Saturday, January 1, 2011

Stepping on Stonefish: A Year On (Part 2)

Stonefish5
In my previous post, I recounted my incident with a hollow-cheeked stonefish (Synanceia horrida) on Beting Bemban Besar on 1st of January 2010, shared some basic information about stonefish biology and venom, and my agony as we rushed to the hospital. To find out what happened after that, my recovery, and some of my current thoughts a full year after it all happened, read on.

1st January: Arrival at Tan Tock Seng Hospital

The staff at the Accident & Emergency Department attended to me relatively quickly. A basin was filled with warm water for me to immerse my swollen foot, which provided some relief. However, by now the pain was getting quite unbearable, and I was gripping the metal bars of my gurney very tightly. In the meantime, James, Andy and Marcus helped with the registration and emphasised the urgency of the situation. My ex-girlfriend arrived, and Andy, James and Marcus left a while later. My sister also came over shortly.

Stonefish6
Stonefish7
Stonefish8
Stonefish9
A catheter was inserted into my forearm, I was injected with painkillers, and I could practically feel the drugs coursing through my system, lessening the pain as they reached my leg. However, it was not long before the painkillers seemed to wear off, and the pain flared up yet again.

I was pushed into an operating theatre, where a doctor made a small incision at the site of the sting to check for foreign bodies; besides the venom from the stonefish, there was a risk of infection due to bits of the spine breaking off inside my foot, leading to further complications. Thankfully, he didn't find anything, and my foot was soon stitched up. The local anaesthesia helped to reduce the stabbing pain, though the dull throbbing ache still remained.

Stonefish10
At various points in time, from the moment I arrived, to the minor operation, the nurses and doctors would ask what had happened to me, and whether I was absolutely sure that it was a stonefish. I recall one of the doctors telling me that while there was an antivenom for stonefish toxins, it was available only in Australia, and I guess I wasn't close enough to dying to justify the effort in getting some vials of it sent here. I would have to admit that I was taking it remarkably well; besides the intense pain in my left lower leg and lack of mobility, I was still very alert and talkative, and was spending all my time chatting with my girlfriend and posting updates on Twitter. I think I was just trying my best to distract myself and tolerate the pain.

Stonefish11
010110-2301(2)
010110-2301

2nd January

I was soon wheeled into another area of the hospital, where I was kept under observation for some time. My sister helped me settle some of the paperwork in preparation of me being warded, while my girlfriend stayed by my side. Initially, I had thought that maybe the pain would quickly clear up, the swelling would go down, and I would be able to go home after a few hours. Turned out that recovery from a stonefish sting was going to take much longer than that.

Stonefish12
After waiting for some time, I was finally warded, and settled in for a long night. I don't know how I managed to do it, but I was able to fall asleep eventually, despite the pain.

Stonefish13
The following morning, more than 12 hours since my incident, my foot was still very swollen.

Stonefish14
020110-0838

Most of my day was spent resting in bed, unable to move around except on a wheelchair. I did try to hobble around on one leg, but my left foot was in quite a peculiar situation; it was numb, yet extremely sensitive to the slightest touch so much so that just brushing my toes against the floor caused me to wince in pain. I was at risk of losing my balance and falling over, so I was pretty much bedridden. Blood samples were taken, as well as an ECG, just to make sure that the venom wasn't causing my muscles to break down or giving me heart palpitations. So far so good, besides being temporarily crippled.

Stonefish15
Stonefish16
Thanks to my sister, I had some books to read. And thanks to the wonders of 3G technology, I could still carry out my usual web-surfing on my iPhone, where I discovered that both Ria and Kok Sheng had put up posts documenting the trip, as well as the rescue mission.

I was placed on a saline drip; I hate catheters, because I'm always afraid that I'll bend the needle if I move around too much. Now my mobility had been reduced even more.

