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Epsom salts & Salve

Posted Oct 01 2008 10:52pm
There's certain tricks of the trade that, quite frankly, I'm shocked that I get away with at times. Not that I'm deceitful or anything, it's just so simple. When I was just starting in rural practice patients would occasionally hold out their arm or leg to show me a rash and tell me, "Well, I put a little salve on it and it seemed to help a little. Was that ok, doc?" "Salve" like it was a brand name or something. After a while, when someone came into the office with a stumper of a rash I'd ask, "Have you tried putting a little salve on that?" Once I figured out what exactly salve was, I found myself suggesting, "Well, why don't you try putting a little salve on that and come back in a week if not better." People generally seem reassured that their skin outbreak is nothing serious or contagious and leave feeling satisfied with the visit. So what is salve? For the record, salve varies from person to person. Some interpret salve to mean over-the-counter hydrocortisone cream or antibiotic ointment, but most are refering to a moisturizing ointment such as bag balm.

I dislike dermatology in general. All family docs have strengths and weaknesses in a specialty so broad as family medicine. I love cardiology, general pediatrics, and if it's sports medicine I'm your guy, but dermatology no. I have a theory that everything skin related is either terribly boring or if at all interesting is also disgusting, quite frankly. Eczema, boring. Acne, boring. Bullous pemphigus, disgusting. Scabies, boring and disgusting. So back to salve. In order to make my job easier, I've often thought of combining my three favorite topical medications--triamcinolone, muciporin, and clotrimazole. Maybe this could go in a base of some bag balm. This would have anti-inflammatory effects from the triamcinolone, antibacterial from the muciporin, and antifungal from clotrimazole. Probably 80% of the rashes I see fall into one of these categories anyway. So my plan would be to bottle this stuff up and just call it "Salve". So simple, but I bet it would sell.

Then there's epsom salts. I don't think I've ever actually read about epsom salts in a medical textbook or read a journal article on them, but they are part of medicine lore and, therefore, have a unique place in a family doctor's arsenal of treatments. Like salve, I often recommend people soak things in epsom's salts because it doesn't hurt and sometimes it does seem to help. Have an ingrown toe nail--go soak it in epsom salts. Have a splinter in your foot--get to the salts. I may treat someone's diabetes, hypertension, and asthma, but it's the recommendation of epsom's salts that often make me look like the genius for some reason. "Ah, epsom's salts," they say nodding their head, "That's a good idea, doctor, I'll go do that."

For those not familiar with the magic of epsom's salts, it is really magneusium sulfate hydrate. The were first used in the town of Epsom in England and made by boiling down the water there. The salts were originally a laxative or purgitive, and magnesium is still the active ingredient in milk of magnesia and magnesium citrate. Magnesium also has many other uses in medicine due to its various chemical properties. Epsom's salts, specifically, also have a role in manufacturing and chemical processing, and some have been known to use them in gardening. For me, it's pretty much just as a soak, however. I'm sure others have many different uses for them as well. I have to admit, I generally have epsom salts stocked in my own bathroom.

Sometimes life's answers don't need to be terribly complicated. So when in doubt, just put a little salve on it and soak in epsom's salts.

The Country Doctor
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