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|Drug: The Double Edged Knife (Part 17)|
Mohamed H. Dahir, Chairman Pharmaceutical Association of Somaliland
A never-ending source of controversy seems to revolve around the best treatment for common household burns. So many suggestions have been offered over the years that no one seems to know whether butter, adhesive tape, or baking soda is the best treatment. Well, the controversy is now over. Without doubt, the application of cold water or a cold, wet compress is the treatment of choice. One investigator reported that there was a reduction in total treatment time and burn severity by two-thirds when immediate cold-water immersion was employed for 150 patients. They had suffered chemical, heat, or electric burns, some of which were quite severe, all infections were eliminated. Do not however, use ice directly because that is just too cold and could actually damage the already sensitive skin (you can, however, add a couple of ice cubes to a pan of water). By sticking the burned skin under cold water or by using a compress, you can decrease the pain right away, and surprisingly enough, actually diminish the severity of the damage done to the skin and underlying tissue. You may even prevent the formation for blisters and promote healing. Effectiveness may depend upon how soon you get the burned area under cold water, so move quickly. Ten seconds may mean the difference between a nasty blister and no obvious skin reaction. It is also a good idea to keep the burned area submerged for quite some time, from thirty minutes to several hours.
Although it has become increasingly popular to apply ointments and aerosol sprays to burns, this can be a dangerous procedure. Most of these preparations contain a local anesthetic (benzocaine is one of the most common ingredients), which can of itself produce a reaction. Often after repeated application, the patient will notice the burned area getting worse due to a sensitization (allergic response) of the skin. Sometimes this can be worse than the original burn. If the tissue has been seriously injured, these ointments can be doubly dangerous, since they may be absorbed into the body. These drugs, which are relatively harmless when applied topically, can be quite toxic when they enter the blood stream (and burned skin is a poor barrier against absorption). It is probably much better to just stick with cold water.
An equally safe but way-out therapy for burns has been suggested, the application of plain old honey to burns, bedsores, cuts, and just about any other local wound will speed healing. It sounds odd, but it certainly canít hurt, and if it works it sure is worth the try. Another suggestion also claims success with this type of treatment, but instead of honey, plain old white sugar is recommended. When it is applied under an airtight dressing, it is supposed to definitely improve the healing of bedsores.
How about sprains, twists, and tears? Which is better for these injuries heat or cold? Ask five different experts and you will probably receive five different answers. Actually, according to the medical letter, both heat and cold are beneficial but only in the correct order. After a minor accident, like a sprained ankle, ice packs or cold water should be applied first and should be used for up to two days. At this early state heat may actually make things worse by increasing the fluid accumulation (edema) in the damaged underlying tissue. After the second day, heat can then be applied to reduce the pain, although its advantages over cold are not clear.
In the case of relief of pain, and as an aid to movement. Unfortunately, like many long-used therapies, which have never been scientifically studied, this practice has disputable benefits. According to a well-controlled investigation, it was determined that heat could actually aggravate the fluid accumulation and pain of joint swollen by rheumatism. Ice packs, on the other hand afforded greater relief for pain and stiffness and seemed to improve the ability to exercise. In the final analysis, of course, you are going to use the technique which works best for you, and that is as it should be.
To be continued next week