# The EpiPen and you.



## Robert Hicks (Sep 28, 2005)

Mike,

Would you be so good as to tell me anything you feel I should know about the EpiPen. 

I just purchased 3 of them.


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## Robert Hicks (Sep 28, 2005)

"Replace any Auto-Injector if the solution is discolored or contains a precipitate.
The EpiPen Auto-Injector is designed with a see-through window to allow periodic 
examination of its contents. The physician may recommend emergency use of an 
Auto-Injector with discolored contents rather than to postpone treatment."

What color should the epinephrine be?


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## SilverFox (Apr 25, 2003)

I'm not MIKE, but carry an epi with me. The best bet if in doubt about the use of an EPI is to contact your doctor, as misuse use can result in serious consequences. they are a prescription and need to be replaced yearly, the liquid should be clear. 
I'm no doctor. The use of the epi is if and, only if symptoms of anaphlixic (sp) shock appear IE, constriction of the airway, extream diffaculty breathing, inability to swallow, DO NOT use if their is just swelling and minor irritation.
Why did you get 3?? At $85.00 a pop, that was kinda spendy.

[ March 30, 2006, 01:26 PM: Message edited by: SilverFox ]


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## Robert Hicks (Sep 28, 2005)

An overkill of safety. I was thinking of keeping one at the house, one by the hive (but cool), and train a neighbor and give them one.


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## Robert Hicks (Sep 28, 2005)

Plus my insurance picked this up. $65.00 for 3.


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## SilverFox (Apr 25, 2003)

Good idea, I have to remember to grab mine as I go out the door, allot of times I find Demerol is all I need. But the EPI is there just in case.


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## Jeff McGuire (Nov 18, 2005)

FYI There is an EPIPEN Jr for use on children that is a lower dose. I have the adult and a Jr in case one of my kids needs it.


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## Ben Brewcat (Oct 27, 2004)

It should be clear, not brown or cloudy. Sunlight degrades it quickly. wrapped in an opaque wrapper (tinfoil for my scored vials of adrenaline) in the fridge is best.


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## SilverFox (Apr 25, 2003)

Mine says not to refrigerate. But to store at 50-60 degrees.


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## GaSteve (Apr 28, 2004)

It all sounds nice but be wary. Epipens are prescription medicine. I'm not sure I have neighbors that trustworthy.

I heard a brief from a volunteer fireman and beekeeper who recommends that no one administer an epipen to someone else (except of course situations like a parent to a child).

The reason is that without proper training you could do much more harm than good. For instance, if someone is unconscious by their hives, how would you know if they had an allergic reaction to a sting or are suffering from heat stroke. Administering an epipen to someone with heat stroke may well do them in. He also indicated that "Good Samaritan" laws may be null and void if you start giving out prescription meds.

Just food for thought.


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## Sundance (Sep 9, 2004)

Are you folks severly allergic??? Or is this simply insurance??


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## Michael Bush (Aug 2, 2002)

I wrote a rather lengthy reply which apparently got lost somewhere. So I'll try again.

First, I don't know which of the many Mikes on here you're refering to, but since I'm one of them, I'll respond.

I have never had an Epipen and have no plans to ever get one. I have no experience with them and, in fact , have never actually seen one.

I do know, from Anatomy and Physiology class what Epinephrine does to the body, and I know from the many medical people I hang out with what anaphylaxis is like. If I had a pen and I was having serious trouble breathing, I would use one.

I have no idea what color it should be.


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## gardenbees (May 8, 2005)

How do you get a doctor to prescribe one if you have no history of severe allergy? In this day and age of managed health care I am amazed that a doctor would agree or that an insurance company would pay for it without documentation of a true need. That being said, I would love to have one just for a precaution. I tried to get my military pediatrician to write a script for my son and he said it wasn't needed since he had no history or reactions. I'm going to try again with my doctor next week but I don't hold out much hope. I tried to find one online but it seems that most of them require a script. Theresa.

[ March 30, 2006, 07:10 PM: Message edited by: gardenbees ]


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## Sundance (Sep 9, 2004)

Primatine mist is an over the counter inhaler that has epinephrine in it. It also has a much longer shelf life.

With several inhalations and a belt of liquid benadryl you'll get to the ER. Call the ER and let em' know you're coming. Arguably safer than injectables.


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## power napper (Apr 2, 2005)

Thanks for that tip Sundance!


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## gardenbees (May 8, 2005)

Yes, couldn't hurt to have one around. Wonder how much epi is in though? Have you heard of it's use during anaphalaxis? Theresa.


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## Sundance (Sep 9, 2004)

If you are certain you are deathly allergic to bees then the epipen is the only way to go, no arguement.

But if you "just want to be safe" then primatine mist and liquid benadryl are good insurance.

And the most important thing is to gently scrape off the stinger and sac quickly without further injection.


