Attack of the Bees

It has been found that four out of every one thousand persons are so allergic to insect venom that a single bee sting can cause fatal reactions in the body within fifteen minutes of a sting. In the case of honey bees, once the bee has stung an individual, its barbed sting cannot be withdrawn once it has penetrated the skin. The only way the bee can escape is to tear away part of its abdomen leaving the barbed sting and attached venom sac. The muscles of the bee’s stinger continues to pulsate even after the bee has flown away, allowing the stinger to drive deeper into the skin, injecting more venom. Immediately removing the stinger by scraping, not pulling will reduce the amount of venom injected into the body.

An interesting fact that I found concerning allergic life threatening reactions stated that: “In sting-induced deaths, the venom toxins, themselves, are of no direct consequence in causing death. What are important are:

• How long the body had had to experience previous stings and develop sensitization,
• How well and how normally the immune system functions, and
• How the rest of the body reacts during an acute anaphylactic episode…venom-induced allergy can be viewed as a malfunctioning of the immune system and its system of regulation

I have always thought that it was the insect venom that the individual was allergic to. I didn’t know that the reaction to insect venom was a result of a faulty immune system.

An allergic reaction occurs when the immune system of the body overreacts to the allergens in the venom, which is referred to as a hypersensitivity reaction. White blood cells begin to produce antibodies to the protein in the venom. The allergic reaction occurs when the antibody, immunoglobulin E, or IgE, comes in contact with the protein. IgE promotes the release of chemicals and hormones called mediators. Histamine is an example of a mediator. Effects of the mediators on organs and other cells causes the symptoms of the allergic reaction.

Two types of reactions are associated with bee stings: (1) local and (2) systemic: allergic or life-threatening. Local reactions are generally characterized by pain, swelling, redness, and itching and lasts only a few hours. There are also two types of bee venom hypersensitivity: Type I is the usual reaction from venom affecting mast cells which release histamines, and Type III produce delayed reactions to stings controlled by a substance called precipitin.

In the allergic individual, a longer lasting (24-48 hours) and severe reaction will occur. Severe reactions include swelling and itching, faintness, sweating, pounding headache, stomach cramps or vomiting, tight chest or choking sensation with swelling of the throat.

Life threatening reactions are more likely to occur in people who are already known to be allergic to bee venom, older individuals with a pre-existing heart condition or those with multiple stings. The most severe case of allergic reaction to bee stings is anaphylactic shock.

Every time I think about bee stings, I remember the movie “My Girl.” Bee stings can be a very fatal event if one’s immune system cannot react to the venom properly. So whenever you see a bee, run far, far away!

For More Information, visit these websites:

• Allergy Society of South Africa
• Emedicine Consumer Health - Allergy: Insect Sting
• Bee Stings & Allergic Reactions

What are Doggies Shouldn't Eat!

Some foods which are edible for humans, and even other species of animals, can pose hazards for dogs because of their different metabolism. Some may cause only mild digestive upsets, whereas, others can cause severe illness, and even death.




Here is a list of some foods and their effects:

• Grapes & Raisins
  Both grapes and raisins can be toxic. Some dogs eat them with, seemingly, no ill effects. However, some dogs become ill after ingesting only a few grapes or raisins. The first symptom is vomiting, followed by acute kidney failure, from which many dogs do not recover. As of yet, the toxin is unknown, nor do we know why some dogs become sick and others eat grapes or raisins without a problem.


• Bread Dough
  The yeast-containing bread dough can ferment in the dog's stomach, releasing large quantities of alcohol which can cause alcohol poisoning. Small dogs are most susceptible to this toxicity.

• Macadamia Nuts
  The ingestion of as few as six macadamia nuts has caused paralysis in dogs. Dogs with macadamia poisoning will appear anxious and have difficulty moving their rear legs. The legs may appear to be painful. Luckily, the paralysis is temporary and clears up within a few days. The causative agent of the paralysis is unknown.


• Various Fish
  Salmon and trout can be infected with a parasite called Nanophyetus salmincola, a type of trematode worm. The worms themselves can be infected with a type of bacteria known as Neorickettsia helminthoeca. The bacteria only infects canids; other animals show no symptoms from eating it. When dogs eat raw fish infected with this bacteria, they can show symptoms including weakness, vomiting, loss of appetite, swollen glands, and fever. Ninety percent of untreated dogs die. Cooking kills the worm and the bacteria.


