Shaving.....

Among the many things that transplant patients need to think about are the many potential sources of infection. Some are obvious: Don't clean the cat box.  Some are clear when you think about it: No raw veggies, scrub all the fruit.  Some seem a bit obscure:  No cold cuts.  Babygirl and I have had plenty of talks about all of these.  But today we tackled a tougher issue.

Beware.  This was an icky conversation.

Most people are aware of MRSA (methicillin resistant Staph. aureus).  This mutant skin germ developed in part because of overuse of antibiotics.  Remember when everybody got a shot of penicillin 'just in case'?  Or when every runny nose got amoxicillin or Ceclor?  The germs remember.  So now what was once a harmless commensile germ has become aggressive.  Not only is MRSA harder to treat that ordinary Staph. aureus, it's MUCH more likely to cause infection.  Studies vary, but it's probably safe to say that more than 1/4 of us are colonized with this bug at some point.

Now consider the current "war on pubic hair"   (http://www.guardian.co.uk/commentisfree/2012/aug/07/pubic-hair-has-job-stop-shaving).  It used to be that people shaved faces, armpits and legs.  Now there really isn't any part of the body that isn't exposed to razors.  And razors cause cuts - anything from microabrasions to flat-out needs-stitches lacerations.  And applying a razor to a body part that can't actually be easily seen by the razor wielder?  Waxing is not really any better.  Yanking a hair out by the roots breaks the skin surface as well.

Doctors see a LOT of abscesses, far more in the last few years than we ever saw before.  And we are seeing a tremendous increase in the number of abscesses located on the labia, inner thighs and buttocks, as well as the axillae.  I don't go a week in my office without treating at least one, and the ER doctors see them at least daily.  I've seen them spread inward to infect artificial joints.  I've seen them spread through the bloodstream to the liver.  And I've more than once had patients who developed severe kidney infections from them. And most of those people were healthy to begin with - not on Babygirl's immunosuppressants.

So today I discussed shaving habits with Babygirl.  I frankly described abscesses and how they are treated (cut a hole, squeeze the ick out, insert packing and re-pack daily), and asked her to consider whether shaving was worth the risk of having total strangers looking at her private parts to see how bad the infection is.  Or whether having an exquisitely painful lump the size of a walnut or bigger right where she has to sit seems like a good idea. 

Like many parental warnings, I'm not sure whether it was an in-one-ear-out-the-other conversation, or something taken to heart (although to judge by the appalled look on her face I think and impression was made).

When I had my roses-and-ice-cream dreams about motherhood, I never imagined having to broach such a subject.  Heck, they never even covered this in med school, let alone What to Expect While You're Expecting.  I'd rather talk about teachers in Spandex.

DeeDee