Brush with Rope = Infected Wrist

[annasea]

A couple of days ago, I had the misfortune to brush up against an anchor line while on a dive here in the Philippines. It stung a bit at the time, but wasn't bothering me too much on the surface so I just left it. This morning I woke up to discover my wrist covered in red lumps and areas that look like a burn gone bad.

I called DAN after some difficulty as the resort I'm staying at doesn't permit international calls and my cellphone disconnects from the toll-free number after a few minutes, and the medical advisor I finally managed to speak with determined my wrist is now infected. His suggestion was prednisone.

After calling DAN, I went to the hospital in town and was given a prescription for cloxacillin (pills) and Bactroban 2% (cream). Does anyone have any experience they'd care to share with these meds? And how long it took to mend and resume diving? (Both the local doctor and DAN advised staying out of the water for approximately one week.)

Thanks in advance...

 

[DocVikingo]

Hi annasea,

No fun.

At this point, I can't determine when or exactly what went amiss in the communications with DAN, but if in fact the statement "the medical advisor I finally managed to speak with determined my wrist is now infected. His suggestion was prednisone" is accurate, there is an apparent problem.

Prednisone is not appropriate as a first line or sole agent to treat a wrist truly infected secondary to a rope abrasion/hydriod stings. An antibiotic would.

Bactroban Cream (mupirocin calcium cream), 2%, is a very effective topical antibiotic. Side effects with short-term use are relatively infrequent and mild. Headache, rash, and nausea are the most common.

Cloxacillin (e.g., Cloxapen, Tegopen) is an oral antibiotic similar to penicillin, though it's semisynthetic. Given that one isn't allergic to penicillin-like drugs, there should be no serious adverse reactions. Side effects can include mild nausea, vomiting, diarrhea, or abdominal pain and yeast infection, most commonly of the tongue or vagina.

Directions by both the prescribing physician and DAN medical advisor to stay out of the water for approximately one week speak for themselves. If such a wound isn't very much resolved by the end of that week, recontact with the physician would be prudent.

Helpful?

Cheers,

DocVikingo

This is educational only and does not constitute or imply a doctor-patient relationship. It is not medical advice to you or any other individual, and should not be construed as such.

 

[wve]

Prednisone is not appropriate as a first line or sole agent to treat a wrist truly infected secondary to a rope abrasion/hydriod stings.

Doc,

I agree that corticosteroids are not appropriate for infected wounds, but do they have any role for non-infected hydroid stings? Will they reduce the inflammation or speed recovery to any significant degree? (I'm thinking topical, not systemic.)

(I suppose I could look this up, but a curbside is always easier )

 

[DocVikingo]

Hey wve,

While topicals like hydrocortisone 1%(OTC) to 2%+(prescription) creams probably do offer a smidgen of relief, those below the semi-nuclear level (e.g., clobetasol propionate creams/ointments such as Temovate) have proven rather disappointing on balance. Moreover, even the big guns don't usually work miracles and they can be problematic. They are not readily prescribed for routine, relatively minor marine envenomations, and for good reason.

The best bet is proper immediate care, which has been covered well in this forum and elsewhere, and close monitoring for infection. After that, it's mostly tincture of time.

Regards,

Doc

 

[Saturation]

Sounds also like a hydroid sting. Can you post a picture?

A couple of days ago, I had the misfortune to brush up against an anchor line while on a dive here in the Philippines. It stung a bit at the time, but wasn't bothering me too much on the surface so I just left it. This morning I woke up to discover my wrist covered in red lumps and areas that look like a burn gone bad.

I called DAN after some difficulty as the resort I'm staying at doesn't permit international calls and my cellphone disconnects from the toll-free number after a few minutes, and the medical advisor I finally managed to speak with determined my wrist is now infected. His suggestion was prednisone.

After calling DAN, I went to the hospital in town and was given a prescription for cloxacillin (pills) and Bactroban 2% (cream). Does anyone have any experience they'd care to share with these meds? And how long it took to mend and resume diving? (Both the local doctor and DAN advised staying out of the water for approximately one week.)

Thanks in advance...

 

[annasea]

Thank you for the replies!

Sorry I can't do a photo... I have my digital camera with me but didn't bring the cable to connect with.

I believe I'm on the mend... today it looked slightly better than yesterday.

Also, as I'm stuck in Dumaguete for an extra day due to a typhoon alert, I went to the doctor that I saw last year. He agreed with the emergency doctor's prescriptions and gave me some gentamycin 2% cream when the other one runs out. Also a bar of tea tree soap to use for its antibacterial properties. Interestingly, he asked me about my lymph node. Shortly after this wrist business flared up, I had a pain under my left arm. I thought maybe I pulled a muscle somehow but he said, no, it was a sign that my wrist was indeed infected. It's gone now so I take this as another good sign.

Thank you again!

 

[drbill]

I see a few others have posted on the possibility of hydroid (or other cnidarian) stings from critters attached to the rope. Based on your description, Anna, it sounds more like stings than infected abrasions. However, as my sig file says, "I'm not THAT kind of doctor... but I'll take a look at it anyway."

Hope you're able to get back in the water and enjoy your time there. Looking forward to your reports after you get back.