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Posted by patrickv on October 20, 2002 at 23:01:01:
Irony can sometimes be so incredible that it just has to be considered funny. This will be a long story but it should make for a very interesting read for anyone interested in the subject. And I’ve got all the fun medical details and perhaps some pics already as well. For anyone who just wants the short version….got bitten on Saturday by a C.v.oreganus neonate while hiking, surprisingly less painful than I expected but under less than ideal conditions. The snake was completely justified in biting me, as I should not have had my hand up on his rock. The irony is in the fact that I keep and work with rattlesnake son a daily basis, and the day I receive my first bite ever is the 1 day I decide to go out and specifically not look for snakes. I guess for some of us it is safer to play with and work with hots than it is to just take a hike to a waterfall. I will now always keep my bite protocols in the car even when I am not out looking for snakes. The end.
I have been keeping rattlesnakes for approx 4 years now. I currently keep a large northern pacific rattler, a sidewinder, a panamint speckled rattler, and an extremely hot tempered great basin rattler. I have also been assisting in collecting blood on northern pacific rattlers for the past 2 seasons for a genetics study and I also go out and photograph rattlesnakes in the wild when I am not collecting as well. This year alone I have already drawn blood from, photographed, or otherwise worked with 60+ snakes and out of all of these encounters and captive snakes I have never even come CLOSE to being bitten. I’ve got my safety protocols and work slowly and carefully to avoid unsafe situations. My friends all say “aren’t you afraid your rattlesnake will bite you someday?” or “you know if you keep those things one day one of them will bite you.” My response has always been “I doubt I will ever get bitten by one of my captive rattlesnakes, I am way too careful and methodical, and they are easy to work with. If I ever get bitten it will be by a snake I never even saw when I am out hiking somewhere.”
So gee, guess what the circumstances of my bite were? Well here goes a chronology:
SAT 10/19/02
I decided in the morning that I needed to get out of the house and go do something. I thought to myself “am I going to go out looking for snakes this afternoon or am I going to go do photography?” it is late in the season and slightly cold, plus I was more in the mood for photography so I ditched absolutely all of the snaking gear in favor of the photography stuff (a mistake in retrospect that will be changed in the future) and set off to go to this really beautiful waterfall out of Middletown to do some time lapse exposures of the waterfall. Didn’t bring my hook, my trap tubes, my blood drawing kit, bite protocols, pressure bandage, nothing snake related. I arrived at the location at around 3pm and took almost a whole roll of film of the waterfall, then deciding to head back up to the car. There are 2 routes back up the slope. One is shorter but has a very vertical part that required climbing finding foot and hand-holds. The other is a bit longer but slightly easier going I guess. Either way though it is about a 30 minute walk back to the car on a very steep uphill slope that is exhaustive even when you are young and in shape. I decided that shorter was better and I hadn’t been rock climbing in quite a while either.
So at 4:40pm I started climbing back up towards the car. At 4:45pm I reached for a rock and gave it a gentle test tug to see if it would work for a handhold or come crumbling off and fall down between my legs. When I grabbed the rock something stuck me on the finger and I immediately thought of all the damn star thistles that I had hiked through to the waterfall the fact that they stabbed me through my pants the whole way down. Holding still however I felt a second and third stab in the finger almost immediately and it burned a little. I withdrew my hand and caught a glimpse above my head of something letting go of my finger. I had a look at my finger, which was dripping blood rather rapidly, and I lifted myself up on another rock to get a look hoping perhaps it was an angry whipsnake with excessively large teeth. I already had an idea of what I was really going to see on top of the rock but I had always figured on a lot more pain involved in a bite. Sitting there on top of the rock, and still yawning widely to readjust his fangs, was an ~8” long neonate Northern Pacific Rattlesnake, coiled tightly and vigorously shaking his 1 useless-for-a-warning silent button. I think at this point I yelled a few choice phrases involving excrement and copulation, and called the snake something having to do with prostitutes and sleeping with your mother. The profanities being finished I thought how nice it would have been to have all my snake stuff with me right now, and perhaps even take him home with me to photograph and exact my revenge upon later by way of sticking him with a needle and drawing some blood.
