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SNAKEBITE: A CAUTIONARY TALE
 
TUESDAY, JUNE 6
(continued from June 5)
 
 
"Man Bitten by Rattler in TR Canyon."
- headline on front-page article in The Sheridan Press 6-6-06
 
 
 

The article by Josh Mitchell, staff reporter, began, "A Virginia man training for a run was bitten on his left foot by a rattlesnake in Tongue River Canyon near Dayton on Monday afternoon, according to Dayton Rescue. Dayton Volunteer Firefighter/EMT Levi Dominguez said the man was in 'stable' condition when he was transported to Sheridan Memorial Hospital. Dominguez said the man, whose name and age are not being released by rescue officials because of medical privacy rights, was hiking with his wife when the snake bit him."  (There was more, but you get the idea.)

Hiking?!!! Ouch. That's gotta hurt as much as the snake bite!! We were definitely running.

Having grown up in Small-Town America, I know how fast news travels. It was still quite a surprise when one of our new Dayton friends, Pat Shilling, who's running in the Bighorn 30K race, told us we made the front page of the Sheridan newspaper. From my years working with the justice system, I should have known newspapers have staff checking on every lead they can get from public safety departments, the courts, other pubic offices, ambulance crews, hospitals, etc. for stories.

It's a wonder we haven't heard from an ambulance-chaser yet. Let's sue that snake!!

"IT BIT ME!"

Two miles from the end of our run yesterday afternoon Jim gave me more fodder to write about so no one would get bored reading our journal. He doesn't know if he stepped on - or just too closely to - a big 'ole prairie rattlesnake, but he's positive he got bitten.

And he's got two puncture wounds in the front of his ankle to prove it.

Now that's a first for either of us. We've each seen plenty of rattlers in our years living in Montana and running all over the country. There were some rattlesnakes living in the field behind our Billings house, and we've seen some on trail runs in sunny, exposed, rocky areas in other states. I was very alert last summer running/hiking the rock-filled sections of the Appalachian Trail, especially through Pennsylvania because timber rattlesnakes are common there. I came very close to one rattler that I could hear right next to the trail (there's a photo in our AT journal).

This time I also came pretty close to the one that bit Jim. He was only six or eight feet ahead of me on the trail, close enough for conversation, when I simultaneously heard him yelp and looked up to see a snake wiggling between his feet.

Jim immediately reported that he'd been bitten. My intelligent response: "Are you kidding??"

No, he was dead serious.

This is the perpetrator after (s)he slithered off into the foliage beside the trail:

I estimate the snake was about 36 inches long. When we enlarged the original, high-resolution photo on our computer, we counted at least twelve rattles. A friend counted thirteen in the blow-up. Part of the tail is obscured by foliage and the tip is under the snake's body, so we aren't sure of the exact count.

The photo gets fuzzy and pixel-y this close up.

The ironic thing is that we were talking about emergency supplies we should maybe carry during the Bighorn 100-miler. I realized Saturday morning just before we began running with Dave Westlake at Dry Fork that my Camelbak bladder was leaking from a puncture and I had to make due with a spare UD bottle and fresh water from springs along the route. I suggested to Jim that maybe during the race, especially at night during the long, desolate upper portions of the course, I should carry an extra, empty bladder in my pack in case there was another problem.

Jim's response was that we can't carry everything for every contingency or we'd be too weighed down with extra supplies. The last thing I said before he tangled with Mr. Rattler was, "It'll be my luck to be out there without a spare bladder and something will happen to the one I'm using - like that second camper tire that blew out when we no longer had a spare."

Now here we were in a hot, rocky canyon where we'd been warned about rattlesnakes - in fact, we didn't take the dogs this time because of Dave's warnings to us Saturday about snake sightings - and we weren't as prepared as we should have been for a poisonous snake bite.

Our bad.

I'm not sure if a snake bite kit would have helped. You can't just carry the anti-venom serum around with you, and that's the most (only??) effective antidote to slow or stop the tissue necrosis caused by snake venom. We knew the old remedy of making a slit and having a companion suck out the venom was no longer considered effective (whew!). We knew we had to get anti-venom from a rescue squad or hospital ASAP, but we didn't know what the time frame for successful treatment is.

Even though Jim recently got his EMT certification in Virginia, the poisonous snake bite "training" was only about three minutes long. Apparently snake bites are pretty rare in Virginia or that comes in an advanced training course.

The first thing we knew to do in our situation was stop running so the venom didn't spread through his circulatory system as quickly. We were about two miles from the trailhead at the end of a 12-mile training run through the Tongue River Canyon (same place we ran with both dogs last Wednesday), up to Horse Creek Ridge, and back.

