Monday, July 19, 2010

DIY medicine on YouTube: It’s not a how-to, people! - The Globe and Mail

Aaron Zube had already been to the emergency room once to treat his broken toes after he had dropped a 120-pound manhole cover on his right foot.

But one evening when the 25-year-old plumber from Hickory, N.C. was enjoying a KFC dinner, the pressure from the blood that was building up behind his big toenail became too much to bear. He couldn't imagine waiting an hour in emergency to have the nail removed, so he pushed aside his plate of fried chicken, macaroni and cheese and potato wedges to perform impromptu surgery with a pair of tweezers.

If you think that sounds gruesome, wait till you see the YouTube video.

Mr. Zube's is just one of a few dozen home toenail removal videos. There are also several that depict cyst excisions, abscess drainages and tattoo removals (the last done with power sanders and a hot spoon burning method). Most popular, though, are the unassisted home births.

Before, doctors worried about patients who self-diagnosed after doing Internet research on questionable medical websites. But the social Web has given birth to a new beast: users who document their DIY medical procedures on camera and share the videos on YouTube.

In Mr. Zube's case, he had a camera right beside him and thought he might as well get the gory procedure on tape.

Toronto media account executive Ryan Narhi, 37, was out of town when he needed surgical staples removed from his elbow (they were put in following a mountain biking injury) and after a few beers in his friend's backyard, decided to take them out.

In a YouTube video he posted that generated more than 8,000 views, he sits in a plastic patio chair while his friend pulls out each of the five staples with an instrument given to him by the doctor who put them in; Mr. Narhi had been told to take the tool to a walk-in clinic.

The first commenter on his video asks a simple question: "y wouldnt u have a doctor do that?"

"To me, it would have felt really silly going to a walk-in clinic to say, 'Could you remove these?' " Mr. Narhi says. "I felt I'd be wasting someone's time to take minutes out of his day to remove them."

Unlike Mr. Narhi, Doug Southern would have preferred to see a doctor, but bad timing meant he was without health insurance. He was laid off from his job a short while before a three-year-old baseball-sized cyst on his back became infected.

When his brother-in-law, a family practitioner, and his sister came to visit him in Tuscaloosa, Ala., he decided to put down a towel and pillow on his kitchen floor and turn it into a makeshift operating room so his cyst could be taken out "Alabama style."

The graphic, seven-minute YouTube video is punctuated with squeals of delight and revulsion from Mr. Southern's sister (the camerawoman) and commentary from the doctor ("Now you see how that's a little bit cheesy there? That's some of the cyst stuff comin' out.").

"I would never recommend anyone doing this at home," Mr. Southern, 41, says. "I obviously did it, but the situation I was in kind of allowed me the ability to have that done and it be controlled and somewhat safe."

His video was posted mostly for entertainment ("You don't want to see it, but once you see it happening, you can't take your eyes off it," he says) but it was uploaded to the "Education" category of YouTube.

That's where doctors say the problem lies if viewers see these videos as how-to guides.

Particularly troubling to Richard Musto, a public health physician with Alberta Health Services in Calgary, are the videos that depict unassisted home births, some of which have garnered millions of hits and several comments from expectant mothers eager to learn about the procedure.

Last month, a 14-year-old girl in Texas was charged in relation to the death of her newborn boy, whom she left in a dumpster. The baby died minutes after he was born and investigators suggest it may have been because the afterbirth blocked his airway. The girl and her younger sister learned how to deliver the baby at home after watching videos on YouTube.

"You can understand it's a natural thing, but things go wrong in childbirth and that's why you need to have someone that's properly trained to manage that," Dr. Musto says.

"Really, it's an extension of what the Web has done for medical care already. Part of the march of access of information," says Simon Kingsley, the acting chief of the department of emergency medicine at St. Michael's Hospital in Toronto.

He's seen the aftermath of DIY medicine in the emergency room: People drain their own boils with sewing needles and contract infections, others remove their own casts early "and get a non-union of a bone in their wrist that will hurt them every day for the rest of their lives."

"I get patients asking me a lot, 'Can I take these sutures out myself?' If you take them out the wrong way you're left with a chunk of nylon under your skin that can cause infection," he says.

Mr. Zube got through his at-home toenail removal with a lot of blood, but no infections. He sterilized the tweezers before he used them by boiling them and soaking them in alcohol. He dressed his wound after with sterile gauze.

While certain procedures may seem foolproof, Dr. Kingsley still says patients should see doctors or nurses for them just for the one-in-10 chance that things go wrong. Looking up a video of an abscess drainage or a toenail removal performed by a doctor may be helpful to prepare a patient for that same procedure, he says, "But doing it? That's just crazy."