The Rusty Nail (Tetanus Scare)

The Rusty Nail (Tetanus Scare)

I recalled the well-known Telugu (Vemana’s) poem with extreme excruciating pain in the left foot:

చెప్పులోని రాయి చెవిలోని జోరీగ/కంటిలోని నలుసు కాలిముల్లు/ఇంటిలోని పోరు నింతింత కాదయా/విశ్వదాభిరామ వినర వేమ!

Even when the roads and neighborhood are meticulously clean we still see an occasional nail, a broken twig, a discarded soda can, or a car wiper steel blade. In modern towns most things on the road or wayside are harmless except for a sharp nail or screw. On the highways too we come across sharp objects – but it is quite rare here in the northeast US; probably I experienced a few tire blowouts once or twice on expressways moving at seventy miles (mph).

Perhaps some unknowable power is instructing me to write these infrequent articles on personal health and bodily maintenance. They may help other sadhakas (spiritual aspirants) - they may instill some courage in bearing the troubles of a fragile human body. Even with utmost care we can run into unexpected health problems, get a cut here or there, or stumble into thorny bushes or fall into rocky valleys. Or get suspended upside down in a rollover auto accident. Such is life. In most of the developed world tetanus related illnesses (గుఱ్ఱపు వాతము, ధనుర్వాతము) have come down drastically due to the arrival of modern vaccine shots, footwear, and hygiene. The vaccine shots must be administered (and regularly updated) with booster shots every ten years.

Recently I got into this terrible situation (rather, pickle) suddenly out of the blue in one morning. Some weeks ago we went through house repairs (roofing, gutters) work; the contractors did all the cleaning and clearing of debris, they did with utmost meticulous care. We thought all the discarded loose nails were gathered (through a magnetic broom) and thrown into the trash. Then suddenly one day a lone rusty nail was on the garden floor sitting (rather lying horizontally) prettily on the slate tiled floor next to the porch. Unaware of the rusty troublemaker I put my sprightly foot on it while descending on the porch steps. Then everything happened within the blink of an eye: The rusty nail flipped into semi-vertical (450) position, went through the Hawaii slipper (flip-flops), and pierced my sole brutally. At the moment I felt as though I got pierced through the heart. It appears there are very sensitive nerves in our feet, particularly in the underneath cushiony areas.  To help us with our erect walking strides we have soft (rubber like patches) of muscular bumps in our soles, i.e., the underneath of feet. That evolutionary gift helps us walk smoothly without any jerks, with minimum friction on our skeletal frames.

There was nothing I could do immediately after the terrible accident; I was in total shock with the shooting pain, barely able to recover. As I looked at the blood-dripping slipper I realized the enormity of the dangerous situation. Quickly I pulled the nail and limped back into the house. After pressing the wound with a soft white tissue I sealed the spot with a bandage (Band-Aid). My immediate concern was to stop the bleeding quickly, as I am prone to excessive bleeding. Luckily the bleeding stopped fully within ten or fifteen minutes. I kept the wound totally dry for a whole day; later I applied a dab of antibiotic topical cream (Bacitracin), just to be on the safe side.

There was no remnant of the rusty nail (piercing tool) in the foot but I could not trust my own care and instincts. So, I followed it with a visit to our family doctor (GP, Internist). There, in the physician’s office they checked my records for the tetanus vaccine and did a thorough exam of the wound. I was discharged with a course of antibiotics (Cipro) prescription; it was to ward off any spread of infection to the heart, etc.. 

Recuperation 

It took more than three weeks for the wound to heal completely – both externally and internally. Still the wounded region (spot) feels a bit sore to the touch sometimes. A long walk or extended hours of standing vertically does make it slightly painful. At the moment I am using only lukewarm sudsy (soapy) water with Epsom salt. It appears such immersion in warm salty water relaxes the muscles – it offers relief for tired feet. 

How do the elderly adults cope with such wound (puncture, pierced) complications? I am particularly concerned about folks in developing countries without easy access to doctors or modern hospitals. But all is not lost due to lack of money or modern medicines. Many societies have sound cultural roots to overcome minor (or even major) medical emergencies. Usually an herbal doctor is at hand to attend to such wounds. Immediate bleeding arrest followed by proper wound dressing should take care of the problem. However in the case of some adults (elders, seniors) we must also take into account these factors: blood thinner medications, diabetes (type II) complications, and tetanus shots.

Both in the immediate (first aid) wound dressing and follow up care I mostly followed my own instincts and intuition gained through experience. In the early days I used to limp and put greater burden on the other healthy foot.

Of course I learned my lesson through this accidental injury. A thick-soled sneaker would have prevented or at least reduced the severity of the wound. That is why in most factory floors workers are advised to wear strong boots. Also it wouldn’t hurt to keep the premises clean without loose debris, particularly after major repairs. I want to conclude with several herbal remedies for skin lesions: turmeric (పసుపు), marigold (బంతి), vinca (బిళ్ళ గన్నేరు), Aloe vera (కలబంద) and gum Arabic (తుమ్మ). These have been well researched (see Materia Medica India)  and there is substantial literature on the Internet (ex:Traditional therapies for Skin Wound Healing). Ideally keeping the wound dry should make it heal faster; ultimately the physical body heals itself aided by our Guru. Our only concern should be this: not to let the patient slip into a grave tetanus infection or other complicated prolonged wound enlargement, etc. Timely medical intervention is a must for such traumatic situations. While writing this article I often think of individuals in the remote corners of Indian villages or some hilly terrain in the Himalayas. As a kid I used to accidentally step on thorny bushes (Acacia) or on the sharp Date Palm leaves. Then mother or sister would gently apply first aid and ease my pain. And we had many (probably more than a dozen) well-trained doctors of various systems (Ayurveda, herbal, Homeopathy, allopathy) in the village. Often they would attend such emergency injuries without charging upfront fees. The tetanus bacterium is mostly found in agricultural environments. It is also found in animal manure (horse dung) and droppings. People with bare feet are especially vulnerable to wounds on the lower limbs. The bacteria can find its path into the body through any accidental cut. The mortality and morbidity from tetanus complications in India is quite high (>40%), hence beware! Copyright 2025 by the author

