That case of death has been discussed on Apitherapy-List (founder dr Stefan
Stangaciu) in May last year. Here is a retort to that article, written by
dr Cristina Aosan and sent to the group by one member.
regards
Predrag
Retort to the article “Death due to Live Bee Acupuncture Apitherapy”
Dr. Cristina Aoșan
Romania
MD - Specialist in General Medicine, Api-phyto-aroma-therapy licenced
Apimondia Apitherapy Commission, member
Licenced medical trainer in api-phyto-aroma-therapy
On February 2018, it was published in Spain an article about a woman who
would have died (date of the event not specified) after one bee sting,
accusing apitherapy and concluding it’s “unsafe and unadvisable”. The
article title is “Death due to Live Bee Acupuncture Apitherapy”,
http://www.jiaci.org/revistas/vol28issue1_6-2.pdf by Vazquez-Revuelta P,
Madrigal-Burgaleta R, from Allergy Division, Ramon y Cajal University
Hospital, Madrid, Spain. In its content there are a number of unclear
things and incomplete data, therefore a number of questions rise up.
First, the article is less than one page. I wonder: is it enough space to
solidly argue such severe conclusion, no matter the targeted domain, that
it is “unsafe and unadvisable” ? Mostly observing that it was fast taken
over in various countries, by very numerous and largely spread publications
(search on Google).
For those who don’t know the article, it’s advisable to read it before this
one.
To be clear about the symptoms that define anaphylactic shock, among a
number there are two obligatory: stridor of larynx and hypotension. If
these two signs are not present, it’s not anaphylactic shock. The
development of symptoms is like this: first generalised rash, oedema and
itch on the skin; then dyspnoea due to lowering the hole of larynx; then
stridor of larynx, dizziness due to the low blood pressure, and at
the end loss
of conciousness. Loss of consciousness doesn’t appear sudden after the
contact with the allergen. Wheezing may appear or not, later than stridor
of larynx. When stridor is present, if few minutes pass without treatment,
the cyanosis (blue-violet colour) of the skin appears, due the lack of
oxygen. Cyanosis appears first on lips, face, extremities of limbs and
extends to entire body, if the lack of oxygen persists. No cyanosis after
minutes, no anaphylactic shock.
To understand, stridor of larynx mean a strong sound like a whistle, heard
both on inspiration and expiration, coming from the throat, which is
unmistakable with anything. It appears because of the oedema in the larynx
that cause the closing of it, situation when the pass of the air produces
the sound like whistle.
Going to the article, it is written that immediately after one bee sting
the patient developed “wheezing, dyspnoea, and sudden loss of
consciousness”. It is not mentioned any skin reaction at the debut, neither
the stridor of larynx, both obligatory for a certainly diagnose. Loss of
consciousness doesn’t appear suddenly in anaphylactic shock. Cyanosis
generalised on the skin has to be found, if they arrived at 30 minutes
after the event, and that enters in the basic description of the patient in
such emergency situation, because it shows a severe generalised lack of
oxygen.
To make the difference from larynx stridor, wheezing is a thinner and weaker
sound like whistle, heard only on expiration, coming from the chest. It is
produced by the constriction of the bronchi, that appears latter than
oedema of larynx. Also unmistakable with anything.
But what if the patient jumped some meals in that day, not sleep enough
during the night (or nights) before, but worked during that day, and as a
consequence in the apitherapy office she had hypoglycemia, when the loss of
conscience may appear faster ? Or what if she developed a panic attack ?
What if she made one of those vaccines considered as obligatory nowadays
few weeks before, and developed one late allergy reaction (serum sickness)
that may lead after some weeks to organs impairment and even anaphylactic
shock ?
The authors didn’t mention anything about the life style factors of the
patient (processed food, synthetic beverages, working hard, sleeping few
and late at night, exposure to electromagnetism,…), neither about possible
anterior common medical treatments (vaccines, antibiotics) that could
determine sometimes severe manifestations, including allergies ? Also
nothing about investigating a possible exposure to toxins.
In the hospital diagnose of anaphylactic shock enters obligatory the
tryptase blood analysis. It is considered the one that confirms the
anaphylactic shock. The blood level of tryptase reach the maximum level
after the debut of anaphylactic shock in 40-60 minutes and remains high for
4-6 hours. The optimal interval to make the analysis is between 30 minutes
and 3 hours from the debut of the problem. And for a patient suspected by
anaphylactic shock tryptase analysis is among the basic ones in an
emergency department, where she was admitted during this time. But it
wasn’t made. Why ?