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## divebee (Mar 15, 2006)

I dont know if this is true, but heard that it's usually not your first sting that you have a bad reaction with, but could occur at a sting later on. If this is so, then why would someone ask if there is a "history" of a reaction to bee stings, prior to issuing a prescrip? I have a couple epi's stored in the house in case I need it. But since I have received some stings, if I can go on history, then I may not buy more of them.


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## Focus on Bees (Mar 6, 2006)

the liquid should be CLEAR. And yes talk to your doctor.


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## SilverFox (Apr 25, 2003)

The reason my doctor prescribed mine was as a preventive, when I first started bee keeping my throat started to constrict, I informed my wife and we both monitored my self through the next 24 hrs. Thankfully it disappeared, when I informed my DR. he thought it might be prudent to have an EPI available. I have heard that some people build up an immunity to bee venom and some a toxicity-you can get stung a million times and nothing, the next one gets you-I haven't had the constriction since, but you never know.
gardenbees; EPI-PENS are used for the treatment of anaphalaxis(sp)shock. 
Mine are prescribed by the VA.
Now I use benadryl and watch myself for indications of a severe allergic reaction.


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## Sourwood (Mar 20, 2005)

<<How do you get a doctor to prescribe one if you have no history of severe allergy? >>

I had no problem at all with my family physician prescribing me one. I simply told them I was a beekeeper who at times moved hives to remote country settings no where near civilization and wanted one as a "precautionary" measure. I would consider talking to other doctors.


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## Hillside (Jul 12, 2004)

For a while, I was carrying one of those things around for reasons not related to bees. My doctor strongly stressed that epi can be very dangerous if improperly used. It can cause extreme stress to the heart. It is intended to be self administered. You really don't want to administer it if you don't really need it.

My doc had me practice with a dummy epi pen while he monitored me and made sure I knew what I was doing.


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## Matz (Nov 21, 2005)

I myself have never carried an epi, mainly cause its expensive and shelf life is too short. Instead I carry benadryl (antihistamine) pills. Never had a reaction, but I figure if I ever get jumped by a swarm of vicious ladies, I'll be popping a couple pills. Maybe I'll get a buzzzz. Actually, a good beek friend of mine who's family has over 50 years exp informed me of their use. He carries the pills himself and in the past he's had severe reactions, which he had to build immunity to by getting Venom injections from Doc. Figure they're good enough for him, they're good enough for me.


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## BULLSEYE BILL (Oct 2, 2002)

When I was getting a cortizone shot for my shoulder Feb 1, my PA was inspecting my gimp finger from an infected sting last year, it may never get any better  He is aware that I do swarm pickups and cut-outs as well as being concerned about my hand and wanted me to get a couple of pens to have just in case.

He was a little more lax about thier use, but I plan to only use it if breathing becomes a problem.

I have a 16 yr old son of a friend that wants to help me with cut-outs this year. He is allergic to just about everything under the sun, even milk, eggs, and wheat. Animal dander, smoke, pollen, mold, on and on.

I told his mother that I would not take him until he was stung under controled condititons. He did not have any breathing problems but I let it pump until dry  He had a good local reaction like I used to get. A five inch swollen and red hot area that lasted for three days. He's still eager to help, but I'm not taking him without a pen handy.

And I've done stupid things before and gotten 50+ stings, so you never know.

BTW, doc said that the pens were about $20 each. Thats' cheap insurance.


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## Jeff McGuire (Nov 18, 2005)

>Are you folks severly allergic??? Or is this simply insurance??

I am just starting this year and have never had a severe reaction myself. As previously stated it is often not the first sting that people have rections too. The first couple couple stings can make you hypersensitive to following stings also my two daughters want to help me and I don't know what there reaction might be. This year I have an epipen for insurance sake. I don't know whether I will continue to purchase them in the future. 
I am a professional firefighter and EMT and have used epinephrine several times for nut, shelfish, and bee sting allergies. I agree that it should not be given unless you are sure the persons condition is from an allergic reaction that is obviously true with any medication. Benadryl and other types can help with mild reaction but won't do much for severe as it takes too long to get in the system.


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## dickm (May 19, 2002)

On Benadryl. I carry a bottle of the liquid stuff made for kids. It will get into the body faster. My son had a bad reaction to a wasp sting and took the last 2 antihystamines in the house. At the ER the doc said they may have saved his life.

Dickm


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## GDH (Jun 15, 2005)

I too keep Epipens for safety sake. Our property is about 40 miles from the closest emergency room. The doctor had no problems on the prescription, paid for through my HMO ($20), but as stated previously, specified the used for "breathing problems." I am very allergic to most nuts (to food type, not the human type, although they give me a reaction too). When filling an order, I suggest having the pharmacy order a fresh package (good for a year).


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## Kieck (Dec 2, 2005)

I'll throw my two cents' worth in here. I do have an Epi-pen, although it's past its expiration date now. My wife thought it would be good "insurance." I agree to a point -- if I have someone else with me when I'm working bees, and they run into problems, an Epi-pen might be worthwhile. Mainly, though, that Epi-pen alleviates my wife's worrying, and that's worth the cost of it to me.

