By Frank Counselman, M.D.
Beach season is finally here. In fact, it is one of the big reasons why many of us chose to live here – to be able to enjoy a lazy day on our beaches along the Atlantic Ocean. Along with the fun, sun, and water however, comes the potential for stings from venomous sea life. Let me offer a few simple tips to keep your summer at the beach healthy and enjoyable.
Not all jellyfish sting. It just seems that way. The jellyfish that do possess stinging cells (or nematocysts) are called Cnidaria. These nematocysts are located on the outer surface of the tentacles and the mouth of the jellyfish. The sting, or envenomation, usually occurs when the tentacles come in contact with an unwary swimmer. Also, remember that detached tentacles can retain their potency for as long as three months. These tentacles are long, shiny and transparent and frequently wash up on shore after a storm. They are capable of causing a sting if handled or stepped on, so you want to avoid them.
Jellyfish stings typically cause immediate pain, from mild and annoying, to moderate and uncomfortable. If you have been stung, first wash the area with salt water, then pour vinegar or isopropyl alcohol on it. This will help decrease the pain of most jellyfish stings. Don’t use fresh water and don’t rub the area. If there are any small tentacles attached to you, which is common, rubbing the area or pouring fresh water on it will only cause further envenomation and pain. Obviously, this requires advance planning on your part. Vinegar should be part of your Beach supplies, along with sunscreen and blankets. Frequently mentioned but ineffective remedies include meat tenderizer, ammonia, and olive oil.
Acetaminophen (Tylenol) or nonsteroidal anti-inflammatory agents (i.e. ibuprofen) will provide adequate pain relief for the majority of stings. Occasionally, a jellyfish sting may cause reddish or brown discoloration of the skin, called tentacle prints. These will usually heal on their own, and can be treated with over the counter hydrocortisone cream 1% twice each day. If you experience any symptoms other than localized pain, like difficulty breathing, palpitations, or abdominal discomfort, seek medical care immediately. There is a product on the market called Safe Sea; it provides both sunscreen and jellyfish protection. Studies have shown it decreases the frequency and severity of jellyfish stings.
Two other sea creatures capable of causing envenomation include stingrays and catfish. Both share a similar venom, although catfish venom is much milder. Stingrays have a spine on their tail that contains venom glands. When stepped on or threatened, the stingray will attempt to strike its victim with its tail and spine, causing both a puncture wound and release of venom. The onset of pain is immediate and usually severe. The majority of stingray injuries are on the feet and legs, because they are stepped on. However, they can occur anywhere on the body and can occasionally be fatal, as in the case of Steve Irwin, the Crocodile Hunter. Stingrays are often found lying on the bottom of reefs and river mouths. To avoid stepping on them, bounce a stick or pole in front of you or shuffle your feet. Stingrays are not aggressive and they do not want to meet you either.
Catfish have venom glands on their dorsal and pectoral fin spines. When frightened or handled, catfish lock their fins in an extended position, and puncture wounds or lacerations frequently occur, along with envenomation. Catfish stings usually occur on the hands and arms so wear gloves if handling them.
For both types of injuries, soak the injured part in hot water to tolerance (usually 100o to 110oF). This will provide dramatic and immediate pain relief. Wash the wound out with salt water, fresh water or even tap water. You will need to keep the injured area in hot water for 30 to 60 minutes. Because these wounds can be deep and cause tendon or nerve injury, and part of the spine or fin can remain in the wound, you should always seek medical attention. They will frequently require irrigation, antibiotics and updating your tetanus immunization.
Keep these safety tips in mind, enjoy the beach, and have a great summer.
Frank Counselman, M.D. is past president of the medical staff for Sentara Norfolk General and Sentara Leigh hospitals and is Chair of the Department of Emergency Medicine at Eastern Virginia Medical School. He is a member of Emergency Physicians of Tidewater.