Another element that sustains the ambulance diagnose of anaphylactic shock
is the cyanosis of the skin related to the level of oxygen in the blood
that should be low. If it is cyanosis, the oxygen mask is immediately
requested, but that didn’t entered in the emergency treatment. Why ? We may
presume cyanosis wasn’t present. Then why they say it was anaphylactic
shock ?
Also, related to the ambulance intervention, they don’t describe the rate,
rhythm and amplitude of respiration, they only give the blood pressure and
heart rate. Why, because the respiration is an essential vital sign watched
and treated in emergency, along with heart rate and blood pressure ?
If it’s not present the cyanosis which is the visible sign of severe
hypo-oxygenation, one of the first acts in emergency is to measure the oxygen
level in blood. This is very simply using a device applied on the finger of
the patient, that is present in any ambulance. And if the oxygen is found
low in the blood, is again an emergency to apply fast the oxygen mask,
which it’s not mentioned.
Why they didn’t measure the oxygen in the blood ? Maybe because there were
no signs to suggest a low level of oxygen, as respiratory dysfunction that
is not mentioned.
Instead, they speak about respiratory intubation, decided by the Glasgow
Coma Scale score on 6. But Glasgow Coma Scale is not related to the
respiration. It is a neurological one, based on three examinations: eye,
verbal and motor. Not this scale dictates the need of intubation, but the
rate, rhythm and amplitude of breathing. But these are not described.
Moreover, in anaphylactic shock it’s impossible to introduce the tube into
the throat because the larynx closing. It doesn’t enter. In this case to
make possible the respiration, tracheostomy is the emergency act. This mean
to cut the skin for making a hole in trachea under the larynx and introduce
in there a tube. This allows the air to enter in the lungs avoiding the
closed larynx.
Another thing: in anaphylactic shock it is present the constriction of
bronchi, but this turns to normal after the adrenalin, along with the blood
pressure and heart rate. They say that that blood pressure and heart rate
were stabilized during the transport to the hospital. Why not the
respiration ? In this case, again the question: what for intubation ? Only
if the coma had another reason than anaphylactic shock, and the respiration
dysfunction was present. And again a previous question: why they don’t
write the rate, rhythm and amplitude of breathing ?
The respiration may be affected also by a cerebral stroke localized in the
brain-stem, when it is associated with heart arrhythmia that remains long
time, creating troubles not only in emergency moment, but also during the
hospitalization. But in this case the heart rate was stabilized during the
transport to the hospital. Interesting is that the watershed stroke showed
by CT has another location, in the hemispheres of the brain and produces
different types of paralysis, not respiratory problems.
Moreover, after arriving to the hospital, why it took 3 days to contact the
allergy department for a patient considered in anaphylactic shock ? In such
case, an allergy specialist should be called immediately, even announcing
during the transport to the hospital.
Why the ambulance doctors administered double dose of adrenalin ? It is not
explained. Adrenalin acts by constriction of blood vessels on periphery
(skin, abdominal organs) in order to direct the blood to the vital organs
meaning brain, heart and lungs. If it doesn’t look like anaphylactic shock
but they only thought it is because of the bee sting, then adrenalin wasn’t
necessary. In this situation, a double dose of adrenaline could determine a
strong constriction of the blood vessels in the abdominal organs meaning
ischemia that may lead finally to their impairment.
And what if the patient had hypoglycemia not anaphylactic shock and instead
of glucose the ambulance administered adrenalin?
And if the patient was in coma, why they administered intravenously saline
solution, but not glucose solution, to sustain the brain ?
After that, at the admission in the hospital, the computer tomography (CT)
of the head was compatible with watershed stroke. Compatible means it was
recently started, not completely installed. But they don’t confirm the
watershed stroke by another CT (or MRI) made after few days, as it is
usually.
Anyway, watershed stroke is cerebral infarction due to ischemia, that may
be produced by two causes: prolonged hypotension or thrombosis. The last
one mostly appears to persons with chronic carotid artery plaques, matter
that can have no symptoms for long time, meaning to remain unknown and to
manifest severely at once. To make the difference between brain ischemia by
hypo-tension or by thrombosis, and to treat it adequately it is necessary
to investigate the blood vessels state by arteriography and Doppler
ultrasound. Again not mentioned.