 

Toe Pain

Toe Pain

There is one tough toe problem that bothers adults. And this one needs urgent intervention and tender care.

Symptoms

“The subject wakes up at 1:00 a.m. with excruciating pain in the big toe, with no apparent cause or injury. Upon close examination under bright illumination, a slight swelling is found around the joint between big toe and foot (metatarsal-phalangeal joint), very tender to touch. The pain is often unbearable and the usual technique of hot/cold compress is of little use. At times even walking becomes extremely painful.”

The disease, known as gout has been around for hundreds of years. It affects mostly men and predominantly it is prevalent in cold climates. Though often associated with alcohol and rich (animal) protein food, anyone can get it - due to the evil coincidence of many factors. Some association is found between the use of diuretics and gout. Its sister (affliction) is kidney stones.

Key factors

Extreme cold climate, low levels of fluid intake (water), and high levels of uric acid are the main contributing factors. Human body needs uric acid, so at normal levels it poses no problem. Often, a vicious confluence of all these factors leads to an acute attack. So, if possible avoid extreme cold. Try to take one extra glass of water before going to bed (or spread around the day). Take vitamin supplements daily – particularly vitamin C. Cut down a little on protein rich foods during winter times or at least during the acute phase. High doses of fructose and fasting are also contributing factors.

Cure and Management

Vitamin C helps in eliminating excess uric acid from the system. A dose of 500 mg per day is enough to yield promising results. Rose hips contain high levels of vitamin C; perhaps, this is one of the most inexpensive sources of vitamin C (ascorbic acid). Towards the end of summer season, I have often seen bunches of rose hips hanging idly on the thorny bushes. The Indian gooseberry (fresh fruit) also seems to be a rich source of vitamin C. Grandmothers used to say that gooseberry pickle has many medicinal properties (for warding off ulcers in the mouth, etc.). Ascorbic acid is rather a delicate vitamin, can easily be destroyed in cooking. Cranberry juice (and cranberry pickle) is another source of vitamin C.

Fructose, particularly in large quantities, seems to aggravate the ailment. So, it is better to avoid very sweet (over ripened) bananas or other sugary fruits. Also, honey (invert sugar) too should be avoided during the acute stage. Moderation is the key word. Once the disease is well under control, occasional indulgences in a small piece of ripe banana or chocolate cookie will do no harm. High fructose corn syrup – is the real culprit here. So, read carefully ingredients of cookies and other confectionary items. Always look for juices without high fructose corn syrup or sugar.

The traditional Indian Ayurveda practitioners are fully well versed in the treatment of joint pains and inflammation. The patient should strictly follow their advice about dietary restrictions. Of the vegetarian protein sources, it is advisable to avoid (or at least limit) the use of peanuts and black gram (urad dal), especially during winter months.

So, what to do during a sudden attack? A good doctor will be able to diagnose properly and prescribe modern medicines. For a full recovery and proper management, the patient has to make a few lifestyle changes. Not, very difficult, if one is a little bit flexible. Through the pain, the body is sending subtle signals. Get rid of sedentary habits, get up and take long walks, bike riding, shoveling snow, or yoga – whichever suits you.

Yoga

Sarvanga-asana, Vira-asana, and Paschimothana-asana will yield good results for this ailment. Also, Surya-namaskarams will help in reducing the severity. Swami Vishnu Devananda, in one of the pages gave excellent suggestion for all foot problems: Gently try to walk on toes and heels, do it slowly alternatively. You can practice this on hardwood floor, carpet, or on soft grass (if need be, with insulating woolen socks). Till you get proper balance, use a stick, wall, or fence for support. It promotes good blood circulation in the feet, preserves and strengthens good arches, and gives a gentle massage to the sole.

Once the acute pain has vanished, you can give gentle massage (with warm sesame seed oil, olive oil, ghee, Iodex, or Narayana Tailam) around the big toe. Regular exercise and daily massage should make the injured toe normal. During the acute phase, you cannot do any massage. But you can dip the painful toe in a bucket with cold water, then switch to a bucket with warm water. Then back to cold water. Or, you can give similar treatment while taking a shower bath.

Pain has a salutary effect on the human body. It makes the mind concentrate and slip into meditation. The great Sri Chandrasekharendra Saraswati Swamigal would go into hours of meditation during high temperature fever bouts. He would just describe it thus: It is like sitting in the midst of five fire places and doing meditation (or penance). Why not? Pain, any ailment for that matter, teaches us the fragility of human body. It imparts us much needed humility – after all even with loads of money, at times, you cannot buy immediate cure. Simply not possible. In a tera Hertz cell phone obsessed, instant gratifying world – only pain can teach some valuable lessons of life. Karma has to be depleted slowly through episodes of pain.