RSS

Category Archives: Medical Issues

Q and A: Will Ingestion of Bee Venom Kill Someone Who Is Allergic to Bees?

Q: If a person is allergic to bee venom and the venom is ingested, would the person be likely to die? Would the venom show up on a tox screen at autopsy?

Bee-apis

A: Bee venom is a protein toxin and would be digested by the acids in the stomach if swallowed. And once digested it would not likely cause an allergic reaction. However, an allergic reaction would happen once the venom contacted the buccal mucosa—big word for the lining of the mouth. This could cause an anaphylactic reaction and kill the victim.

Anaphylaxis is a rapid allergic reaction to some antigen. These antigens are typically foods, drugs, or insect venoms. Common foods are peanuts and shellfish; common drugs are penicillin and iodine, which is found in many radiographic dyes; and common insects are bees as in your story. There a myriad other foods, drugs, and bugs that can cause anaphylaxis in the allergic person.

This rapid immune (or allergic) reaction involves antigens (the food, drug, the bee venom, etc.) and antibodies, which are manufactured by the body and react to the specific antigen that they are directed against. This reaction is a critical part of our defense against bacteria and viruses. The body recognizes the antigen (virus, let’s say) as foreign and builds antibodies that will recognize and attach to the virus. This reaction attracts white blood cells (WBCs), which release chemicals that kill or harm the virus, which is then consumed by the WBCs and destroyed.  This process is essential for each of us to survive in our bacteria and virus-filled world.

But, in allergic individuals, this reaction is rapid and massive and causes a release of large amounts of the chemicals from the WBCs and it is these chemicals that cause the problems. They cause dilatation (opening up) of the blood vessels, which leads to a drop in blood pressure (BP) and shock. They cause the bronchial tubes (airways) to constrict (narrow severely), which leads to shortness of breath, wheezing, and cough. This is basically a severe asthmatic attack and prevents adequate air intake and the oxygen level in the blood drops rapidly. The chemicals also cause what is known as capillary leak. This means that the tiny microscopic blood vessels in the tissues begin to leak fluids into the tissues. This leads to swelling and various skin lesions such as a red rash, hives (actually these are called bullae and are fluid-filled, blister-like areas), and what are called wheel-and-flare lesions (pale areas surrounded by a reddish ring). These are also called Target Lesions because they look like targets with a pale center and red ring.

In the lungs this capillary leaking causes swelling of the airways, which along with the constriction of the airways, prevents air intake. In the tissues it causes swelling of the hands, face, eyes, and lips. The net result of an anaphylactic reaction is a dramatic fall in BP, severe wheezing, swelling and hives, shock (basically respiratory and cardiac failure), and death.

Usually anaphylaxis onsets within minutes (10 to 20) after contact with the chemical, but sometimes, particularly with ingested foods, it may be delayed for hours—even up to 24 hours. With a bee sting it would begin in a matter of minutes. Bee venom in the mouth might take only a few minutes to instigate the reaction.

Your victim would suffer swelling of the tongue and face—particularly of the lips and around the eyes—as well as swelling of his hands. Hives and wheel-and-flare lesions would pop out over the skin. He would begin to gasp for breath and develop progressively louder wheezing. As the oxygen content of his blood began to drop he would appear bluish around his lips, ears, fingers, and toes. This would progress until his skin was dusky blue. He would sweat, weaken, and finally when his BP dropped far enough would lose consciousness, lapse into a coma and die. Unless treatment was swift and effect that is.

Untreated anaphylaxis leads to shock and death in anywhere from a very few minutes to an hour or more, depending upon the severity of the reaction and the overall health of the victim. Treatment consists of blood pressure (BP) and respiratory support, while giving drugs that counter the allergic reaction. BP support may come from intravenous (IV) drips of drugs called vasopressors. The most common would be Dopamine, Dobutamine, epinephrine, and neosynephrine. Respiratory support may require the placement of an endotracheal (ET) tube and artificial ventilation. The victim would then be given epinephrine IV or subcutaneously (SubQ) and IV Benadryl and steroids. Common steroids would be Medrol, Solumedrol, and Decadron. These drugs work at different areas of the overall allergic reaction and reverse many of its consequences. The victim could survive with these interventions. Or not. Your call.

