Two Studies in Cellulitis (including antibiotic resistant staph)

This is my online journal entries (plus added summaries and updates) during the treatment of two serious cases of cellulitis and my accompanying treatment. Be sure to read the WHOLE thing before undertaking treatment based on my experience (which is just that, an experience, not a set of rules on how to fix cellulitis).

4-19-08 I have recently attended to a great number of acute injuries to the hands and feet of various family, clients, students and assorted other people. Several of these issues required fairly prolonged treatment over period of days to weeks, with several applications/treatments a day. In quickie cases, I like to use tinctures or other ready made preparations I have on hand, but with something like this it’s much more useful to make water based herbal preparations as needed, and usually cheaper too. In every case I resorted to using a strong infusion as a soak for the affected body parts.

In one case, the foot had been cut in several places by a piece of dirty, rusty metal. The wounds appeared shallow and minor so were not properly attended to. A week later the foot began to rapidly swell from toes to ankle, turning somewhat purple and very hard in the process. The wounds were scabbed over and there was some redness around them, but not nearly enough to warrant the dramatic swelling and pain. The discomfort grew to the point where the person was not even able to walk, and then so bad they couldn’t have their foot below heart level without a terrible throbbing pain occurring. Also, it was worsening by the minute, and I could WATCH the swelling rise just while standing and looking for a minute or two. There was considerable stiffness from the calf down and the person could no longer feel their toes at all. The foot was also very hot, and so tender to the touch it was exceedingly difficult to examine.

I gave myself a 12 hour timeline for treatment, if it wasn’t considerably better in that time I would recommend a doctor’s office, which would likely result in strong antibiotics and massive scolding to the client for not seeking “appropriate” medical treatment earlier.

So, I infused the following into very hot water for half an hour (this is not a strict recipe or anything, just my intuitive choices and the reasoning behind them) for external application.

3 parts Rose (A favorite anti-inflammatory healer of mine that helps greatly lessen or eliminate heat from infection)

3 part Beebalm (One of my tried and true herbs for serious infections, especially those of the fiercely acute kind)

3 parts Mugwort (Great for pain and swelling, as well as serious inflammation)

2 parts Sweet Clover (For swelling and inflammation)

Internally, I used a triple herb tincture consisting of 3 parts Usnea, 3 parts Oregon Grape Root and 2 parts Beebalm flower. This was mainly to address infection and get the immune system going. This person is already taking Balsamroot and Redroot for other reasons, or I might have added one or both of those to the formula as well. And yes, I can hear you all muttering Echinacea under your breath at me, but as most of you know, I have an attitude about Echinacea and I’m busy proving I don’t need anything but local plants for my practice 😉

Even after the first application of the infusion that evening, the swelling slowed and then began to recede. I used water as hot as was bearable, soaking a cloth in the infusion and then wrapping the foot in the cloth until it began to cool, then repeating until the pot of infusion got too cool to use. I followed up with a lanolin based salve of Pine to help draw out the infection which seemed to have a mind to burrow into the body.

Next morning, the swelling was visibly reduced, pain was lessened but there was an awful itch happening in the foot, and a red rash around the areas that were the most swollen. At first I thought the rash was broken blood vessels, but no, it was really a red rash. I thought about it being an allergic reaction to the herbs used, but in retrospect I realized this person had already used all of the herbs included in both the external and internal formulas without trouble. So maybe it was the foot trying to eliminate some of the infection byproducts or other unpleasantness. The latter made the most sense to me, so I continued with the treatment. Foot soak, tinctures and salve every three to four hours during the day, and extra long soak first thing in the morning and right before bed. During the second day of treatment, strange hard white goo oozed from one of the wounds that he re-opened during treatment (a very good thing to have the wounds opened back up in this case). After two days of treatment, I changed the salve to a lanolin based formula of Cottonwood, Alder, Elder flower and Sweet Clover for its general healing, rebuilding abilities along with continued anti-bacterial treatment.