Brain injury requests the collaboration with a neurologist, also not
mentioned. The neurological sufferance looks like incomplete described and
treated during the hospitalization.
As an example, hypoglycemia may appear when someone jumps meals, not sleep
well and enough, but work hard or practice physical exercises. When in
hypoglycemia the person can develop stupor, coma and abnormal breathing.
Such hypoglycemia may lead to brain injury, if not treated in few minutes.
But again the ambulance didn’t measure the blood glucose, even if it’s very
simple using a glucometer that is a simple small device for emergency. By
administering adrenalin, the glycemia may increase a bit, so as in the
basic analysis of blood made in the hospital to look like normal.
The impairment of many organs that they accuse, may have few systemic
causes: toxic reaction or ischemia due to persistent hypotension or late
allergy reaction. Not by anaphylactic shock directly.
In a “persistent hypotension” appear in the blood analysis signs of severe
hypoperfusion: metabolic acidosis, hyperlactacidemia, abnormal liver tests,
coagulopathy. But they affirm the blood analysis at admission were normal.
How is that possible ? Or they didn’t analyze these important parameters ?
In the case of late allergy reaction, the disease is named serum sickness,
and it is diagnosed by the presence in the blood of fractions of serum
complement and circulating immune complexes. Again these obligatory
analysis don’t seam to be performed. Also they don’t mention imagistic
investigations (MRI, computer tomography) to highlight the failure of
organs, neither blood parameters specific for failure, at least for
kidneys, when creatinine has high level. Anyway in the case of kidney
failure the dialysis is necessary, another one not mentioned.
Two of the causes of serum sickness are antibiotics and vaccines.
In serum sickness symptoms appear usually after two weeks, rarely after
minimum 4 days. The first symptoms include rash, itch, joint pains,
enlarged lymph ganglions, but in 50% of cases these may not appear,
therefore you don’t know you have it, before some severe manifestations may
appear. What if she took some antibiotics (e.g. cephalosporins, penicillin,
cefaclor, sulfonamide) or a vaccine about two weeks before ? In serum
sickness, those complexes circulating in the blood determine inflammation
and swelling of blood vessels that lowers the blood flow. Serum sickness
may lead to kidney failure and anaphylactic shock. What if she was in a
non-symptomatic situation at the moment of the apitherapy session, added a
hypoglycemia, and right at that moment the severe manifestations of serum
sickness appeared ? By the combination of these two possible factors, the
hypoperfusion of blood and sufferance of organs is assured.
If we don’t have elements of investigation to highlight hypoperfusion or
serum sickness as cause of organs impairment, it remains the toxic one. For
a patient in such severe condition, it is usual to search toxins in blood
analysis. But they don’t write anything about that.
The failure of organs is not documented neither its cause, but expressed
only as an extension of the idea that the debut would have been
anaphylactic shock.
The entire description of this case looks superficial and incomplete.
Moreover, numerous elements do not match each other. It is unacceptable for
a scientific article.
Their diagnose of anaphylactic shock on bee venom started from the bee
sting, but was based only on incomplete symptoms and on IgE level of Apis
mellifera. But we know that many patients under bee venom treatment have
increased levels of IgE on bee venom, without any allergic reaction. If
they have a normal life, they don’t develop allergies. Because allergic
reactions are determined not only by the presence of IgE, but more by
adding many disturbing life style factors (processed food, synthetic
beverages, working hard, sleeping few and late at night which it’s usual in
Spain, exposure to electromagnetism, antibiotics, vaccines,…).
Now let’s count again:
− no rash, no itch, no edema on the skin, no stridor of larynx at the debut
− no cyanosis on the skin after 30 minutes from the debut
− intubation in anaphylactic shock ? Which it is impossible…
− but no tracheostomy needed…
− no oxygen level in the blood determined
− no rate, rhythm and amplitude of respiration to attract attention in
emergency
in order to be described as severe
− no tryptase determination in the hospital
− no signs of persistent hypotension in the blood, in the hospital
How they sustain the diagnose of anaphylactic shock ?
