had been reading books on addiction since college, for seven years before medical school. I might have had an edge there. Opioids don't make people stop hurting, ever, they just drop it about 30%. More is just bad. Around the clock is bad. Ok, you can make people stop hurting if you act like a Michael Jackson doctor, but first do no harm, am I right?

    In residency (93-96) they said put people on methadone. I thought Fuck me running. No fucking way am I EVER going to do that. And I didn't. But I laid low and didn't say anything to anyone about it. One of the rare times I was smart enough to keep my mouth shut. Here on the Olympic Peninsula, I would accept patients on methadone, but I would wean them. Some didn't put up with it and scooted. When I took the buprenorphine course, free, at UW Medicine, I thought "I HAVE FOUND MY PEEPS!" At least as far as addiction and pain medicine goes. Eventually the group of doctors noticed that something was off with me, even though it was telemedicine. Fuck, my human disguise is wearing on me. I forget, and act like a natural lizard. I'm tired of this fucking assignment, when do I get to move on? Oh, be careful what you wish for, right?

    Currently I disagree with some of the diabetes guidelines. I think doctors are drug happy. My initial treatment for type II diabetes is to explain what a carb is (anything that isn't protein or fat) and have them get a glucometer. Test fasting and two hours after one meal a day. You'd like the fasting under 130 and the after eating under 150. Well, 180 if the person is over 80. Come back in two weeks. Talk about locus of control. People are so pleased with themselves when they bring their sugars down. They are powerful, enabled, smart. Yeah, all of my patients are smart. If you hand them a medicine on that first visit, why would they even try to change their diet? Sends the wrong goddamn message. Yeah, American Diabetes Association, I am looking at you. Do you get any money from the drug companies? Fuckers.

    At any rate, I keep my fingers on the pulse of alternative medicine. Fucking Dr. Oz, the manwhore. For sale to any quack that offers money. Functional Medicine, The Thyroid Secret, the Seattle mushroom doctor, pills, pills, pills, all sorts of quackery. Fucking Dr. Google. However, some of it will turn out to be right. Not much, and the level of bullshit is really really high. I am talented with a shovel and now I finally I know how to ask for help.

    Information is piled into my piler brain and then I can retrieve it, like a toaster. Pop, there it is. Cool.

    I wonder if hookworms would downregulate PANDAS? They downregulate the immune system. Hmmm, now there is a novel idea for treating covid, heh, heh.

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