Visiting Vet: Simple treatment can work wonders

Using Manuka honey to treat this cat’s injury was the right thing to do.

Roro's swollen paw is healing after treatment with honey. — Michelle Gerhard Jasny

Roro, a 3-year-old cat, lives a freewheeling feline life rambling around the backwoods of West Tisbury, but coming home regularly for food and affection. When he didn’t show up for a few days, his owners were concerned, but when Roro finally limped his way home, the reason for his absence was obvious. His right front paw was massively swollen. Knowing my office is closed on Wednesdays, his owner contacted the veterinarian covering emergencies, who examined the infected foot, prescribed antibiotics, and advised the owner to contact me the next day for follow-up.

My first look at that foot had me worried. The paw was swollen two to three times normal size, the whole thing caked with matted fur and dried blood and pus. I tried to shave away the fur but it was too solid. I tried gently washing the area to soften the hardened material and see what was underneath, but it was too painful. “We need to anesthetize him to clean this up and evaluate it,” I told his owner. After anesthetizing Roro, I immersed his foot in a bowl of warm water and slowly, slowly, slowly soaked off the crud. If you are squeamish, skip the next paragraph or two. As the caked fur pulled away, so did most of the skin on both sides of Roro’s paw. It looked like he had stuck his foot in a meat grinder. This wasn’t your average abscess from a cat fight or injury from stepping on a stick or nail. “What happened to you, poor boy?” I murmured as I continued cleaning the paw.

When all the debris and dead tissue was removed, I looked at it for a long time. There was not enough viable skin left on the top to suture closed. There were exposed tendons. On the bottom, at least all his pads were intact but much of the tissue between the pads, and farther up the leg, looked like hamburger. I palpated all the bones. Carpus. Metatarsals. Toes. There did not seem to be any broken. (We later confirmed this with radiographs.) “Okay,” I said to myself, trying to be optimistic. “I’ve seen worse things heal.” Out loud I asked my assistant to lay out my surgical equipment while I went into the house and grabbed the honey from my pantry.

That’s right. Honey. People have been using honey to treat wounds for more than 4,000 years. Now science has analyzed and documented why this ancient remedy can be so effective in certain circumstances. Honey helps dissolve away tissue that is no longer viable while simultaneously having antimicrobial effects, inhibiting bacterial growth. It helps draw fluid out of edematous tissues, reducing swelling. Honey can help the body to activate its own lymphocytes and to release substances that help with wound healing. Honey has antioxidant and moisturizing properties. Manuka honey, a product native to New Zealand made by bees who pollinate the manuka bush or tree (Leptospermum scoparium), is touted to have greatly enhanced anti-bacterial and anti-inflammatory effects and to be the best type of honey for healing. It is actually approved by the FDA as a medical treatment for open wounds.

I didn’t happen to have medical grade Manuka honey, or any Manuka honey, in my cupboard, but in a pinch, any honey was better than none. I flushed Roro’s lesions thoroughly with sterile saline, sutured what I could to minimize the areas that would have to heal as open wounds. Then I slathered honey over the entire paw and applied a “wet-to-dry” bandage dressing. An injection of a long-acting broad spectrum antibiotic and a course of an oral nonsteroidal antiinflammatory medication and an opioid pain medication to be given for the next few days completed my ministrations. “Bring him back tomorrow for a bandage change,” I told his owner when Roro was awake enough to go home. “And pick him up a jar of Manuka honey.”

I have to admit I was anxious about whether we would be able to save Roro’s foot, and whether honey therapy was the right choice. But I knew honey had been studied numerous times, particularly in  human burn patients, and for treatment of infected wounds that failed to respond to conventional therapy. In one clinical trial, babies with large, open, postsurgical wounds were treated with honey. These infants had been unsuccessfully treated with injectable antibiotics and topical twice-daily cleanings with antiseptic solutions and ointments. Honey resulted in complete healing in one to three weeks. Another study involved 59 patients with wounds and ulcers, 51 of whom had bacterial contamination, all of whom had failed to respond to traditional treatment. After dressing with unpasteurized honey, all wounds were free of bacteria in one week. Previously swollen and foul-smelling wounds became odorless. Dead tissue sloughed virtually painlessly and surgical debridement was not needed.

Roro came back for Manuka honey bandage changes daily at first, then every few days. Twelve days post-surgery the healing was progressing. We removed the sutures, but when we tried to leave his foot unwrapped, Roro gnawed aggressively at the paw. I was afraid he might be developing a condition called hyperaesthesia syndrome that can result in severe self-mutilation. So we wrapped it a while longer, added a new medication to reduce self-trauma, and fitted him with an Elizabethan collar. That night I sat after work reading “The Book Woman of Troublesome Creek,” a work of historical fiction set in Appalachia in the 1930s, I came across a passage about a man who was shot in the foot and developed a life-threatening infection. The herbalist heroine saves his life by slathering his paw . . . I mean foot . . .  with honey. I nodded my head in agreement. Today, three weeks after he first limped home, Roro’s foot is almost completely healed. He is leaving it alone, no longer wearing the cone of shame, and starting to bear weight on it. I only wish he could tell me what happened to him in the wilds of West Tisbury.