The snake bit Jim on the top/side of his left ankle. You can see the two puncture wounds in this photo taken less than two hours later, after his ankle had been cleaned:

The only symptom Jim noticed on the way out of the canyon was pain radiating throughout his left leg. Neither of us knew what to expect. I stayed behind him so I could watch him better. We didn't know if he'd be able to make it to the truck, but we tried that first. It would have taken much longer for me to run to the truck, drive into town for rescue workers, have them go back out on the trail, and help him in. He was able to walk the distance and, in hindsight, it was the best course of action.

When we reached the truck, Jim took off his shoe and sock, and his ankle quickly swelled up. That was scary, too. It took us thirty minutes to walk real fast to the truck, ten minutes to negotiate the dirt road back to Dayton, and another five minutes before we rounded up several volunteer EMTs and an ambulance. Our cell phones (Verizon) don't work in this area so we couldn't call ahead. No one was at the volunteer fire department. I ran next door to the Dayton town hall and had a woman alert the rescue squad. Everyone was very helpful.

As an EMT, Jim has ridden in the back of an ambulance several times now, attending to patients on their way to the hospital for various emergencies. Being the patient was quite a different experience for him, one that no role playing could accurately simulate! You can barely see Jim (in the white hat) on the stretcher in this photo:

I followed the ambulance to the hospital in our truck, taking this picture out the windshield:

While onboard, the EMTs checked Jim's "vitals" and started an IV with a saline solution for the fluids he would receive in the hospital. Ambulances here do not carry the anti-venom serum.

Jim was transferred to another ambulance with an Advanced Life Support (ALS) team on board at the I-90 exit near Ranchester, five miles away. The two men who attended to him are paid firemen/paramedics from the Sheridan Fire-Rescue Department. They continued to monitor Jim's condition and notified Sheridan Memorial Hospital they were bringing in a snake bite victim.

By now, an hour after being bitten, Jim's leg was increasingly painful, his fingers and toes were tingling, and he had a metallic taste in his mouth. He was also very thirsty, but that may have been dehydration from our dry, sunny canyon run.

It took a total of thirty minutes to reach the hospital after Jim got in the first ambulance, for a total of 1:15 hours elapsed since the bite. We were pleased with the prompt, professional care Jim received from the rescue personnel and hospital staff. I'm surprised how big the hospital is, considering Sheridan has a population of only 16,000 people (only about 25,000 in the entire county - remember what I said about the sparse population in Wyoming?).

The emergency room was calm and mostly efficient. I'm glad it wasn't hectic and the staff could give him the immediate attention he required. We came in with dirty, sweaty bodies and clothes after running on dusty trails for four hours. There was no time to stop at the camper, even though we drove right by it. There was no time to clean up, change clothes, even get the dogs out of the camper. Although it took a while to get him something to eat (about three hours) and a shower (about five hours), the medical procedures were carried out swiftly.

Here's Jim a few minutes after arriving in the ER:

Jan, the ER nurse (above) who attended to Jim from 4:30 PM until her shift ended at 7 PM, and other staff members took down all the information about the snake bite and Jim's medical history. The swollen area was very painful to the touch when Jan cleaned the dirt off his foot and lower leg. You can still see the dirt here:

The swelling continued to increase during the evening, but had subsided some by the next morning. You can see the pen marks on Jim's lower leg where the EMTs and nurse marked the progression of pain up his leg.

Dr. Robinson, the ER physician, examined and questioned Jim further before ordering morphine for his pain, antibiotics to prevent an infection, and anti-venom serum to counteract the poison already coursing up his leg. Other staff members came in and out, hooking up tubes. I was out of the room for a little while handling insurance information so I missed some of the action.

Dr. Robinson helped calm our nerves when he said it is important to begin the anti-venom treatment within four or five hours of being bitten. The serum was flowing into Jim less than two hours after the bite. As long as he wasn't allergic to it, there shouldn't be any lasting damage to his body, the young doctor predicted.

The main problem with rattlesnake venom is tissue necrosis (death). The doctor explained that snakes who feel threatened usually inject less venom into humans than into an animal they want for dinner. They tend to conserve their venom for what really counts - their next meal. That's good to know!

The venom apparently causes the mouse (or whatever) to bleed internally and die. In humans, clotting is affected and tissues turn black and die if treatment isn't given soon enough. Dead tissue doesn't grow back, so it's a serious problem. Jim's blood was drawn soon after arrival in ER and again the next morning to check for clotting and other things that could be affected by either the venom or the serum. Everything they tested for was OK. The fact that he's in great physical shape should help his recovery.