Having said all that, my 'pen (I covered virtually all the cost myself) cost me about $50. I'm sure you can get them less expensively if insurance kicks in on them, but sooner or later we all end up covering that cost, too. The expiration date on an Epi-pen is roughly one year from the date of prescription, so you should count on replacing any of them every year.

I would view an Epi-pen as a "last resort" measure. I hear about a lot of people who have "bad reactions" to bee stings, yet I wonder how many of these people would actually go into shock from a sting. One of my brothers-in-law, for example, swells up terribly from bee stings. Some of his family members are EMTs and push him to take epinephrine when he's been stung. So far he has never taken epinephrine (just benadryl), and so far he's never experienced anything approaching anaphylaxis. I think, in most instances, if someone with me was stung and began experiencing problems, I'd try to do what others have suggested -- get them to a medical facility as quickly as possible for treatment by professionals -- rather than using an Epi-pen.


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## Michael Bush (Aug 2, 2002)

In my experience the first sting of the season is the worst and then they get better until they are hardly noticable.

Sometimes a first sting is really bad. This last year I had my ankle swell up so much I couldn't walk on the first sting. The rest of the stings were nothing.

This, of course, is backwards from the concept that subsequent stings are worse.


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## BULLSEYE BILL (Oct 2, 2002)

>This, of course, is backwards from the concept that subsequent stings are worse.

I think your body gives you two choices, build up an immunity, or build up a toxicity (sp).


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## beecron (Nov 7, 2004)

"With several inhalations and a belt of liquid benadryl you'll get to the ER. Arguably safer than injectables."

Taking "several inhalations" isn't any safer than any other treatment suggested on this string. Taking any medications, OTC or not, beyond the recommended dosing on the label without consulting a physician is just as dangerous.

I, like J. McGuire, am a career firefigher/paramedic. As I said above, it's not good at all to take medications any way other than which they were intended. Likewise, using medications which were prescribed for somebody else is just as ill-advised. 

Yes, Epi should be as clear as water, no discoloration and no "cloudiness". Would you use one that was discolored or out of date in an emergent situation if it was your best option at the time? The choice will be totally yours. It may beat the alternative, it may be a very risky maneuver. 

I know that many people on this site live in rural areas and keep their bees in rural areas, but if you have a cell phone, many places such as these are still within range. Always keep yours with you to access emergency medical help and be able to provide ACCURATE information as to your location since obviously cell phones are unable to provide dispatchers with the location the call comes from as many enhanced 911 operations can on landlines.

Barry


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## dickm (May 19, 2002)

According to the directions on mine, there will still be liquid visible after use. It cannot be used again. Dump it.

Dickm


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## NorthALABeeKeep (Nov 10, 2004)

Walter Kelley sells a product thats called "Denver's Sting Stopper" that works great on stings if you can apply it soon after the sting. Something in the stuff "neturalizes" the chemicals in the venom. Do a search on the net and you can find out about it. I've used it before and it stopped the hurt almost right away. But if your truly allergic to bee stings I won't rely on this alone.


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## Sundance (Sep 9, 2004)

"Taking "several inhalations" isn't any safer than any other treatment suggested on this string. "

I would argue that primatene mist is safer than injectable. Not as effective, but the danger aspect of an injectable is there.

Primatene mist coupled with liquid benadryl is safer than doing nothing when you are 20 miles from an ER.

[ March 31, 2006, 11:29 PM: Message edited by: Sundance ]


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## Irsqu911 (Nov 14, 2005)

OK, I had 5 pages written on this and my computer dumped it. So, I will make it brief and summarize what everyone has already said.
Yes, in almost all (except in extremely rare cases which make it almost improbable) you need to be stung twice to become allergic. First sting the body identifies the poison (protein) then develops the antigens and histamines. Second sting it releases it. 
If you have been stung more then twice by the same type of insect without an allergic reaction the chances of you having a severe reaction are extremely slim (In the area of lighting strike or asteroid strike to the head type chances). So, If you have been raising bees for a while you probably dont need it. 


