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StingMate: A New Treatment For Jellyfish Stings

As many of you know, I serve as a medical advisor to the Diver’s Alert Network (DAN) regarding incidents involving hazardous marine animals. This includes jellyfish (and related animals) stings.

I’m always on the lookout for new therapies or modifications of existing therapies to treat marine stings (envenomations). At a recent gathering of Beneath the Sea, I was introduced to Smithwick’s StingMate intended for jellyfish sting first aid. The product is composed of 5% acetic acid gel containing menthol. Acetic acid 5% is usually the concentration found in household vinegar, and menthol is a component commonly used in topical anti-itch preparations. StingMate is sold in a 4 fluid ounce manual spray bottle. The instructions that accompany the product are standard for proper first aid treatment of a jellyfish (or related species) sting:

1. Apply the StingMate gel
2. Scrape the skin to remove the stinging cells (nematocysts)
3. Reapply the gel
4. Rinse the skin

I would annotate these instructions to allow an initial decontamination time (first application of the gel) to be a minimum time of two minutes. In terms of scraping the skin, the standard dictum is to apply shaving cream (foam) and use a straight-edge razor or very sharp edge to scrape the cream from the skin. The reapplication of gel should once again be for at least a few minutes.

How vinegar is effective is not without some controversy. Most authorities believe that it renders the stinging cells inoperative, so that they cannot fire. That makes the most sense, because it is unlikely that the vinegar could penetrate the skin and neutralize active venom, although it is possible that vinegar might inactivate surface venom that it is able to reach. The important thing is that vinegar is an effective remedy and absolutely essential to treat the stings of most of the world’s most hazardous (and potentially lethal) jellyfish, such as the Indo-Pacific box jellyfish. I have used vinegar effectively for years, so I have every expectation that StingMate will prove to be a clinically useful product.

Oceangoers should be aware that allergic reactions to jellyfish stings are possible, so should also carry allergy medications or an allergy kit with their first aid supplies.

Preview the Annual Meeting of the Wilderness Medical Society, which will be held in Snowmass, Colorado July 24-29, 2009.

Join me from January 24 to February 2, 2010 for an exciting dive and wilderness medicine CME adventure aboard the Nautilus Explorer to Socorro Island, Mexico to benefit the Wilderness Medical Society.

This post, StingMate: A New Treatment For Jellyfish Stings, was originally published on by Paul Auerbach, M.D..

Alcohol At The Beach

In continuing with the theme of getting ready for the beach and water sports this summer, let’s consider what to do about substance abuse. There is no controversy whatsoever about the fact that persons under the influence of alcohol or any other mind-altering substance have a higher incidence of accidents. In fact, ingestion of alcohol figures prominently as a statistic in falls, drownings, motor vehicle accidents and virtually every variety of activity that has ever been studied. The issue, then, is not whether or not alcohol contributes to illness and injury, but to what extent we are able to control its use by reason and, when necessary, prohibition.

Im June of 2008, Solana Beach, California banned alcohol consumption on its beaches for at least a year. This ban continues. Here is what appears on the city’s website:

Alcoholic Beverages – Alcohol is banned at all beach areas in Solana Beach. Alcohol is also prohibited in the parking lot, community center, viewpoint or any other public place adjacent to the beach. Glass is prohibited as well.

There are similar rules at, among others, Torrey Pines State Beach, Cardiff, San Elijo, South Carlsbad and Carlsbad state beaches.

City officials made this move proactively, to avoid the sorts of tragedies and social problems that have intermittently plagued “wet” beaches. Recognizing that judgment is often an irrelevant factor when it comes to drinking alcohol, they made a strong and, in my opinion, laudable move. Like it or not, judgment is impaired by drinking alcohol, so the concept of “responsible drinking” is an oxymoron when water sports and potentially hazardous surf conditions coexist with beer, wine, and liquor. Of course, the same is true for certain prescription drugs and illicit drugs.

Needless to say, civil libertarians and numerous other individuals are opposed to mandated prohibitions. They cite lack of observation of problems, principles of freedom and personal rights, and even the loss of romanticism. The issue obviously has two sides.

From a safety perspective, it’s a no-brainer. There’s no benefit to drinking alcohol and entering the ocean. It can never make you safer, and can only make you less safe. Even if you are able to drink alcohol at the beach and safely dispose of your metal cans and glass bottles, not litter, not be rowdy or obnoxious, and keep your drinking to yourself, the moment you dip a toe, you are a greater risk to yourself and to the lifeguards and other rescuers entrusted to protect you. You may not believe that to be the case, but the stories and statistics don’t support you. Having pulled intoxicated victims from the water, treated them at the scene, stitched their heads and set their broken bones in the emergency department, and having had to tell their families and friends that they are dead (while knowing that none of this would have ever happened had the victims been sober), I am offering well-intentioned advice. Not every city will mandate that you leave your beer cooler at home when you head to the beach. When you need to be the one to decide, choose wisely.