• Onions & Garlic
  Onions and garlic contain a chemical called thiosulfate. When ingested either in large quantities or in small quantities over a long period of time, they can cause an anemia called Heinz body anemia. This is reversible if you stop feeding the onions or garlic.


• Xylitol – Artificial sweetener
  This toxicity usually occurs when dogs eat large amounts of sugar-free candy or gum. In humans, xylitol does not cause a drop in blood sugar; in dogs it does. This can lead to weakness, staggering, and other symptoms of hypoglycemia. There is also some evidence that some dogs may develop liver failure after ingesting xylitol.


• Foods with High Fat Content - e.g. Turkey Skin
  In dogs, pancreatitis often results from eating a very high-fat meal. While dogs that are used to eating a high-fat diet, like sled dogs, can eat pure fat with no problems, dogs that are not used to such foods often cannot. When such a dog eats a high-fat meal, its pancreas overproduces enzymes, to the extent that they actually begin to "digest" the pancreas and inflame it. Common culprits are turkey skin and ham fat. Symptoms include vomiting and stomach pain. This is a medical emergency, and such dogs must be treated by a vet. Some breeds, like miniature schnauzers, are genetically predisposed to pancreatitis.


• Mushrooms
  Various species of mushrooms are toxic to dogs, and can cause shock and death. Effects will differ depending on the type ingested, but avoid feeding any type. Pluck "backyard mushrooms" that might sprout on the lawn, as these are known to be toxic to canines.


• Tomatoes and tomato plants
  Tomatoes of all kinds are toxic to cats, as are parts of the tomato plant. Ingesting as little as a cherry tomato can cause severe gastrointestinal upset.


• Chicken Bones
  Though not toxic, chicken bones can get stuck in the roof of the mouth, throat and intestines, and should be avoided, according to many veterinarians. Splinters of chicken bones can also become lodged internally. Cooked chicken bones are more dangerous than raw bones as they are more brittle and can splinter more easily.


• Other foods to avoid include: raw potatoes, especially those containing green spots; nutmeg; and anything with caffeine, including tea. Alcohol and hops should also be avoided as alcohol poisoning can lead to coma and death. Do not allow your pet to rummage through the trash, as moldy food contains toxins that can cause serious illness.

For additional Information visit these websites:

Known Toxic Foods for Dogs

Plants Poisonous to Dogs

Toxic Plants for Dogs

Animal Toxins - Here are things on the list that are common in Hawaii: aloe, avocado, bird of paradise, hydrangea, macadamia nut, marijuana, taro vine, and tomato among others.

ASPCA – The American Society for the Prevention of Cruelty to Animals: Animal Poison Control Center

Sinus infection, or sinusitis, is an inflammation of the sinuses and nasal passages. A sinus infection can cause a headache or pressure in the eyes, nose, cheek area, or on one side of the head. A person with a sinus infection may also have a cough, a fever, bad breath, and nasal congestion with thick nasal secretions. Sinusitis is categorized as acute (sudden onset) or chronic (long term, the most common type).

Anatomy of the sinuses (also called paranasal sinuses): The human skull contains 4 major pairs of hollow air-filled sacks called sinuses. These connect the space between the nostrils and the nasal passage. Sinuses help insulate the skull, reduce its weight, and allow the voice to resonate within it.

• Frontal sinuses (in the forehead)
• Maxillary sinuses (behind the cheek bones)
• Ethmoid sinuses (between the eyes)
• Sphenoid sinuses (behind the eyes)

The sinuses contain defenses against foreign bacteria (germs). If a disruption occurs that affects the normal host defenses inside the sinuses, those defenses may allow bacteria, which are normally present in the nasal passages, to enter any of the sinuses. Once there, the bacteria may stick to the lining cells and cause a sinus infection.

