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September 2015    Download the Entire Issue (PDF) Available to the Public Vol. 41, No. 9   RSS Feed for Undercurrent Issues
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The Total Anguish of a Lionfish Sting

physical, mental, financial -- and a trip to the “butt doctor”

from the September, 2015 issue of Undercurrent   Subscribe Now

There's more than just a sting and a rash when you get pricked by a lionfish. As our correspondent learned, you may have to deal with long hospital waits, many medical providers and multiple dealings with your health insurance firm. Undercurrent subscriber Carol Cox (Mexico Beach, FL) has been dealing with this over the summer. Here is her story (which doesn't have an official final ending until she is paid in full by DAN and her insurance company).

I got stung by a lionfish in July, and getting care has been interesting, to say the least. I wasn't even hunting lionfish, but my buddy asked for help getting a big one into his lionfish containment case. My hand slipped, and I got pricked in my thumb and two fingers. I took Motrin right away. I knew something was wrong when the pain resolved in my two fingers but not my thumb, so I had my husband drop me off at the ER. I kept my hand in hot water for the two hours it took to get to an emergency room, as well as the entire time in the ER, about four hours total.

I was the first lionfish patient for that ER, which isn't good news. They kept my hand in hot water, gave me oral antibiotics and pain pills, and kept me until the painkiller had time to kick in. I showed them a blister developing on my thumb, but they didn't seem concerned. By the time I was discharged, it covered the entire pad of my thumb. That night, when the blister covered a third of my thumb, I called Divers Alert Network (DAN), but all they said was blistering was normal.

On Sunday, at least half my thumb was covered by a large, deep blister. I contacted a triage nurse in my healthcare system by phone. She wasn't concerned until I said I was worried about necropsy. That got her attention -- she gave me a referral to an urgent care center close to home. I discovered they weren't open on Sundays, so I was referred to another place 45 minutes away, only to be told there that they don't treat "poisonous lionfish bites." So I called the referral line again, insisting on talking to the on-call doctor, who asked me what he was supposed to do about it. I told him to write me a referral to the closest ER in my area, one in a larger hospital than the place I had been the day before.

That ER doctor tried to find lionfish anti-venom (no luck, of course -- it's not available in the U.S.) and did an ultrasound to see if any spines remained (nope). He put me on an IV antibiotic for an hour, and told me I would lose all the skin on my thumb -- it might require a skin graft, but I wouldn't know until the venom had run its course. He said there wasn't much else to be done other than watch it and follow up with my main doctor.

Cox's Thumb Before TreatmentI contacted DAN to request claim forms and started to tell the DAN person that I was not happy about the response I got when I called on Saturday, but the woman replied, "DAN is really a marine accident organization, such as in barotraumas, and not a marine life encounter organization." She recommended a specialist who wasn't in my network, although my insurance would still pay much of it. I didn't see any exclusion for lionfish stings in my DAN handbook, and the woman I talked to didn't say anything about exclusions.

I also talked with a couple of folks who got similar blisters from lionfish encounters. One had a surgeon remove the skin and he was able to begin diving again in two weeks, albeit with a tender finger. The other ended up with an infection and a black finger, which one surgeon wanted to amputate. However, he got a second opinion and the finger was saved, although he still has nerve problems after five months.

As for my thumb, the blister encapsulated at least three-fourths of it before I was convinced by the guy who almost lost his finger to pop it. Then it was tender and stiff, but the leak kept the blister from spreading more. To prevent infection, I kept it slathered in Bacitracin, wrapped in bandages, and I kept on taking oral antibiotics.

A few days later, I saw my regular doctor, and she sent me to a proctologist -- a hemorrhoid doctor -- the next day. My thumb must have looked really bad for it to be mistaken for a bunghole. But his bio said he was once director of a wound healing center and "he has a keen interest in the management of acute and chronic, complicated wounds." I just hoped he had some skills to go along with that keen interest.

The butt doctor was very nice and wise. He took one look at my thumb and said I needed a hand specialist. DAN pointed me to Peter McAllister in Panama City. He wasn't in my network, which meant my copay was much higher, but DAN assured me it would take care of my out-of-pocket expenses.

Finally, a doctor who knew what he was doing. Dr. McAllister said popping the blister was the correct procedure to let the toxins out and begin moving my thumb joint. He treated my wound like a seconddegree burn, removing the dead skin and slathering it in burn creams and bandages. Two weeks later, I was back in the water, getting my revenge on lionfish -- minus a thick layer of skin on my thumb.

What I blame the lionfish most for is that it made me deal with the medical system. Without insurance, my total for two emergency room visits, three doctors and prescriptions would be $8,000. My insurance covered many of the bills, and my out-of-pocket expenses, including prescription co-pays, are covered by DAN, so my total is about $425. There are still $4,000 in emergency room bills my insurance is processing; the wrong billing codes may have been used. (There is no billing code for lionfish injuries; they have to classify it as a non-specific venomous animal bite.) However, it is comforting knowing I can turn the bills over to DAN if my insurance doesn't pay.

Five weeks after the sting, my thumb is doing well, and it has a new layer of skin. I have minor numbness and sensitivity, and I experience bouts of pain that come and go. But all this is a huge improvement compared to what I went through getting it treated.

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