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From the Idaho Statesman, Boise, Idaho, USA, August 2, 2009, by Katy Moeller:

Snakebite victim still recovering weeks later
Forget the tourniquet — get yourself to a hospital if a rattler bites you.


Sheila Kramer didn’t see the rattlesnake in the tall grass before it plunged its fangs into her right leg just above the ankle.
“I was cutting grass away from a fence line, walking backwards,” said the Elmore County woman who does yardwork for friends for extra cash. “I felt something on my ankle. I thought maybe it was a sticky weed.”
The stinging sensation went from annoying to painful in seconds.
“It was 10 times worse than a hornet,” said Kramer, who was hospitalized for 10 days at a Boise hospital before she was transferred to a rehabilitation facility in Meridian two weeks ago.


Kramer is one of the unlucky few in Idaho who have suffered a snakebite this year. Bites are rare but can be painful and debilitating - especially if not correctly treated.
Kramer hopes to go home in a couple of weeks but is still suffering side effects from the snake venom and antivenom. The swelling in her leg has gone down and the discoloration has faded, but the venom left its mark. A wound she had on her heel still feels raw when she tries to walk. She developed blisters in her mouth and throat that have made swallowing and breathing difficult.


Doctors say recovery times vary greatly, though many bite victims are able to go home after a night or two at the hospital.


“I still hurt like the dickens,” said Kramer, who noted that her tolerance for pain is high. “I thought I’d walk out of the hospital the next day.”


Concern about her liver enzyme levels kept her at the hospital longer. She said she had flu-like symptoms and muscle and joint aches.
Kramer has lost more than 10 pounds since June 26 - the day she was bitten outside her friend’s Glenns Ferry home. She now watches the TV show “I Was Bitten” - about humans bitten by animals - with even greater interest.


RARE OCCURRENCE
Snakebites aren’t common in Idaho, according to snake experts, local hospital officials and data from the American Association of Poison Control Centers.
Idahoans reported about a dozen snakebites each year in 2007 and 2008 to the American Association of Poison Control Centers, with about half of them rattlesnakes. So far this year, nine snakebites have been reported in Idaho.
The Western rattlesnake is one of four snakes in Idaho that are venomous but is the only one that is potentially harmful to humans, according to Frank Lundburg, president of Reptile Conservation Resources and the publisher of Ecosnake.com.
“The others are small snakes with venom that is so mild that you don’t really have to worry about them,” said Lundburg, who teaches a workshop on amphibians and reptiles at Boise State. He also presents programs on rattlesnake awareness and outdoor safety

.
For those who want to learn more about Idaho snakes, Lundburg recommends the Idaho Fish and Game booklet “Idaho’s Amphibians and Reptiles: Description, Habitat & Ecology.”


Western rattlesnakes live throughout Idaho, except for the Panhandle. The rattlers in Idaho aren’t as aggressive and their venom is not as toxic as others, such as the Eastern and Western diamondbacks.


They live in rocky areas, where they can find shelter in rocks and holes. “If you’re going to hike Hells Canyon, you can learn very easily that it’s prime rattlesnake territory,” Lundburg said.


People enjoying Idaho’s outdoors are most likely to encounter rattlers in the early morning or evening when temperatures have cooled. Lundburg said snakes are shy, so if you leave them alone, you are likely to escape without getting bitten.

DON’T DO WHAT YOU’VE SEEN IN THE MOVIES
When Kramer was bitten, she swatted the 18-inch, brown and gray snake off her leg as fast as she could and went for help. Her friend Mary Ellen Hervey was mowing some grass up the hill from where Kramer was.


“I could definitely tell it was fang bites,” Hervey said. “But I didn’t know for sure if it was a rattler.”
Kramer said Hervey offered to try to suck the venom out, but Kramer didn’t think that was a good idea.


She was right. Despite what you’ve seen in old cowboy movies, trying to cut out or suck out venom from a snakebite isn’t a good idea - and there’s no evidence it helps, even though suction kits are available, experts say.


“The reality is, there’s no evidence that any first aid in the field does any good,” said Dr. Thomas Huntington, director of Minimally Invasive Surgery at Saint Luke’s Boise Medical Center.
No suction. No tourniquet. No ice. Just get to a hospital as soon as possible.
Huntington estimates he treated a couple dozen rattlesnake bites in Arizona.


While en route to the hospital, Kramer worried the venom was going to travel straight to her heart and kill her. “I’m thinking all the way to Mountain Home, I’m going to die. You watch these shows with snakes in them, they always go into cardiac arrest.”
Hervey said Kramer also had concern about possibly losing her leg as local physicians consulted with officials at the poison control center in Denver.


Kramer said she received six vials of antivenom at the Mountain Home hospital before she was taken by air ambulance to St. Luke’s Boise Medical Center. She believes she received another 12 vials of antivenom in Boise.


Huntington said the toxins can do lots of damage to the body, but they don’t directly affect the heart.
Venom breaks down tissues and affects blood clotting. The kidneys can be damaged because of the byproducts of muscles breaking down. In the most serious cases, patients need transfusions of platelets and blood plasma.


Why do some people get so much sicker than others?
“It all depends on the degree of envenomation. No two snake bites are exactly the same,” said Dr. John Epperson, an emergency physician at Saint Alphonsus Regional Medical Center.


There’s some debate about whether it’s better to be bitten by an adult snake or a juvenile. Some say juveniles are worse, in part because their venom is more concentrated.
Huntington doesn’t buy it.
“The juvenile rattlesnakes do have more concentrated venom … but bigger snakes inject a lot more venom,” Huntington said. “If you want to choose who you get bit by, pick the little guy. The popular myth is that the small snakes are more dangerous.”

A SLOW, PAINFUL RECOVERY
Kramer, who is weak from her body’s battle with venom, rests in bed at a Meridian rehabilitation facility with her right leg elevated when she’s not in physical or occupational therapy trying to regain normal movement in her legs and feet.
Putting weight on her right foot is excruciatingly painful - it brought her to tears Wednesday.
The blisters in her mouth are slowly healing.
“My tongue is still really sore. I’m having a hard time eating,” said Kramer, who has been eating mostly Cream of Wheat.
She’s looking forward to getting home soon to her five dogs, three cats and fish.
Her friends in Glenns Ferry are buying her a pair of snake-proof boots from Cabela’s, and she’s heard that others in her hometown are also wearing boots to protect against snakebites.
“I’ve had so much pain and discomfort, I don’t ever want to get bit again,” she said. “I’ll be spooked for the rest of my life.”
Katy Moeller: 377-6413 - copyright August 2, 2009 Idaho Statesman, McClatchy newspapers.

Posted by Frank - August 4, 2009

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