Sinus Infection Symptoms
Ethmoid sinusitis (behind the eyes)

• Nasal congestion with discharge or postnasal drip (mucus drips down the throat behind the nose)
• Pain or pressure around the inner corner of the eye or down one side of the nose
• Headache in the temple or surrounding the eye
• Pain or pressure symptoms worse when coughing, straining, or lying on the back and better when the head is upright

Maxillary sinusitis (behind the cheek bones)

• Pain across the cheekbone, under or around the eye, or around the upper teeth
• Pain or pressure on one side or both
• Tender, red, or swollen cheekbone
• Pain and pressure symptoms worse with the head upright and better by reclining
• Nasal discharge or postnasal drip
• Fever common

Frontal sinusitis (behind forehead, one or both sides)

• Severe headaches in the forehead
• Fever common
• Pain worse when reclining and better with the head upright
• Nasal discharge or postnasal drip

Sphenoid sinusitis (behind the eyes)

• Deep headache with pain behind and on top of the head, across the forehead, and behind the eye
• Fever common
• Pain worse when lying on the back or bending forward
• Double vision or vision disturbances if pressure extends into the brain
• Nasal discharge or postnasal drip

Sinus Infection Treatment
Self-Care at Home

• Drink plenty of water and hydrating beverages. Hot tea is often recommended.
• Inhale steam 2-4 times per day by leaning over a bowl of boiling hot water (not while the water is on the stove) or using a steam vaporizer with a towel over the head and bowl to prevent the escape of the steam. Inhale the steam for about 10 minutes.
• Taking a hot, steamy shower may also work. Mentholated preparations, such as Vicks Vapo-Rub, can be added to the water or vaporizer to aid in opening the passageways.
• Expectorants are drugs that help to expel mucus from the lungs and respiratory passages. They help to thin mucous secretions, enhancing drainage from the sinuses. The most common is guaifenesin (contained in Robitussin, for example).
• Over-the-counter (OTC) liquid cough medications or prescription tablets can also combine decongestants and cough suppressants to reduce symptoms as well as to eliminate the need for the use of many medications. Read label ingredients to find the right combination of ingredients or ask the pharmacist for help.
• Pain medication such as ibuprofen (Motrin and Advil are examples), aspirin, and acetaminophen (Tylenol is in this category) can reduce pain and inflammation. These medications help to open the airways by reducing swelling

Medications

• Decongestants help to reduce airway obstruction and are important in the initial treatment to alleviate symptoms.
• OTC nasal sprays (Afrin, Neo-Synephrine, Naphcon Forte, Otrivin, for example) work the fastest—within 1-3 minutes. However, these agents should not be used for more than 3 days because they become less effective and more frequent applications become necessary to attain the same clarity in breathing. This "rebound" phenomenon can be reduced by alternating between nostrils and using the medicine less frequently.
• OTC oral decongestants (in tablet or liquid form) contain the active ingredients pseudoephedrine, phenylephrine, or phenylpropanolamine. (CAUTION: Phenylpropanolamine has recently been recalled from the market. Do not use products that contain this ingredient.) Usually, oral decongestants achieve their effect within 15-30 minutes. As with the nasal preparations, oral decongestants may become less effective with prolonged use. The rebound phenomenon exists but is not nearly as severe.

Eliminate infection

The chief goal of treatment is wiping out bacteria from the sinus cavities with antibiotics. This helps to prevent complications, relieve symptoms, and reduce the risk of chronic sinusitis.

• For acute, uncomplicated cases, a synthetic penicillin is used—most commonly amoxicillin (such as Amoxil, Polymox, Trimox). This antibiotic has good effectiveness against the usual microorganisms and is relatively inexpensive. Amoxicillin’s main side effects include allergic reactions (throat swelling, hives) and stomach upset.
• People allergic to penicillin can take a sulfur-containing antibiotic called trimethoprim/sulfamethoxazole or TMP/SMX (such as Bactrim, Cotrim, Septra). This drug is not recommended for people who are allergic to sulfur.
• Prescription antihistamines such as fexofenadine (Allegra), loratadine (Claritin), or desloratadine (Clarinex) do not seem to dry out the mucosa. If nasal congestion is severe, a decongestant can be added (for example, Allegra-D or Claritin-D).

For More Information

National Institute of Allergy and Infectious Diseases, Sinusitis

MedlinePlus, Sinusitis

Sinusitis

The Sneak Thief of Sight

There are several standard glaucoma tests available to patients. Glaucoma testing is called tonometry. Two of the most common methods for testing eye pressure are Applanation tonometry and Non-Contact Tonometry.

