The Hollywood Shaman
Want to know why people are intentionally poisoning themselves with frog poison? What happens when you take it? And what could possibly go wrong? Listen to find out!
This is the Pick Your Poison podcast. I’m your host Dr. JP and I’m here to share my passion for poisons in this interactive show. Will our patients survive this podcast? It’s up to you and the choices you make. Our episode today is called The Hollywood Shaman.
Want to know why people are intentionally poisoning themselves with frog poison? What happens when you take it? An what could possibly go wrong? Then stay tuned.
Today’s topic is a little lighter than our last few. It starts with a phone call from a friend. Olivia is going through a hard time. Last year, her 18-year-old-son died of a fentanyl overdose. The stress led to a divorce from her husband and she’s lost her job. Quite frankly, she’s barely hanging on. On the phone, she’s distraught about her soon to be ex-husband’s latest legal maneuvers. After venting, she asks you to go with her to a kambo ceremony. Another friend backed out at the last minute, and she doesn’t want to go alone. Kambo, you search your brain, having vaguely heard of it. It’s frog poison from the Amazon. You say no. She says the shaman is a famous Hollywood practitioner in town for a few days. You say definitely no and tell her there’s no medical data to support the many claims made online. You explain the potential risks. She hangs up crying. You doubt she listened to a word you said.
Olivia’s obviously having a mental health crisis despite having seen multiple psychologists and psychiatrists and despite trying multiple antidepressants and other psych meds. After a few minutes thought, you change your mind. If she can’t be deterred, it’s safer if you go with her, regardless of your opinion of the circumstances. You grab a bottle of nausea medicine on your way out the door.
You meet her at the location in an affluent suburban neighborhood. Kambo is used by indigenous people in the Amazon to cleanse and energize hunters. It’s also called hunting magic. This setting about as far as you can get from the jungle. A man with a manbun opens the door, introducing himself as Shaman Dave. He has small circular scars on his shoulders, aligned in vertical rows. Shaman Dave ushers you into a room smelling of incense with soft music playing in the background. A certificate propped against the wall says he’s a certified kambo practitioner by the International Rainforest Chakra Society.
On the floor are two yoga mats. On each mat is a bucket and a liter bottle of water. Olivia looks nervous. You whisper it’s not too late to leave. She says she needs to purge her evil humors to give herself a fresh start. You tell her evil humors were part of medicine in the Middle Ages, along with leeches and bloodletting. She’s undeterred.
The shaman invites her to sit on the floor, you do the same. He starts chanting – as far as you can tell—nonsensically, then puts a pipe in her nostril and blows smoke up her nose. You try not to recoil. She might be purging evil humors, but she’s definitely acquired some new germs. Probably rape, or hape, a snuff mixture. He then uses an eye dropper to put something in her eyes. She winces and blinks. The eye drops are made from a plant also from the Amazon, and used by hunters to improve their vision and by Indigenous tribes to treat visual problems.
He asks if you’re certain you don’t want to participate. You are.
After more chanting, which at least seems to calm your friend, he opens the kambo. The frog secretions are dried on a flat stick, like a paint stirrer. First, he burns Olivia’s skin with what looks like an incense stick. Round burns in three vertical lines on her arm. Ten spots in total. He then tells her to spit onto the dried frog secretions, mixes it into a paste with her silva, and dabs it into the burns.
You ask him if she should get so many spots. He says they’d spoken at length about the imbalance in her chakras yesterday. You try, and fail, not to roll your eyes. First the middle ages, now to ancient ayurvedic medicine. He says Olivia needs a large dose because she has a lot to purge.
You haven’t seen a kambo ceremony before, but you did some quick research on the way here. Olivia does have a lot going on, but beginners start with a few spots, like three. Not ten. You protest. Olivia nods yes to Shaman Dave. He ignores you, applying paste to all ten burns.
You check your watch. The paste isn’t supposed to stay on for long, typically just a few minutes before its wiped off. Frog secretions aren’t monitored by the FDA and it’s anyone’s guess how much active ingredient is in the reconstituted paste mixed with her spit.
Question 1: What type of compounds are in kambo?
