A Prescription for Maggots

You can’t say you haven’t been warned: there are creepy crawlies in this post

Things I will never like:
1. Drying off with a cold, damp towel.
2. The feeling of seaweed wrapping around my legs.
3. Anything that was popular in the 70’s.
4. Licorice, yam, or raisins.
5. That high-pitched screech that babies make.
6. Writhing maggots.
~Bill Watterson from It’s A Magical World: A Calvin and Hobbes Collection

A fly maggot photo from a recent Atlantic article on maggot therapy found here

A few weeks ago, I had a bit of home-made potato corn chowder left over that I added to our compost bin in our barnyard. It isn’t often that much animal protein makes its way into the bin so when I checked on the compost a few days later, I was amazed to see it teeming with fly maggots in the midst of their Thanksgiving feast. Ordinarily pictures and videos of maggots would not find their way to this blog. People might be looking at this blog while eating their breakfast or lunch and writhing maggots are not something you are expecting to see. My apologies in advance and now is the time to delete delete delete.

Therefore: a trigger warning. Don’t scroll down further if you would rather avoid seeing (and hearing) creepy crawly things.

My first medical exposure to maggots came while examining the leg and foot wounds of the homeless folks I helped care for when training in an inner city emergency room. Peeling off old ragged stockings and socks would often reveal more than dirty feet – in fact, the maggots may have been somewhat beneficial in those cases yet we were quick to dispose of them.

Maggots are, in fact, fascinating creatures with potential therapeutic value, notwithstanding their gross-out factor. This week in a brief Atlantic article found here, there is a summary of a recent study in France comparing typical surgical debridement of venous ulcers of the skin with maggot therapy. Maggots were faster in cleaning the wounds but didn’t enhance eventual healing any more than traditional surgical care. There wasn’t a difference in the discomfort level as long as the patient didn’t know which therapy was being used. For those who had been randomly assigned to maggot therapy in one study, an astounding 89% said they would opt for the insects over surgeons if faced with needing wound care in the future.

I’m not sure what that says about surgeons, but it is a great compliment to maggot larvae!

Here is a formal cross-referenced evidence-based summary from UptoDate.com about wound treatment with biologic methods:

Biologic — An additional method of wound debridement uses the larvae of the Australian sheep blow fly (Lucilia [Phaenicia] cuprina) or green bottle fly (Lucilia [Phaenicia] sericata, Medical Maggots) [42,43]. Maggot therapy can be used as a bridge between debridement procedures, or for debridement of chronic wounds when surgical debridement is not available or cannot be performed [44]. Maggot therapy may also reduce the duration of antibiotic therapy in some patients [16].

Maggot therapy has been used in the treatment of pressure ulcers [45,46], chronic venous ulceration [47-50], diabetic ulcers [42,51], and other acute and chronic wounds [52]. The larvae secrete proteolytic enzymes that liquefy necrotic tissue, which is subsequently ingested while leaving healthy tissue intact. Basic and clinical research suggests that maggot therapy has additional benefits, including antimicrobial action and stimulation of wound healing [43,47,53,54]. However, randomized trials have not found consistent reductions in the time to wound healing compared with standard wound therapy (eg, debridement, hydrogel, moist dressings) [55,56]. Maggot therapy appears to be at least equivalent to hydrogel in terms of cost [56,57].

Dressing changes include the application of a perimeter dressing and a cover dressing of mesh (chiffon) that helps direct the larvae into the wound and limits their migration (movie 1). Larvae are generally changed every 48 to 72 hours. One study that evaluated maggot therapy in chronic venous wounds found no advantage to continuing maggot therapy beyond one week [48]. Patients were randomly assigned to maggot therapy (n = 58) or conventional treatment (n = 61). The difference in the slough percentage was significantly increased in the maggot therapy group compared with the control groups at day 8 (67 versus 55 percent), but not at 15 or 30 days.

The larvae can also be applied within a prefabricated “biobag”, commercially available outside the United States, that facilitates application and dressing change [58-61]. Randomized trials comparing “free range” with “biobag”-contained larvae in the debridement of wounds have not been performed.

A main disadvantage of maggot therapy relates to negative perceptions about its use by patients and staff. One concern among patients is the possibility that the larvae can escape the dressing, although this rarely occurs. Although one study identified that approximately 50 percent of patients indicated they would prefer conventional wound therapy over maggot therapy, 89 percent of the patients randomly assigned to maggot therapy said they would undergo larval treatment again [62]. Perceived pain or discomfort with the dressings associated with maggot therapy may limit its use in approximately 20 percent of patients.

