Two weeks ago, Olga Hassiotis was halfway back on a swim between Gibbet Island and Shelly Bay when she felt a sensation like barbed wire wrapping around her legs and feet.She knew immediately that she been attacked by a Portuguese Man o' War.Portuguese Man o' War (physalia physalis) are a jelly-like marine invertebrate. They are not actually a jellyfish, but a siphonophore. The two differ in that siphonophore are not actually a single creature, but a colonial organism made up of many minute individuals called zooids. They have a blue bubble or sail that floats above the water, and stinging tentacles that can stretch a long way from its body. The tentacles wrap around prey and use nematocysts (like barbs) to inject toxin to immobilise the dinner.In humans they can cause severe stings, and in rare cases can be fatal. On this day, Mrs Hassiotis, was only a few strokes away from the rocky shore, and began frantically trying to pull the tentacles from around her legs and feet. Looking around in the slightly rough waters of the North Shore, not usually known for hosting Portuguese Man o' War, she couldn't see the tell-tale floating blue bubble anywhere.“When I was swimming I knew right away what happened,” said Mrs Hassiotis. “I knew it was a Portuguese Man o' War because it is not the typical jelly fish sting you get.”Because she was so close to land, she was able to clamber to safety.“I think it would have been far worse if I had been far out. I only had two minutes to get the tentacles out. The tentacles feel like barbed wire. The barbs are the nematocysts that are going into your body. Once it attaches it takes a minute or two for them to go into your skin. If you are lucky enough to yank them out before a minute or two, the damage is way less. If you don't get them within a minute or two then, [they] will burrow into your skin and then you can't take them out, and then they start introducing the poison.”The Greek-born resident has lived on the Island for ten years. During that time she has probably swum in the waters off Bermuda a thousand times, but this was a new and horrible experience. She yanked out as many tentacles as she could. Some literature recommends you not use your hands, but she felt she had no choice.“The reality is that the palm of your hand is very thick skin,” she said. “My palms were unscathed afterward, although I did get some swelling on the top of my hands. If I hadn't used my hands the damage would have been much worse to my body.”After pulling at the tentacles, shock began to set in. Her legs shook. Her mind whirled and she suddenly realised she was very alone.“I knew that if I stayed where I was, I would be in big trouble,” said Mrs Hassiotis. She decided to make her way to her car. Oddly enough, when she started walking, the pain subsided a bit.“That was interesting,” she said. “You wouldn't expect that. When you are bitten by a snake they tell you don't walk, because the poison will mess you up. This is a neurotoxin. I don't recommend that people do this, but my personal experience has been that when I started moving and walking and then jogging and then running, the faster I went the less pain I felt. By the time I was running there was no shaking, I was in a much better mental and physical shape.”But once she got in her car and was still, waves of pain assailed her again. She had to make a decision. Should she drive home to her house, or drive to the hospital? They were both an equal distance away.“I chose not to go to the hospital out of fear that I would go to the emergency room and would wait there in so much pain without being seen instantaneously,” she said. “I needed treatment in 30 seconds, not three hours.”She managed to drive home, where she called a friend, Louisa Hajjar, who had been stung three years before by a Portuguese Man o' War. In a state of shock, she refused to let her friend come over to administer to her.“I was a bit crazy,” said Mrs Hassiotis. “I wouldn't recommend this. You really need another adult with you, because you don't know how it is going to affect you. You could pass out. It could affect your heart. You could go into anaphylactic shock [a severe allergic reaction].”Luckily, none of these things happened, and her friend recommended she put hot compresses on the area, as hot as she could stand it.“From what I have read the hot water breaks down the toxin,” said Mrs Hassiotis. “I don't know how true it is, but hot, hot water was the only thing that alleviated the pain. In addition to that, I took maximum amounts of Ibuprofen and Benadryl to reduce the inflammation.”She has yet to go back in the water she wanted to wait until her scars were healed. The tentacles have left a track of dots along her legs that really do look as though she encountered barbed wire.