A. Hallucinogenic
B. Cardioactive steroid, like digoxin
C. Paralytic
D. Mixed peptides
Answer D. Mixed peptides. Unlike many alternative drugs from the Amazon region, kambo isn’t a hallucinogen. It’s a purgative.
Olivia says she feels dizzy and her heart is racing. The shaman says the kambo is beginning to work. Her lips swell up. Then her face. You reach for your phone, you’re first instinct is to call 911. This looks like angioedema, a life-threatening allergic reaction. You stop yourself. The shaman nods sagely. “Frog face,” he says. You sit on your hands instead of digging in your bag to see if you might have a spare EpiPen. It’s a transient reaction caused by the kambo. It doesn’t result in airway swelling and shouldn’t last for long.
Olivia turns pale and sweaty, like she might pass out. She begins vomiting. Copiously, retching and gagging. This is a sound normally associated with a bowel obstruction or cannabis hyperemesis. The shaman says “Viva!” every time she vomits. Why? Who knows. She vomits and vomits then runs to the bathroom. Now diarrhea, and she still hasn’t stopped vomiting.
What exactly is going on here and why would anyone do this voluntarily?
Kambo is the name for the giant monkey frog. The frog, Phyllomedusa bicolor, secretes the poison from its skin when stressed or threatened, as a defense mechanism to deter predators. It’s use by indigenous people in the Amazon was first reported in 1925 by a French priest.
It’s become popular around the world, purportedly treating a wide variety of ailments, including addiction, anxiety, depression, diabetes, HIV/AIDS, infections, vascular and joint diseases, just to name a few. There’s no medical evidence to support any of these claims. Believers say the purging leads to an afterglow that lasts for days to weeks. They report increased mental clarity and fortitude. Some believe it increases their physical strength and sexual stamina.
He wipes the frog paste off her skin. Olivia moans, “My chest hurts,” then runs back into the bathroom. She’s vomited so many times Shaman Dave has stopped saying Viva. He’s turned up the music. No one ever promised an easy path to enlightenment, but who knew it was paved with intractable vomiting. The purging is supposed to last about twenty or thirty minutes, then stop. Users describe the purging as being wrung out from the inside and like being punched in the head. Olivia should feel better in a few minutes.
Kambo is harvested from the frogs after they are caught. Each leg is tied to a stick, and sometimes they’re placed near a fire. Once stressed, the frog begins to secrete the poison from its skin. The secretions are scraped off and dried on sticks. The frogs are released alive, but I have to say, doesn’t look like a pleasant experience for the them.
The secretions contain over 100 different peptides with different properties. Some cause low blood pressure, others a high heart rate, flushing and some activate opioid receptors. Pharmaceutical companies have patented many of the peptides for potential therapeutic use, though no medicines have been developed thus far.
After almost an hour, Olivia is still vomiting. You get out the nausea medicine you brought and tell her to put one under her tongue. The shaman tries to wave you away, saying she must purge in order to heal. She’s clutching her chest. You ignore him. The entire room smells like vomit, overpowering the incense. Her facial swelling has mostly resolved and she isn’t as flushed. But she’s sweating profusely and moaning with every retch.
Something doesn’t seem right here. Even the shaman is beginning to sweat though pretending to be calm. Enough is enough. You tell him to help get her into the car and you drive her to the ER.
As physicians, we try to avoid caring for friends or family to avoid conflicts of interest or clouded thinking. This is a fictional case, however, so you’re in charge of your friend’s care. The nurse hooks her up to the monitor, noting her vital signs. Her heart rate is 120 beats per minute, fast. Her blood pressure is 100/60. On the low side, but ok. Her respiratory rate is fast at 30 breaths per minute, though her oxygen saturation is good.
You order an IV, fluids, and nausea medicine.
Question 2 True or false. There’s an antidote to frog poison?
A. True
B. False
Answer: B. False. There’s no antidote for this. The treatment is supportive care. The IV fluids and nausea medicine, and managing the complications if any arise.
Most likely the shaman gave her too high a dose and it just needs more time to wear off. You also order some basic labs because kambo can cause electrolyte disturbances and kidney failure, more on that in a minute. After two doses of nausea medicine, Oliva finally stops vomiting. You breathe a sigh of relief.
However, she says her chest pain is getting worse. It’s 10/10 and increasing.
