Can’t You Smell That Smell?

Sometimes the diagnosis is pretty obvious as soon as you enter a room – usually by sight but in some cases by smell. This is often the case with certain infections – be warned, if you are reading this at your lunch break, you might want to put that salami on rye down for a minute. A few weeks ago a man brought his 60 year old diabetic cousin into the ER mainly for a foul odor – oh yeah, and by the way, he has a “problem” with his foot. When that stench hit my nostrils as I entered the room I made sure I breathed through my mouth for the rest of the patient encounter (ER staff gets pretty good at this skill). Imagine what it must have smelled like on a warm day after a major offensive in World War 1 – bodies rotting in the trenches – and rats nibbling at them. This is what this room smelled like. His foot had an ulcer that was completely black with dark reddish streaks going partially up his shin. Purulence oozed out. When you palpated his shin, it made the sound of rice crispies popping. Not a good sound when it comes from your leg. An X-ray confirms little bubbles in the foot and shin – and you know what?, this is often what killed soldiers in WW1 – Gas Gangrene. Caused usually by Clostridium Perfringens it will rapidly kill you if the dead tissue is not removed. In this guy’s case it meant a quick trip to the OR for some old school surgery with a saw. He actually survived but is now one leg less than he had before. Goes to show, don’t wait until you smell like a corpse to see a doctor for an infection- you could end up one.