DON'T TREAD ON ME - STINGRAY PTSD

The stingrays have had a busy week in Isla Coronados.

Three people got nailed by stingray barbs this week in shallow water.

I sailed around the world for eleven years, and I have never been in a place where people I know have been stung by stingrays.

I am fairly sure we are not in the early phase of a stingray pandemic, but you never know. I have never seen this many stingrays anywhere else on planet ocean.

When I cruise the shallow clear water of Isla Coronados, it takes less than a minute to find a stingray basking in the sand or swimming in the water. Most of the stingrays in shallow water are the color of sand and are the size of a dinner plate with a tail. Large dark brown stingrays are also present, but they tend to evacuate the beach when we glide by in our kayak or we start the stingray shuffle.

It’s common knowledge that you should shuffle your feet in the sand to scare stingrays away when walking in the water. Theoretically, that should work. Unfortunately, two of the people stung this week had done the stingray shuffle, and they still got stung. So, conventional wisdom does not always work.

If you are in Stingray Land in shallow water, it’s probably safer to do the stingray shuffle than swim or float over a stingray in the shallows.

If you get stung while doing the shuffle, at least you will get stung in the foot or lower leg.

If you get stung while swimming or floating, you may get stung anywhere from the top of your head to the tip of your toes. Stings in the neck, chest and abdomen are particularly serious and may be life threatening. Stings to your private parts is an unforgettable and possibly life changing experience. I saw a picture of a male suffering from an ignominious sting to his parts down under, and I am willing to bet he now suffers from Stingray PTSD.

What should you do if you get stung by a stingray.

It depends.

The stingray barbs can be very large, and if they are in your neck, chest, or abdomen, you should not attempt to remove the barb yourself. Such attempts can make the injury worse or even fatal.

When I worked in a mission hospital in Kenya, I had a patient who was on the losing end of a fight with a bow and arrow. He showed up at the mission hospital with an arrow in the middle of his back over his spinal column - not a good thing. It was deeply embedded in soft tissue and bone. The arrowhead had multiple tangs on it like a stingray barb, and pulling it out would create additional soft tissue destruction.

We took the patient to the operating room, and we cut down on the steel arrowhead minimizing surrounding soft tissue damage. The patient turned out to be extremely fortunate because the tip of the metal arrowhead was embedded in a vertebral body (bone). If the arrow had been just a little forward, it would have gone into his aorta with instant death. If it had gone just a little backward, it would have hit his spinal chord and paralyzed him.
If we had just taken a pair of sterile pliers and ripped the arrow out of his back, it would have caused lots of soft tissue damage, and we would not have known the extent of the injury.

The same is true from stingray barbs in the neck, chest, and abdomen. You don’t pull them out. You may convert a survivable injury in an operating room to a lethal injury at the beach.

Injuries to the feet and legs are much more common and have a smaller chance of serious/lethal complications.
If a stingray barb hits you in the shin, ankle, or toe, the barb may just create a puncture wound because the barb struck bone rather than soft tissue. You end up with a painful puncture, but no barb embedded in you body.
If the barb goes into the soft tissue of your foot or calf, you have a good chance of having the stingray barb being stuck in the soft tissue, and you have to make a decision on whether to pull the barb out.

If you pull it out, you will certainly increase the soft tissue damage, but you may have no other option. If the barb is deeply embedded, the removal involves more risk. If it is superficial, then there is less risk of creating additional damage.

If you are on a beach in Los Angeles with immediate medical care available, it’s probably wise to let medical experts sort out the situation for you.

If you are cruising in a remote location with no medical care for hundreds of miles, your options are more limited. If you have lidocaine and a syringe and needle on board your yacht, you do what you have to do to get the barb out under local anesthetic and eventually get medical care from a professional.

Fortunately, most stings are to the toes, feet and lower leg, and if you are lucky, the barb will not be embedded in soft tissue or the barb is superficial and can be easily removed.

The treatment consists of pain relief and wound care.

If there is bleeding, you apply pressure until the bleeding stops.

You clean the wound as you would any traumatic injury.

If your tetanus toxoid injection is not up to date, you go get a tetanus shot.

Many people advocate putting hot water on the site of the injury. They believe the hot water deactivates the venom and decreases the pain associated with the injury.

The recommended water temperature is 110 degrees F to 115 degrees F. Put the hot water on a sopping wet cloth and put it on the wound for half an hour to an hour and a half or for as long as it takes for the pain to subside.

As with any open traumatic wound, you should apply antibiotic ointment and place a sterile dressing on the wound.

If a stingray spine breaks off in soft tissue, you may need an X-ray to identify the location of the barb fragments.

A stingray injury is a dirty wound, and it’s possible that you may develop a serious infection in the foot or leg, and the infection may not become obvious until a week later. If the wound is getting worse rather than better, you need to be evaluated for the possibility of an indolent infection.

Every stingray injury is different and the amount of time required for the recovery is different.

You may experience numbness and paresthesia in the area of the wound as healing occurs.

How long it takes for healing to occur depends on the location of the injury, the depth of the injury, the amount of venom in the wound, whether fragments of the barb remain in the wound site, whether infection occurs, and whether surgery was required.

As long as you are getting better each day after the injury, you will likely be fine.

If the problem is slow to resolve and if it gets worse each day, then medical attention is mandatory and should not be delayed.

If you are a diabetic with poor circulation in your legs and feet, you should aggressively seek medical attention because what would be trivial injury in a healthy person could become a life threatening injury in a poorly controlled diabetic with multiple other medical problems.

Dr. Dave

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