Botulism, Napoleon, and a miracle

Towards death you might go to the brink

From eating the foods they call stink

Fermenting such fare

In glass with no air

And such poisoned eyes cannot blink

Synopsis: I’m a Family Practitioner from Sioux City, Iowa. In 2010 I danced back from the brink of burnout, and honoring a 1 year non-compete clause, travelled and worked in out-of-the-way places in Alaska, Nebraska, Iowa, and New Zealand. After three years working with a Community Health Center, I am back having adventures in temporary positions until they have an Electronic Medical Record (EMR) system I can get along with. I spent last winter in Nome, Alaska, followed by assignments in rural Iowa. The summer and fall included a medical conference in Denver, working Urgent Care in suburban Pennsylvania, and Thanksgiving in Virginia. Just finished with 2 months in western Nebraska at the most reasonable job I’ve ever had, I am back in coastal Alaska.  Any specific patient information has been included with permission.

We discuss significant cases in the medical staff offices every working morning; the collegiality makes us all better doctors.

We started out with a spirited discussion of Native foods and botulism.

A lot of Alaska Natives prefer fermenting foods to cooking them. The non-Natives refer to those foods as what they are, preceded by stink.  Thus fermented salmon roe are stink eggs, fermented salmon heads are stink heads, the choice parts of seals are stink flipper.  Usually fermentation lasts six weeks, and traditionally takes place in a hole in the ground lined with grass and covered over with dirt.

Bacteriologically, fully rotten foods carry much less danger than those partly decayed; bacterial toxins break down with time and the germs themselves die off. Problems arise when fermentation takes place without oxygen, permitting the formation of botulinum toxin, giving rise to botulism.  Thus the hole in the ground produces less risky delicacies than Tupperware, Mason jars, or Ziploc bags.

I learned today to ask about the 4 D’s: Dry mouth, Double vision, Dysgeusia (trouble swallowing) and Dyspnea (shortness of breath), in the context of vomiting or other gut disturbance after eating native foods, especially those prepared in modern vessels.

Few Gussicks (the Native word for non-Natives) realize that Americans eat a lot of fermented foods. Most everyone, for example, knows about stink cabbage (sauerkraut), but few think about stink milk (sour cream, buttermilk, yogurt, and cheese), and stink juice (wine, cider, beer).  The English love their hung pheasants.  And traditionally eggnog was allowed to sit at room temperature for 6 weeks.

Napoleon could wage his wars because a Frenchman patented a process of fermenting ground meat with lactobacillus to kill the pathogens, and in the process made botulism-free salami and other sausages.

And later in the day, I twice gave out my never-fail recipe for constipation, the prune water protocol. Put a prune in a glass of water, I said, leave it by the side of the sink, when you go to bed drink the water, eat the prune, and brush your teeth.  Repeat morning and evening.

Rounds ended with a discussion of a medical miracle. I cannot give details about a death sentence and a reprieve, but I can talk about the ripples of hope that spread through the family, the village and the medical community.


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