− contact with the bee
− wheezing, that doesn’t appear fast in anaphylactic shock
− sudden loss of consciousness that doesn’t appear fast in anaphylactic
shock
− IgE level in blood, which frequently are present without any allergic
reaction
Too few yes, which are weak and inconsistent for a correct diagnose of
anaphylactic shock, that looks more subjective and forced than medical
correctly.
And too many NO which are obviously, medically speaking, against the
diagnose of anaphylactic shock. I would rather say it wasn’t anaphylactic
shock.
Then what was that ? Considering the poverty of investigations, it’s
impossible to understand what was the sufferance and its cause. We can’t
even be sure it was multi-organs impairment, because they don’t sustain it
by anything, but only affirm it. Anyway, thinking it could be, we can only
presume it could be toxic sufferance or serum sickness. Or who knows what ?
Another thing: when someone dies in the hospital, it is obligatory by law
the necropsy. Out of this result the report of the legal medicine on the
cause of death, including the eye visible elements on body and inside of it
and the microscopic description. Where are these. How to know the real
cause of death ?
But what if on that ambulance was a beginner physician, non experienced who
didn’t diagnose and manage correctly the case ? And then in the hospital
the physicians assumed his idea of anaphylactic shock and didn’t pay
attention to other possible causes of the entire sufferance ?
Even if it would be real, it's one case. During this time, apitherapy helps
so many people that conventional medicine can not, and without important
not-wanted effects. But how many people die exactly in the hospitals by
allergic and toxic reactions on medicinal drugs, and no one declares
conventional medicine as “unsafe and unadvisable” ? How many of the doctors
working in their own offices are trained to treat such emergency situations
at the level recommended by the authors for apitherapists ? Because all
doctors work with substances that may provoke allergies. Do they make blood
analysis and allergy tests before each antibiotic or vaccine injection ?
Now looking at the structure of the article. For a medical scientific case
report, there are number of obligatory elements accompanied by arguments to
be included. I mention shortly:
− medical history
− detailed description of initial physical condition
− initial medical investigations to sustain the diagnose; in this case
anaphylactic shock
− if the diagnose was added during the observation, again physical
description, blood analysis, imagistic investigations to sustain; in this
case watershet stroke, multi-organs impairment
− evolution of symptoms
− evolution of parameters investigated
− if the case ended by death, compulsory the necropsy report to proof the
cause of death
− if adding references, they should be related to each point of the
diagnose.
The case report of this woman, if it would be presented by a student to his
University Professor during an exam, he wouldn’t pass it. All the more for
a specialized physician, it is embarrassing to sign such article.
Related to the conventional medical system, I mention that, according to a
recent warning of UN, on worldwide the number of deaths caused by the
consume of medication equalizes the number of deaths caused by drugs.
And that a large statistic made in USA reveals that the third cause of
death is iatrogenic (meaning medical mistakes) after heart diseases and
cancer. About quarter million people die annually by various iatrogenic
causes. But these things do not enter in the official statistics. That
explosive statistic was performed by Dr. Barbara Starfield, University
Distinguished Service Professor at the Johns Hopkins University Bloomberg
School of Public Health and School of Medicine. The article was published
in 2000
https://www.jhsph.edu/research/centers-and-institutes/johns-hopkins-primary-care-policy-center/Publications_PDFs/A154.pdf
with the title “Is US Health Really the Best in the World?”, in the journal
of American Medical Association. Mass media showed a small and short
interest for this alarming report, and the Government none. Dr. Starfield
died suddenly in 2011, apparently due to a coronary event while swimming at
her home. She had an intense activity around the world to share ideas,
nurture young professionals, and push leaders to do better.
To finalise, it looks like the aim of this too short article but enough to
impact the non-advised public by the conviction with which the allegations
are made, was to blame apitherapy, serving only the negative propaganda of
Big Pharma, that considers any natural therapy as competitor. Because for
the medical public and scientifically speaking, this article inconsistently
argued is unconvincing and on low level. It can not intimidate us, the
practitioners of apitherapy.
So, dear apitherapists all over the world, continue with confidence to do
what you believe in.
May 07, 2018
***********************************************
The BEE-L mailing list is powered by L-Soft's renowned
LISTSERV(R) list management software. For more information, go to:
http://www.lsoft.com/LISTSERV-powered.html
|
