Thursday, June 19, 2008

Mushroom Season

As part of my duties as an Emergency Physician, I do 200 toxicology consultations each year for patients in New England who eat wild mushrooms and seek medical care.

My complete (warning -it's a 21 megabyte Powerpoint) guide to mushroom poisonous identification and treatment is available online.

There are three basic types of patients who I treat via Regional Poison Control Centers referrals:

1. Toddlers - 2 to 4 year olds wander out to the lawn and munch a mushroom. They usually eat small quantities and most often parents find unchewed pieces in their children's mouths. Common mushroom types are the Fairy Ring pictured above (Marasmius oreades) and "little brown mushrooms" (Mycena), both non-toxic. I generally try to avoid treating toddlers with activated charcoal, the common treatment for poisonings, by rapidly identifying the mushroom as non-toxic. My experience with activated charcoal in pediatric poisoning is that more charcoal ends up all over the parents than in the patient.

2. Teenagers - 14-18 year olds who search cow pastures looking for blue-staining mushrooms i.e. "Hey man, do THOSE shrooms grow around here?" Yes, various hallucinogenic mushrooms grow in New England - Psilocybe species, Panaeolus, and Amanita Muscaria abound. The challenge for these teenagers is that these mushrooms contain wildly variable amounts of toxins. One mushroom may contain virtually no toxin and another may contain an overdose. I remind teenagers that "intoxicate" contains the word "toxic". The treatment for overdose of hallucinogens is largely supportive - a quiet dark place and the use of anti-anxiety drugs to treat a truly bad trip.

3. Gourmets - the 20+ educated amateur mushroom hunter with an Audubon field guide who looks for mushrooms based on pictures in the book. There are 2500 species of mushrooms in North American, of which 35 are great to eat and a dozen are lethal. Edible mushrooms and toxic mushrooms can look similar. A mushroom expert considers the time of year, where the mushroom is growing, and trees growing near the mushroom when picking edible mushrooms. A photo from a field guide is really not that helpful. The only deaths I've had in my consulting practice are the Gourmet amateur mushroom hunters. A typical story is that an educated person picks two pounds of wild mushrooms, makes stroganoff, gets ill 12 hours later, waits a few days, feels better, then suddenly develops seizures, liver failure, kidney failure and seeks medical care. By that time it's too late and not even liver transplant works. If you want to pick mushrooms to eat, learn from an expert how to identify a few key species such as morels, chantrelles, and porcini. Learn where they grow and pick them from the same patch year to year. Avoid eating any mushrooms with white gills (the underside of the cap). Not all white gilled mushrooms are poisonous, but Amanitas are white gilled mushrooms that can kill you.

How am I consulted? Today, I've received 4 consults already. Doctors throughout New England call Poison Control Centers, which refer callers to me. The doctors use their cell phones to take pictures of the mushrooms and patients, then email them to me. On my Blackberry, I can view the mushroom, determine the species, outline a course of treatment and followup with the patient to ensure all is well.

Mushroom Season runs from June to October in New England. Based on the volume of incoming consultants, I can tell it's going to be a busy year!

10 comments:

The Imp ;-) said...

Growing up a in rural community, one of the 'staples' that my father enjoyed harvesting were wild mushrooms; entire meals were built around his finds.

While no one in our family ever became ill from eating the wrong kind of mushroom, the sheer volume seems to have contributed to a psychosomatic aversion shared by myself and two siblings.

To this day, mushrooms of any kind equals mild nausea. My father believes that we are all daft...

Matthew said...

Nice post. As a veteran eagle scout, I always found wandering around in the woods very appealing. Unfortunately in Louisiana I think the most mushrooms I see are in fairy rings, and growing on decaying logs.

I'd love to know more about plants that are edible, beyond the traditional herbs.

DrVal said...

I could have used your help identifying my new collection of garden visitors. The only one I could figure out was the dog stinkhorn. It's definitely disgusting. ;)

http://www.revolutionhealth.com/blogs/valjonesmd/how-is-healthcare-lik-14163

John said...

I can relate to the comment from the imp. When we were small children, our family vactioned at a small resort in Northern Wisconsin. Our Hungarian grandparents would take my brother and me mushroom picking.

I usually zeroed in on any mushroom that was unusual or brightly colored, which invariably was labelled "bolond gomba" ("crazy mushroom") by my grandmother, who then told stories about people she knew who regretted eating them.

At some point, my brother and I drew the conclusion that mushroom picking should be left to the "experts" - old Hungarian grandparents, and the Polish, Russian or Lithuanian grandparents of all of our friends in Chicago. Seems like we may have drawn the right conclusion...

John said...

Oh John, what you are missing...
Been an active gatherer of mushrooms for some 35+ years and what a treat. Nothing quite like harvesting your own oyster mushrooms, chanterelles, morels, hen in the woods or king bolete to name a few. All of these I have happily harvested in the Boston metro area.

Luckily, most people take a similar view as yours, so that just leaves a little more for me in the woods.

Unfortunately, you may have inadvertently misled people with this post, particularly the comment about mushroom books and color plates etc. Here is the simple rule I follow and have never had a problem (then again you may call me an expert), the rule is this:

Never eat a shroom in the wild unless you are absolutely sure of what it is. If you don't have a field guide with you, take careful notes of where you found the shroom (location, type of trees, what it was growing upon, time of year, etc) and carefully compare these notes with what is stated in field guide. Also, as you are collecting shrooms in the field, do not mix unknown varieties in the same bag.

If there is any doubt at all (i.e., you can not make an absolute postive ID from your notes and field book as to what type of shroom you have before you, don't consume it. Simply admire its beauty and try returning it to a spot similar to where you found it to let it drop its spores and continue the cycle of life..

John Halamka said...

John - really well said. If folks want to key out a mushroom and not just compared it to a photo, use David Aurora's Mushrooms Demystified. This follows John's suggestion about identifying the time, place, and character of the mushroom, not just a photo.

John said...

John - If I find a good harvest of chicken mushrooms or hen in the woods, I'll drop some off for you - of course have handing over some of my harvest to my 98 yr old Lithuanian neighbor Sophie.

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Alex said...

Is there a mushroom season map or something available?