Got A Question? He knows!
Note to Bee Culture readers: An answer in my September column elicited such decided responses, both pro and con, that I felt some additional comment was required. A beekeeper in New York was concerned because a doctor there was providing bee club members with prescriptions for EpiPens – without any exam – to be used in case someone were to have an anaphylactic reaction to a bee sting. The club encourages this practice. My response, in brief, was that EpiPens should be prescribed after a medical exam and used on the patient for whom it was prescribed or, alternatively, should be administered by emergency medical personnel. An endorsement of my response by an Indiana doctor and beekeeper appears as a letter to the editor in this issue. An email (edited for length) denouncing my view appears below with my answer.
A beekeeper in Michigan writes:
. . . I have always read Ask Phil and valued your opinion . . . All my trust for your advice ended when I read your response in the Sept. issue to a reader who was uncomfortable with giving epi to someone having an anaphylactic reaction.
I am a retired R.N. With nearly 50 years of experience in ICU, CCU and Emergency departments. As staff, then supervisor and mentor to new nurses. I have also been very active in layperson training of basic and advanced first aid, including CPR, Automatic defibrillator and the EPI PEN!!! Through the years, the medical profession has realized that the key for survival of catastrophic events such as cardiac arrest and anaphylaxis was proper initial treatment IN A VERY TIMELY MANNER. Results of survival rates very much prove that.
You sir, using your “expert” status, have given some VERY dubious advice. There is a vast difference between a perscribed [sic]med which is tailored to an individual healthcare status and an emergency med which is used for specific medical conditions to stabilize a very dangerous event.
. . . Do you realize the school and child placement institutions in Michigan are REQUIRED to have epi pens and provide training twice a year on their use.
Do you realize that the reader, as untrained as you, will probably, based on your flawed “knowledge” not seek training to get the knowledge that answers his concerns in a correct manner.
. . . Wouldn’t it have been much better to suggest to him that you are in no way qualified to advise him on this matter and it would be much better for him to voice his concerns to his family health provider or to seek out training through the agencies which have excellent programs to teach and inform.
. . . [I am] very disappointed in you.
I often edit letters and emails sent to me when they appear in my column, either for length or to leave out details which would tend to identify the writer without his or her permission. I’m sorry if my omissions in this case caused you to misunderstand the writer’s question. She – herself an RN with decades of emergency room experience and married to a retired emergency room physician – is not “uncomfortable with giving epi to someone having an anaphylactic reaction.” She is uncomfortable with a doctor’s writing prescriptions for club members, without examining or even meeting them, for use by a third party, also not a patient, who might possibly experience anaphylaxis while visiting a beeyard. She made this explicit in her letter, and I hoped that it was clear in the edited version which appeared in the magazine.
You mention that you have been active in layperson training in the use of EpiPens and that school systems in Michigan are required to have them on hand and to provide training in their use twice a year. I think the essence of my correspondent’s concern, and mine, is that prescriptions are being provided to her club members, not only without examination, but also without training of any kind. As you know, allergic reactions to insect stings are common, but truly severe ones are rare. Certain common medical conditions and medications can make the administration of EpiPens dangerous and contra indicated in any but life threatening situations. Also, it is my understanding that dosages of epinephrine are adjusted by body weight – impossible when the prescribing physician doesn’t know to whom the Epi will be administered. To expect a lay person, without any training, to correctly diagnose a case of anaphalaxis and to properly administer an injection without necessarily knowing anything about the victim’s medical history or condition is reckless to the point of malpractice – especially when the chance of a reaction so severe that it can’t wait for an emergency medical response is extremely remote.
In part of the original letter which I omitted, the New York nurse/beekeeper says: “ I have seen many, many, mild and moderate reactions from a variety of causes which warranted treatment. In some cases because of medical co-morbidities we just gave the diphenhydramine [Benadryl] because the risk of giving epinephrine was too great. In all those years, I have seen only a few, truly severe reactions. I think that having some diphenhydramine on hand and calling 911 for further treatment is the reasonable course of action. In very rural settings where EMS is not readily available, I suppose that might be another matter. I worry that giving someone epinephrine in an uncontrolled setting can put the person at risk especially if the first injection could have waited until they were at least evaluated by EMS.”
Dr. Kotnik, the ER doctor whose letter to the editor appears in this issue, concurs about the rarity of severe reactions, likening keeping an EpiPen on hand just in case to “carrying a vial of cobra antiserum when hiking in Vermont.” He goes on to discuss additional arguments, both legal and financial, against the casual, indescriminate prescription of injectable epinephrine.