If you decide that your victim will die, then at autopsy, the findings are non-specific. That is, they are not absolutely diagnostic that an anaphylactic reaction occurred. The ME would expect to find swelling of the throat and airways and perhaps fluid in the lungs (pulmonary edema) and maybe some bleeding in the lungs. He may also find some congestion of the internal organs such as the liver. He must however couple these findings with a history of the individual having eaten a certain food, having ingested or being given a certain drug, or having receives an insect bite or sting and then developing symptoms and signs consistent with anaphylaxis. And in the case of insects, such as the bee you are using, he may be able to find antibodies to the insect’s venom in the victim’s blood. Maybe not. So you can have it either way—yes he finds the antibodies or no he doesn’t.

Originally published in the October, 2014 issue of Suspense Magazine

 
6 Comments

Posted by on December 14, 2014 in Medical Issues, Poisons & Drugs, Q&A

 

Is There A Genetic Basis For Violence?

_78564403_g1100306-dna_molecule-spl

Is there a genetic make up that leads people to commit violent acts? Probably. Is it a simple “if this then that” connection? Not likely. But we are each a product of our genetic make up and our environment. That includes everything from medical issues such as heart disease and diabetes, to success in the arts such as music and writing, to our basic personality and the way we deal with others.

New research suggests that the elusive “warrior gene” might exist and it might result from defects in two genes: The MAOI gene and a variant of the cadherin 13 (CDH 13) gene.

Wish it were that simple but this is interesting research.

Here are few articles on this research:

BBC News: http://www.bbc.com/news/science-environment-29760212

Telegraph UK: http://www.telegraph.co.uk/science/science-news/11192643/Violence-genes-may-be-responsible-for-one-in-10-serious-crimes.html

The Independent: http://www.independent.co.uk/news/science/two-genes-found-linked-to-tendency-for-violent-crime-9824061.html

Also, I posted on this back in June, 2010:

http://writersforensicsblog.wordpress.com/2010/06/15/dangerous-dna-the-warrior-gene/

 
4 Comments

Posted by on December 11, 2014 in Forensic Psychiatry, Medical Issues

 

Do the Phases of the Moon Alter Sleep Patterns and Behavior?

1024px-Moon_nearside_LRO

The full moon makes people crazy. Don’t believe it? Ask any Emergency Room MD or nurse. Full moons always bring out the crazies and the most bizarre circumstances. Common things present in odd fashions; odd things become downright bizarre. Can’t prove that scientifically but experience suggest it’s a fact.

During my medical training at the University of Alabama in Birmingham, you could count on having a busy and eventful day (and night) during the full moon. If you added that to a payday weekend, you had a recipe for chaos. The “Friday-night Knife and Gun Club” was especially busy on pay weekends and under full moons.

Probably has to do with tidal shifts in the brain or something like that. Excess water in your brain pan is never a good thing.

One example is The Bean. He’s our Bengal cat. Nocturnal and noisy by nature, he often gets completely out of hand around the full moon. We call it Moon Bean.

The Bean

The Bean

Now research done at the University of Gothenberg in Sweden suggests that the cycles of the moon alter sleep patterns. If so, these cycles might also alter behavior. Poor sleep leads to poor decisions, labile emotions, altered perceptions (see previous post), reduced hand-eye coordination, diminished attention, and these can in turn lead to mistakes—-many of which will land you in the ER. Never a good place to be.

 
10 Comments

Posted by on December 1, 2014 in Forensic Psychiatry, Medical Issues

 

Q and A: Could Death From Bleeding Be Delayed For Several Days After a Frontier Wagon Wheel Accident?

Q: My story takes place in a wagon train in the late 1800’s. My character is dragged by a horse while crossing a river. He hits rocks and is bounced off the back wheel of a wagon. Of course the horse’s hooves do damage as well. Three days later he dies from massive bleeding from his internal injuries. This three day delay followed by the sudden loss of blood is important to the story’s timing, but is it realistic?

wagon_train-2

A: The answer to your question is yes.

This type of accident could, as you can imagine, result in all types of injuries. Broken bones, skull fractures, neck fractures, cracked ribs, punctured lungs, and intra-abdominal injuries (injuries inside the abdominal cavity). This last type of injury might serve you well.

A ruptured spleen or lacerated liver or fractured kidney would bleed into the abdominal cavity. Death could be quick or take days if the bleed was slow. There would be great pain, especially with movement or breathing, and the abdomen would swell. Also a bluish, bruise like discoloration could appear around the umbilicus (belly button) and along the flanks. This usually takes 24 to 48 hours or more to appear. This occurs as the blood seeps between the “fascial planes.” The fascia are the tough white tissues that separate muscles from one another. The blood seeps along these divisions and reaches the deeper layers of the skin causing the discoloration. But, these injuries wouldn’t lead to external bleeding since the blood has no exit from the abdominal cavity.

