Date: Dec. 2005
From: R.T. Senior research consultant, specializing in envenomation
investigation.June 29 or 30. This 'rash' is suspect. It could
be one full dermal layer thickness bite and two or more minor
envenomations. It will become obvious with 48-72 hours.
July 2. A bite or sting is highly suspect. If that is in fact the
case, the central effected location is fully intradermal. The spread
of the effected area is in contradiction to normal profusion. Lateral
and actually extending away from the heart. Secondary epidermal bites
are probable.
July 5. A bite or sting is assumed. The only question here is will it
diffuse, spreading through the tissues, more indicative of a hemotoxin,
or erupt.
July 6th. Strongly suspect local neurotoxin-envenomation. If that is
the case, applying ice over night will aggravate the injury
significantly as only existing blood profusion would be containing it
and ice will restrict the profusion.
July 7th. Suspicion confirmed. Neurotoxic venom induced necrosis now
visible. What is of interest in this photo is the original nerve
damage area has been outlined. As additional nerves fail to function,
this area will grow. All the treatments she is being given are wrong
as they are suppressing blood flow. All the tissue damage is the
direct result of loss of vascularization. This picture is very similar to a suspected wasp bite as well as
several spiders. It appears she was bit three times significantly and
possibly several more times with varying degrees of dermal penetration.
July 9. The black, tissue filled with dead blood, is giving way to
white in a normal progressive fashion. The body is attempting to
revascularize the area, accounting for the redness and swelling. As
this is 1 week, the area effected is probably about 2/3rds the entire
neural damage zone.
July 10. Normal 'weeping' as there are many compromised blood vessels
in the central area.
July 11. The outline shown is probably close to the limit of the
neural effect area. Nearly all of the nerve damage most likely
occurred within the first 48 hours and the expanding injury is the
natural course of tissue where vascularization is failing.
July 12 & 13. She has used a treatment that promotes blood profusion
forthe first time. Dramatic improvement is only logical.
July 14th. Healthy wound. Still lots of functional blood vessels as
indicated by reddened locations. This causes doubt of the injury being
one of the more powerful neurotoxins. When the wound starts pushing
out necrotic yellowish tissue it will indicate the body is coping well
with the problem.
July 17th. Out comes the necrosis. The body is now replacing dead
tissue which is pushing it out.
July 19th. Patient reports hives. Right on time for an allergic
reaction to antibiotics. Wound healing normally.
July 20th. Patient is correct. Each necrotic patch that comes out is
an area of effect of the neurotoxin. I suspect 3 significant
bite/stings and about 7 minor ones. They relate perfectly to the first picture's
initial lesions. (Note from Linda: The initial lesions
were higher up on the back of my leg and gone by the time the actual
bite appeared several days later. )
July 24. The bruise the patient mentions is typical of latent
neurotoxin effects. The blood profusion in and around the wound is
still minimal. Bruising, hematoma, is the blood rupturing small blood
vessels that are still partially compromised.
July 25. Here comes the itching. About 24 days. Right on time for
nerve regrowth to make it's presence felt.
1 month after. As patient has noted, varicose veins, which are already
compromised blood vessels, are, of course, severely effect by the
neurotoxin.
6 weeks. The extreme sensitivity patient notes is typical of nerve
regrowth. Phantom pains, sensations entirely unrelated to the injury,
will probably be noted as well. The nerves are, essentially, getting
reorganized and signals are getting mixed up. This can continue for
another 6 months to 2 years.
Conclusion: Classical local neurotoxin envenomation. Two very common
causes are a spider trapped in a fold of a pants leg or a rapid series
of stings by a wasp. Severity of the envenomations, mild to moderate.
It appears only the dermal layers were involved and the effected area
was minimal.
It this was a Loxosceles, (Brown Recluse) bite, it would probably be
from an immature specimen. The depth of effect was minimal as was the
devascularization. Most Loxosceles bites entirely destroy blood flow
and this injury retained excellent profusion. More likely, an insect
sting.
