The EpiPen and you.

[Sourwood]

<<How do you get a doctor to prescribe one if you have no history of severe allergy? >>

I had no problem at all with my family physician prescribing me one. I simply told them I was a beekeeper who at times moved hives to remote country settings no where near civilization and wanted one as a "precautionary" measure. I would consider talking to other doctors.

[Hillside]

For a while, I was carrying one of those things around for reasons not related to bees. My doctor strongly stressed that epi can be very dangerous if improperly used. It can cause extreme stress to the heart. It is intended to be self administered. You really don't want to administer it if you don't really need it.

My doc had me practice with a dummy epi pen while he monitored me and made sure I knew what I was doing.

[Matz]

I myself have never carried an epi, mainly cause its expensive and shelf life is too short. Instead I carry benadryl (antihistamine) pills. Never had a reaction, but I figure if I ever get jumped by a swarm of vicious ladies, I'll be popping a couple pills. Maybe I'll get a buzzzz. Actually, a good beek friend of mine who's family has over 50 years exp informed me of their use. He carries the pills himself and in the past he's had severe reactions, which he had to build immunity to by getting Venom injections from Doc. Figure they're good enough for him, they're good enough for me.

[BULLSEYE BILL]

When I was getting a cortizone shot for my shoulder Feb 1, my PA was inspecting my gimp finger from an infected sting last year, it may never get any better He is aware that I do swarm pickups and cut-outs as well as being concerned about my hand and wanted me to get a couple of pens to have just in case.

He was a little more lax about thier use, but I plan to only use it if breathing becomes a problem.

I have a 16 yr old son of a friend that wants to help me with cut-outs this year. He is allergic to just about everything under the sun, even milk, eggs, and wheat. Animal dander, smoke, pollen, mold, on and on.

I told his mother that I would not take him until he was stung under controled condititons. He did not have any breathing problems but I let it pump until dry He had a good local reaction like I used to get. A five inch swollen and red hot area that lasted for three days. He's still eager to help, but I'm not taking him without a pen handy.

And I've done stupid things before and gotten 50+ stings, so you never know.

BTW, doc said that the pens were about $20 each. Thats' cheap insurance.

[Jeff McGuire]

>Are you folks severly allergic??? Or is this simply insurance??

I am just starting this year and have never had a severe reaction myself. As previously stated it is often not the first sting that people have rections too. The first couple couple stings can make you hypersensitive to following stings also my two daughters want to help me and I don't know what there reaction might be. This year I have an epipen for insurance sake. I don't know whether I will continue to purchase them in the future.
I am a professional firefighter and EMT and have used epinephrine several times for nut, shelfish, and bee sting allergies. I agree that it should not be given unless you are sure the persons condition is from an allergic reaction that is obviously true with any medication. Benadryl and other types can help with mild reaction but won't do much for severe as it takes too long to get in the system.

[dickm]

On Benadryl. I carry a bottle of the liquid stuff made for kids. It will get into the body faster. My son had a bad reaction to a wasp sting and took the last 2 antihystamines in the house. At the ER the doc said they may have saved his life.

Dickm

[GDH]

I too keep Epipens for safety sake. Our property is about 40 miles from the closest emergency room. The doctor had no problems on the prescription, paid for through my HMO ($20), but as stated previously, specified the used for "breathing problems." I am very allergic to most nuts (to food type, not the human type, although they give me a reaction too). When filling an order, I suggest having the pharmacy order a fresh package (good for a year).

[Kieck]

I'll throw my two cents' worth in here. I do have an Epi-pen, although it's past its expiration date now. My wife thought it would be good "insurance." I agree to a point -- if I have someone else with me when I'm working bees, and they run into problems, an Epi-pen might be worthwhile. Mainly, though, that Epi-pen alleviates my wife's worrying, and that's worth the cost of it to me.

Having said all that, my 'pen (I covered virtually all the cost myself) cost me about $50. I'm sure you can get them less expensively if insurance kicks in on them, but sooner or later we all end up covering that cost, too. The expiration date on an Epi-pen is roughly one year from the date of prescription, so you should count on replacing any of them every year.

I would view an Epi-pen as a "last resort" measure. I hear about a lot of people who have "bad reactions" to bee stings, yet I wonder how many of these people would actually go into shock from a sting. One of my brothers-in-law, for example, swells up terribly from bee stings. Some of his family members are EMTs and push him to take epinephrine when he's been stung. So far he has never taken epinephrine (just benadryl), and so far he's never experienced anything approaching anaphylaxis. I think, in most instances, if someone with me was stung and began experiencing problems, I'd try to do what others have suggested -- get them to a medical facility as quickly as possible for treatment by professionals -- rather than using an Epi-pen.

[Michael Bush]

In my experience the first sting of the season is the worst and then they get better until they are hardly noticable.