It was never my intention to suggest that there is no appropriate use for EpiPens. Anyone who had ever had a severe, or even a moderate reaction, to an insect sting would be well advised to consult his or her physician. A prescribed dose from a doctor familiar with the patient’s medical condition, accompanied by training in the pen’s proper use (including instruction for the patient’s family or close associates) is a reasonable and prudent precaution. Even when a person’s medical condition makes the administration of epinephrine risky, a severe enough reaction could preclude any other option. But do you really want an untrained, and perhaps panicky, bystander making that call instead of an EMT or doctor?
I hope this explanation has restored your confidence in me. My advice was based on research and consultation with experts, and clearly there are medical professionals who agree me. At any rate, I stand by it.
A beekeeper in New York writes:
I have a question about upper entrances for the bees. Is it good to give them an upper entrance, or does it do more harm than good?
I gave my strongest hive an upper entrance by putting small spacers between the second brood box, and the bottom super. They crowd around the entrance, but do not pile up on each other, and seem to lick the wood of the boxes, while moving from front to back. There are no foragers flying in or out. What is going on?
As to the value of upper entrances – lots of beekeepers provide them and consider them beneficial for several reasons. The most common is that an upper entrance, under or between supers, facilitates honey production by providing foragers with direct access to the boxes where nectar is stored. Even a hard working bee will take advantage of a short cut when it’s offered. Another advantage is that an extra entrance promotes ventilation by allowing air flow between upper and lower. Beekeepers from northern parts of the country say that an upper entrance can provide ventilation even in winter when the lower one is covered by snow or ice.
There are a number of ways to create an upper entrance, including drilling holes in honey supers or using spacers such as you describe. I’ve even seen more elaborate constructions, with wood strips inside to prevent the bees from building burr comb in the spacer. The way some of my hives acquire extra entrances might best be described as the laissez faire method, due to some of my woodenware’s not being in the best of shape. The first areas to deteriorate in hive bodies are the corners of the boxes where they are repeatedly pried apart. As a result, many of mine have gaps between the upper hive bodies and elsewhere. The accompanying photo is of a hive that made me seven supers of honey this year. It might not win a most beautiful contest but, throughout the honey flow, foraging bees laden with nectar were lined up at every gap and hole. Who knows, maybe the extra entrances helped to make it such a good producer.
You asked about the possibility of an upper entrance’s doing more harm than good. The only risk would be to a very weak hive in which multiple entry points would make it more vulnerable to being robbed. In such a hive, I would recommend sealing any extra entrances (whether planned, or incidental like mine.) Duct tape works quite well.
The second part of your question is more interesting, but not so readily answered. First of all, I think the reason you aren’t seeing foragers flying in and out of the upper entrance is simply that you are in a dearth period. (This question was sent to me on the 31st of July.) In the absence of a nectar flow, the bees have no need to make frequent trips to and from the honey supers. That they are using the upper entrance, however, is evident from the way they crowd around it. You ask what is going on when they seem to lick the wood while moving front to back. What you have provided is an excellent description of a behavior called washboarding which some hives exhibit during the hot part of the summer – usually during a dearth.
Washboarding manifests as a rhythmic movement, in which bees on the front of the hives seem to step forward and backward, swinging their front legs in what looks like a sweeping movement. In another era, when I was a child, my mother still sometimes made use of a washboard to do small batches of laundry by hand. (Her main laundry chores were done in an old fashion ringer washing machine.) This movement of the bees does remind me of the up and down motion she used on the washboard. However, I think it looks even more like a dance. Since the phrase “honey bee dance” was already taken to describe the way forager bees communicate the location of nectar sources by dancing inside the hive on the face of the comb, I guess a new term was needed for this behavior. I find it interesting that only certain hives take part. Last summer, out of the 20 full, two story hives in my apiary, only two were exhibiting this behavior. Most of my hives were strong – full of bees – and almost all of them had bearding on the hive entrances, but only two acted this way. Why only these two hives were washboarding, I do not know. One is shown in the photo. Though the picture can’t convey movement, the way the bees are aligned may give some sense of the choreographic aspect of their display. As you say, they don’t just pile on each other as in clustering or bearding.
That is what is going on in your strongest hive; the question I can’t answer is why. While many beekeepers believe that the bees are cleaning the surface of the hive near the entrance, I am not convinced. I do not know of any scientific research or evidence which supports that theory. Readers, if you are aware of any, please let me know. I did find one interesting article, co-authored by Dr. Jeff Pettis – former head of the USDA Bee Research Lab in Beltsville, Maryland, discussing some of the scant research which has been done on washboarding, but the authors conclude that the reason for it is still unexplained. You can view this short paper at: http://iussi.confex.com/iussi/2006/techprogram/P2650.HTM. If you have internet access, you may try the link below of a little video I filmed of some of my girls doing their “washboard dance” – and turn up the sound. http://philcrafthivecraft.com/wp-content/uploads/2012/08/Washboard-for-website.mpg