For reference, look at confirmed Loxosceles bites. The surrounding
area turns black very rapidly and recovery usually takes far longer.
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Date: Dec. 2005
From: R.T. Senior research consultant, specializing in envenomation
investigation.Much thanks to your web site. Very nicely done
and well organized.
To date, I have been bitted by a black widow, (latrodectus), a
rattlesnake (crotalidae sistrurus), a Brown Recluse and a horse (largus,
obnoxious, quadrapedicus). Of the four, the horse and the rattlesnake
competed for the worst and most painful.
In regards to bites in general, and the Brown Recluse in particular,
perhaps the following might help enlighten people about getting bitten
and what to do.
In order to accurately identify a spider bite and use the findings to
further research and treatment development, all bites need to be
identified as the spider was witnessed biting, or all reasonable doubt
has been eliminated. As example, my widow bite was accompanied by an
irate widow sitting on the back of my hand. Bites where the spider is
not directly identified with the bite MUST be labeled as
'/suspected/'. There is a reason for this. There are millions of
insects and members of the aranaea family that are not spiders and
bite without being seen. The fact of the matter is, insects are far
far more likely to bite then spiders and are much more common. In
addition to this, there are a vast number of insects as well as
arachnidia that are yet to be properly identified. Subsequently,
automatically assigning a bite to a given spider reduces the
probability of the biter to be properly identified. While most
suspected spider bites are in fact, as in your web site, probably
caused by a spider, there are wasps and hornets that cause very
similar bites and can cause identical reactions. One needs to keep in
mind, for every significant spider bite there are tens of thousands of
wasp and hornet stings. It is very common for people to 'assign' a
spider as the culprit of an envenomation but much less common for them
to produce the spider. Why? With some of these bites, the spider grew
wings and flew away. Some wasps as well as other insects have a very
powerful neuro or pseudo neurotoxin. This field is largely unexplored.
We do know however, some wasps have a venom which will effectively
paralyze it's victim for up to 2 months. That is a very powerful
poison.
With 'hit and run' bites where the biter is never spotted, wasps are
almost always suspect.
Many people will immediately claim that spider envenomation as on your
site is obviously very different from a wasp or hornet sting. This is
not always true. There are two different kinds of envenomation.
Hemotoxic and neurotoxic.
Hemotoxins are violently irritating poisons which actually start the
digestion process in the victims body as an aid to the biter digesting
it's prey. One problem with hemotoxins and their identification is
their effect will vary extremely widely, depending on the sensitivity
or resistance of the victim. For example, some people are violently
allergic to bee stings and can even die from them or from the
anaphylactic effects. Other persons find bee stings nothing more than
the most trivial of irritations.
The other form of envenomation, neurotoxic, is, or can be, very
different. Neurotoxins attack the nervous system. Sometimes locally,
at the site of the bite, or sometimes the entire central nervous system.
The venom alters the function or completely incapacitates the nerves.
In the case of the Loxosceles, the Brown Recluse, the nerves at the
location of the bite are incapacitated. The nerves are what causes
blood vessels to function and they shut down. With the vascular system
compromised, the body can no longer send nutrients or antibodies to
the injury site or begin the process of healing. As nerves grow back at an
extremely slow rate, this is why neurotoxin envenomations are so slow
to heal. Until the nerves resume sending instructions to the bite site
and from the central nervous system, the body cannot execute repairs.
Subsequently, a localized neurotoxic bite may appear that there is
venomeating away at the body when in fact the venom may be long gone.
The increasing damage is simply what happens to any area of the body
when it does not receive proper blood flow and nutrients.
The treatment of these two different toxins is radically different.
This is why it is so important to identify the biter if at all
possible. For one thing, there is no treatment of the immediate bite area effected
by a neurotoxin. Now, there are two different neurotoxic effects.
Where the venom is invasive and attempts to compromise the entire
nervous system, (systemic), and localized. With systemic, the effects
are wide ranging central nervous disorders and possible respiratory
arrest. As example, the Widow, Latrodectus, has a systemic toxin.