So 4:45 pm and I am bitten without 1st aid kit, by myself, at the bottom of a very steep hill, 30 minutes from my car, without my bite protocols (which I had luckily memorized). Unfortunately, eager as I was to lie down, immobilize my hand, elevate my arm, and wait for help, following all the other recommendations for snakebite, what I HAD to do was hike my bitten finger back out of the valley and back up to the car which was still 10 miles outside of town. I started back up the hill holding some pressure on my finger with my other hand but at some point had to let go to grab hold of a bush to pull myself up. I figured getting up really fast in as little time as possible would be better than exerting myself slightly for a full 30 minutes so I put a little haste into my climbing. About half way to the top though I started to sweat more profusely than the heat should have warranted, and get a nice battery taste in my mouth. I reluctantly decided that I couldn’t take my extra 20 pounds of backpack all the way back up the hill with me safely and would have to leave it, and the $800 in camera equipment inside of it, on the trail to be retrieved later. I took one picture of my newly bitten and bleeding finger while catching my breath on a rock and then continued to the car minus backpack. In hindsight I should have taken the camera out and brought it with me because I missed some very significant opportunities to document the whole event, but at the time it seemed that getting out was more important than getting out carrying extra weight.
So shortly after 5pm I arrive at my car with a heart rate, breathing rate and blood pressure of god knows what, with rubbery legs, numb lips, and sweat dripping off of my nose. The dead end road I was parked off of offered little hope of friendly traffic so hazard lights on, I drove ¼ mile down to the first residence I came to for help. I banged on the door and was greeted by an elderly woman and her jack russle. I called for an ambulance at 5:05pm and used some silk tape the woman had come up with to make a loose pressure bandage from my elbow out. I called my mom who was on her way to work at Kaiser in Santa Rosa, and had her start the 2 hour drive to meet me in Clear Lake. Being a nurse I figured it would be good to her her as my advocate if ayone wanted to do something stupid and wouldn’t listen to me. I then sat on the porch trying to relax, slow my heart rate and drink some ice water, dog in lap, until the ambulance arrived at 5:15pm.
5:15pm: The ambulance crew was very helpful, after initially asking if I was sure it was a rattlesnake, and were very glad that I had memorized the bite protocols since I was their first snakebite. On initial exam in the ambulance I was sweating profusely with a slight fever and a heart rate of 160bpm, and a blood pressure of 170/115. at this point my finger was swollen and extremely tight feeling but the pain was considerably less intense than I was expecting. With an icepack on my forehead, the sweating and intense headache, which were apparently due to the hike more than the bite, subsided and the only systematic symptom I had was the numbness and tingling which had spread from the inside of my lower lip to the inside and outside of both lips and most of my tongue. I never actually became nauseated, dizzy or slurred in speech or unable to keep my eye lids up. The paramedic started an IV, but unfortunately did so in the bitten arm, which wasn’t going to work if I swelled up like a balloon. I was feeling rather cheated at this point that I wasn’t getting lights and sirens so they kindly changed to code 3 and made some noise taking me in. I was rather thirsty at this point from the hike but I was told they weren’t allowed to give me water so the guy gave me a wet paper towel to suck on which really wasn’t cutting it. Without much convincing I promised not to choke and he agreed to produce a water bottle and turn his back if I didn’t tell anyone about it (oops, my bad). He responded that no he wouldn’t think it was funny if I pretended to aspirate after I was done. J when they called into the hospital the paramedic had me dictate over the radio what was going on and what I would need.
We arrived at Red Bud hospital in Clear Lake at 6pm. Upon arrival I was greeted by 2 doctors who both said “wow, so you were bitten by a gophersnake right?” This did not help to calm me in reassurance that I was in completely knowledgeable hands. At this time My pulse had stabilized at 140bpm and my blood pressure was holding at 160/90. She swelling had continued over my knuckles and onto the top of my hand. They measured the circumference of my hand at 240mm, and there was a greenish yellow bruise beginning to form around the bites and under my fingernail. Although there was still relatively little pain the pressure in the finger was quite intense and the bite marks were weeping plasma as a steady pace. I asked the nurse to read me the labels of the antivenom she was bringing out and she said “wyeth” I asked if it was equine or ovine and was told that the box said polyvalent equine serum. Unfortunately, after some discussion and searching, there was no crofab to be found. The doctor was holding on the phone with poison control, so in the interest of saving time since it had already been more than an hour, I convinced the nurse to start reconstituting 5 vials due to the fact that the instructions said that it could take up to 5 minutes for them to completely dissolve. I also asked her to give me 0.1mL subcutaneously on my right arm and mark the spot to check for any allergic reaction. Thankfully there was none. I overheard the doctor saying he wanted to treat this aggressively and told the nurse to push 3 of the vials of antivenom directly into the IV line. I objected and got them to agree to putting the 5 vials in a bag of saline and just starting a drip. I began receiving the antivenom at 6:30pm, and hour and 45 minutes after the bite. Within 10 minutes the swelling in my had had gone down to 230mm. At this point my mom arrived just in time to find out that they had decided to send me on the Medi-Vac helicopter to Kaiser in Santa Rosa where she had just come from. I thought it a little excessive since the swelling ultimately stopped at my wrist even before the AV was administered, but the helicopter ride at 7:30 was lots of fun and I was really wishing at this point that I hadn’t left my camera out on the trail.