The EpiPen is Epinephrine. Epinephrine is synthetic adrenalin. Adrenalin is a fight of flight hormone and is released by the body when its fighting or fleeing for its life. 
Epinephrine is unstable and has a somewhat short shelf life and this is reflected by the expiration date on the box. Old Epi is weak Epi exponetionally. Keep in cool dry dark place blah blah says it all on the box.
Epinephrine can cause some severe side effects.heart attacks, deathother worse things. Remember the body only uses it when its fighting for its life and is in a do or die situation. 
The EpiPen is a prescription medication and should only be given to the person prescribed to. I believe your box should have the name of the person prescribed on it. ONLY they can use that medicationand Yes you will (WILL) be held liable for giving your prescription medication to another person even in a life or death situation. You and I are not doctors and cannot make that decision, sorry. Consult the FDA on that one. 
The EpiPen is not for mild allergic reactions. Your doctor should not have prescribed it to you. It is not a prophylactic medicationMeaning it should not be prescribed or taken because you think you need it. This crap is somewhat dangerous. And should be used only when your thinking I cant breathe and I am going to die or I really need to go to the emergency room. In fact, the manufacture recommends that if you use the EpiPen you go to the ER right away (30% of people have secondary allergic reactions once the initial dose of Epi wears off) for evaluation and another prescription for EpiPen 
The EpiPen comes in 2 sizes Adult (gray tan box 0.3mg of Epinephrine) and Pedi (yellow? 0.15mg Epinephrine). The PediPen is for people under the weight of 50 pounds. Do not give the adult dose to kids. The EpiPen is a metered dose one time use injector designed from the militarys Mark 19 auto injector used for Biological and chemical warfare. You cannot give a half dose. 
To use EpiPen remove from box, it will be in an amber tube, slide out from tube. Inspect it. (expiration date and for clarity in window) Hold in fist, remove gray safety cap from rear of injector.. The EpiPen is designed to be injected into the thigh only and can go thru clothes. (thigh area means take fist with thumb outhold at side and press against leg naturallyright there) press black knob against this area firmly. You will hear a snap..hold for 5-10 seconds..remove. Take the Epipen bend the needle over on a hard surface( to protect others from accidentally being stuck) and return it to the amber tubeTake it with you to the hospital so they can make sure it worked properly and what dose was used. You can rub the injection site for more rapid absorption. 
Remember the FIVE RIGHTS
RIGHT person (only the person the medication is prescribed to)
RIGHT Medication (Epi or noteasy one)
RIGHT Dose (Adult or Pedinot interchangeable)
RIGHT Time (Life threatening situations only)
RIGHT Route (Mid Thigh area only)

Many healthcare professionals across the country have lost licenses for not following the above rules in the past, You as an untrained professional also have to follow them and cannot do anything your not trained to do. The Good Samaritan laws state you can do what any other person trained to the same level would do in good judgment in the same situation and not be held liable. Overstepping those bounds is when people get in troublemostly due to poor judgment. 
Personally, I have issues with any physician who hands out prophylactic prescription medications for just in case situations to someone who has no proven allergic history as it shows bad judgment on their part. Should he also prescribe you Nitro in case of a heart attack because your in the optimum age category but never had cardiac problems in the past? NO!
Basically. Keep it simple. 
First Identify the hazardsGo out and get stung a few times, find out if your allergic first! If you get stung..
Non-Life threateninguse OTC medications others have discussed earlier. They should help. Also ice packs, elevation above the heart and a light constricting band (not a tourniquet) higher up on the limb to prevent further spreading also help
Life Threatening-Use your prescribed EpiPen 
Somewhere in there you should be thinking 911 Almost all ambulances in the country (I can only speak for Nebraska..and all have them) should carry Allergic reaction kits containing both EpiPen and PediPen and the providers are trained in proper usage. They can also provide other life saving measures. IE oxygen, Cardiac monitoring, IV therapy, Other supplemental medications etc..and get to drive fast to the hospital Safer then you in your privately owned vehicle. 
I have been around the EpiPen a while. Works great most of the time. But, I have seen it used in the wrong situation before with a detrimental outcomeThe last I saw of that guy was when we where driving away in the ambulance with a really sick person and the police where pulling him to the side talking to himRules are in place for a reason.


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## brent.roberts (Dec 31, 2005)

I was in the Florida Keys cleaning up after hurricain Georges when I got bit by something, 2 holes in my leg about 1/2" apart. After about 15 minutes I got red rashes in my groin and armpits, 10 minutes later my lips started to get thick, my tongue started to get stiff. A few minutes later my throat started feeling tight. I high tailed it to the hospital. By the time I got there I could not speak proberly because of the stiff tongue and lips. 
At triage a doc overheard and asked if I got bit. I pointed to the leg and she grabbed me off to a room and injected some epi. 

I had never had an anaphalactic shock reaction before. I asked her, on a scale of 1 to 10 how severe was this. Oh about 9.99 she said. In another 15 minutes you would not have been able to breathe.

She told me to get an epi-pen and keep it on hand all the time. Furthermore she warned me to avoid using until I really felt I needed to and to try to get some help or contact with anyone before injecting with it. Epi can cause significant, even fatal drop in blood pressure, so someone should know what you've done. After injecting do not sit around by yourself. Get medical help and monitoring.

Lessons learned.


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## brent.roberts (Dec 31, 2005)

And not the other side.

Last summer I was working on my woodpile for the next winter's heating and overturned a wasp nest. Got 7 or so stings in close proximity around my face. Within a short few minutes my nose and lips swelled up. Ran to the house, took a few benadry tabs, got some ice and the epi pen and my wife to drive me to the hospital.

There the docs made and exam, laid me down and started and IV drip of ... not epi but benadryl.
Actually not benadryl but the generic drug, diphenhydramine HCL. Two bags of drip in 15 minutes.