“I do love the water, and I will go back,” she said. “The waters here are spectacularly beautiful. If you do see jellyfish, or you see Portuguese Man o' War on the beaches you don't go swimming. I go swimming on the North Shore so often and I have hardly ever see them. It is less likely, but it happens.”She urged other beachgoers to purchase a special beach first aid kit that includes gloves, tweezers, antiseptic and other important first aid items. She found hers at Royal Imports on Serpentine Road.Ed Schultz, director of emergency medicine at King Edward VII Memorial Hospital (KEMH), said in rare cases, Portuguese Man o' War stings can be fatal.He said: “There have been well-documented deaths on the East Coast of the United States from envenomation by Portuguese Man o' War stings, although these are extraordinarily rare and usually involve very young victims, very elderly victims, or persons with other medical problems who have massive envenomations [those wrapped up in numerous tentacles]. Deaths may also occur secondary to anaphylaxis if the person was previously stung, although these events are also quite rare.“Generally, Portuguese Man o' War stings are mild although the venom contains a number of proteases that dissolve RNA, DNA and at least two neurotoxins.”Dr Schultz said approximately 20 to 50 patients come into the KEMH emergency room each year with marine envenomations, the majority of which are from Portuguese Man o' War stings. These stinging organisms are present from February until August with the peak months being March to June. Some of them, such as Portuguese Man o' War, often appear after a storm or a period of strong winds.He advised that if you are stung, leave the water as soon as possible and remove the tentacles with sea water and-or a wet towel, if on hand.“Remember that further envenomation may occur to rescuers themselves during this process,” he said. “All authorities agree that seawater can be used to physically remove tentacles or nematocysts at the beach. A wet towel can also be used, but rescuers should try to avoid being stung themselves. They should then seek first aid, such as vinegar or hot compresses.”However, he said that vinegar was rapidly becoming a controversial treatment for Portuguese Man o' War stings.“Vinegar is the preferred inactivation compound for all jellyfish stings, although some recent studies have demonstrated that for Portuguese Man o' War stings vinegar treatment can result in firing instead of inactivation of nematocysts,” said Dr Schultz. “I have spoken with a number of authorities about vinegar for Portuguese Man o' War stings.“We still use it and it seems to work well but I do advise patients that its use is controversial and if they visit some medical websites they may receive conflicting advice about treatment. What I would stress is that people who have been stung should not rub the affected areas with sand, apply ammonia, or ice water, as in my experience this makes more nematocysts fire and the envenomation worse.”He said traditional cures such as alcohol, ammonia, urine, meat tenderiser, and so forth, no longer have any place in the treatment of jellyfish stings although they were used in the past.“After application of vinegar, hot compresses to tolerance should be applied,” he said. “Nearly all marine venoms and toxins break down when exposed to heat. Finally, after vinegar and hot compresses, we apply shaving cream and then use a dull tongue blade to “shave” or physically remove the toxins that may have leaked onto the skin as these may cause further injury and blistering. People can do this themselves to clean an area that has been stung, but should remember to use a dull blade not a razor. In the Emergency Department, occasionally we have to prescribe narcotic analgesics, but these are rarely required as most patients have good relief from the measures outlined above.”He said sometimes severe cases require narcotic medications. And he warned that after being stung once by a Portuguese Man o' War your chances of an anaphylactic reaction is heightened the next time you are stung.Other things that will sting you:lUpside down jellyfish (cassiopeia) are common all year round and are found on the bottoms of the inland harbours and Harrington Sound. They leave a nasty, but transient sting.lTiny box jellies (cubozoa) can be found in Bermuda's waters. In addition to the immediate onset of intense pain, these can cause fever, joint aches, nasal congestion and cold-like symptoms after an envenomation and the symptoms may persist for as long as one or two days.lMoon jellies (aurelia aurita) are common all year, but these cause a very minimal sting.lFire coral (millepora alcicornis), are in the same family as Portuguese Man o' War but only pose a threat to divers or persons handling objects such as mooring lines that have been submerged for an extended period of time.What should people do if they are stung by a jellyfish?All jellyfish have nematocysts, or stinging cells, on their tentacles that can break off and attach to skin. These can continue to “fire” and inject the victim with more venom. Therefore the goals of treatment are to :1. Physically remove as many tentacles-/nematocysts as possible,2. Inactivate those nematocysts that are still attached to the skin so that they do not keep firing, and3. Remove any venom or toxins that have leaked out of the nematocysts so that further skin damage-envenomation does not occur.Useful websites: firstaid.about.com/od/bitesstings/f/07_JellyfishPee.htm; www.jellyfishfacts.net/man-of-war-jellyfish-sting.html