About a week later, the foot is still healing, though the swelling is mostly gone and the stiffness is only present in the evenings. The rash comes and goes, but the wounds have now healed to barely pink scars. At this point, I’m using a soak of Plantain, Comfrey and Larrea to help draw and heal, with less emphasis on anti-infective qualities. I’ve also switched the salve to a Plantain/Evening Primrose (again, in lanolin) for similar reasons.

The other cases were less serious, but similar. One was a red, welted rash that appeared to be a reaction to some unknown irritant, another was a sliced up finger and so on. Because of what I have on hand, my herbal soak was fairly similar each time, although I added Mallow flower, Lavender and Oats to the herbal soak for the rash because of the soothing qualities, and avoided any salve so as not to hold in the heat and itchiness of the rash (and I asked her to let the soak cool to lukewarm before using it as well). Each time, the condition/issue has cleared up remarkably well. In some cases, I recommend whole body immersion in herbal baths, although that’s not terribly practical on site here at the Center with no plumbing and all.

I do love how the simplest things, just weeds and hot water, can treat issues that would have a doctor looking very grave indeed. Acute cases can be so gratifying too, often going from frightening to fine in 24 hours, and can make one appear to be a very competent herbalist too! In reality, while they can look more minor, chronic cases are the most difficult and most likely to defy treatment, but it’s nice to have some variety in one’s frustration/satisfaction levels.

As a side note, if you live in the SW, White Sage (S. apiana) and Larrea make a great all-purpose soak, it’s crazy-wonderful smelling in a desert kind of way and very effective. If you don’t live in the SW, I can pretty much guarantee you have some equally amazing herbs nearby that will work just as well.

4-22-08 So you know that case I talked about the other day? Well, it got worse again the next day. In fact, it got downright scary again, the swelling didn’t reoccur much but the red rash (cellulitis) started to spread up the ankle. And then I smacked myself in the head in disbelief at my own stupidity. I know this (I’ve even seen it before) and you should know this: do NOT, do NOT put salves (especially those that contain beeswax in any amount) even if they are extremely antibacterial on suspected staph, strep or other such infections on the skin. It holds the bacteria in and keeps the area too moist, allowing the infection to rapidly spread. The reason the foot got worse is because the client and I were so incredibly diligent about keeping the salve on the wounds, and it didn’t get a chance to dry out enough. The salve might have even been ok in less frequent, or less copious applications, but I chose to eliminate it completely to help get things under control quicker.

The good news is that as soon as we removed the salve from the regimen it started to improve. Also, I began using some slightly diluted Alder/Rose tincture topically too right away to help dry things out and get a head start on the bacteria. Switched the foot wash back to a very antibacterial formula of Rose, Alder, Calendula and Plantain. Current tincture regimen is 2 parts Alder, 2 parts Usnea, 1 part Oregon Grape Root and 1 part Redroot. It’s getting better by the hour, at least 70% better than 24 hours ago, and 90% better than 42 hours ago. Thank goodness. An antibacterial powdered herb like Usnea would certainly be appropriate, but is unlikely to work in this particular case thanks to limited compliance.

And if I had to do this again, and I could only use two herbs to work with for it, they would be Alder and Beebalm. Maybe especially the Alder, amazing stuff.

I tend not to use fancy medical jargon but cellulitis is a useful word to know. Basically, it’s an infection of the skin and soft tissue that occurs when bacteria (usually staph or strep critters) invade broken skin. These bacterias can be carried around on normal, healthy skin and only be a problem when they get into an untreated wound, as in this case. Anyhow, these bacteria cause lots of unpleasant infection and inflammation, and if untreated can spread like wildfire, sometimes all the way into the blood etc. People with compromised immune systems, as in Diabetes, are far more vulnerable. An herb teacher of mine, Chuck Garcia, taught me to use Usnea first and foremost for any outbreak of staph or similar. As a diabetic with frequent outbreaks himself as well as treating others he has successfully subdued many outbreaks. Usnea’s not very water soluble, so he always uses the tincture/liniment externally, which is what I do as well, in addition to internal doses and the Alder. The Alder IS quite water soluble, as is Rose and both are hightly antibacterial, astringent and healing to the skin.