So when everything was under control we asked the doc and his answers were:
Yes you did the right thing to come to the hospital. 
Yes you did the right thing taking the benadryl before coming.
Yes you did the right thing NOT using the epi pen.

The reaction to the stings was all localized on my face. Not systemic. Never bothered my throat or breathing.

On the other hand at our cottage about 3 years ago a 45 year old woman who knew she had severe anaphalaxic reaction to wasps went for a walk in the woods with some friends. Stepped on a wasp nest. The husband ran home for the epi pen. He did not get back to her in time.

Lots to learn about when, where and how to use one if you get one.

When I got the dose my whole body felt like the tension was melting down within me. 

It's powerful stuff. Use well ... use carefully

[ April 01, 2006, 07:05 PM: Message edited by: brent.roberts ]


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## gnor (Jun 3, 2015)

> Epipens are prescription medicine.


Just had a bad reaction, so spoke to my pharmacist about epipens. They are sold over the counter here in Nova Scotia at about $110 a pop. A drug plan will pay for them if you get a prescription.
As far as when to use it, a good first aid course should be a must for all beekeepers, because there are other things to do in an emergency other than the pen.


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## jjohnsind (Apr 24, 2014)

NorthALABeeKeep said:


> Walter Kelley sells a product thats called "Denver's Sting Stopper" that works great on stings if you can apply it soon after the sting. Something in the stuff "neturalizes" the chemicals in the venom. Do a search on the net and you can find out about it. I've used it before and it stopped the hurt almost right away. But if your truly allergic to bee stings I won't rely on this alone.


Baking soda paste will do the same thing. It doesn't do anything for you if you are allergic though.


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## Pete O (Jul 13, 2013)

I’m one of those people whose heart did stop after having epinephrine; I was in a hospital and my surgery required cocaine. Following surgery I was given epinephrine to bring me down. * Cocaine +* *epinephrine = heart attack;* I was only 18 years old at the time. 

These days I’m on fairly heavy doses of prescribed OxyContin, a form of cocaine. There’s no way I would chance another heart attack by using an epi-pen. I’ll stick to Benadryl thanks.


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## deknow (Jul 17, 2006)

Oxyconton is nothing like cocaine...it contains a synthetic opiod. Much more like heroine than coke.

It is difficult to take this account as accurate given the obvious lack of understanding of what you are actually taking.

I'm no doctor, but epinephrine to "come down" from cocaine makes no sense to me.


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## Nabber86 (Apr 15, 2009)

deknow said:


> I'm no doctor, but epinephrine to "come down" from cocaine makes no sense to me.


It does sound like a recipe for a heart attack.


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## oldfordguy (Dec 5, 2009)

When I first started I thought it would be a good idea to have an epi-pen around as well. My doctor prescribed without a problem, but my insurance company blocked it. Apparently, it's against policy to give synthetic adrenaline to someone with an internal cardiac defibrillator.:no:


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## dynemd (Aug 27, 2013)

"There are NO absolute contraindications to epinephrine use in anaphylaxis.
Patients with cardiovascular diseases: Reluctance to administer epinephrine due to fear of adverse cardiac effects should be countered by the awareness that the heart is a target organ in anaphylaxis. In the healthy human heart, mast cells are present throughout the myocardium and in the intima of coronary arteries. Anaphylaxis can unmask subclinical coronary artery disease, and myocardial infarction and/or arrhythmias can occur during anaphylaxis, even if epinephrine is not injected. Moreover, anaphylaxis itself can cause vasospasm, arrhythmias, and myocardial infarction in patients, including children, with healthy hearts as confirmed by normal electrocardiograms, echocardiograms, and coronary angiograms after resolution of anaphylaxis.
To reiterate, there are no absolute contraindications to the use of epinephrine in the treatment of anaphylaxis. The risk of death or serious neurologic sequelae from hypoxic-ischemic encephalopathy due to inadequately treated anaphylaxis usually outweighs other concerns. Existing evidence clearly favors the benefit of epinephrine administration in anaphylaxis."
Up-To-Date, Anaphylaxis: Rapid recognition and treatment, Simons, F., Camargo, C. 

This does not mean there can not be dangerous side effects to the epinephrine, but if you truly are having an anaphylactic reaction (not just rash and itching) there is no reason not to use epinephrine to treat. If you have cocaine in your system or have a defibrillator and heart problems it would probably be best administered by trained professionals in a medical setting if possible.