A tonometry test measures the pressure inside your eye, which is called intraocular pressure (IOP). This test is used to check for glaucoma, an eye disease that can cause blindness by damaging the nerve in the back of the eye (optic nerve). Damage to the optic nerve may be caused by a buildup of fluid that does not drain properly out of the eye. See an illustration of the eye .

Tonometry measures IOP by recording the resistance of your cornea to pressure (indentation). Eyedrops to numb the surface of your eye are used with most of the following methods.
Tonometry methods:

Applanation (Goldmann) tonometry: This type of tonometry uses a small probe to gently flatten part of your cornea to measure eye pressure and a microscope called a slit lamp to look at your eye. The pressure in your eye is measured by how much force is needed to flatten your cornea. This type of tonometry is very accurate and is often used to measure IOP after a simple screening test (such as air-puff tonometry) finds an increased IOP.

Electronic indentation tonometry: Electronic tonometry is being used more often to check for increased IOP. Although it is very accurate, electronic tonometry results can be different than applanation tonometry. Your doctor gently places the rounded tip of a tool that looks like a pen directly on your cornea. The IOP reading shows on a small computer panel.

Non-contact tonometry (pneumotonometry):Non-contact (or air-puff) tonometry does not touch your eye but uses a puff of air to flatten your cornea. This type of tonometry is not the best way to measure intraocular pressure. But it is often used as a simple way to check for high IOP and is the easiest way to test children. It may also be used for people who have had laser-assisted in-situ keratomileusis (LASIK) surgery. Non-contact tonometry does not use numbing eyedrops.

Indentation (Schiotz) tonometry: This type of tonometry uses a plunger to gently push on your cornea. The pressure in your eye is measured by how much weight is needed to flatten your cornea. This test is not as accurate as applanation tonometry and is not used very much by ophthalmologists and optometrists. However, other doctors, such as family medicine doctors or urgent care doctors, may still commonly use this test.

Glaucoma is a group of diseases of the optic nerve involving loss of retinal ganglion cells in a characteristic pattern of optic neuropathy. Although raised intraocular pressure is a significant risk factor for developing glaucoma, there is no set threshold for intraocular pressure that causes glaucoma. One person may develop nerve damage at a relatively low pressure, while another person may have high eye pressures for years and yet never develop damage. Untreated glaucoma leads to permanent damage of the optic nerve and resultant visual field loss, which can progress to blindness.

Glaucoma has been nicknamed "the sneak thief of sight". Worldwide, it is the second leading cause of blindness. Glaucoma affects 1 in 200 people aged 50 and younger and 1 in 10 over the age of 80

Symptoms of Glaucoma
While glaucoma may or may not have distinct symptoms, an almost inevitable complication of glaucoma is vision loss. Visual loss from glaucoma usually first affects peripheral vision, but can also affect central vision. Early vision loss is subtle, and is not noticed by the patient. Moderate to severe vision loss may be noticed by the patient by careful examination of the full visual field. This can be done by an optometrist or ophthalmologist using a visual field analyser by closing one eye and examining the level of vision at various places in the visual field, then repeating with the other eye closed. All too often, the patient does not notice the loss of vision until he or she experiences "tunnel vision". If the disease is not treated, the visual field will become more and more narrow, obscuring central vision, and finally progressing to blindness in the affected eye(s).

Waiting for symptoms of visual loss to occur is not optimal care. Visual loss related to glaucoma is irreversible, but can be prevented or slowed by treatment. Those at risk for glaucoma are typically advised to consult with an ophthalmologist or optometrist on a regular basis. With advances in testing, treatment and surgery, most people diagnosed with early glaucoma are able to maintain their vision and function well, which was not always the case in the past.

Below are pictures that depict someone with normal eyesight (left), and someone with glaucoma (right).

Automated External Defibrillators

Statistics show that more than 200,000 Americans die of sudden cardiac arrest every year. Up to 50,000 of these deaths could have been prevented if someone had initiated the Cardiac Chain of Survival, and an automated external defibrillator (AED) had been available for immediate use at the time of the emergency. Statistics show that more than 200,000 Americans die of sudden cardiac arrest every year. Up to 50,000 of these deaths could have been prevented if someone had initiated the Cardiac Chain of Survival, and an automated external defibrillator (AED) had been available for immediate use at the time of the emergency.