Stonefish18
3rd January

Stonefish19
A doctor made his rounds, and asked me the same set of questions that I had gotten from other medical staff before:
  • Which island was I on when I got stung? Technically not an island, but Beting Bemban Besar, a submerged reef that is exposed at low tide.
  • Was this in Singapore? Yes.
  • Beting Bemban Besar? Where exactly is that? It's in the Southern Islands, close to Pulau Semakau.
  • Is it near Sentosa/Ubin/Tekong/Kusu/etc.? No.
  • Was I sure it was a stonefish? Yes, I'm no ichthyologist, but I know a stonefish when I see one.
  • Was I stung while diving? No, I was walking around in shallow water in booties.

After some basic examination of my leg, he told me that I had a mild secondary infection, and would need to be prescribed some antibiotics, to be administered intravenously. Interestingly enough, I could feel that my left leg was noticeably warmer than my right leg; fascinating concept, this idea of a leg developing a fever.

Stonefish20
030110-1641
Sometime later that night, there was a problem with my drip. After some troubleshooting, the staff on duty decided that it would be best to switch the catheter over to my right arm. Great, so now my mobility was reduced even further, given that I am right-handed.

Stonefish21
4th January

I was brought in for an MRI on my left leg to see if there was any internal damage to my leg from the venom. I also found the time to slowly write and post a short blog entry about my brush with a stonefish and hospitalisation.

Stonefish23
040110-1959

Most of my time was spent sleeping, reading, tweeting, checking e-mail or surfing the web on my iPhone. I was grateful for the many friends who came to visit me, or who sent me words of sympathy and encouragement. One of the most important people was my girlfriend at that time, Christel. Every day, she made the trip to hospital to keep me company, spent hours with me, often staying late, and gave me emotional and moral support at a time when I was confined to bed. Her presence definitely made the whole experience a lot more bearable.

Things settled into a routine of sorts. Blood samples were taken twice daily, after breakfast and dinner. Blood pressure was measured at regular intervals, often while I was asleep, to my mild annoyance. Every so often, my saline pack and antibiotics were replenished, and whenever I felt the urge, I would ring for the nurse on duty to unplug me from my drip so that I could visit the toilet. I think the nurses took pity on me getting into a wheelchair and being pushed the few metres to the toilet, and one of them asked if I wanted a bedpan, which I immediately refused. I may have been partially crippled, but I was no invalid.

At least we were also able to make use of the wheelchairs to go around the ground floor of the hospital occasionally and spend some time away from the ward.

5th January

Stonefish24
050110-1035

I was getting quite restless and eager to make a quick recovery so that I could escape the confines of my bed and the drip, and the nurses knew it too. Not that I gave them any trouble; most of the other patients in my ward were elderly men, and I think they were in far greater need of medical attention than I was.

A urine sample was taken, to test for the presence of creatine kinase and myoglobin, which would indicate that my muscles were breaking down due to the effects of the venom. Indeed, according to my discharge summary, I was diagnosed with cellulitis, in which the connective tissues and skin of my left leg were inflamed, and the creatine kinase in my blood and trace amounts of myoglobin in my urine indicated that I was going through rhabdomyolysis, or the breaking down of muscles. But it appeared that the worst was over, and I was slowly recovering from the effects of the venom.

Stonefish25
Eventually, with a little help, I could limp and hop on one foot to make the short trip to the toilet.

Stonefish26
Stonefish27
050110-1207
050110-1207(2)

Having a dislike for needles, I was not exactly having a good time. Still, I tried to make the most out of the situation with candid observations and quips.

Stonefish28
6th January

I was continuing to make good progress; while I could not rest the whole of my left foot on the ground, I could at least limp along, shuffling along and dragging my left leg like some zombie.

Stonefish29
Stonefish30
060110-1902

The doctor also gave me good news: I was healing, there were no signs of long-term internal damage, and if all went well, I could be discharged the next day.

7th January: I'm going home!

After breakfast, I received the wonderful confirmation that my tests had all come out fine, and that I was able to be discharged in the afternoon.

It didn't matter that I still couldn't walk properly; at least I could hobble along with the use of crutches. It was the removal of the catheter in my right arm that brought me so much relief.

Stonefish31
070110-1038
Stonefish34
Stonefish32
070110-1042
You can see the stitches on my sole.
Stonefish33
070110-1136
You can also see how the swelling has gone down noticeably.