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## dynemd (Aug 27, 2013)

"Agents that may be given as adjunctive therapies to epinephrine in the treatment of anaphylaxis include H1 antihistamines, H2 antihistamines, bronchodilators, and glucocorticoids (e.g. prednisone). None of these medications should be used as initial treatment or as sole treatment because they do not relieve upper or lower respiratory tract obstruction, hypotension, or shock and are not lifesaving.
Epinephrine is first-line treatment for anaphylaxis and there is no known equivalent substitute. A systematic review of the literature has failed to retrieve any randomized controlled trials that meet current standards and support the use of H1 antihistamines in anaphylaxis.
Despite this, H1 antihistamines are the most commonly administered medications in the treatment of anaphylaxis. This suggests overreliance on these agents, which should be considered adjunctive to epinephrine for the purpose of relieving itching and hives."
Up-To-Date, Anaphylaxis: Rapid recognition and treatment, Simons, F., Camargo, C. 

"Other medicines that are used in the treatment of allergic reactions can help with some of the symptoms, but only epinephrine treats the entire reaction. Antihistamines (such as diphenhydramine and others) help with itching and hives, and asthma inhalers (such as albuterol) can help with coughing and wheezing, but these medications do not treat the dangerous symptoms of throat swelling and low blood pressure. In addition, antihistamines taken by mouth are too slow-acting to be effective in a rapidly-developing episode of anaphylaxis. In contrast, injected epinephrine works within a few minutes. In short, antihistamines and asthma inhalers are useful in the treatment of anaphylaxis, but they are NOT substitutes for epinephrine. There is no substitute for epinephrine in anaphylaxis."
Up-To-Date, Anaphylaxis: Rapid recognition and treatment, Simons, F., Camargo, C.


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## Nabber86 (Apr 15, 2009)

dynemd said:


> "There are NO absolute contraindications to epinephrine use in anaphylaxis.


You overlooked the part where oldfordguy said that he had an internal cardiac defibrillator. There may be contradictions in his case. Another reason not to get your medical advice from the internets.


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## dynemd (Aug 27, 2013)

I repeat "There are NO absolute contraindications to epinephrine use in anaphylaxis." 
I may not give a dose in the field, or I might choose to give a smaller dose but if a person is dying of true anaphylaxis the only thing that would save him might be epinephrine. The risks and benefits would need to be considered, sure. Would I send this gentleman out of my office with a prescription for self administered epinephrine- probably not. The advise I'm quoting is from respected experts in the medical field. I don't know of any better way of communicating true accepted medical facts but you are certainly entitled to your own opinion. 

"Patients with cardiovascular diseases: Reluctance to administer epinephrine due to fear of adverse cardiac effects should be countered by the awareness that the heart is a target organ in anaphylaxis. In the healthy human heart, mast cells are present throughout the myocardium and in the intima of coronary arteries. Anaphylaxis can unmask subclinical coronary artery disease, and myocardial infarction and/or arrhythmias can occur during anaphylaxis, even if epinephrine is not injected. Moreover, anaphylaxis itself can cause vasospasm, arrhythmias, and myocardial infarction in patients, including children, with healthy hearts as confirmed by normal electrocardiograms, echocardiograms, and coronary angiograms after resolution of anaphylaxis.
To reiterate, there are no absolute contraindications to the use of epinephrine in the treatment of anaphylaxis. The risk of death or serious neurologic sequelae from hypoxic-ischemic encephalopathy due to inadequately treated anaphylaxis usually outweighs other concerns."
Up-To-Date, Anaphylaxis: Rapid recognition and treatment, Simons, F., Camargo, C


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## Nabber86 (Apr 15, 2009)

dynemd said:


> I repeat "There are NO absolute contraindications to epinephrine use in anaphylaxis."


So if I had ¼ of a kidney and was on dialysis, a failing liver, high blood pressure, multiple embolisms, and addicted to crack and PCP, you would have no problem giving me epinephrine? Because that is what you are saying. I mean no contradictions right?


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## jbeshearse (Oct 7, 2009)

Nabber86 said:


> So if I had ¼ of a kidney and was on dialysis, a failing liver, high blood pressure, multiple embolisms, and addicted to crack and PCP, you would have no problem giving me epinephrine? Because that is what you are saying. I mean no contradictions right?



Everyone here seems to be ignoring the person in need. If you are laying there suffocating on the ground in front of me and I ask you if you want me to use an Epipen on you, I doubt you are going to nod your head "no". If you nod "no" then I would have to let you suffocate, anything else, including no response would get a shot to the thigh. 

Which is worse? Damaging you remaining 1/4 of a kidney or allowing you to suffocate to death. I image that the person in need will most times be able to respond in some way. If not, then a shot is probably their only hope.


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## Nabber86 (Apr 15, 2009)

jbeshearse said:


> Everyone here seems to be ignoring the person in need.


How about we concentrate on Oldfordguy who started this branch of the thread. His insurance told him to not use an epipen, so he should not use one until he checks with his doctor (specifically his cardiologist). Maybe there is a miscommunication that needs to be clarified. Maybe there isn't. Nobody knows at this point. Based on this, we shouldn't go around telling somebody to use an epipen when they were told not to.


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## deknow (Jul 17, 2006)

I get all my health advice from insurance companies.


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## jbeshearse (Oct 7, 2009)

deknow said:


> I get all my health advice from insurance companies.