An automated external defibrillator (AED) is a portable electronic device that diagnoses and treats cardiac arrest by re-establishing an effective heart rhythm. This treatment is called defibrillation, which applies an electric shock to the entire heart muscle, uniformly clearing the electrical activity of the heart, hopefully allowing it to resynchronize.


How does an AED work?
An AED is easy to operate. It uses voice prompts to instruct the rescuer. Once the machine is turned on, the rescuer will be prompted to apply two electrodes provided with the AED to the victim's chest. Once applied, the AED will begin to monitor the victim's heart rhythm. If a "shockable" rhythm is detected, the machine will charge itself and instruct the rescuer to stand clear of the victim and to press the shock button.


Liability
Most health professionals agree that automated external defibrillators are so easy to use that most, if not all, states in the United States now include the "good faith" use of an AED by any person under the Good Samaritan laws. "Good faith" protection under a Good Samaritan law means that a first aid responder cannot be held civilly liable for the harm or death of a victim by providing improper or inadequate care, given that the harm or death was not intentional (and other certain circumstances). In most states, Good Samaritan laws provide protection for the use of AEDs by trained and untrained responders, to a point. Even for trained providers, AEDs provide little liability if used correctly, in fact even the NREMT-B and many state EMT and almost all Basic Life Support/Professional CPR classes offered incorporate AED education as parts of their program.



Could an AED be misused?
One particular brand, the Medtronic LIFEPAK® CR Plus AED is simple to use yet sophisticated in its technology. As such, there are numerous safeguards in place to detect the particular heart rhythms that require a shock. The CR Plus is designed to allow a shock only when a patient requires one, making it difficult to misuse.





What is sudden cardiac arrest (SCA)?
Sudden cardiac arrest cases are usually due to abnormal heart rhythms called arrhythmias, the vast majority of which are ventricular fibrillation. Ventricular fibrillation is a condition in which the heart's electrical impulses suddenly become chaotic, causing the heart to cease pumping blood effectively. Victims of SCA collapse and quickly lose consciousness, often without warning. Unless a normal heart rhythm is restored, death will follow within a matter of minutes.
The cause of sudden cardiac arrest is not well understood. Many victims have no history of heart disease, or if heart disease is present, it has not functionally impaired them. Unlike a heart attack, which is the death of muscle tissue from loss of blood supply, many victims of SCA have no prior symptoms. SCA can strike anyone, at any time, anywhere.


How common is SCA and who is at risk?
SCA is one of the leading causes of death in the United States. It strikes more than 200,000 Americans each year: nearly one death every two minutes.

What is the current treatment for sudden cardiac arrest?
The cardiac chain of survival is the current treatment for sudden cardiac arrest.

What is the cardiac chain of survival?
The cardiac chain of survival is a series of four critical steps. All four steps of the chain must be present to help ensure survival from sudden cardiac arrest. The four steps are:

• Step one: Early access to care (calling 9-1-1 or another emergency number)
• Step two: Early cardiopulmonary resuscitation (CPR)
• Step three: Early defibrillation
• Step four: Early advanced cardiac life support, as needed

The third step, delivering an electrical shock to the heart, which is known as defibrillation, is recognized as the most critical step in restoring cardiac rhythm and resuscitating a victim of SCA.

For More Information
Medtronic

Stinging Nettle Caterpillar

The Cooperative Extension Service of the College of Tropical Agriculture and Human Resources at the University of Hawai‘i at Manoa has posted a brochure on the Stinging Nettle Caterpillar where I got most of my information from.

Stinging Nettle Caterpillar
Scientific Name – Darna pallivitta
First appearance – September 2001, Panae‘wa, Hawai‘i (Foliage Nursery)
Origin – It is believed that the nettle caterpillar arrived from Taiwan. It is also found in China, Thailand, Malaysia, and Indonesia

The nettle caterpillar poses a big threat because of its painful sting, large appetite, lengthy larval feeding stage, high reproduction rate, and wide host range.

Host Plants
The nettle caterpillar has been found on more than 45 different plants in Hawai‘i including but not limited to palms, pasture and ornamental grasses, weeds, and foliage. When the nettle feeds off the host plant it damages and reduces the value of the plant, putting a burden on nursery owners who rely on their plants for export. Originally found in Pana‘ewa near Hilo, the nettle has now spread to Waiakea, Waiakea ‘Uka, Kaumana, Pi‘ihonua, Kea‘au, Kurtistown, Hawaiian Paradise Park and Orchidland.