HIGH-DOLLAR STUFF

Although snake bite procedures were new to Jim and me, we figured it wouldn't be anything new to the hospital staff, what with all the hot, rocky canyons, meadows, and range lands in the area that are favored by rattlesnakes. Yes, it is the beginning of the season (June has been hotter than normal, bringing out the snakes earlier this year), but surely snakebites are a common emergency in the area?

We quickly learned there was some research and other activity going on behind the scenes to properly care for Jim.

This is NOT a common medical emergency for this hospital, which surprised us. Staff members had to look up some of the information about treatment. Jim said after I left for the night, several folks came in to see the bite marks and talk to him because they hadn't seen a snake bite victim before. And the staff and attending physician responsible for his care after he left the ER (Susan Snyder, DO) gave conflicting information about the efficacy of ice for the swelling.

We also discovered the hospital didn't have adequate anti-venom serum for Jim and had to order more vials delivered ASAP via the Sheriff's Department from the hospital in Buffalo, about 35 miles away. I saw the deputy hand the box to a staff member out in the hall. (Too bad my camera was out in the truck then!) The Sheridan hospital usually gives patients between four and six vials of the serum for rattlesnake bites, closely watching for allergic symptoms like nausea, fever, rash, or headache. Fortunately, Jim developed none of those symptoms.

Hospital staff was also calling other hospitals around the state to see if they had more serum in stock, in case Jim needed more than the six vials now in hand. He used all six and didn't need more, but the pharmacist is ordering more before 500 other runners arrive for the Bighorn races! Maybe our case is a blessing in disguise for someone else who may be bitten this summer.

We soon learned another reason why the hospital doesn't keep much of the stuff in stock - it's very expensive. We don't know just how much yet, but apparently the six vials he received cost many thousands of dollars. Let's hope his insurance covers most of it!

CANINE, EQUINE, BOVINE

When Jan found out we have dogs that run with us, she told us that a canine vaccine is available for poisonous bites. Several staff members said they've given it to their dogs to protect them. It's ironic they aren't available for humans yet, but I presume drug companies are working on it.

I got a strange look on my face when Dr. Robinson told us they'd have to use both equine and bovine serums to give Jim since Sheridan didn't have enough of one for him. Was he getting serum intended for horses and cows??

I misunderstood completely. The serum is derived from horses and cows, not given to them. We don't have enough internet access to research how the stuff is made. (Maybe it's one of those things we don't really want to know?) If someone has time to clue us in, we'd appreciate the information.

Once Jim was stabilized and the morphine was relieving his pain somewhat, hospital staff began talking with us more about the races, which are a big deal in this small community. Dr. Robinson and an orthopedic doctor (Charles Guilford?) are both running the 30K. Dave Westlake, the hospital's health information and records manager, is running the 100-miler. The Dayton Rescue Squad EMT who hooked up the serum IV works one of the aid stations. We heard of several other members of the medical team that run or volunteer at the race. The volunteers at this race are experienced and superb.

A LONG NIGHT AT THE HOSPITAL

Jim entered the hospital about 4:30 PM yesterday (Monday). He was quickly stabilized but kept in ER for several hours to monitor his response to both the poisonous venom and the anti-venom serum. He didn't exhibit any symptoms of allergy or rejection. We met his attending physician, Dr. Susan Snyder, before she left for the evening. She was attentive, thorough, and had a wonderfully calming "bedside manner." Both she and Dr. Robinson explained why it was important for Jim to remain at the hospital overnight. He wanted to go home, of course, but understood why he had to stay there a few more hours.

Around 7 PM I went back to the camper (about 22 miles away) to take care of the dogs and myself. Cody and Tater are fine left alone during the day in the camper, but naturally they were happy to get out to "potty" and eat their supper. I took a shower, ate dinner, and reorganized our running gear and supplies. Before going to bed, I downloaded our e-mail, sent a letter to Dave Westlake that Jim had written that morning (adding info re: the snake bite, since he works at the hospital), prepared a bag of items for Jim, and went to bed.

Neither of us slept well. I was concerned about Jim and he was in a busy, strange place with a very sore leg, expecting nurses to come in to poke and prod throughout the night (they didn't). His pain increased during the evening, but was better by the time I arrived the next morning about 8 AM. Hospital visiting hours are very open, so I was able to go on back to his room. Dave was in the room talking with Jim, who was just finishing his breakfast.

I was relieved that Jim was in such good spirits despite his ordeal. The swelling was down noticeably, it didn't hurt nearly as much when Dr. Snyder touched his ankle and up his leg (photo below), and he was psyched about being discharged soon:

More tests were run on his blood sample in the morning. They all came out fine, indicating he was handling the situation well. Dr. Synder prescribed an anitbiotic for five days (Augmentin) and a heavy-duty pain killer that he probably won't use but will get just in case he needs it (later: after being discharged, even occasional Ibuprofen was not needed).