Preview the Annual Meeting of the Wilderness Medical Society, which will be held in Snowmass, Colorado July 24-29, 2009.

Join me from January 24 to February 2, 2010 for an exciting dive and wilderness medicine CME adventure aboard the Nautilus Explorer to Socorro Island, Mexico to benefit the Wilderness Medical Society.

photo courtesy of

*This post, Alcohol At The Beach, was originally published on by Paul S. Auerbach, MD, MS.*

Doctors Really Want Well-Informed Patients

I met a patient today in the emergency department and had what is becoming a common interaction. Despite feeling quite ill, the woman had taken the time to prepare for her visit. When I first spoke with her, she enumerated her symptoms and how frequently she had suffered them. Then she reached into her purse, pulled out a stack of printed pages derived from several medical Internet sites – all of them names you would recognize. The pages covered her specific symptoms, a wide range of possible conditions, and a myriad of treatments. Some of the information was good, and some of it was not so good. But, the information was better than it would have been a year ago, or even six months ago.

This patient’s preparedness pointed out to me how well-informed many consumers are becoming as they attempt to manage own health. The fact that she may have been influenced by some misinformation merely underscores how much responsibility there is for information quality control, and how much of the assurance process is being delegated by default to the individual patients.

My take on this is that certain aspects of healthcare are increasingly shifting to self-care. Between the increased strain on healthcare resources (when was the last time that a doctor in a busy practice could expect to spend more than ten minutes with a patient) and increase in specialization, patients are forced to encounter numerous clinicians and coordinate their responses, in effect becoming navigators of the health care system.

Rather than resent it, I appreciate it when a patient is well informed, particularly if they have the ability to understand some of the basics of disease and disease management. The Internet has vastly changed the landscape of possibilities for understanding and confusion. The sheer quantity of health information that is easily and rapidly available to consumers via the Internet is staggering, and far exceeds what was formerly available to trained medical professionals.

If the reader is not overwhelmed and can apply practical filters to what is presented, then he or she becomes an educated patient. An educated patient makes smarter decisions and tends to be a strong partner in the treatment decision process.

The caveat is that every patient must recognize his or her limitations, and not attempt to self-treat beyond prudent boundaries, which will be determined over time. Of course, if one acts on incorrect information, that is a formula for failure, or worse. But what about good information? The downside of the increasing ubiquity of information occurs when any patient becomes overly convinced of particular facts of his or her diagnosis or treatment in the absence of proper clinical oversight.

I’ve heard colleagues tell stories of patients that were so completely convinced of a self-diagnosis based on articles they read online that they ended up opting not to pursue the treatment path recommended by their providers.  These patients inevitably ended up back in the doctors’ offices, having lost precious time. What this points out is that doctors have the greatest advantage to put everything in context. My advice is simply to be cautious. Even if the source is a trusted medical encyclopedia, “good information” misunderstood or misapplied can slow down the process. The goal is to apply superb information to make a layperson better informed, not overconfident.

As far as getting reliable information into a patient’s hands, in my relationship with Healthline Networks, I’ve advised on and reviewed Healthline Treatment Search, a product that creates customized, medically-guided pathways to inform and empower consumers on important health decisions. Whereas most treatment information is embedded deep within articles on health websites, Healthline Treatment Search surfaces a semantically-generated, stand-alone list of possible treatment options for diseases and conditions. The current release covers nearly 1000 health conditions, and includes 4,500 treatment options and 1,200 over-the-counter and prescription medications, with content from ADAM, Cerner Multum, Gale Cengage, Natural Standard, and others. It is Healthline’s policy that feedback from users, both consumer and professional, will allow their experience and observations to improve the product.

Not everyone is in agreement that the Internet is the best place for a consumer to begin his or her search to diagnosis or for treatment. But I would doubt whether this trend will be curtailed, because as the tools improve, we are witnessing increased demand for information. No other information source with the breadth and reach of the Internet looms on the horizon.

What do you think? If not with information from the Internet, how might we as professionals help empower consumers as they take control of their healthcare decisions? Perhaps another way would be to truly empower practitioners to use the Internet and electronic medical records for decision support, for we are also in need of assistance. Let me know.

*This post, Doctors Really Want Well-Informed Patients, was originally published on by Paul S. Auerbach, MD, MS.*

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