Commonly there is little or no pain at the bite itself and the injury
may vanish in a day or two.
With localized neurotoxins, the nerve damage is pretty much done
within the first 24 hours and all the rest of the damage is what
naturally happens to any area of the body that has been devascularized (without
proper blood profusion). At the center, where the venom was
introduced, all nerves have been compromised. Farther away from that
location, fewer and fewer nerves have been damaged, This is the area
that the bite will effect, /regardless of treatment/.
Envenomation treatment. One major problem in the treatment of
localized neurotoxic bites is the medical profession. They do not
treat the bite at all, they give drugs to help prevent secondary
infections, (antibiotics), anti inflammatories and pain killers. The
obvious problem with the administration of antibiotics is the chemical must find it's
way via the blood vessels to the bite location. If you had functional
blood vessels you wouldn't have a problem with the bite. What most
modern medical treatments do is load the body up with extremely
powerful broad spectrum antibiotics that can cause a galaxy of
entirely unrelated problems at a later date. One very common one, the
bite victim developing an allergy to certain antibiotics. Many medical
researchers and doctors firmly agree a 1 month treatment of, as
example, massive doses of Augmentin, will invariably cause some side
effects. In addition, the common pain killer given to bite victims
contains codeine, synthetic codeine, or similar. Morbidity reports
show that these drugs cause side effects over 2/3rds of the time.
Subsequently, when a person does suffer a neurotoxic spider bite, very
often some of the symptoms they describe, especially in the latter
stages, are caused in part or wholly not by the venom by but the
treatment.
One thing to note about bites, is a spider will bite repetitively if
trapped and under extremely unusual circumstances. Subsequently, the
multiple bite location will be very small. A hornet on the other hand,
as example, at certain times of the year, commonly stings multiple
times. One recorded incident had a child stung over 400 times in the
period of a few seconds by about 10 hornets. So, multiple bites over a
large area, an inch or more, is reason to suspect it may not have been
a spider. So catch the culprit if at all possible.
There are 3 forms a sting or bite will take and how it will feel. If
it hurts, a severe sharp pain that begins immediately, the venom is
either a hemotoxin or combination hemo and neuro toxin. Examples of pure
hemotoxin bites are ants, bees and the common hornet (yellow jacket).
In many cases, the bodies natural reactions, responses, to hemotoxins,
will emulate the neurotoxin in their effect. That is, nausea,
headache,dizziness and so on could be venom induced or a body produced function
known as an anaphylactic reaction. This reaction sometimes causes
misdiagnosis. The treatment for hemotoxins is very different. The
second form is the combination toxin. It produces both immediate
intense pain and longer term neurological symptoms. Many wasps carry
this combination venom. The gravest concern of both these two
envenomations is respiratory arrest. The airway becomes restricted or
some degree of paralysis sets in causing respirations to become
irregular, difficult, etc. The third form of envenomation is typified
by the Brown Recluse (Loxosceles Reclusivii) bite. There is often no
immediate pain and commonly, most of the bite effects are localized to
the area surrounding the bite. The central nervous system may still be
effected however.
Upon noticing you have been bitten, try to identify the culprit. With
the Brown Recluse and similar, this may be difficult or impossible.
The big rule to follow is, do NOT ignore any strange, unexplained wound
that grows in size or symptoms. If you have a wound that steadily
increases in discomfort or size for 48 hours, medical attention is
strongly advised. When given medications for your bite or sting, learn
everything about your medication! Be fully informed of what side
effects and long term exposure effects it can have. Upon reading over
1000 spider bite cases, it is easy to spot that about half the people
reporting their bites did not understand what the drugs they were
given were used for and what side effects they may have. Nearly all
bites and stings will have developed most of their symptoms within 48
hours. In the case of the Loxosceles and some wasps, it can take as
long as 1 to 2 weeks. After that period of time, if you develop
additional symptoms, suspect your medication first! As two excellent
examples, if you read through the reports people give of their bite or
sting and their recovery, persistant nausea lasting for weeks is
common.
