Parasitic Worms that can Penetrate Intact Skin


ISSN: 1059-6518

Parasitic worms and shoes – all about why, to stay healthy, we wear shoes.

By Frank Hubbell, DO

Illustrations By T.B.R. Walsh

The intention of this article is to explain why you should never, ever walk around the great outdoors barefoot, and why you should never, ever lie on moist ground exposing unprotected bare skin to the soil.

The reason is actually quite simple and a bit disgusting. There are parasitic worms that can live in warm, moist soil. When they come into contact with your skin, they will latch on to you, make a hole in your intact, healthy skin, and burrow into you. Once inside, they will proceed to their target organ, usually your intestinal tract, and parasitize you. As their unwilling host, you become sick and are now part of their life cycle.


Helminthes are parasitic worms in the Kingdom of Animalia.

Within this Kingdom there are two Phylum of parasitic worms, Platyhelmenthes and Nematoda.

The Phylum of Platyhelmenthes has two Classes of parasitic worms, Cestodes – tapeworms and Trematodes – flukes and flatworms.

The Phylum of Nematoda contains one Class of parasitic worms, Nematoda – roundworms.

There are many ways to divide up the world or parasitic worms. One way to distinguish them is by how they enter and parasitize their host. Most commonly, these parasitic worms gain entrance via the alimentary canal when you consume contaminated food or water. The other way is by penetrating intact, healthy skin.

In this article we are going to review the parasitic worms that gain access to their host by directly penetrating intact, healthy skin.

Parasitic Nematodes that enter the body by penetrating intact skin:

Necator americanis /Ancylostoma duodenale – hookworm

Ancylostoma braziliense – cutaneous larva migrans

Strongyloides stercoralis – threadworm

Parasitic Trematodes that enter the body by penetrating intact skin:

Schistosomiasis – swimmer’s itch

All of the other parasitic worms: cestodes – tapeworms, nematodes – round worms, and trematodes – flatworms and flukes, enter by ingestion of the infectious parasite in food or water.

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Elbow Injuries and Ankle Injuries


Elbow Injuries and Ankle Injuries


By Frank Hubbell, DO

Illustrations By T.B.R. Walsh




A couple is hiking down a trail into the Grand Canyon, enjoying the day and looking forward to reaching some shade at the bottom. The trail is in good shape with the occasional rock in the middle of the trail. The female companion unfortunately stubs her toe on a rock and falls. She falls forward, downhill, with a 40# pack on her back. She instinctively reaches out with her right hand to control the fall. As her right hand impacts the ground with her arm straight, she feels an intense searing pain in her right elbow, a sharp snap, and her arm collapses. Crumbling onto the trail, she immediately rolls over and grasps her right elbow in her left hand, letting her companion know that her right elbow is in excruciating pain.


Upon examination, he finds that the elbow is very tender to palpation and is locked in position at 90 degrees of flexion. The elbow is deformed and looks like the butt of a gun, a gunstock. He also notes a decreased sensation in her fingers and no radial pulse at her wrist. Over the next half hour her right hand goes from pale to cyanotic, with pins and needles sensation in her fingers, and she is unable to move her fingers.




Elbow pain is the second most common reason to see an orthopedic surgeon, the first reason being shoulder pain.

The “funny bone” is not a bone. It is actually the ulnar nerve. When you bump the nerve, you are going to have temporary pain and tingling in the forearm distal to where the nerve goes over the lateral aspect of the elbow.

“Tennis elbow” is a sprain of the lateral aspect of the elbow referred to as lateral epicondylitis.

“Golfer’s elbow” is a sprain of the medial aspect of the elbow referred to as medial epicondylitis

“Student elbow” is caused by leaning on the elbow while studying. This compresses the bursa over the olecranon of the ulna, causing it to become inflamed and swollen. This is referred to as olecranon bursitis.





There are 3 bones that make up the elbow joint.

Humerus – the upper arm

Radius – the forearm

Ulna – the forearm

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November/December 2010   ISSN-1059-6518  Volume 23 Number 6

By Frank Hubbell, DO

Illustrations by T.BB.R. Walsh


It may sound trite, but one of the riskier activities for hikers is crossing streams. Not major white water rivers with Class 3 or 4 rapids, but small, shallow, slow-moving streams and rivulets that are 1 – 2 feet deep and 6-10 feet wide with a stream bottom that is lined with smooth river stones and many larger rocks sticking up several inches above the water. The stones are just close enough together to make hopping from one wet, slippery rock to another impossible to resist.

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September/October 2009 ISSN-1059-6518  Volume 22 Number 5


By Frank Hubbell, DO

Illustrations By T.B.R. Walsh

Injuries to the fingers and toes are very common regardless of whether you are in the backcountry, on the high seas, or at home. We somehow manage to sprain, strain, fracture, or dislocate them with an alarming frequency. These injuries are the bread and butter of emergency medicine. However, when these injuries occur alone, they seldom require 911 and a ride to the local ER via ambulance.

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