We took off at 7:30pm from red bud and arrived in Santa Rosa 15 minutes later, followed 2 hours later by my mother. I was taken to Kaiser from the airport helipad by ambulance and upon arrival at Kaiser at 8pm the swelling in the hand had decreased to 215mm, my pulse was holding at 105bpm, and my blood pressure had gone down to 130/75 (all a bit high for my normal resting rate but much better than earlier).
My AV drip finished at 9pm and due to the decrease in symptoms and the fact that Kaiser also did not have any crofab, I was not given any further antivenom. By 10pm I was checked into a room for overnight observation with a resting pulse of 100. At this point my hand had stabilized at a circumference of 220mm, but the numbness and tingling in my mouth had spread to include everything from the bridge of my nose to the underside of my chin. It wasn’t extremely sever but it was strong enough that I had to concentrate more than usual to make any facial expressions or speak clearly. The pain from the whole bite experience was really never even 20% as bad as I was expecting and the swelling ultimately was restricted to my finger and hand. Actually, each of the 3 IV’s that they started on me (one in the ambulance, one with a monster needle that didn’t take, and the final on my right hand) hurt worse than the initial bite did. I had my vitals checked every 2 hours over the night.
By 1:45am (Today, Sunday now) my pulse had dropped to 80bpm, and my blood pressure to 121/55. the only new development was an increasing amount of pain and slight swelling in the lymph node in my left armpit. This has now extended to a general soreness in the lymph node in my left arm and both nodes in my neck. I also have slightly swollen tender areas leading down my bicep from my armpit and across my forearm, but overall there was no swelling proximal to the wrist.
At 10am blood was drawn to check for coagulopathy.for our resident science weenies my CBC came back with WBC = 6.7 K/uL, RBC = 4.94 M/uL, Hemoglobin = 15.2 g/dL, Hematocrit = 44.4%, MCV = 90fL, RDW = 12.5% and PLT = 235 K/uL (all pretty much in the middle of the normal distribution). My lab for coagulation problems came back with a PT level of 12.1 sec (normal is 9.3 – 11.7) so my high reading suggests a minimal decrease in clotting ability.
At 11am I was discharged. At 3pm my dad and I arrived back at the site where I was bitten and located my camera bag exactly where I had left it (the magic of rarely traveled areas off of dead end roads). We took some pictures of my hand, the location where I was bitten, and various shots of the hike I had to make to get back out. We then retrieved my car from the elderly woman’s house and left her flowers, a card, and a roll of medical tape which she will hopefully get when she arrives home if her dog doesn’t eat them.
At 4:45 (exactly 24 hours after the bite) I stopped on my drive back home to check for a predictable rattlesnake under a board by a barn, but alas he was not there. I am not deterred in my interest and passion for working with rattlesnakes. I would have bitten me had I been the snake I squashed my hand down on, or perhaps my fingers looked like a tasty white mouse hence the chewing and repeated envenomation, but I can only blame the fact that I chose to climb instead of walk out. I arrived home at 5:05pm swollen, stiff and slightly sore from the fingertip to the lymph nodes, but otherwise shocked at the minor degree of the pain and discomfort involved in the whole experience. Not planning to do it again any time soon I unfortunately may never get a picture of me being loaded into another REACH helicopter. Minimal bruising, minimal swelling, no adverse reaction the the AV, no necrosis, no blistering, no systematic symptoms other than the numbness and battery taste, and the pain was never great enough that I required or requested any pain meds. I am already able to (barely) touch my middle finger to the palm of my hand again…a great improvement over my initial condition upon reaching the top of the hill, having pumped every mg of the venom all over the damn place.
Feel free to email me if you have questions or comments…..this email is more reliable than the one listed with kingsnake: psviehoever at ucdavis dot edu. Pictures to follow (unfortunately all you get now are crappy digicam pics til the slides come back)
patrickv