However, if the injury was to the bowel, then external bleeding could occur. For blood to pass from the bowel, the bleeding would have to be within the bowel itself and not just in the abdomen somewhere. If the bowel were ruptured or torn so that bleeding occurred within the bowel, the blood would flow out rectally. But, blood in the bowel acts like a laxative so the bleeding would likely occur almost immediately and continue off and on until death, which in this situation would be minutes to hours to a day, two at the most. It would be less realistic for the bleeding to wait three days before appearing in this case. With one exception.

The bowel could bruised and not ruptured or torn, and a hematoma (blood mass or clot) could form in the bowel wall. As the hematoma expanded it could compromise the blood supply to that section of the bowel. Over a day or two the bowel segment might die. We call this an “ischemic bowel.” Ischemia is a term that means interruption of blood flow to an organ. If the bowel segment dies, bleeding would follow. This could allow a 3 day delay in the appearance of blood.

In your scenario, the injuries would likely be multiple and so abdominal swelling, the discolorations I described, great pain, fevers, chills, even delirium toward the end, and finally bleeding could all occur. Not a pleasant way to die, but I would imagine this happened not infrequently in frontier days.

The victim would be placed in the bed of one of the wagons and comforted as best they could. He might be sponged with water to ease his fevers, offered water or soup, which he would likely vomit, and prayers would be said. They could have tincture of opium (a liquid) available and give him some. This would lessen the pain since it is a narcotic and would also slow the motility (movement) of the bowel and thus lessen the pain and maybe the bleeding.

Of course, during the time period of your story, your characters wouldn’t know any of the internal workings of the injury as I have described. They would only know that he was severely injured and in danger of dying. Some members of the wagon train may have seen similar injuries in the past and may know just how serious the victim’s condition is, but they wouldn’t understand the physiology behind it. They might even believe that after he survived the first two days that he was going live and then be very shocked when he eventually bleed to death. Or they might understand that the bouncing of the wagon over the rough terrain was not only painful but also dangerous for someone in his condition. They train may be halted for the three days he lived or several wagons might stay behind to tend to him while the rest of the column moved on.

 

Murder By Meme: Slender Man and the Wakefield Anti-Vaccine Hoax

Slender Man

We all know that viral illnesses can kill. Ebola would be an example. So would small pox and the 1918 Flu.

But can an internet viral hoax kill? An interesting article titled “Murder By Meme: Slender Man and the Wakefield Anti-Vax Hoax” by Travis Langley, Ph.D. in Psychology Today looks at this issue.

In June, 2009, Eric Knudsen (aka Victor Surge) posted a pair of black & white photos of groups of children in which he had inserted a thin figure in a black suit into the background. This was the birth of the Slender Man hysteria. It led to the attempted murder of a 12-year-old girl by two of her classmates, also 12. Why would they stab their classmate 19 times? Apparently to serve as “proxies” for The Slender Man and to show that he really existed.

Crazy is as crazy does.

And then there’s the 14-year-old who read about Slender Man and decided she needed to burn down her home—-with her mother and brother inside. Fortunately there were no injuries but the house and family car took a hit.

But such internet hoaxes aren’t confined to the world on teen angst. It has also entered the world of legitimate medicine. And has done great harm.

MMR

Ever seen a case of Whooping Cough? Diphtheria? Probably not. I’ve never seen diphtheria and whooping cough (pertussis) only a couple of times way back during my pediatrics rotation as a junior medical student. The reason these and other childhood diseases such a rubella and mumps are now not so common is a robust and widespread immunization program that has done a stellar job in keeping these illnesses at bay.

Enter Dr. Andrew Wakefield. He apparently created an entirely fraudulent research study that suggested that the MMR (Measles, Mumps, and Rubella) vaccine caused Autism. Based on this scam, allegedly funded by an “ambulance-chasing” law firm, many well-meaning and fearful parents refused to vaccinate their children. This led to outbreaks of these uncommon diseases. Here in my own backyard, Orange County, CA, we had an outbreak of pertussis that could be traced for the most part to a single pediatrician who bought into this “bad science.”

The truth? There is not a single piece of legitimate evidence to suggest that MMR is in any way related to autism.

And Slender Man does not exist.

 
3 Comments

Posted by on October 16, 2014 in Medical History, Medical Issues

 

Frankenstein and Creativity

Dr. Frakenstein

An interesting article recently appeared in The Atlantic on the origins of creativity and whether it is innate or can be learned: “Can Creativity Be Learned?” by Cody C. Delistraty. It makes for interesting reading and raises some intriguing questions. For example, creative folks tend to have more grey matter in the right posterior middle temporal area of their brain. Is this what makes them creative or does this result from them flexing their “creative muscle”? Chicken or egg?