Yep, they always have your best interests in mind! My epi pens are $400.00 a year, if I work through my deductible, the insurance pays 80% of that.


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## deknow (Jul 17, 2006)

If you want to discuss old ford guys situation (he brought it up), his words that the insurance company "blocked it". 

In my experience, an insurance company might not pay for an epipen (which is what I expect happened in his case), but they can't really void the prescription. 

The doctor could certainly have made an error...but the insurance company doesn't "fix" an error a doctor makes by "blocking" a prescribed treatment. My impression is that many people pay out of pocket for epipens.

My guess is that the insurance company doesnt want to pay for epipens for someone with no history of having a reaction. My guess is that the doctor made a judgement call...and probably wasn't unaware of the implanted device.

Regardless of what I guess, it would never be the insurance company that would correct such an error (if it were one).


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## dynemd (Aug 27, 2013)

Nabber86 said:


> So if I had ¼ of a kidney and was on dialysis, a failing liver, high blood pressure, multiple embolisms, and addicted to crack and PCP, you would have no problem giving me epinephrine? Because that is what you are saying. I mean no contradictions right?


No absolute contraindications...


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## Nabber86 (Apr 15, 2009)

deknow said:


> If you want to discuss old ford guys situation (he brought it up), his words that the insurance company "blocked it".
> 
> Regardless of what I guess, it would never be the insurance company that would correct such an error (if it were one).


The insurance had to have some reason to deny it. It could have been as simple as his insurance plan does not cover epipens, period. Money? Who knows? Even if it turned out to be evil insurance profit mongering, dont you think it would be prudent to check with the cardiologist, before you tell an internet stranger that he should use an Epipen. I mean seriously, why wouldn't you check with your doctor? 

Your tag line indicates searching for truth. Are we going to the subjective side now?


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## Nabber86 (Apr 15, 2009)

dynemd said:


> No absolute contraindications...


They didn't test all possible scenarios. Do you deny that there are not case by case exceptions? Is a doctor going to go by a paper that says, "No problem, use an epipen whenever you want, no exceptions". I certainly wouldn't want a doctor like that. Maybe your doctor has really good reasons and you should talk to him about your particular situation. Ya think that might be a good thing to do, or just ignore somebody who may be trying to save your life? It doesn't sound like a good plan for life.


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## deknow (Jul 17, 2006)

Using an epipen if your life isn't in danger from anaphylaxis is improper usage.

There are pluses and minuses, pros and cons, risks and benefits that all must be considered when prescribing or taking medication. Even asprin isnt universally recommended against heart disease anymore because of the risks vs the benefits.

The risks associated with using an epipen (which are considerable) vary with everyone's individual circumstance.

If old ford guy thinks that the epipen was (in his case) c9ntraindocated, then he certainly should seek another opinion...his cardiologist or otherwise.

The account, as related here (which I'm sure was posted with good intentions) makes no sense. The insurance company decides what to pay for, not what is medically advisable.

If it were really contraindicated or an obvious bad idea, it would be called malpractice, not 'blocked by insurance'.


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## Nabber86 (Apr 15, 2009)

deknow said:


> If it were really contraindicated or an obvious bad idea, it would be called malpractice, not 'blocked by insurance'.


So your subjective advice is to not consult you doctor? Neil wants to have a word with you.


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## deknow (Jul 17, 2006)

I suppose I should have said something clear...like:


> If old ford guy thinks that the epipen was (in his case) c9ntraindocated, then he certainly should seek another opinion...his cardiologist or otherwise.


...oh wait, I did.

He did consult his doctor. If he thinks he isn't getting good medical advice he should find medical advice he trusts.

...but if you want to talk nonsense have at it.


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## rookie2531 (Jul 28, 2014)

My wife just had a regular checkup and I asked her to talk with her doctor and see if she would give her a pen. She subscribed it and my wife asked "what about my high blood pressure" the doctor replied, " a stroke is better than death". So, I agree if you are going to absolutely die in the next minute, any body would keep you alive in that situation, even if death came from a heart attack 5 minutes later. That's 4 more minutes than you had before and who knows, you might live a few more years than that one minute.


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## deknow (Jul 17, 2006)

Yes. No one is recommending recreational use of an epipen....if you aren't on your way to the emergency room or on the phone with medical personal, you should not even be thinking of injecting yourself.


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## deknow (Jul 17, 2006)

It's also worth noting that it isn't easy to have an epipen.

You have to have it with you. You can't leave it in a hot car. You will probably never use it (especially if you are getting one just in case but have no reason to believe you are at risk)....which makes it easy to want to leave in the car and hard to actually have it with you when you end up needing it (like the recent post about a woman dying while her husband ran to get it).

It probably isnt worth having one if you don't jeep it closer than your smartphone.