Life Cycle
The life span of the nettle caterpillar from egg to adult is 75-99 days depending on the number of larval stages. Adult females live for approximately 10 days and adult males live for approximately 11 days. The larvae develop during a seven day incubation period where embryos are visible. When ready to pupate the larvae move to the base of the host plant for protection. The prepupa will spin a brown silk around itself forming a hardened cocoon approximately 5/8 inch long, and pupation occurs with the cocoon after five days. And do we get a beautiful butterfly perhaps? Of course not…the caterpillar turns into a moth. The adult moth is approximately ½ inch long. The adult female deposits eggs in small clusters on the underside of leaves. The adult moths are nocturnal. During the day they are inactive and head for vegetation in an upside-down perched position.

Harm to Humans
The nettle caterpillar has stinging spiny hairs that releases an irritant (mixture of histamines) produced by a poison gland. The irritant causes the skin to burn and itch, much like the effect of fiberglass. If not treated, the site of irritation can become infected. If you are stung you should avoid further contact with the caterpillar, and immediately wash the area with soap and water to calm the pain. Antihistamines or hydrocortisone cream can be used to stop the itching and swelling. If you are stung in the eye or begin having difficulty breathing, seek medical attention immediately. Individuals will have different symptoms depending on the severity of any allergic reaction.

Control Methods
- Minimize outdoor lighting at night
- Use bug zappers with UV bulbs (position zappers away from potential host plants and place a bucket of soapy water underneath to catch fallen moths)
- Don’t bring in host plants from an infected area
- Use of pesticides/insecticides

For more information on the Stinging Nettle Caterpillar visit these websites:
Nettle Caterpillar
Stinging Caterpillar Expanding its Range on the Big Island
Have you seen Stinging Nettle Caterpillar?

Baking at High Altitudes

What’s the difference between baking at sea level or at 5,000 feet?

Got undercooked, overcooked, coarse, or collapsed baked goods? Are you in Hawaii or Colorado, one might ask. What’s the difference, right? A cake is a cake no matter where you go, yet how it turns out can be a big pain in the A! A for altitude that is…

Who knew that baking a cake at sea level or at 5,000 feet would make such a big difference? I’ve heard of flattened out cupcakes and undercooked brownies, but I never knew why. The extent of my knowledge was that it had “something” to do with the altitude and that was it.

While researching, I found a great website that contains everything you need to know about baking at high altitudes. This website recognizes a book called “Pie in the Sky” by Susan G. Purdy. All my questions answered in one handy website.

Here's a little introduction to the technical part...baking depends on food chemistry, atmospheric pressure, humidity, climactic conditions and last but not least elevation. As elevation increases the boiling point of water decreases causing liquids to evaporate quicker and leavening agents to expand quicker. For a baker, these things mean big trouble.

For every 500 foot increase in altitude the boiling point of water drops one degree. When the boiling point temperature drops food takes longer to cook in or over liquid, custards take longer to set, and foods in a double boiler may not receive enough heat to cook properly. When water begins to evaporate from batter or dough the ratio of liquids changes resulting in a higher concentration of sugar and fat, weakening the structure of baked goods sometimes causing them to collapse or have a coarse texture.

When leavening agents expand too quickly, bake goods can rise too fast, and yeast breads can over-proof or rise then fall. Higher altitude also means drier conditions, or drier ingredients in this case. Recipes made at high altitude may require more liquid than recipes done at sea level.

Just when you thought baking was all fun and games, it all really comes down to a science. Hooray for science!

For more information on high altitude cooking visit the "Pie in the Sky" website or Google these and other websites:

High Altitude Cooking Tips

High Altitude Cooking

High Altitude Baking at 5000 feet

Here are some books that I found on baking at high altitudes. Look for these books and others at Amazon.com

High Altitude Baking: 200 Delicious Recipes & Tips for Great Cookies, Cakes, Breads & More - by Colorado State University Cooperative Extension

Baking at High Altitude: The Muffin Lady's Old Fashioned Recipes - by Randi L. Levin