With all the alcohol and water on the skin, the area has got quite dried out and uncomfortable, so I’ve been using sparing applications of a light herbal lotion twice a day to moisturize without creating dampness, and that seem ok. Client wants to scratch his foot off, but the lotion helps a bit.

5-8-08 Right after I wrote the above entry, the client cut that same foot again on the same bit of weirdly venomous metal. One long ragged cut across the top of the foot. I could have cried. Despite nearly immediate treatment the foot proceeded to blow up bigger than it ever was, and the red rash spread rapidly up the leg. At this point, the toes were cold and numb, the pain intense enough to warrant the use of crutches and color of the skin a disturbing purple/brown/scarlet. As it continued to swell (in spite of hourly treatment, internally and externally) the skin started to split in places, leaving angry and inflamed wounds. Veins popped all over the leg and foot, resulting in bright red lines. Amazingly enough, there were still no signs of septicemia or similar, no swollen glands, chills, fever etc. The client felt fine besides the extreme pain and throbbing in the now immobile foot. But it was getting worse every hour, and I was deeply stressed about the whole thing.

At this point, I was recommending the client at least go to the doctor to see if they had any clue as to the exact nature of the infection and any constructive ideas for treatment. The client reluctantly agreed to make an appointment for the next day. As an afterthought, the client mentioned they’d been having some indications of a slight sinus infection. After a brief discussion I recommended a medium dose of Yerba Mansa to be taken until symptoms cleared. Client went to the doctor and the doctor was beyond baffled at the whole thing, she kept saying things like “it looks like cellulitis but…” and “those look like broken blood vessels but…”  and “ummmm, I just don’t know” in the end, she couldn’t find a single distinctive pattern of symptoms to make a diagnosis with. She prescribed antibiotics of course.

Client went home and didn’t take the antibiotics. Continued suggested foot regimen plus the Yerba Mansa. Sinus stuff cleared up by the next morning, AND the food suddenly, miraculously turned a corner. After looking at the decreased swelling, I agreed we might be ok holding off on the antibiotics for another day or so, as long as it didn’t start to get worse again. Every day since then (about five days ago) the foot has increased in leaps and bounds. Every day the swelling receded a bit further, there was less heat coming from the foot, the skin splitting wounds healed and the dead skin slowly sloughing off to reveal healthy new skin underneath. Today, on close examination, there is NO heat coming from the wound or surrounding area. There is very little swelling, no redness except a faint pink directly around the most recent cut, no sign of cellulitis whatsoever, no numbness in the toes and best of all, no pain or impediment to walking, not even a trace of a limp. Client can actually wear shoes again without any discomfort (though I don’t recommend shoes much at this point except for needed protection).

The only remaining symptoms are a very small amount of residual swelling, some stiffness in the ankle joint, and slight sensitivity on the wound site. The regimen has been scaled back in the last three days to include foot soaks (Rose, Mugwort and Beebalm just now) four times a day, with a very light herbal cream applied afterwards and tinctures of Usnea and Yerba Mansa internally. Was it the Yerba Mansa that caused the shift or was it just ongoing intensive treatment by a stubborn herbalist? I dunno. I’m not stopping the Yerba Mansa for another few days though, just in case. Gentle massage has also been used for the last three days since the inflammation has died down in order to increase circulation and healing. The client feels that this is very helpful in this stage of the healing process.

I can’t even express my huge relief over this, as it was more than severe enough to freak out the doctor and had the potential to go systemic and therefor possibly endanger the life of the client. I am thrilled we were able to work through with herbs rather than resorting to what probably would have been multiple rounds of antibiotics.  I think I’d like to have a little foot party now, toasting the recovered foot with homemade prickly pear wine and strawberries.