Sometimes a first sting is really bad. This last year I had my ankle swell up so much I couldn't walk on the first sting. The rest of the stings were nothing.

This, of course, is backwards from the concept that subsequent stings are worse.

[BULLSEYE BILL]

>This, of course, is backwards from the concept that subsequent stings are worse.

I think your body gives you two choices, build up an immunity, or build up a toxicity (sp).

[beecron]

"With several inhalations and a belt of liquid benadryl you'll get to the ER. Arguably safer than injectables."

Taking "several inhalations" isn't any safer than any other treatment suggested on this string. Taking any medications, OTC or not, beyond the recommended dosing on the label without consulting a physician is just as dangerous.

I, like J. McGuire, am a career firefigher/paramedic. As I said above, it's not good at all to take medications any way other than which they were intended. Likewise, using medications which were prescribed for somebody else is just as ill-advised.

Yes, Epi should be as clear as water, no discoloration and no "cloudiness". Would you use one that was discolored or out of date in an emergent situation if it was your best option at the time? The choice will be totally yours. It may beat the alternative, it may be a very risky maneuver.

I know that many people on this site live in rural areas and keep their bees in rural areas, but if you have a cell phone, many places such as these are still within range. Always keep yours with you to access emergency medical help and be able to provide ACCURATE information as to your location since obviously cell phones are unable to provide dispatchers with the location the call comes from as many enhanced 911 operations can on landlines.

Barry

[dickm]

According to the directions on mine, there will still be liquid visible after use. It cannot be used again. Dump it.

Dickm

[NorthALABeeKeep]

Walter Kelley sells a product thats called "Denver's Sting Stopper" that works great on stings if you can apply it soon after the sting. Something in the stuff "neturalizes" the chemicals in the venom. Do a search on the net and you can find out about it. I've used it before and it stopped the hurt almost right away. But if your truly allergic to bee stings I won't rely on this alone.

[Sundance]

"Taking "several inhalations" isn't any safer than any other treatment suggested on this string. "

I would argue that primatene mist is safer than injectable. Not as effective, but the danger aspect of an injectable is there.

Primatene mist coupled with liquid benadryl is safer than doing nothing when you are 20 miles from an ER.

[size="1"][ March 31, 2006, 11:29 PM: Message edited by: Sundance ][/size]

[Irsqu911]

OK, I had 5 pages written on this and my computer dumped it. So, I will make it brief and summarize what everyone has already said.
Yes, in almost all (except in extremely rare cases which make it almost improbable) you need to be stung twice to become allergic. First sting the body identifies the poison (protein) then develops the antigens and histamines. Second sting it releases it.
If you have been stung more then twice by the same type of insect without an allergic reaction the chances of you having a severe reaction are extremely slim (In the area of lighting strike or asteroid strike to the head type chances). So, If you have been raising bees for a while you probably donÂ’t need it.


The EpiPen is Epinephrine. Epinephrine is synthetic adrenalin. Adrenalin is a fight of flight hormone and is released by the body when its fighting or fleeing for its life.
Epinephrine is unstable and has a somewhat short shelf life and this is reflected by the expiration date on the box. Old Epi is weak Epi exponetionally. Keep in cool dry dark place blah blah says it all on the box.
Epinephrine can cause some severe side effectsÂ….heart attacks, deathÂ…other worse things. Remember the body only uses it when its fighting for its life and is in a do or die situation.
The EpiPen is a prescription medication and should only be given to the person prescribed to. I believe your box should have the name of the person prescribed on it. ONLY they can use that medicationÂ…and Yes you will (WILL) be held liable for giving your prescription medication to another person even in a life or death situation. You and I are not doctors and cannot make that decision, sorry. Consult the FDA on that one.
The EpiPen is not for mild allergic reactions. Your doctor should not have prescribed it to you. It is not a prophylactic medication…Meaning it should not be prescribed or taken because you “think you need it”. This crap is somewhat dangerous. And should be used only when your thinking “I cant breathe and I am going to die” or “I really need to go to the emergency room”. In fact, the manufacture recommends that if you use the EpiPen you go to the ER right away (30% of people have secondary allergic reactions once the initial dose of Epi wears off) for evaluation and another prescription for EpiPen
The EpiPen comes in 2 sizes Adult (gray tan box 0.3mg of Epinephrine) and Pedi (yellow? 0.15mg Epinephrine). The PediPen is for people under the weight of 50 pounds. Do not give the adult dose to kids. The EpiPen is a metered dose one time use injector designed from the military’s Mark 19 auto injector used for Biological and chemical warfare. You cannot give a “half dose”.
To use EpiPen remove from box, it will be in an amber tube, slide out from tube. Inspect it. (expiration date and for clarity in window) Hold in fist, remove gray safety cap from rear of injector.. The EpiPen is designed to be injected into the thigh only and can go thru clothes. (thigh area means take fist with thumb outÂ…hold at side and press against leg naturallyÂ…right there) press black knob against this area firmly. You will hear a snap..hold for 5-10 seconds..remove. Take the Epipen bend the needle over on a hard surface( to protect others from accidentally being stuck) and return it to the amber tubeÂ…Take it with you to the hospital so they can make sure it worked properly and what dose was used. You can rub the injection site for more rapid absorption.
Remember the FIVE RIGHTS
RIGHT person (only the person the medication is prescribed to)
RIGHT Medication (Epi or notÂ…easy one)
RIGHT Dose (Adult or PediÂ…not interchangeable)
RIGHT Time (Life threatening situations only)
RIGHT Route (Mid Thigh area only)