What’s going on? Everyone knows vomiting can hurt, it can cause acid reflux, burning in your chest and sore ribs and abdominal muscles. The pain might linger, but it doesn’t get worse after you stop. You check her lab results. Kambo can cause a low sodium. Olivia’s is normal, so is her kidney function. Surprisingly, you note an elevated white blood cell count, typically associated with inflammation or infection. There’s always a risk of infection after a burn, but this is way too soon for infection to develop.
What do you do? Give her some pain medicine, tell her she’ll be fine in a few hours and send her home? Or do more testing? If you send her home, Olivia didn’t survive this podcast!
She says her neck is swelling up. You re-examine her. The frog face swelling is completely gone. Her neck is mildly enlarged. She doesn’t have pain. When you press on it, it’s crunchy, like rice crispies crackling underneath her skin. The same crackling is happening in her upper chest and armpits. The medical term for this is crepitus.
What is this? Did she get the wrong frog?
We’ve discussed toad secretions before, see Episode 1. Different species of frogs and toads contain many different kinds of toxins. They can secrete hallucinogens, tetrodotoxin (the poison in puffer fish), and digoxin-like substances, among others. Some of the side effects related to kambo use have been blamed on using the “wrong frog”. An easy culprit that’s difficult to prove or disprove. Olivia’s not hallucinating, she isn’t paralyzed and doesn’t have a low heart rate. The wrong frog is unlikely.
Question 3. Kambo has been associated with which of the following problems?
A. Sudden death
B. Seizures
C. Hepatitis
D. Altered mental status
E. All of the above.
Answer: D all of the above.
Kambo has been associated with a number of different medical problems. I’m using the word associated here intentionally. It’s difficult to know if these cases are just that-- associated with kambo use or actually caused by the kambo itself. Several cases of low sodium are reported, and it does appear that kambo causes SIADH, or syndrome of inappropriate anti-diuretic hormone release. This results in a low sodium, which in turn causes seizures and altered mental status. Drinking excessive amounts of water exacerbates this problem, so typically users are advised to drink water, but not more than one liter. Two cases of dangerously low sodium are reported, both patients drank six liters of water while taking kambo.
Kidney failure can result from the copious nausea, vomiting and diarrhea causing dehydration. Hepatitis has been reported.
In Australia, there are several cases of sudden death after kambo use. There, and in Brazil, its use has been outlawed. Limited information on these cases is available, its unclear to me if kambo caused the deaths directly, or more likely contributed to the deaths. A business man in Brazil was convicted of murder using kambo.
Olivia’s chest pain isn’t improving, so you order a chest x-ray. Her lungs are normal, but there is an abnormality. There’s air outside her lungs, where it doesn’t belong. It’s in her mediastinum, the center region of the chest, between the lungs, where the heart, aorta, esophagus and other important structures lie. There’s air in the subcutaneous tissues of her chest, also. Air outside of the lungs isn’t dangerous in and of itself, but it isn’t normal.
So you order a CT of the chest for more information. The CT demonstrates a tear in her esophagus. This is called Boerhaave’s syndrome. It’s a rare disease that can occur after copious vomiting. It’s also called effort rupture of the esophagus. You can see it in patients with bulimia, after heavy lifting, and childbirth. It’s dangerous because it means material from the esophagus, food or stomach acid, is getting into the mediastinum. The mediastinum is supposed to be sterile, to protect the vital structures inside it. Food is not sterile.
Infection here is called mediastinitis. It’s both life-threatening and difficult to treat. Luckily, your friend has a small, contained rupture. The cardiothoracic surgeon thinks conservative management with IV antibiotics, rather than an operation will be enough.
This is a fictional case, as are all our cases, to protect the innocent. But it is based on real poisonings. The bottom line is that complications from kambo don’t appear to be common, but if they occur can be potentially life-threatening. Given that there’s currently no proven benefit, there isn’t much reason to take it. The risk benefit analysis just isn’t favorable.
Question #4 What poison is contained in the poison dart frog?
A. Batrachotoxin
B. Curare
C. Aconitine
D. Physostigmine
Post your answers on our Twitter feed @pickpoison1. I’ll post the answer in the next 24 hours. Remember, never try anything on this podcast at home or anywhere else.
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