Never underestimate the remarkable power of weeds!

Note: There were continued complications in this case for another month and a half, during which cellulitis was officially diagnosed by a doctor and antibiotics were taken. The antibiotics, instead of helping, caused the infection to go into a complete flareup, resulting in another emergency herbal treatment. Turns out this was a nasty strain of antibiotic resistant staph that was incredibly hard to treat. Eventually though, the client recovered full mobility with no lasting effects whatsoever from the infection. Keep in mind though that the herbal treatment required hourly intensive treatment for periods of time and was dangerous. If I had had any less experience or confidence in the herbs I would have escorted to the client to an ER for emergency treatment. Be careful with this kind of infection, it can result in death.

9-7-08 I’m now dealing with another case of cellulitis. Loba stepped on a scorpion the other night and was stung. Now, usually this isn’t a big deal at all, it hurts and tingles and then goes away. But she squished a ton of venom into her toe which seriously traumatized the foot. And even though we used Peach tincture and Larrea oil on it, by the next morning it was hugely swollen, red and impossible to walk on. It LOOKED like an infection but I couldn’t imagine how a scorpion sting could get infected in such a manner. We tried various things topically with no luck and then even a benedryl (though it certainly didn’t look anything like an allergic reaction to me) which of course had no effect. The next morning I hauled her into the doctor because I couldn’t understand what was happening and the redness was rapidly spreading up her leg, getting awfully close to her knee. The pain and redness increasing, literally, by the hour. The doctor (who loves herbs and who I share many clients with) confirmed that it was full blown infection a la cellulitis. He was very concerned about it and said that we had exactly six hours to stop it or cause it to recede before antibiotics should be taken. We dutifully accepted the antibiotics and headed home. I stopped along the way to gather fresh Plantain, Alder leaves and Bidens leaves.

Back home, I made up a hot soak of Monarda, Sweet Clover, Alder bark and Rose and Loba rotated her foot between that and cold water. When she was done soaking it we wrapped it up in a Plantain and Alder and Bidens leaf poultice saturated in clay. After the first poultice though we left out the clay because it was just a sticky, leg hair pulling mess that didn’t seem to be doing too much. I also had her take Monarda and Alder by the dropper full on the hour every hour. By the end of the six hours, the redness had not only stopped spreading, it had receded a couple inches. I almost fell over with relief. To be perfectly honest, I really didn’t know if we could back off a serious infection that fast

Two days later, the infection is only in her foot and is still receding, slowly but surely. We’re still very much on alert, and still pumping in the herbs very frequently. I’m not convinced it’s going to resolve, but I have hope that we won’t need those antibiotics. And then this morning she got stung on her hand by a wasp, which flipped her immune system out. Peach & Plantain for that. Here’s praying it doesn’t make the foot worse.

9-8-08 I’m happy to say that this case of cellulitis has been much easier to treat than the one earlier this year. Today, Loba’s walking around fairly easily, almost no redness in the foot and just a little swelling. We continue to do the soaks, poultices and internal tinctures, but I expect she’ll be completely back to normal in a matter of days. Yippee!

Plantain, Alder and Beebalm formed the core of my treatment here, and have proven themselves over and over in stubborn infections from a variety of causes. These are nice simple herbs, all commonly available as weeds in North America or easily grown.

The Peach fixed that wasp sting right up too, it’s good and dependable that way.

Note: Both cases of cellulitis resolved completely with no lasting complications, but both were acute, extreme and frightening. If you’re not comfortable dealing with an emergency situation with herbs (as in, you have lots of experience and know your herbs very well) then I suggest you bring in the help of a doctor, professional herbalist or other knowledgeable health practitioner. Blood poisoning is a serious problem and can lead to death or long term damage.