Dr. Snyder told Jim it was important to elevate his leg as much as possible until the swelling is gone. She recommended he ice the swollen area for twenty minutes at a time, several times a day, to reduce the swelling. The nurse (Connie) gave us contradictory written instructions about the use of ice/cold packs, however, saying the staff's research found that icing is contraindicated in snake bites. Since Jim was going to be seeing Dr. Snyder in her office the next morning, he decided to follow her instructions to ice the ankle.

We waited patiently (?) for Jim to be discharged from the hospital. He was in good spirits because the doctor was very optimistic about his recovery. She didn't tell him not to run Bighorn, but said he'd have to use his best judgment before and during the race. Even if the swelling is gone, enough trauma has occurred to possibly increase swelling during the race. Some swelling of the feet and legs occurs anyway, so he'll have to monitor himself carefully. He is considering dropping down to a shorter distance or pacing me in the 100-miler. I hope he'll be able to run his own 100-miler if he feels he can handle it.

Before we left, the hospital pharmacist came in to get more information about Jim's bite and the race. Staff members are concerned about being adequately prepared for other snake bite victims this summer, and with about five hundred runners participating in the race soon, their antennae are UP. The pharmacist indicated she'd be stocking up on more anti-venom serum "in case."

I believe this is the 15th year for the Bighorn Mountain Wild and Scenic Trail Runs (5th year for the 100-miler). Race folks say they've never had a snake bite during the race. That's good. Perhaps with so many people out there, the snakes stay the heck off the trail!

SPRUNG!

We left the hospital about 9 AM and headed to Wal-Mart to get Jim's prescriptions and some groceries. We stopped in the Sports Stop to talk to Karen and Michelle Powers, who direct the race, but neither was in. Jim was able to talk to Melanie, the woman who does the website, to tell her about the snakebite so runners can be adequately warned. She put up a note about it on the website message board. Jim and others added to the thread.

Rich Garrison and Karen stopped by our camper later. They'd been clearing more trail and wanted to see how Jim was doing. We also got a visit from Pat Shilling and his family. Pat lives half a mile from the campsite in Dayton and is running the 30K. He's hesitant now to train up in the nearby canyon. Jim and I don't intend to go back up there until race day, either!

This fella is still out there (we didn't kill him). Here's his mug shot:

This was a lot more excitement than we bargained for. We've learned some things about prevention and treatment of poisonous snake bites and hope our cautionary tale will help to educate others. We haven't been able to do much internet research yet, but I did scan a couple websites about rattlesnake bites and came up with the following recommendations for hikers and runners in rattler territory:

  • Be ever-vigilant. Jim and I were engrossed in conversation and let down our guard after being wary for four hours.

  • Listen carefully. Don't wear headphones or talk so much that you can't hear the distinctive rattling. We didn't hear it this time, and rattlers don't always rattle, but we've heard them give notice before.

  • Don't sit on a rock or put your hands between rocks without first visually  determining for certain that there are no snakes hiding there.

  • Run or hike with someone else in rattlesnake territory. If Jim had been alone or 'way in front of or behind me, we wouldn't have gotten to the hospital as quickly.

  • Carry a cell phone or have one in your vehicle to notify medical personnel ASAP, even before you arrive. They may have to find some serum from another hospital, and time is of the essence.

  • Be careful if your dog is running with you. Better yet, don't take a dog into rattler territory unless (s)he's been vaccinated for bites.

  • If help is close, stay as still as you can in a safe location. If you have to go for help, as we did, walk out - DO NOT RUN. The less the venom circulates through your system, the better.

  • Keep the affected body part (hand, foot) below the heart level to decrease circulation.

  • Do your best to get the anti-venom serum into your system within four to five hours of the bite to eliminate or reduce tissue necrosis.

Jim and I were fortunate in this incident. We were relatively close to our vehicle, the bite apparently wasn't as serious as some, Jim was able to walk out OK by himself, we got to the hospital quickly, hospital personnel went to work immediately on the serum problem, and he received the treatment he needed in a timely manner. His excellent physical condition also helped. This could have been a disaster if we'd been a lot farther up the trail or unable to get proper medical care as soon as we did.

We are indeed grateful. And we will be more careful next time!

Next: update on Jim's recovery, and fun training on the upper portion of the course. Tune in for some moose photos soon . . .

Sue
"Runtrails & Company" - Sue Norwood, Jim O'Neil, Cody, and Tater

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2006 Sue Norwood and Jim O'Neil