Wednesday, August 13, 2008

We learned the hard way: wasp stings can be lethal

the Common Aerial Yellowjackets that went after Ken (photo by Richard Stenhouse)

After our frolic in Peru (see the last few posts), we had an "adventure" of a different kind much closer to home. Last weekend, my husband Ken met up with two yellowjackets who almost killed him, on a 3-day camping trip. The event rattled our cages pretty profoundly. I decided to write this post to share what we learned from the experience. Ken's a biology teacher who understands the immune system thoroughly and I'm an environmental writer, yet neither of us was prepared for the events that unfolded after the yellowjackets nailed him.

We were at Grayson Highlands State Park in Virginia with our extended family and some friends.

some of our family members at the campsite

It's a great park for camping and mountain hiking, with Mount Rogers, the highest point in Virginia at 5,729 feet. Our family meets there every August, when the wild blueberries along the trails are ripe and the nights offer meteor showers. The kids love the wild ponies at Massie Gap.

ponies at Massie Gap in Grayson Highlands State Park, Va.

our family on the trail at Grayson Highlands, l to r: son Alan Kneidel, nephew Tom with his daughers Maddie and Ali, and Pam & Richard Stenhouse

Ken's unfortunate encounter with the yellowjackets happened when he went into the woods to get sticks for a campfire and yanked a dead stick dangling from a tree. He disturbed a nest of yellowjackets in the tree; they stung him once on his ear and once on the side of the neck.

About 25 years ago Ken was stung by some kind of wasp about 20 times while helping with his advisor's field research at UNC. About 12 years ago, the same thing happened on an earlier version of this same annual family camping trip. After that second time Ken got a rash about a week after the stings; his doctor told him it was an allergic reaction and he should carry an EpiPen. So Ken got an EpiPen and for years he took it on trips.

As the years went by we both began to doubt that Ken really was allergic. He was stung by a honeybee a couple of times and nothing happened. (Turns out people who are allergic to wasps are usually not allergic to honeybees...but nobody ever told us that). We both got pretty lackadaisical about his carrying an EpiPen. We didn't even take one to Peru. Over the years he's been bucking through brush while birding or walking in the woods; in Peru he was off alone in the rain forest with all kinds of wasps around him. We know now he's been taking big chances over and over.

When Ken got stung last weekend in the woods, his first action was to run up the hill to the campsite. He said he was scared because the neck sting was right over his carotid artery, the artery carrying blood to the head and brain. At the time of the sting - late afternoon - most of our family and friends were still out hiking. Only myself and our daughter Sadie were at the campsite, along with my sister-in-law Marty. Ken took two Benadryl tablets as Marty ran off to ask other campers for an EpiPen. Then he sat down in a camp chair with an improvised ice-pack, but just a few seconds later he called out to Sadie and me that he was "losing it" and that it was "happening fast." He pleaded with us to get help and especially to find an EpiPen somewhere. Then he did lose it - Sadie ran to catch him as he passed out. His eyes were still open, but his face was gray and he went completely limp and unresponsive. We didn't know if he was dead or alive. As we learned later, he was in anaphylactic shock.

All that happened in the first 5 minutes after he was stung.

I was completely freaked out. What to do? There was no one close by. But we couldn't leave him. The only thing to do was scream for help. So we did. Sadie and I screamed "medical emergency, help!!" and "911" over and over as loud as we could. Within a minute, two campers pulled into a campsite about 100 feet away - they were both emergency medical technicians! But they had no gear with them. Still, they recognized anaphylactic shock and a plunging blood pressure and knew that Ken had to lie down - he had no detectable pulse at all. He was alive, but his blood pressure had plunged to about 50, too weak to feel it in his wrist or neck. Cool-thinking Sadie suggested putting Ken in the van and driving him up to the camp store where there's a phone, where we could find the rangers and call an ambulance. Travis the EMT and a friend who had shown up carried Ken to the van. Sadie drove the van, with Travis tending to Ken, up the hill to the ranger station, passing a woman walking along the road with her husband. The woman was headed to the camp store too, and amazingly she was carrying 3 EpiPens in her pocket. She has asthma and always keeps them with her, she told us later. She heard Sadie and me yelling for an EpiPen and a few seconds after we arrived at the camp store, she gave us one. I can't describe the relief we felt.