Many of these people were put on a Codeine pain killer which commonly
causes nausea. Many people develop intense rashes, hives or similar
after a week or two. This is a common reaction to massive doses of
antibiotics. Two weeks after a bite or sting it is very unusual for
the bite or sting to cause nausea or general itching and hive like
symptoms.
The treatment of localized necrosis, as caused by some wasps and the
Loxosceles spider:
There is none. It is entirely up to your own body to do damage control
and repair. However, there are things that you can do to aid your body
in doing it's job. Your primary concern is infection. As mentioned
earlier, antibiotics administered by mouth or injection will help
prevent the spread of infection throughout your body. They will have
little or no effect at the actual wound site. The best thing you can
do is follow a very strict regimen of cleanliness. Think hospital
surgery suite area. Use Betadyne or similar powerful antibiotic
cleaning agents and if possible, get sterile gloves. Keep the wound
covered at all times with a proper dressing that lets it breath yet
keeps out bacteria. Use topical antibiotic agents, creams or salves.
Neosporin as example. Then let nature run it's course. Your primary
concern is certain bacteriaL infections that, if permitted to get established, can go systemic and
become potentially life threatening. Subsequently, with reports I have
read of people not wishing their wounds be debriided, this is
generally quite acceptable. But learn the 'watch fors'. A foul smell
coming from the wound and or a greenish color. Indications of gangrene
and similar bacterial infections. By all means, while being very
careful about infections, go ahead and use hot packs, poltices or
similar remedies. These may help to draw out the dead fluids and
tissues and can stimulate nerves and blood vessels into functioning a
little better.
After a week or a month or however long,... "It itches like fury
around the wound!" This is time to break out the champagne and
celebrate. Itching in and around the wound means the nerves are revitalizing and
starting to grow back. You are on the road to recovery. Don't scratch!
Itching is a natural body function that causes you to scratch. In
turn, scratching inflames the local tissues causing greater
blood flow, stimulates the nerves, and causes the body to pool blood
and body fluids into that area, all of which can be beneficial. Go
ahead and scratch all you want BUT not enough to damage the skin. The
best way to scratch is keep the wound covered with a sterile dressing
and massage (have someone help if need be) the area. Just don't
compound your injury by breaking open the surrounding epidermal layers
or breaking away any scabs that might have developed.
As a last word. Your body is a very powerful, complex machine. It runs
on hundreds of different chemicals. The higher quality those chemicals
are, the better it runs. As well, the better you treat that machine,
the better it works. A significant necrotic wound may seem localized,
just in one place, but do NOT BE FOOLED. Your entire body is engaged
in trying to repair the damage. As many people have discovered, they
think they are generally okay and try to go back about their normal
lives while recovering from a significant bite only to discover
faintness, weakness and the like.
Do's and Don'ts while recovering from necrotic wounds:
Do NOT smoke! Nicotine is a powerful vasoconstrictant! It closes down
the blood vessels. Some studies indicate a necrotic wound often heals
at only 1/3 the speed in someone who smokes. Since you are going to be
miserable anyway, it is a good time to stop smoking. Do not 'push
yourself'. Unknown to you consciously, your body is burning a lot of
energy. Don't try to deny it. Recovering from 2 inch across necrotic
wound can burn as much of your bodily reserves as running for a
mile or two every day.
Do eat your veggies! In fact, see if you can overeat every kind of
veggie you can find. Stuff yourself. Add lots of fruit and fruit
juices and make certain you drink at least four large glasses or water a day.
More if possible. Your body does not need that much high powered
proteins as found in meat during recovery of an injury when you are
'taking it easy'. What it wants is all the vitamins and nutrient
supplements it can get.
Do keep track of the chemicals the doctors are pouring into your body.
After prolonged treatment it is quite common to develop allergies to
various drugs.
Best wishes,
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