Temporal Lobe

The author uses Mary Shelly and her classic horror story Frankenstein to underline his points.

In a past post on this blog I briefly talked about how Mary Shelly’s classic story came about. Here is an except:

On a literary and historical note, Frankenstein might never have been written had it not been for a volcanic eruption on the other side of the world. In 1815, Mount Tambora in Indonesia erupted with such force that it filled the air with millions of tons of ejected particulate matter. This rose into the high atmosphere, dropped world temperatures for many months and resulted in 1816 being called the “Year Without Summer.” Snow fell in New England in July!

During that summer, Mary Wollstonecraft Godwin, her lover and future husband Percy Bysshe Shelley, and Lord Byron settled into Villa Diodati on Lake Geneva. The summer was so cold and wet that they spent much of their time in the villa talking and telling stories. They decided to have a writing contest and see who could write the best short story. Mary’s story evolved into the classic Frankenstein; or the Modern Prometheus.

There has long been controversy over how Mary came up with such a story, She said it came to her in a “waking dream,” but some have suggested that her father had told her stories of a doctor who did such experiments and others have suggested that she and Shelley had actually visited Castle Frankenstein, the birthplace of Johann Conrad Dippel, a physician and alchemist who did indeed perform reanimation experiments on corpses. Either way she wrote a kick-ass story that has survived for nearly two centuries and will survive for many more.

The full post can be found here: http://writersforensicsblog.wordpress.com/2009/09/14/more-decapitation-and-reanimating-the-dead/

 
4 Comments

Posted by on September 22, 2014 in Forensic Psychiatry, Medical Issues, Writing

 

Crime and Science Radio: From Firefights To Fiction: An Interview With Military Surgeon and Author Dr. Jeffrey Wilson

dg2 500X667

Join Jan Burke and DP Lyle in a discussion of combat surgery and fiction writing with Vascular and Trauma surgeon Dr. Jeffrey Wilson.

BIO: Jeffrey Wilson has at one time worked as an actor, a firefighter, a paramedic, a jet pilot, a diving instructor, a Naval Officer, and a Vascular and Trauma Surgeon. He also served numerous tours in Iraq and Afghanistan as a combat surgeon with both the Marines and with a Joint Special Operations Task Force. He has written dozens of short stories, won a few fiction competitions, and currently has a 3 book deal with JournalStone Publishing for his novels. His first novel, THE TRAITEUR’S RING, was published in 2011. His second book, THE DONORS was released in June of 2012 and won a Gold Medal in the sci-fi/fantasy/horror category from the Military Writers Society of America. FADE TO BLACK is his third novel from JournalStone. Jeff and his wife, Wendy, are Virginia natives who, with children Emma, Jack, and Connor, call Tampa, Florida home. He still works part time as a Vascular Surgeon and as a consultant for the Department of Defense when not hard at work on his next book.

me hind

LISTENhttp://www.blogtalkradio.com/suspensemagazine/2014/09/09/crime-and-science-radio-with-special-guest-jeff-wilson

Dr. Jeffrey Wilson’s Recommended Reading:

Service by Marcus Luttrell

Lone Survivor by Marcus Luttrell

American Sniper by Chris Kyle

LINKS: Website: http://www.jeffreywilsonfiction.com/index.html

Annals of Surgery: Combat casualty and Surgical Progress: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1570575/

How Stuff Works: What Equipment Do Army Combat Surgeons Have?: http://health.howstuffworks.com/medicine/army-medicine/army-combat-surgeon-equipment.htm

You Tube: 212th Combat Field Hospital (Warning: Graphic Content): https://www.youtube.com/watch?v=1Qvt3YSAHpE

You Tube: Battlefield surgery PART 1 2 Survival: https://www.youtube.com/watch?v=yOI3oBQxxRc

Fade To Black on Amazon: http://www.amazon.com/Fade-Black-Jeffrey-Wilson/dp/1936564858/ref=sr_1_1?ie=UTF8&qid=1407420070&sr=8-1&keywords=Fade+to+black+by+jeffrey+wilson

Fade To Black at B&N: http://www.barnesandnoble.com/w/fade-to-black-jeffrey-wilson/1115405616?ean=9781936564859

You Tube: 212th Combat Field Hospital (Graphic): https://www.youtube.com/watch?v=1Qvt3YSAHpE

You Tube: Battlefield Surgery: https://www.youtube.com/watch?v=yOI3oBQxxRc

FTB

 
 
Follow

Get every new post delivered to your Inbox.

Join 2,564 other followers