We hunters find ourselves in a unique position in terms of our risks of encountering all manner of crawling and flying pests. We are “big game” when it comes to these critters. We are fortunate that arthropods do not have a SCI like organization teaching them hunting ethics for almost all these predators only wound their game. Some however can make one shot kills! We being the game animals for these bugs and the like, we need to be wary and prepare for their (our) hunting season.
The subject of arthropod (insects, spiders, scorpions, etc) bites and stings and their consequences can fill books. What we plan to do here is not to focus on these animals as disease vectors, but to deal directly with the management of their shots fired directly at us. Information about malaria has been covered earlier and can be found on our web site. We plan an extensive article on Lyme disease, spiders, and scorpions bites in upcoming issues and will no doubt visit some of this illnesses carried by bugs later.
OK, so hymenoptera? Well, in order to renew our medical licenses we have to use confusing Latin instead of plain ‘ol English at regular intervals. Now that we have that base covered, hymenoptera are the family of insects that includes bees, wasps, hornets, ants and yellow jackets. These animals are widely distributed wherever we hunt except the extreme north. You can not help but to run into these bugs in the woods, bush or field. Unlike their cousins; spiders and scorpions, hymenoptera lack a systemic toxin per se. They are capable of the minor wound and in some people the fatal shot (anaphylaxis). Let’s start with the most common sequel, the local wound.
The local wound created by a hymenoptera sting is usually of nuisance quality only (we are talking about the sting itself). Pain, itching and a raised hive like lesion are the most common reaction. We always get asked about techniques for removing the “poison sack” from a hymenoptera sting. You can link to a picture illustrating the technique from our web site. Treatment involves the removal of any foreign tissue (stingers), careful washing, and topical creams and ointments to reduce pain and itch. Infection is possible and should be watched for. An expanding area of redness, abnormal warmth and pain a day or so after the sting may be a sign of cellulitis and may require antibiotics such as Keflex.
Home remedies abound for the treatment of these types of stings. We think we have heard it all but would love to hear from you. Tobacco juice, lemon juice, meat tenderizer and lots of more…er...exotic cures have been brought to our attention over the years. If you have a home remedy, please send it via the web site and we’ll post the collection. Who knows, Alfred Nobel’s people may be contacting you (I wonder what there is to hunt in Stockholm?)
Of much greater concern is potentially fatal allergic reaction known as anaphylaxis. In cases of anaphylaxis, it is the body’s own over reaction that is the problem, not the toxicity per se of the sting. These reactions can occur after the first exposure but is more common after several exposures. Because these reactions are fatal it is critically important to have an idea about your risk. A family history of “allergy” to stings mandates getting yourself tested. As a seven year old, I almost lost my father to a yellow jacket sting. I was tested, found allergic and treated. To this day, I carry an Epi-pen and Benadryl into the field. Even in the absence of a clear family history, if your reaction to previous stings resulted in hives then you are at risk and you must get tested. Swelling or pain at the site of the sting is not a risk for a future anaphylaxis from another sting. Anaphylaxis due to hymenoptera stings kills an estimated 100 per year in the USA alone, so this is the real deal. You don’t want to be that other guy.
Anaphylaxis of course also occurs in the non-hunting setting. Common every day causes include food allergies (peanuts being notorious) and medications (penicillin, IV contrast dye). The pathology with these causes are essentially the same as with the bee sting; the body simply over reacts to the presence of a foreign substance. It is estimated that 15% of the American population is at risk for a possible anaphylactic reaction if exposed to a provoking agent.
What happens in an anaphylactic reaction is that the body’s defense systems react extremely rapidly and vigorously to the stuff injected during the sting. A normal bodily response would be to bind to the foreign proteins and hence de-activate them. No big deal happens all the time. In anaphylaxis, the body’s defenses are inappropriately primed, ready and send off a cascade of chemical messengers that bring in other defense mechanisms until the process of self defense becomes life threatening itself.
Clinically, anaphylaxis starts with an exaggerated skin response to the sting. Usually hives begin to form, not just at the site of injury but all over. Diffuse reddening of the skin and wide spread itching are very common and occur within minutes to an hour or so after the exposure. These skin symptoms are mostly caused by a massive flood of histamine released in response to the sting. By themselves these dermal symptoms are self limited. Prompt administration of OTC oral antihistamines (like benadryl) can greatly reduce the symptoms and may reduce the likelihood and / or severity of the syndrome’s progression toward real trouble.
Real trouble involves the further release of numerous chemical mediators with long names. We already met our confusing doctor speak quota so we won’t list them all. Suffice to say that there are several normal body functions that begin to go awry. The risk to life starts with the involvement of the respiratory system. First the upper respiratory system gets involved with symptoms ranging from sneezing, runny nose, red watery eyes. This can be followed by a sense of ones throat closing up (laryngospasm).
Progression is rapid at this point. The chemical mediators loosen up the bonds in certain blood vessels causing them to leak out fluid (not blood cells). The result can be severe lowering of blood pressure (hypotension, and possibly shock) as well as fluid accumulating in the lungs (pulmonary edema). Combine this with spasms of the breathing tubules (bronchospasm) and it is clear that this is a bone fide emergency of the highest order.
If you suspect that you or a member of your party is developing an anaphylactic reaction, begin to evacuate to formal medical care as soon as possible. Delay can be life threatening. Often however, we find ourselves hours and even days away from such care. Therefore a discussion of field treatment is in order. There are two basic groups of medicines that can be used in the field to treat anaphylaxis.
Anti-histamines are safe and well known entities. There is hardly a person around who has not taken a Benadryl. At the first indication of a skin reaction (hives, diffuse reddening) an oral dose of 50 to 100mg of Benadryl is safe place to start. Follow this up with another 25 to 50mg every 6 hours for a day or so. This intervention will reduce the severity of the reaction and may even prevent a more serious syndrome from developing. While safe and with relatively few contra-indications, we recommend a discussion with your personal physician before you take this or any other medicine into the field for unsupervised use. Be aware that Benadryl can cause sedation. So we further recommend that even if the syndrome is aborted and you feel fine that you put your firearm away for the duration of treatment.
The more serious complications from anaphylaxis require a more serious medical intervention. Epinephrine (adrenaline) increases blood pressure, relieves bronchospasm and can be absolutely live saving in an advancing reaction. It is available in the form of a standard dose injection via a pen type device that is made to be easily carried into the field. This medication can also flat out kill you as well by causing a heart attack or an irregularity in your heart beat. If there is ever a medication that requires a complete and thorough consultation with your personal physician prior to use, it is this one. Fortunately your adventure into emergency medical services at least when it comes to obtaining an “Epipen” will require a prescription that will absolutely generate discussion between you and your doctor (or get a new one immediately).
The Hunt Doctors want to emphasize that prevention is key. Sting avoidance requires common sense and can prevent more than just a pain in the …uh…arm. Never enter the wilderness without a full knowledge of the nearest formal medical care and a plan of evacuation if needed.
As always be safe and enjoy the great outdoors.