Many healthcare professionals across the country have lost licenses for not following the above rules in the past, You as an untrained professional also have to follow them and cannot do anything your not trained to do. The Good Samaritan laws state you can do what any other person trained to the same level would do in good judgment in the same situation and not be held liable. Overstepping those bounds is when people get in troubleÂ…mostly due to poor judgment.
Personally, I have issues with any physician who hands out prophylactic prescription medications for “just in case” situations to someone who has no proven allergic history as it shows bad judgment on their part. Should he also prescribe you Nitro in case of a heart attack because your in the optimum age category but never had cardiac problems in the past? NO!
Basically. Keep it simple.
First Identify the hazardsÂ…Go out and get stung a few times, find out if your allergic first! If you get stungÂ…..
Non-Life threateningÂ…use OTC medications others have discussed earlier. They should help. Also ice packs, elevation above the heart and a light constricting band (not a tourniquet) higher up on the limb to prevent further spreading also help
Life Threatening-Use your prescribed EpiPen
Somewhere in there you should be thinking “911” Almost all ambulances in the country (I can only speak for Nebraska..and all have them) should carry Allergic reaction kits containing both EpiPen and PediPen and the providers are trained in proper usage. They can also provide other life saving measures. IE oxygen, Cardiac monitoring, IV therapy, Other supplemental medications etc..and get to drive fast to the hospital Safer then you in your privately owned vehicle.
I have been around the EpiPen a while. Works great most of the time. But, I have seen it used in the wrong situation before with a detrimental outcomeÂ…The last I saw of that guy was when we where driving away in the ambulance with a really sick person and the police where pulling him to the side talking to himÂ…Rules are in place for a reason.

[brent.roberts]

I was in the Florida Keys cleaning up after hurricain Georges when I got bit by something, 2 holes in my leg about 1/2" apart. After about 15 minutes I got red rashes in my groin and armpits, 10 minutes later my lips started to get thick, my tongue started to get stiff. A few minutes later my throat started feeling tight. I high tailed it to the hospital. By the time I got there I could not speak proberly because of the stiff tongue and lips.
At triage a doc overheard and asked if I got bit. I pointed to the leg and she grabbed me off to a room and injected some epi.

I had never had an anaphalactic shock reaction before. I asked her, on a scale of 1 to 10 how severe was this. Oh about 9.99 she said. In another 15 minutes you would not have been able to breathe.

She told me to get an epi-pen and keep it on hand all the time. Furthermore she warned me to avoid using until I really felt I needed to and to try to get some help or contact with anyone before injecting with it. Epi can cause significant, even fatal drop in blood pressure, so someone should know what you've done. After injecting do not sit around by yourself. Get medical help and monitoring.

Lessons learned.

[brent.roberts]

And not the other side.

Last summer I was working on my woodpile for the next winter's heating and overturned a wasp nest. Got 7 or so stings in close proximity around my face. Within a short few minutes my nose and lips swelled up. Ran to the house, took a few benadry tabs, got some ice and the epi pen and my wife to drive me to the hospital.

There the docs made and exam, laid me down and started and IV drip of ... not epi but benadryl.
Actually not benadryl but the generic drug, diphenhydramine HCL. Two bags of drip in 15 minutes.

So when everything was under control we asked the doc and his answers were:
Yes you did the right thing to come to the hospital.
Yes you did the right thing taking the benadryl before coming.
Yes you did the right thing NOT using the epi pen.

The reaction to the stings was all localized on my face. Not systemic. Never bothered my throat or breathing.

On the other hand at our cottage about 3 years ago a 45 year old woman who knew she had severe anaphalaxic reaction to wasps went for a walk in the woods with some friends. Stepped on a wasp nest. The husband ran home for the epi pen. He did not get back to her in time.

Lots to learn about when, where and how to use one if you get one.

When I got the dose my whole body felt like the tension was melting down within me.

It's powerful stuff. Use well ... use carefully

[size="1"][ April 01, 2006, 07:05 PM: Message edited by: brent.roberts ][/size]