Travis stabbed the EpiPen into Ken's thigh (still lying in the van) and Ken cried out in pain - it's a hefty needle. Ken opened his eyes immediately but was still only semiconscious. After a couple more minutes though he regained consciousness and was able to respond weakly to our voices and touches. He lay in the van for another 45 minutes while a volunteer ambulance made its way to the campground over the narrow mountain roads. Travis kept his fingers on Ken's wrist feeling for a pulse. I was running from person to person, spitting out questions like a nut case - questions no one could answer, like "is he gonna be all right???" We did what had to be done, as a group, but it wasn't because I was calm and collected. I was frantic. At one point our friend Fred came up behind me and just grabbed me by the shoulders and held me for a moment, just to make me stand still. That really helped me get a grip.

When the ambulance finally arrived, it was another 45 minute drive to a hospital.

Ken was conscious by the time the ambulance came, thanks to the EpiPen.

The ambulance EMTs gave Ken an IV that helped restore his blood pressure, and by the time we arrived at the hospital, his face had pinked up. His blood pressure had risen to 80 when they first measured it in the ER. The hospital doctor said he would have died if he hadn't gotten the EpiPen. She ordered Prednisone or Decadron or some other steriod injected into his IV, to suppress his immune system, plus an H2 blocker, Tagamet. (Who knew Tagamet and Pepsid are histamine blockers?) After Ken's blood pressure was back up to 105, they released him from the hospital with a handful of prescriptions.

me (Sally) and Ken at the campground the day after the stings: feeling better

So…all's well that ends well. We've been shaken the last few days - Ken, Sadie, and myself. Unfortunately, school started this week, which is always a sort of stressful week. Sometimes we're not sure where the stress is coming from - work, or our continuous need to review the events of the fateful weekend.

Ken's carrying an EpiPen everywhere now and will start desensitization therapy in a couple of weeks. This is a very successful procedure for reducing or eliminating wasp allergies. He'll get increasing doses of wasp venom weekly, then monthly, for several years (starting at about 1/1000th of one sting). The weekly trips will be inconvenient, but he can't live his life the way he wants to in constant fear of wasps. This past week, it's been frightening for him being outside and seeing wasps flying around. He says he feels like someone at Yellowstone brushing by a grizzly bear every few minutes. For me, I've never been afraid of any animal (and never has Ken really) - even the various vipers we've seen in the tropics. But I am now. My heart will skip a beat every time I see a wasp, I think, from here on out.

Tips for preventing stings from eMedicineHealth

Note about yellowjackets: Yellowjackets and hornets are in the insect family Vespidae. They are both types of wasps. Vespidae is just one of several wasp families. We identified the species of yellowjackets that stung Ken by using the photo at the top of this post, which my brother Richard Stenhouse took. It's the Common Aerial Yellowjacket, Dolichovespula arenaria. The website helped us identify it (use the search window on the website). In general, yellowjackets have yellow and black striped abdomens, while hornets are largely black.

Cool-headed Sadie in foreground, with other family members: 6-yr-old Lily, and Pam and Richard Stenhouse

Photos by Sadie Kneidel, Marty Stenhouse, Jim Stenhouse, Mike Stenhouse, Richard Stenhouse

Keywords:: wasp allergy hornet allergy yellowjacket allergy epipen anaphylactic shock anaphylaxis low blood pressure desensitization therapy allergic to wasps common aerial yellowjacket Dolichovespula Richard Stenhouse Alan Kneidel Sadie Kneidel Ken Kneidel Sally Kneidel

1 comment:

Anonymous said...

stephI was interested in reading your blog regards your husband because i had a similar experience. When I was 5 or so I got stung by a dozen wasps and had a very mild reaction, then last year at the age of 36 one yellowjacket stung me in the arm, and withing 10 mins I was loosing conciousness, blood pressure dropping, full body hives,major back pains, vomit, diareha etc. I was 5 mins drive from the hospital, but the nurses treated me pretty crappy and didnt hook me up to oxygen and give me the drugs for at least 15 mins...I don't know if they thought I was faking it or on drugs or something! Anyhow, I've been going to an allergist for immulogy shots for about 9 months now, and I am still on 30% dillution and very low level and sometimes I get tight throat and ears , swelled tongue reaction. Funnily enough I do not get a rash. The doctor does not hold much hope of me ever being able to tollerate full shots.

I was wondering how your husband did with his shots and if he has heard of anyone not being able to tollerate the shots?

feel free to respond to my email below