And so, after nearly 6 days in the hospital, I was able to return home. It took a while longer for me to make a full recovery; my left foot still remained a little swollen, and I still needed the crutches for at least another week.

I had a follow-up appointment a few days after I was discharged, on the 12th of January:

Stonefish35
Stonefish36
I also remained on antibiotics, painkillers and anti-inflammation medication for a week. I'm not sure exactly when the swelling completely disappeared, but it was probably almost a month later. And for several months after that, I could feel a hardened plug of flesh in my sole, where the stonefish spines had penetrated my foot. I did have some slight difficulties from time to time; applying pressure on the site of my wound did cause discomfort, and sometimes, the friction from normal walking caused a blister to form. After the use of a corn plaster for several weeks in July, this problem vanished.

And so right now, a year after my accident, I can safely say that I have made a full recovery. In some way, I suppose that my incident could be considered a mild case of envenomation; I did jump up and lift my leg immediately after I felt the poking of the spines, which possibly meant that it was a shallow wound and that I did not get a full dose of venom. I'm fairly fit and have a healthy weight, which also probably prevented further complications from occurring. And in some way, trying to remain upbeat despite my mishap, and the support of important people in my life, also played a part in maintaining my emotional and mental well-being during my recovery.

It could have turned out a lot worse; I found out that the hot water treatment after getting stung by a stonefish can lead to some very nasty infections under certain circumstances. And just in August 2010, a diving instructor in Okinawa died after he was apparently stung by a stonefish.

As an aside, journal articles documenting treatment of stonefish stings in Singapore make for some very fascinating reading, and I'm all too aware of how much worse things could have turned out for me.

I'm a lot more careful while out on the shores now, and try my best to stay away from patches of sargassum. But despite my accident, I bear no animosity towards stonefish; for a moment, I was hasty and let my guard down, and paid the price. I don't quite see the need to exact vengeance and eat a steamed stonefish at a seafood restaurant. Stonefish are creatures that deserve a lot of respect, and while most of us don't really want to see one while out on a shore trip, we all accept stonefish as just part and parcel of the risk of exploring our shores. Besides, you have to admit that for a fish, a stonefish is an excellent photographic subject, considering that it hardly moves.

I don't think I'm being fatalistic or excessively morbid, but I think that if unlucky visitors to Sentosa can inadvertently step on stonefish, then there really is no point in getting all paranoid about the dangers on our wild shores; we acknowledge the risks, take necessary precautions and don't do anything silly, while accepting the fact that every once in a while, a mishap will occur no matter what we do. What counts is that we are adequately prepared to react promptly during such a crisis.

On a personal note, I've always been thrilled by venomous creatures, and while I don't deliberately put myself in harm's way, I am still very much drawn to them. I was absolutely thrilled when a visit in February to the Singapore Science Centre turned up an aquarium with stonefish. Christel, on the other hand, was not amused.

Hollow-cheeked stonefish (Synanceia horrida)
Hollow-cheeked stonefish in aquarium at Singapore Science Centre

I finally recovered enough to go on another shore trip in April, and coincidentally, it was a return to Beting Bemban Besar. To be honest, I was actually hoping that I could find a stonefish (and not step on it), so that I could say that I had returned to the place where I could have died and come face to face with the very same creature that caused me so much pain and suffering (but also unforgettable stories to share). But alas, no stonefish were found on that morning.

I did however find a stonefish on Tanah Merah in May, and spent quite a lot of time taking photos of it.

P1450263

So that's my story of 2010, and it will probably be one that I will be retelling for many more years to come. I am grateful for all the people who helped me in whatever way possible or gave me words of support; my fellow shore explorers, my friends and family, my ex-girlfriend, and of course, the staff of Tan Tock Seng Hospital.

Now that I'm in one of my morbid moods, I wonder if anyone has ever been stung by both a stingray and a stonefish, and can give an accurate assessment of which one is more dangerous...

15 comments:

Sivasothi said...