Biobag of maggots on a wound from http://www.uptodate.com

The STARZ show Outlander (a show and series of books by scientist Diana Gabaldon I thoroughly enjoy) used real maggots in the fifth season of the show when in 18th century America, wife (and surgeon) Claire successfully treats her husband Jamie’s snakebite wound with the larvae. Actress Caitriona Balfe describes her co-starring maggots in this brief video:

image from Starz – Outlander Season 5 Episode 9
image from Starz – Outlander Season 5 Episode 9

So there are still things to learn about medical therapies we used in the past which have been sidelined or forgotten in our push for modern treatment modalities. The days of leeches and maggots may not be over after all.

And now for video, complete with little maggotty sound effects — scroll down

Maggots in our compost bin – enjoying corn and potato chowder leftovers

A new book from Barnstorming is available to order here

(no maggot pictures in this book, I promise!)

Submerged Day After Day

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If God makes the world, populates the world,
infuses the world with every kind of ethical meaning,
then the signature of God is the beauty of the world.
Why even imagine a mystical experience when we’re born into one,
submerged in one, day after day?
~Marilynne Robinson from Image Journal

 

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I’m reminded,
drowning in a morass of tiny details,
trying to make sense
of the incomprehensible~
life sometimes spread so thin
it’s punched with gaping holes
filled only by God’s breath.
This is Him
staking His claim
by signing His name
on our hearts.
There is beauty in the world
from our insides out,
submerged in
every hole of nothingness,
every connecting thread
every letter He has ever written
reminding us we are His.

 

 

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A Curious Gladness

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Light splashed this morning
on the shell-pink anemones
swaying on their tall stems;
down blue-spiked veronica
light flowed in rivulets
over the humps of the honeybees;
this morning I saw light kiss
the silk of the roses
in their second flowering,
my late bloomers
flushed with their brandy.
A curious gladness shook me.
So I have shut the doors of my house,
so I have trudged downstairs to my cell,
so I am sitting in semi-dark
hunched over my desk
with nothing for a view
to tempt me
but a bloated compost heap,
steamy old stinkpile,
under my window;
and I pick my notebook up
and I start to read aloud
and still-wet words I scribbled
on the blotted page:
“Light splashed…”

I can scarcely wait till tomorrow
when a new life begins for me,
as it does each day,
as it does each day.
~Stanley Kunitz  “The Round”

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It is too easy to be ground to a pulp by the little things, those worries that never seem to wane, sucking the gladness out of the day.  They become four dimensional and soon we’re enveloped within, losing all perspective on what got us out of bed to begin the day.

God is in these intricate details, whether the splash of light on a petal or the smell of rotting refuse and it is our job to notice.  It is tempting to look past His ubiquitous presence in all things, to seek out only the elegant grandeur of creation.   Yet even what lacks elegance from our limited perspective, is still worthy of His divine attention.

The time has come to be refreshed and renewed
even when surrounded by decay.
His care is revealed in the tiniest way.
He is worthy of my attention.

A new life begins for me,
as it does each day,
as it does each day.

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Between Midnight and Dawn: From Decay, Beauty

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I remember my affliction and my wandering,
    the bitterness and the gall.
20 I well remember them,
    and my soul is downcast within me.
21 Yet this I call to mind
    and therefore I have hope:

22 Because of the Lord’s great love we are not consumed,
    for his compassions never fail.
23 They are new every morning;
    great is your faithfulness.
Lamentations 3: 19-23

 

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I wished to wade in the trillium
and be warmed near the white flames.
I imagined the arch of my foot
massaged by the mosses.
This field immersed in gravity
defying growth.  Green and glorious.
It let me know that out of the
soil came I, and green I shall be.
Whether an unnamed weed or a
wild strawberry I will join in
the hymn.
~Luci Shaw from “Spring Song, Very Early Morning”

 

The trillium only thrives where death has been.

The mulch of hundreds of autumns fluffs the bed where trillium bulbs sleep, content through most of the year.

When the frost is giving way to dew, the trillium leaves peek out, curious, testing the air.
A few stray rays of sun filtering through the overgrowth and canopy encourage the shoots to rise, spread and unfurl.

In the middle, a white bud appears in humility, almost embarrassed to be seen at all.
There is pure declaration of triune perfection.

In a matter of days, the petals spread wide and bold so briefly, curl purplish. Wilt and return aground.

Leaves wither and fall unnoticed, becoming dust once again.

Beauty arises from decay.
Death gives way to pure perfection.

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During this Lenten season, I will be drawing inspiration from the new devotional collection edited by Sarah Arthur —Between Midnight and Dawn