Posted on 01/13/2017 10:05:06 PM PST by nickcarraway
Three hours after Dr. Todd Mitchell’s Dec. 3 flight from Beijing landed in San Francisco, a call demanded his immediate attention.
Mitchell, 59, had spent two-and-a-half weeks in China, which has the most mushroom poisoning deaths in the world, sharing the treatment method he developed at Dominican Hospital.
The call concerned a Santa Rosa hospital patient believed to have eaten deadly mushrooms.
Principal investigator of an amatoxin mushroom poisoning clinical trial that has treated nearly 100 patients across North America in the past 10 years, Mitchell arranged for the patient’s overnight transfer to Dominican Hospital.
This patient was the first of seven from outside Santa Cruz County to be treated at Dominican Hospital over the next three days — a cluster of death cap cases.
On Dec. 4, the call came from closer to home.
A Mexican-Indian family of five at Natividad Medical Center in Salinas had eaten soup made with wild mushrooms that looked similar to edibles they foraged in Mexico. They had no idea their mistake could be deadly.
Four members of the family ate them for dinner and a fifth ate the leftovers for breakfast.
Unfortunately, death caps are tasty, and cooking does nothing to reduce the toxic effects.
Dominican Hospital agreed to treat the entire family — a last chance to save their lives.
“The sickest cohort I have ever seen,” Mitchell said.
GRIM ODDS
One was a 19 month old. For the youngest, the odds of survival after ingesting amatoxin — the poison in the mushrooms — are grim.
After six hours on the “Santa Cruz protocol,” the toddler’s condition improved but remained critical. She was flown to UC San Francisco Medical Center, ultimately undergoing a liver transplant five days later. Her aunt recovered after undergoing a liver transplant at Stanford.
Treating six patients with amatoxin poisoning, a life-or-death situation, strained Dominican Hospital’s resources.
“It was like a bus accident occurring right in front of the hospital,” Mitchell said, reporting most of the family members returned home after five days at Dominican.
Later that week, Oakland hospitals used the Santa Cruz protocol for two patients with amatoxin mushroom poisoning. Both recovered.
Around the world, rapid recovery is not the usual outcome.
“These mushrooms continue to wipe out entire families each and every year in Nepal, South Africa, Russia, Ukraine, Vietnam and India as well as China,” Mitchell said. “Amatoxin mushroom poisoning is an unrecognized worldwide public health crisis. Literally, hundreds die every single year.”
The Santa Cruz Fungus Fair at the Louden Nelson Community Center aims to help people figure out the difference between deadly and delightful mushrooms, with Henry Young and Debbie Viess speaking on that topic this weekend.
STEPPING UP
Dominican Hospital provides the home of this clinical trial, with the Dignity Health Institutional Review Board providing oversight required by the U.S. Food and Drug Administration.
Hospital pharmacy staff volunteered to stock and ship silibinin, purified from the common milk thistle and which must be given intravenously as soon as possible.
After hours, at night, on weekends — the pharmacy staff receives urgent calls for the medication, which is kept in locked storage bins.
“It’s always an emergency,” said Mitchell. “But Dominican always finds a way to get the antidote delivered within 24 hours of the initial hot line call.”
Since July, the pharmacy had shipped the antidote to liver transplant centers affiliated with Indiana University, Duke University in North Carolina, Thomas Jefferson University in Philadelphia, University of Rochester, UC San Francisco and the Cleveland Clinic.
Mitchell said all seven of those severely poisoned patients enrolled in the clinical trial made complete and rapid recoveries.
Dominican pharmacists calculate how much to send, package the drug, add mixing instructions and consent forms and negotiate shipping arrangements for FedEx SameDay.
“We get it to San Francisco and they fly it out,” said clinical consulting pharmacist Glenn Robbins. “Calls, texts, we get it there.”
Robbins, 61, began working at Dominican Hospital’s pharmacy in 1986 and saw it become a 24/7 operation 12 years ago.
He answers telephone questions about mixing the drug, maintains the inventory and keeps up with the FDA paperwork.
The pharmacy has 18 pharmacists and 18 technicians, all of whom had to be trained to know what to do.
“They’ve done a yeoman’s job,” Robbins said.
Mitchell, a UC Santa Cruz alum who has practiced medicine in Santa Cruz for 28 years, is amazed at the support provided by a community hospital that has no medical school affiliations with Stanford University or UC San Francisco.
IMPROVING ODDS
Mitchell’s dive into amatoxin poisoning treatment began in January 2007 when a local Mexican immigrant family of six ate tacos made with death cap mushrooms foraged at Wilder Ranch State Park.
Searching online for an alternative to a liver transplant, he asked Madaus, a German drug company, to ship its European-licensed antidote, silibinin, brand name Legalon SIL, via air courier to Santa Cruz.
Ownership of the drug has changed hands several times since. In mid-2007, Madaus was acquired by Rottapharm of Italy, which was acquired in 2014 by Meda of Sweden, which was acquired by Mylan in August.
Mylan made headlines last year after the company headed by Heather Bresch raised the price of the lifesaving allergy treatment EpiPen by 400 percent as her own compensation grew 600 percent.
Currently, because Legalon SIL is part of a clinical trial, Mylan provides the drug to patients at no charge.
Silibinin had never been tested in a well-designed clinical trial, according to Mitchell, noting the drug had developed a reputation for being unreliable.
Of nine people in Australia treated with the drug between 2000 and 2013, four died; one needed a liver transplant.