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## Agis Apiaries (Jul 22, 2014)

Irsqu911 said:


> OK, I had 5 pages written on this and my computer dumped it. So, I will make it brief and summarize what everyone has already said.
> Yes, in almost all (except in extremely rare cases which make it almost improbable) you need to be stung twice to become allergic. First sting the body identifies the poison (protein) then develops the antigens and histamines. Second sting it releases it.


Wow... you nearly wrote a book. And I only got a couple of sentences into it before I found it to be wrong. Must be stung twice before you become allergic? Where did you come up with that nonsense? :scratch: I was stung by a honey bee when I was about ten. First sting in my life. Went into shock and nearly died. It was my first sting.

Please don't give medical advice on BeeSource. :no: Great place for beekeeping advice. Terrible place for medical advice.


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## Nabber86 (Apr 15, 2009)

deknow said:


> He did consult his doctor. If he thinks he isn't getting good medical advice he should find medical advice he trusts.
> 
> ...but if you want to talk nonsense have at it.


i didn't see the post where fordguy consulted with his doctor.


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## Knisely (Oct 26, 2013)

> Must be stung twice before you become allergic? Where did you come up with that nonsense? I was stung by a honey bee when I was about ten. First sting in my life. Went into shock and nearly died. It was my first sting.


Agis Apiaries: As nonconfrontationally as possible, there was nothing I found wrong in the capsule summary that you found fault with.

Your situation was included in what was stated, in that it was your first sting, but much more commonly, a first exposure sets the stage for an overexuberant reaction to a second exposure. 

Might you have grown up in a beekeeping family?

More beekeepers family members develop anaphylactic reactions to beestings because they are exposed to bee venom from their beekeeping family member's clothing, etc. From that exposure, and not from a sting, their bodies immune systems get ready to do an inappropriate battle with any further exposure to bee venom. I believe I recall Michael Palmer recounting his daughter's experience with anaphylaxis after an inadvertent sting she got in his truck when he picked her up from an after-school activity.

For those who wish to learn a bit more, do websearches on the terms 'immediate hypersensitivity reaction' and 'anaphylaxis', which are more specific terms dealing with this sort of reaction than 'allergic', which is a more catch-all phrase that covers many of our immune system reactions to things considered 'non-self'.


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## oldfordguy (Dec 5, 2009)

Wow, I had no idea how an off-hand comment would start a fire. My doctor and I had discussed all the implications of using epinephrine injectors for a person with my heart condition (3 stents, pacemaker, defibrillator, numerous heart, blood pressure, cholesterol, diabetes, etc medications) and she agreed that I understood the difference between local, systemic, and anaphylactic reactions and could be "trusted" with an epi-pen. The insurance company computer, however, balked at the prescription due to condition/drug interactions; certainly some sort of liability issue. So the doc prescribed it for my wife and the insurance covered it without question.

That being said; I think it was a waste of money and time. My family is not allergic to bee stings. We have all been stung numerous times, and my wife has the worst reaction (a little local swelling.) I have no reaction to speak of any more, no swelling or itching, and it seems to ease the stiffness in my fingers to get stung a few times every couple of weeks. My son never has had much of a reaction, he got stung on the lip and it wasn't any bigger than a blemish that evening, and gone the next day. If you or a family member is allergic to bees enough to need an epi-pen around, you need a new hobby or a different job. 

Think about this; you are more likely to be involved in a violent crime than associated with a bee-sting anaphylactic reaction; do you carry a gun with you? (I conceal carry, but gave up the epi.)


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## Hops Brewster (Jun 17, 2014)

attack of the Killer Zombie threads. :banana:


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## brettj777 (Feb 27, 2013)

Sundances medical advice is some of the worst I have ever heard.

If you are having an anaphylactic reaction Primatene Mist or anything else, rubbing dirt in it, sniffing bee butts.... none of that is going to work. 

if you have an EpiPen use it if you are having an allergic reaction and cannot get help you will die.

If you're not having an allergic reaction then any of the above non effective treatments are perfectly fine for you.

Signed, 
Wilderness First Aid, AHA CPR/First Aid Instructor.


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## deknow (Jul 17, 2006)

Nabber86 said:


> i didn't see the post where fordguy consulted with his doctor.


Uhhh...the post where he said his doctor prescribed it?



> My doctor prescribed without a problem, but my insurance company blocked it.


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## Nabber86 (Apr 15, 2009)

deknow said:


> Uhhh...the post where he said his doctor prescribed it?


You are right, but I was thinking why didn't he talk to his doctor after the insurance company denied it.


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## dgrc (May 4, 2015)

GaSteve said:


> It all sounds nice but be wary... no one administer an epipen to someone else... He also indicated that "Good Samaritan" laws may be null and void if you start giving out prescription meds.
> 
> Just food for thought.


Good points all. My daughter is a crew leader for a youth conservation group. They do not carry epipens in their first aid gear and are instructed not to use them even if available -- although they can assist if a person with a prescription and an epipen if that person decides to use it on him/herself. Without the right medical training, there are just too many ways for things to go badly wrong and too few ways for things to go right.


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