Dear Dr. Roach: In a recent column, a reader questioned the advice of their doctor to use Vaseline rather than an antibiotic ointment on a surgical incision following removal of skin cancer. The doctor stated concern about antibiotic resistance, and you added that antibiotic creams could cause skin irritations.
I have had eight surgical procedures for basal cell cancer and at least as many more negative biopsies, which were negative but still needed post-surgical care.
I am highly allergic to many antibiotics, both oral and topical, so after several complications, I learned I could apply honey to the surgical site to keep the tissue moist and provide a barrier. As a bonus, it has properties that aid in healing.
Honey has been used for millennia for the treatment of wounds, and modern medicine is finally catching up to the ancients in this regard.
Honey is now known to have antibacterial properties against many different bacteria, as well as providing the barrier and moisture functions you correctly point out.
The wound care specialists I consulted were generally optimistic about honey-based dressings, which now come in gels, bandages, ointments and other forms for convenient skin care.
Honey is not appropriate for clearly infected wounds.
I would caution against buying just any honey from the market or a health food store, as it is medical grade honey that has been studied.
This can be purchased at surgical supply stores or online retailers.
Surgical wounds are usually clean, and most do not need the antimicrobial properties of either antibiotics or honey, so my advice for plain petrolatum stands for people with clean surgical wounds.
Dear Dr. Roach: I am a 74-year-old man in generally good health. A recent routine blood test showed that I had M protein in my blood. That led to a diagnosis of monoclonal gammopathy. I was then referred to a hematologist for additional testing. This included a bone marrow biopsy.
The hematologist said the diagnosis was a rare blood condition called Waldenstrom macroglobulinemia. She indicated that this is a type of cancer, classified as non-Hodgkin lymphoma and is treatable but not curable.
Could you comment on this condition, the treatment plan and the prognosis?
The blood disease Waldenstrom macroglobulinemia is seen in only three people per million.
Its cause is unknown. It is more common in men in their 70s. It is indeed classified as a lymphoma.
The M protein is immunoglobulin M, one of the five types of antibodies the body can make.
Since high levels of M protein can appear in monoclonal gammopathy of uncertain significance, primary amyloidosis and some leukemias and lymphomas, a bone marrow biopsy is necessary to be sure of the diagnosis.
An expert is needed to manage this condition, as it’s generally not curable.
In people without symptoms, the condition is usually not treated, and people in this situation with near-normal laboratory findings have an excellent prognosis. If a person with WM develops symptoms, the chemotherapy rituximab is often used.
More aggressive WM requires additional therapies.
One emergency complication is hyperviscosity syndrome, where the blood literally is too thick because of the high amount of protein.
It is treated by removing the protein through plasmapheresis, but the protein will rapidly come back unless the malignant cells are treated.
Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers can email questions to [email protected]
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