In 2015, dozens of amatoxin mushroom poisonings occurred in Germany among Syrian refugees foraging for food. Of 40 given the drug, at least 10 died or needed a liver transplant.
Mitchell discovered that silibinin fails when the patient’s kidneys, gallbladder and biliary tract are not given appropriate attention during treatment.
Feeding patients, he said, allows bile to recirculate back to the gut, allowing the amatoxin poison to re-attack the liver again. Kidney function and a brisk urine output must be maintained for silibinin to work successfully, he added.
If the patient gets plentiful intravenous hydration, the kidneys can move amatoxin into urine to exit the body; however, insufficient intravenous fluids lead to kidney injury and treatment failures.
Patients who recover on the Santa Cruz protocol “are virtually good as new,” Mitchell said.
In late November, Mitchell presented in Singapore at the 15th Annual Asia Pacific Medical Association of Medical Toxicology.
Invited for the first time to China, Mitchell set up two demonstration projects to begin this summer. He presented at an acute liver failure symposium in Kunming, capital of Yunnan Province, where up to 100 deaths occur each year from amatoxin mushroom poisoning.
He was invited to Shenyang, a city the size of Chicago near the North Korean border, where 17 people died in University Hospital from amatoxin poisoning last summer.
In Beijing, he participated in a daylong meeting with the head of the national Chinese Centers for Disease Control and Prevention Poison Control.
Treating the cluster of Bay Area cases slowed Mitchell’s progress on publishing the clinical trial results, which could be midyear, but the experience provided a wealth of data that backed up his suppositions.
“We can’t recover every single poisoning, but fortunately it’s quite rare when the protocol does not successfully do so,” he said.
The amatoxin hot line: 866-520-4412 or 412-563-1400.
Fungus Fair
What: 43rd Annual Santa Cruz Fungus Fair, speakers, cooking demonstrations, kids’ room, panel to identify mushrooms; books, wild mushroom delicacies for sale.
When: 10 a.m. to 5 p.m. Saturday and Sunday.
Where: Louden Nelson Community Center, 301 Center St., Santa Cruz.
Details: Fungus Federation Santa Cruz, ffsc.us.
This was a thing in Switzerland. Families died every year. In every canton there was an office to visit with your foraged mushrooms to have them checked before you ate them. There was no excuse. But people are so stupid-proud they didn’t go.
I’m shocked that so many of these people [are they US citizens?] are immediately sent to the top of the list of liver transplants!
Even Steve Jobs had to move to get a liver.
Do we give them out?
Is reading from a Teleprompter a useful skill in the
When I was a teen I made some money babysitting. A couple of the kids I babysat at some wild mushrooms and had to make a trip to the hospital. Fortunately they did it on their parents’ time.
I don’t know what their treatment was or how sick they got but they survived to adulthood.
Needless to say I am in no hurry to sample the mushrooms in my yard.
Some mushrooms are notsofungi as others.
And THAT’S why I get my ‘shrooms at the store...
Courtesy ping.
China "harvests" livers from executed criminals - the U.S. doesn't. Hence: Transplantation Tourism.
Regards,
I was once thinking of taking up mushroom gathering, but after some research realized that I’d never be able to tell the good from the bad without a lifetime of study. As the old saying goes: There are old mushroom hunters, and there are bold mushroom hunters, but there are no old, bold mushroom hunters.
Don’t eat the Amanitas.
The active ingredient in Milk Thistle is called silymarin, and its effects on the liver have been known for several decades. Silibinin, also known as silybin, is the major active constituent of silymarin.
It limits the uptake of deadly toxins by the liver, so it is not overwhelmed. It also has a protective effects against toxins as well. Last but not least, it speeds healing of liver damage around 30% faster than normal. It has been described as “the perfect liver medicine”.
Both milk thistle and silymarin have been sold OTC for decades. Unless you already have some liver damage (always ask doctor), the purpose of taking silymarin is prophylactic, preventative, prior to eating wild mushrooms or exposure to other known liver damaging chemicals.
Here’s the science about cirrhosis and liver cancer.
https://www.ncbi.nlm.nih.gov/pubmed/21466434
http://www.upi.com/Archives/1981/09/16/French-finds-antidote-to-mushroom-poisoning/8295369460800/
http://www.nytimes.com/1981/10/07/garden/perils-of-mushroom-hunting-in-germany.html
With considerable ceremony, Dr. Bastien ate 70 grams of the mushrooms in Geneva last week and then said he would survive without monkeys or transfusions. His antidote was nifuroxazid acid and neomycine, two drugs obtainable in France without a prescription. After a few days in a hotel bed and some nausea, Dr. Bastien got up and drove home.
Every spring, late summer, and fall, I hunt mushrooms in France. There are delicious ones that cannot be mistaken for the toxic ones. I search for about seven or eight specific ones. Everything else iignore although there are some that are edible and other people like but i find not to my taste. A true woodsman taught me about the good mushrooms and I have always followed his advice. It is true that in France one may take mushrooms to the pharmacy to be verified if in doubt. They are most helpful.
You’re absolutely correct. Unfortunately, they are often shown in children’s stories about elves as the favorite chair of a fairy or elf.
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How are the beautiful people in the article, listed as Mexican-Indians, the beautiful people?
Even Steve Jobs could not get a liver. He had to establish residency in another state whose laws were different.
Why would we bump Mexican-Indians in this country?
For anyone interested, the Santa Cruz Fungi Fair is today. Fungus for the whole family!
Thank you. See Above.
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