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The Itching Games, Part 1: "Bee-ware"

Posted on Tuesday, August 05, 2014, by Ashley Snyder

By Dr. Kathryne Buege

You have arrived at a summer picnic and, unbeknownst to you, your name has been picked by the Phylum Arthropoda to participate in their annual "Itching Games."  Here are a few survival tips to navigate their playing field.

What is Phylum Arthropoda?

It is the largest division of the animal kingdom. Bees, wasps, mosquitoes, fire ants, black widow and brown recluse spiders, ticks and scorpions, to name a few. This post is dedicated to the bee and insect stings that inevitably cross our paths this time of year.

Toxic reactions to multiple stings by Hymenoptera (wasps, bees and ants) and severe systemic allergic reactions to one or more stings or bites of other insects such as deer flies, black flies, horseflies, and kissing bugs can all present emergency, life-threatening situations. "Bee" aware of what to do when stung by an insect or bee and take appropriate action.

What you need to know about Hymenoptera:

  • The most important venomous insects known to humans
  • This order of species includes honeybees, bumblebees, yellow jackets, hornets, wasps and ants.
  • Honeybees and bumblebees are usually docile and only sting when provoked.
    • Males have no stinger! Yes, ladies - the females pack the punch, but are only able to sting one time and then die.
  • Wasp, hornet and yellow jacket stings cause most of the reported allergic reactions.
    • They nest in the ground, in walls and have volatile tempers.
    • Like honeybees and bumblebees, the females have the stinger, but have the ability to withdraw their stinger, allowing for multiple stings. OUCH!
  • Sting signs and symptoms:
    • Pain, slight erythema (skin redness), edema (swelling) and itching at the sting site
    • In some cases, more serious reactions may develop (anaphylactic reaction).

What to do if you are stung:

  • Remove the stinger and wash the affected area with soap and water. Older conventional methods recommend scraping the sting site with a flat surface, like a credit card.
  • Apply cold compresses.
  • Elevate the affected limb.
  • Control any itching with anti-histamines, such as Benadryl (sedating), Zyrtec (sedating for some), or Claritin and Allegra (non-sedating).
  • NSAIDS (non-steroidal anti-inflammatories) for pain relief
  • H-2 blockers (Zantac) for any gastrointestinal symptoms

Signs & symptoms of anaphylaxis:

  • The majority of reactions occur within 15 minutes, and nearly all occur within 6 hours of the sting or bite.
  • There is no correlation between the number of stings and the systemic reaction.  Typically the shorter interval between the sting itself and the onset of symptoms, the more severe the reaction.
  • Watch for facial flushing, tongue swelling, generalized urticaria (hives), dry cough, throat constriction, vomiting, diarrhea and bluish discoloration in the extremities.
  • Seek immediate medical attention/call 911.
  • If available, use an EpiPen, injected into the muscle, massaging the injection site to hasten absorption.
  • Patients should be monitored/observed for several hours in an acute care setting.

Uncomplicated local reactions typically consist of redness and painful swelling at the sting site, and resolved within a few hours. Occasionally, swelling may last one to two days.

Large, local reactions may have exaggerated redness and swelling that does not resolve until 5 to 10 days later. Most stings do not become infected, although this can occur. An infected sting must be differentiated from a large local reaction, so contacting your medical care facility or MASH Urgent Care for evaluation is a great idea if you experience prolonged or unusual symptoms.

Remember, talk to your health care provider about what treatment regimen is best for you, and "may the odds be ever in your favor!"

How to Tame a Tick

Posted on Tuesday, June 17, 2014, by Ashley Snyder

By Dr. Kathryne Buege

As I mentioned in an earlier blog post, I live in Erie, PA.  We have had an increased incidence of Lyme disease in recent years, and this past spring we have had twice as many ticks reported to the Erie County Department of Health.  Why?  Despite a cold spring, the ticks are hungry and looking to feed.  Yes - the ticks are on a feeding frenzy.  You and your pets are the targets, and I have written this in order to help protect you and provide some insight into the symptoms of Lyme disease.

What should you do?

  • First, protect yourself when you go outdoors.  Wear long pants and tuck them into your socks.  (Not the most fashion forward, but worth the embarrassment compared to contracting Lyme disease!)
  • Use bug spray that contains at least 20% deet.
  • Do a thorough check for ticks when you return home.
  • Take a shower immediately after walking trails or doing yard work. You should also wash and dry your clothes right away, as the the dryer is what kills any ticks.

If you have a tick, how do you remove it?

  • Use fine, flat tweezers and grip the tick as close to the skin as possible.
  • Pull backwards gently but firmly, using an even, steady pressure.   Do not jerk or twist.
  • Do not squeeze, crush or puncture the body of the tick, since its bodily fluids may contain infection-causing organisms.
  • After removing the tick, wash the skin and hands thoroughly with soap and water.
  • If any parts of the tick's mouth remain in the skin, these should be left alone - they will be expelled on their own.  Attempts to remove these parts may result in significant skin trauma.
  • DO NOT use a smoldering match, nail polish, petroleum jelly (e.g. Vaseline), liquid soap, or any other folk remedies, as they may irritate the tick and cause it to behave like a syringe, injecting bodily fluids deeper into the wound.

What are a tick's characteristics?

It is helpful when a patient can provide information about the size of the tick, whether it was actually attached to the skin, if it was engorged (full of blood) and how long it was attached.

  • Deer ticks are brown and approximately the size of a poppy seed or pencil point.  They may transmit Lyme disease
  • Dog ticks are brown with a white collar and are about the size of a pencil eraser.  These ticks DO NOT transmit Lyme disease.
  • Lone star ticks aren't exclusive to Texas, as its name might imply.  This type of tick is brown to black in color with a white spot on its back.  They may be transmitters of STARI (southern tick-associated rash illness), which causes a rash similar to Lyme disease, but has no other similarities.

Only ticks that are attached and have finished feeding or are near the end of their meal can transmit Lyme disease.  A tick that is not attached, easy to remove or just walking on the skin, and still flat, tiny, and not full of blood when removed could not have transmitted Lyme disease or any other infection, since it has not yet taken a blood meal.

When treatment is needed:

  • If the attached tick is identified as a deer tick
  • If the tick is estimated to have been attached for 36+ hours, based on how engorged the tick is and the amount of outdoor exposure

Treatment involves antibiotics, often administered within 72 hours of tick removal.

What are the symptoms of Lyme disease?

  • In the days and weeks after a tick bite, you may experience:
    • a red rash that may develop and expand, however some infected people may not develop a rash. This rash may be uniform in its coloring and is usually salmon in color, but can be an intense red. The rash tends to expand over the span of a few days or weeks, and can reach over 8 inches in diameter.  As the rash expands, the center can become clear with concentric rings appearing around it, giving it a "bulls eye" appearance.
    • flu-like symptoms, such as fatigue, chills, fever, stiff neck, body and head aches
    • swollen lymph nodes
    • additional rashes on the body
    • swollen and painful joints
    • neurological disorders, such as numbness or leg weakness
    • loss of muscle tone in the face
    • heart palpitations
    • dizziness
  • If a small bump or redness at the bite site goes away in 1-2 days, it most likely is not Lyme disease. 
  • Confirmed cases of Lyme disease are treated within 3-6 weeks with antibiotics, which may be given intravenously in more serious cases.

Don't get "ticked" off if you can't remove a tick or are unsure what to do.  When in doubt, seek medical attention immediately at your local MASH Urgent Care or your primary care physician.  Enjoy the outdoors this summer!