AS is a 42 year old white heterosexual female who reached out to us for the first time to the clinic with a history of persistent nausea and vomiting as well as a rash. Last year she had bariatric surgery for weight loss and when she was weighed for surgical prep, she weighed 525 lbs. She has not felt right since the surgery and developed a rash in between her skin folds. She was very concerned. In addition, she also discovered in her medical history that there was a blood clot during her time on oral contraceptive pill (OCPs) and living in a house with an in-door smoker. She has stopped the oral pills (OCPs) but still lives with in-door smoker. During the interview portion of the visit it was revealed that the last time she experienced nausea and vomiting was after drinking “an entire bottle” of rum one night while watching TV alone. She denies that this is a regular occurrence.Diagnosis:Vitals: Weight 315 lbs; Height 5’6”; Blood Pressure 135/80; Heart Rate 90Constitution: Appears well groomed, developmentally normal and over-nourished/obeseSkin: One 0.5 inch lesion under each breast that appears newer is more superficial than the other lesions. These are beefy red, oval shaped lesions on the trunk where the breasts make contact.Contiguous ulcerative beefy red lesions noted in intertriginous spaces on her lower abdomen, umbilicus and reaching around her side on the right as well as distally around her pelvic floor and wrapping around to her gluteal region. There is evidence of tunneling between several of the wounds on her right flank and inner right thigh and adjacent areas are weepy. They are non-TTP except for the most weepy and ulcerated spots on her abdomen and periumbilical which are tender to light pressure. SPECIAL MANEUVERS: A Wood’s Lamp test was NEGATIVEGI: ulcerations made palpation contraindicated; there was an absence of bowel sounds in all 4 quadrants after auscultating for 5 minutes. A//: The weepy, tunneling infection needs to be drained and this patient refuses to go to an MD out of lack of trust. As an ND, my botanical toolkit is the obvious resource to draw from. I want to lyse any organisms with tannins and salt and use strong antimicrobials along with fungicidal and bactericidal herbs while promoting healing of the tissue layers without closing the wounds too quickly so as to prevent creating abscesses or promoting sepsis.Dx: Epidermal ulcerations secondary to Hidradenitis suppurativa.
I suggested the following treatment plan.
Organic fresh shredded carrot poultice covering all lesions, left on for 20-30 minutes and changed out for another round until weeping wounds are dry.
Salt and black tea poultice on all lesions to continue drawing fluids out of the tissue.
Healing herbs bath with Calendula officinalis, Centella asiatica, Plantago major & lanceolate, Jinuperus berry and Rosmarinus spp.
Rx: Fresh Shredded Raw Organic Carrot Poultice
Sig: Approx. 1 carrot per application, peeled into strips, covering wounds for 20-30 mins TID-QD x 2 wks.
Qty: 10 lbs fresh organic carrot (shredded)
Refills: prn x 3 months
Patient Instructions: after a shower, pat yourself dry with a newly cleaned towel and apply 1 layer of shredded fresh organic carrot to lesions and wrap with plastic wrap to hold in place for 20-30 mins. then replace with fresh carrot and fresh plastic wrap.
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Rx: Camilla Sinensis bulk herb
Sig: 1 tbsp. dry herb per cup hot a.q. and add 1 tsp table salt TID x 2 wks.
Qty: Disp. 1 oz.
Refills: prn x 3 months
Patient Instructions: Add one tablespoon of herb to one cup of hot water and cover with a tight-fitting lid for 15 mins. Spill condensed fluid from underside of lid into the cup to capture all the medicinal constituents in the condensed vapor.
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Rx: Bulk Herbs for Herbal Wound Soak (2 oz Calendula officinalis; 2 oz Centella asiatica; 2 oz Plantago lanceolata; 2 oz powdered Jinuperus berry, 2 oz Rosmarinus spp.)
Sig: 2 tbsp of each herb added to 10 cups hot a.q. Steep w/ tight-fitting lid 15 mins, strain and add to half-filled bathtub and soak for 20+ mins. qd x 2 weeks
Qty: Disp. 10 oz
Refills: 1 refill.
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Follow up visit: 5 weeks later:
S//: This combination cleared up the weeping wounds and healed the tissue over a 3.5 week period. The carrot poultice seemed to really make the biggest impact right away and the repeat application of the wound soak helped her heal nicely.
CC1: acid reflux – constant but worse after meals and at night. Started after GI surgery and progressively worsening. Omeprazole helps but wonders if there is another way. Still regularly drinking liquor – ½ – 1 whole bottle over a weekend alone, watching TV.
Denies that drinking causes issues in her social or family life and fails to see the link between drinking and the acid reflux. She thinks the alcohol helps calm down the reflux.
O//: Vitals: BP: 125/80; HR 70; RR 20; Temp 98.7
Skin: All prior wounds are closed, pink/non-erythematous, non-tender to palpation. No new wounds.
Psych: Apparent depression in office but denies any current or past depression; no sign of anxiety; thoughts are clear and expresses no desire to harm self
A//: While AS’s external wounds are healing nicely, she is clearly suffering inside.
P//:
Tea: Gotu kola for adaptogenic and tissue healing effects; Licorice for reflux; Rose for mental health and astringent effects
Rx: Bulk Herbs (Centilla asiatica, Glycyrrhiza glabra, rose.
The patient felt much better after treatment as described above.
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