In a related note, see the mangrove whipray caught in the act here: http://otterman.wordpress.com/2009/06/10/ben-stabbed-by-a-mangrove-whipray/

Danizona said...

That was a great story, thanks for telling it.

Grace said...

thank you for this post!! Now I know how long exactly I should be enduring this numbness and swelling on my right foot.. I just had a taste of its venom T_T currently on my 9th day. As far as I'm concern, NO ONE should ever experience this, coz it's sooo painful!! arggghh >.<

Ivan said...

Grace: Oh dear. Wishing you a speedy recovery! Maybe you could share more about your own personal experience and we might be able to see if there are any similarities and differences.

Madhawa Thilan said...

after 22 days from sting I still have 99 F fever sometimes and dizziness
when will I get fully recovered
please tell me I dont like this feeling

Chill said...

Very interesting and informative read with lots of links. I was stung by a stonefish 4 days ago (in a very similar way as on the above story) on Siquijor Island/Philippines and I'm still recovering from it. Worst pain imaginable for 4 hours straight and the right foot still badly swollen. Good to know that there will be no neurological damage left...hopefully... Stefan

matt kearney said...

Took me 3 hours to get the drip, hot water and anti biotics...what the heck r u doin in the hospital for 6 days? I think you got screwed by the hospital for needless tests.

yada said...

Thank you for sharing your story! It was fantastic. Glad you're doing well :)

Zach said...

Just stepped on one (probably) 3 hours ago in Okinawa and now back from the clinic -- thanks for the detailed read (while soaking my foot in hot water)! Didn't see the thing but it's pretty much identical to your story except for not so much pain. Stung in exactly the sort of area I sometimes see stonefish diving (shallow reef/rocks near shore). Of course I was surfing without booties and of course I'll be back out in the water the day the swelling is gone :)

Thomas Siderius said...

I stepped in one now 7 days ago.. I recognise a lot from your story, although i do think that you stayed pretty cool during the first hours of pain, i felt like i was having a seizure, uncontrollingly flailing and shaking of the pain like a fish on dry land, pulling out my hair and beggin for more morphine as nothing they gave me worked. Now 7 days later i still can't walk with it, being really frustrated with staying indoors whilst everyone is having a great time in Singapore (me being an exchange student).

Ruth said...

I got stung yesterday in Palawan, Philippines. Good thing that (1) the small island government hospital was used to these cases so their calmness in the midst of my excruciating pain comforted, and (2) I survived with hot water and pain killer/anti tetanus shots because the little hospital didn't have much!

My leg however (from foot to right below the knee) is more swollen that it was yesterday (but thankfully much less painful too). I shouldn't be worried, right?

I decided not to go to another hospital here in Manila because I figured an island hospital (albeit smaller) would have more experience handling such case.

Cheers,
Ruth

yasmina said...

i got stung month ago in ora island, seram, mollucas, Indonesia. I couldn't reach any hospital around because that island was 6 hours from the city. So i have to swallowed the pain, all night long. And there's no cellphone signals too, no internet, no doctor, God, it was so horrible. But then, I realize that stone fish has given me a lesson to learn.

Thanks a lot for this post man. I'll post something too, later...

Siargao cheap accommodation said...

Thank u very much for telling us ur story . I step a stone fish 2 days ago,i went to clinic nearest here in my place , they gave me a painkiller and antihistamine injection , then they send me to hospital emergency room then put me drips on my right hand , i was only there for 2 hours and half, i dont like to stay in hospital so i discharge myself, I take a rest in my home ,my foot still swelling now , now im just resting and waiting to go down the swell..
its was really traumatic , Really pain and i almost faint.

Dierald said...
This comment has been removed by the author.
Rudi said...

Got stung yesterday evening while walking along a shallow shore in North Mauritius. Instantly felt a strange sharp pain. Rushed to the hospital and was given the hot water compress and pain killers. Pain gradually lessened through the night, can limp now but foot still seems swollen and tight. They had stonefish antivenom but said I should think twice as it cost 900USD a vial and I wasn't able to confirm if my medical card covered this lol. Stay safe fellas.